Imagine getting hassled by a bus driver because you don’t look the way she thinks you should look. Or not getting served in a restaurant for the same reason. Or being referred to ― repeatedly ― by your doctor with the wrong name.  
It happens regularly here in Massachusetts to people who are transgender. 

A report released last month by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition found that two out of three people who are transgender experienced discrimination in one or more public settings in the last year. “Discrimination and Health in Massachusetts: A Statewide Survey of Transgender and Gender Nonconforming Adults” found that a startling 65 percent reported discrimination in an area of public accommodation at least once during the previous 12 months. The report is based on surveys completed in 2013 of nearly 500 people in Massachusetts who self-identified as transgender or gender nonconforming (in which their gender identity or expression is different than their sex at birth).

Public accommodations are places that are open to the public and provide goods or services. Common examples include restaurants; public transit such as busses, trains, and airplanes; movie theaters; health care centers, emergency departments, pharmacies, and hospitals; restaurants and hotels; retail stores; supermarkets; nursing homes; and parks and beaches. In other words, places where most of us take for granted that we can conduct our business or leisure activities without fear that we will be harassed or assaulted.

But our survey found that that is simply not the case for the Commonwealth’s transgender residents. The five areas of public accommodation where transgender people are most likely to experience discrimination include transportation (36%), retail (28%), dining (26%), public gathering locations (25%), and health care (24%).

Among those accessing health care settings, 23 percent delayed preventative care such as check-ups, and 20 percent postponed care when they were sick or injured due to fear of discrimination. Adding to the grim picture, 25 percent were verbally harassed or mistreated, and nearly six percent were refused medical care altogether due to their gender identity.

Discrimination in health care settings is perhaps most alarming because our study also found that those who reported experiencing public accommodations discrimination in the previous 12 months saw their risk of illness increase dramatically. The risk of physical symptoms such as headaches, stomach upset, muscle tension, or increased heart rate increased 84 percent. The risk of emotional symptoms such as feeling upset, sad, or frustrated increased 99 percent.

There are three steps that can be taken to end discrimination in areas of public accommodation. State lawmakers should pass the state’s Equal Access Bill, which would prohibit discrimination based on gender identity in public settings. The bill has 59 Legislative supporters and backing from companies, advocacy groups, and general support among Massachusetts residents. Health care administrators should implement cultural competence training for frontline staff and providers alike. And employers should update their nondiscrimination policies so that they explicitly prohibit discrimination on the basis of gender identity.
In recent years many national organizations have publically recognized the need for more inclusive policies, including the American Psychiatric Association, the American Medical Association, and the National Association of Social Workers. Last month, some federal agencies, Medicare, and Massachusetts’ own Department of Insurance, joined the growing consensus for transgender equality. With such strong support at all levels, now is the time to capitalize on the need for change. At the end of the day, regardless of gender identity, no one should have to worry about their safety on the sidewalk or in their doctor’s office.

Emilia Dunham is the Director of Community Engagement at The Fenway Institute and a co-author of “Discrimination and Health in Massachusetts: A Statewide Survey of Transgender and Gender Nonconforming Adults.”