Highlighting 'invisible' populations


Photo credit: Dana Nosella

By Ciara Parsons

Greta Bauer, PhD, is a leading expert in her field of research which focuses on the impacts of social marginalization on health.

When Bauer began her career at Schulich Medicine & Dentistry in 2005, she began to conduct research on health care access for transgender (trans) individuals after observing the barriers and negative feelings her friends had encountered when attempting or considering accessing health care services.

“I had friends who delayed emergency care because of fear of how they would be treated; not getting Pap smears because they were trans men and it was socially and psychologically difficult; and having mental health professionals refuse care for issues not related to their gender—because providers assumed all issues were related to their gender,” said Bauer.

As she dove deeper into this area of research, she discovered that despite a few small needs assessment studies, there was a notable absence of research centred on documenting the experiences of trans individuals when attempting to access health care services and their pathways to care. This lack of inclusivity in data is often referred to as ‘erasure’.

Erasure—the passive or active process through which invisibility is manufactured or maintained in institutional and informational contexts—presents as a large obstacle to care for trans and other marginalized populations says Bauer. While a lack of evidence-based research on these populations is only one component of a larger systemic paradigm, it does serve to obscure the improvements necessary to better serve these communities and provide equitable care.

She notes that erasure has reduced for gay, lesbian and bisexual populations through the introduction of more inclusion-focused frameworks in Canada, but estimates that trans populations are 20 to 30 years behind their fellow LGBTQ counterparts in their own bid for inclusion.

Focused on conducting research that positively impacts policy and influences practice in ways that are meaningful to trans populations, Bauer created the Trans PULSE project in collaboration with a group of Ontario researchers and community leaders to better study trans health in the province.

The initiative, which was initially only meant to be a one-year project, became a booming research hub that has collectively published 42 papers, book chapters and reports. Trans PULSE has produced some of the first research on trans access to emergency care, access to family medicine, strategies for suicide prevention and impacts of parental support on trans youth.

“Trans visibility has increased and our work has contributed to policy changes in health care, medical and health professional education, human rights, identity documents, and other areas provincially, nationally and internationally,” said Bauer.

Speaking about the future of the Trans PULSE project, she is hoping to expand the research program’s reach to include data from other provinces and territories. The goal is to be able to harvest a sample size large enough to conduct greater analyses of sub-groups within trans communities, such as those who are Indigenous, rural, of an older demographic, immigrants, refugees, sex-workers or those who identify as a non-binary gender.

Bauer says that the community of researchers has contributed to some of the stigma surrounding marginalized populations through its pathologizing approach to sexual orientation or gender identity. This poses as a threat to marginalized populations as it directly affects inclusivity and trust and participation in research.

“These issues sometimes scare researchers away from ‘hard to reach’ populations, but this creates an ethical dilemma; if we are aiming for evidence-based policy and practice, we need to be able to produce rigorous evidence regarding those experiencing the most severe effects of inequity,” she said.

This ethical dilemma led Bauer to develop a further research project on survey and statistical methods to improve epidemiological research on marginalized populations.

Though more progress is necessary on this front, research conglomerates are paying close attention to Bauer’s recent work on explicit inclusion of trans participants in health research. Statistics Canada, The Canadian Institute for Health Information (CIHI) and the Canadian Human Rights Commission have also taken note of her work and used her research to inform potential revisions to their present sex and gender surveying methods as a means of being more inclusive of sexual and gender diversity.

Bauer believes that there is a need to continue this type of research and says training a new wave of researchers who can carry on this important work is one of her goals as a supervisor of graduate trainees.

“I have focused on building capacity of a new generation of junior researchers in my work, and I’m pleased to see them starting to take leadership positions within the research community,” she said. “My former students are working everywhere, from universities to Public Health Ontario to the Mayo Clinic. My goal is to have them leave with a strong methodological background, ability and drive for continued learning, and a strong sense of ethics and social responsibility.”

As per the long-term goals for the continuum of Bauer’s research, she aims to continue to pair community-based research with epidemiological methods as a means of furthering innovation in this area of work and positively impacting the lives of marginalized populations.