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Recognizing Gender Diversity


Dear Colleagues ,

The U.S. Department of Health and Human Services is considering a proposal to define gender as an “immutable condition determined by genitalia at birth” under federal civil rights law, according to recent news reports. We at the Bloomberg School stand with our colleagues from Johns Hopkins University and Medicine who wrote this morning to affirm support for Johns Hopkins’ transgender and gender nonconforming communities.

This proposed change by HHS contradicts a wealth of scientific evidence demonstrating that gender is not a binary construct; in fact, it has varied physical and mental components that range far beyond the sex an individual is assigned at birth. The mutability and complexity of sex has been widely recognized and incorporated into standards practiced by medical and public health professionals.

Adopting this unscientific definition would cause great harm. It would immediately threaten the health and well-being of approximately 1.4 million U.S. citizens and an estimated 22,300 Maryland residents who identify as transgender or gender non-binary. Education, employment, health care and housing are critical determinants of health that have been well-established in public health and epidemiologic research. Barriers to their access exacerbate chronic and infectious disease, as well as negative mental health and social outcomes for transgender people and communities. Conversely, evidence shows that affirming gender identity is critical for reducing transgender health disparities.

Even with recent social and political progress, transgender and gender non-binary people experience exceedingly high levels of violence and discrimination. In a 2015 survey of almost 28,000 transgender and gender non-binary people across the U.S., almost half of all respondents experienced discrimination, verbal abuse or physical violence within the last 12 months based on their gender identity. Forty-seven percent of respondents had experienced sexual assault at some point in their lives. Reducing this violence is an important goal for public health. Unfortunately, HHS’s reported proposal—by denying the science on gender identity—would contribute to discrimination and move the nation in the wrong direction.

The Johns Hopkins Bloomberg School of Public Health values and supports our gender diverse community, including those who identify as transgender and gender non-binary. I am proud of the work of our faculty, staff and students in this area. For example:

  • In training: The Bloomberg School now offers a Lesbian, Gay, Bisexual, Transgender, and Queer Public Health Certificate to support advanced training in legal, theoretical, epidemiologic, global and applied aspects of LGBTQ health issues.
  • In research: Bloomberg School researchers lead innovative and groundbreaking work related to transgender health in Baltimore, the U.S. and internationally. For example, Dr. Andrea Wirtz is principal investigator of the first multisite cohort in the U.S. to assess HIV and other health outcomes among transgender women; Dr. Stefan Baral leads studies related to stigma and HIV among transgender populations worldwide; and Dr. Danielle German is collaborating with the Maryland Department of Health to develop community-engaged action research to improve the local landscape and evidence base in support of transgender health and well-being.
  • In practice: Many School faculty collaborate with the Johns Hopkins Center for Transgender Health, which provides affirming, objective, person-centered care to improve health and enhance wellness; educates interdisciplinary health care professionals; informs the public on transgender health issues; and advances medical knowledge through research.

Our School and our field will continue working against discrimination in health care, education and all other basic rights on the basis of sex, which we as scientists and public health professionals recognize includes gender identity and expression. We will also continue providing scientific evidence to support informed decision making on policies that affect public health for all communities.


Ellen MacKenzie Signature

Ellen J. MacKenzie, PhD ’79, MSc ’75
Bloomberg Distinguished Professor
Johns Hopkins Bloomberg School of Public Health