Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Jaime Collins, who describes herself as a passionately curious woman with a deep love of humanity. Jaime says it was through a lifelong journey of self-discovery that she learned and unlearned the societal dictates that, for years, had kept her imprisoned in a gender that wasn’t hers.

Eventually, Jaime learned to love and accept herself and, at 52 years old, came out as transgender.

In addition to her career as a healthcare marketing and communications professional, Jaime is a wife, parent, grandparent, athlete, entrepreneur and steadfast advocate for the LGBTQIA+ community.

Jaime and I are both active members of IHA’s online health literacy discussion list. Jaime responded to a post about micro-aggressions and the use of pronouns. Curious to learn more, I contacted Jaime and asked if she’d be a guest on Health Literacy Out Loud. Happily, she said yes.

Welcome, Jaime.

Jaime Collins: Thank you, Helen. It’s great to be here, and it’s great to be here with your audience, too.

Helen Osborne: Our audience is worldwide, of many professions and points of view, but we all care about communicating about health better today than we did yesterday.

Since we all care about communicating and we like clarity, I started with an acronym when I introduced you. The acronym, or the initialism perhaps, had a lot of letters in it: LGBTQIA. Can you start off by explaining what that is?

Jaime Collins: Absolutely. That is a long acronym, and I know that I’ve added a couple of letters in there that often don’t appear there.

People would typically hear the acronym LGBT, which stands for lesbian, gay, bisexual and transgender.

Sometimes a Q is added. That stands for queer or questioning. I also add the IA to recognize those folks as well, because they’re an important part of our community. The I stands for intersex, and the A for asexual.

There is also often normally a plus added. The plus indicates there are other possibilities for sexual orientation or gender identity. It also importantly adds ally to that equation too. Allies are those people who stand up for us, stand up for the community and help tell our story and speak for us.

Helen Osborne: That’s interesting. I was looking at Facebook the other day and somebody has a rainbow-colored frame around their picture and the word “ally” there. I wonder if that’s what they’re referring to.

Jaime Collins: That would be what they’re referring to, yes. Allies are a very important part of our community.

Helen Osborne: You talked about so many issues: gender, sex, transgender. What are these all about in ways that it relates to health communication?

Jaime Collins: I go back to this thing called the gender binary. That is really the source of, I think, the confusion and the problems that our community experiences.

That is the transgender and intersex communities, in particular. I speak to those especially rather than strictly the lesbian, gay and bisexual communities. Partly because that’s the community that I know the most about, that I’m part of, the one that is the most marginalized, the most misunderstood, and is, frankly, subject to violence of different sorts to a great degree.

I go back to this thing called the gender binary, and that’s where it all starts, which is really a social and cultural system that postulates that only two completely distinct genders, man and woman, exist and they’re biologically determined at or before birth.

The problem with this is that we’ve assigned all sorts of different behaviors, roles, feelings and expectations to those two genders. It does not recognize that anything else can possibly exist. They are mutually exclusive genders, and nothing else exists.

That is really the basis of the bias, stigma and discrimination that we experience out there in the world.

Helen Osborne: What’s the difference between gender and sex?

Jaime Collins: There’s a thing called biological sex. As transgender folks commonly call it, sex assigned at birth.

The beginning of my story, of course, is that I came out of the womb and the doctor took one very brief look at me and told my mother, “It’s a boy.” At that point, he was assigning me this role throughout the remainder of my life, supposedly. All of these norms that I was supposed to stick to, that’s my biological sex.

But I do not identify as a boy. I never really have, but I hid that part of myself for many decades. I finally came out after many years of learning and unlearning, as you said in the introduction, those societal dictates.

Biological sex is really of a couple of different kinds. Male and female, of course, but there’s also, as I mentioned before, intersex folks. They’re less than 1% of the population, but they exist. They’re real and it complicates the idea that everybody should be one or the other.

Helen Osborne: That gets back to that binary part there, one or the other.

Jaime Collins: Correct.

Helen Osborne: What about issues of gender or gender identity? How is that different from the sex assigned at birth?

Jaime Collins: Let me throw another acronym at you and your audience, and that’s SOGIE.

Helen Osborne: Oh, dear. You’re going to be at your max on acronyms. Just warning you. You’ve got one more to go.

Jaime Collins: This is a shorter one, SOGIE, which stands for sexual orientation, gender identity and expression.

All of these things that we’ve talked about so far, the biological sex, the sexual orientation, the gender identity and gender expression, are distinct categories. They don’t all have to be the same, and they often are not.

Every one of us human beings has these characteristics, one or the other of them.

I, for example, was assigned male at birth. My gender identity, however, is female, or I’m a woman.

My gender expression has changed through the years. Originally, I presented to the world as a male, as what people expected of me. Then one day I announced to the world that really wasn’t my identity, that my sex assigned at birth did not align with my gender identity, and therefore I was transgender. I began this transition to a different gender expression.

Then there’s sexual orientation, which is different yet. It’s often confused with gender identity. You see a transgender woman and you automatically assume, “This person is gay,” or something. No. Sexual orientation is completely different.

A transgender person, just like a cisgender person . . .

Helen Osborne: Cis means the way you were born, right?

Jaime Collins: Yes, your gender identity and biological sex are aligned. In my case, I’m pansexual, which really recognizes that gender is a spectrum. I can be attracted to anyone along that spectrum, male, female or anywhere in between.

Helen Osborne: Wow. Thank you for so comprehensively explaining that.

Jaime Collins: There are a lot of terms that go underneath each of these categories. You can Google those terms any time, but we don’t need to cover those.

Helen Osborne: I’d like to move on from this, Jaime, because as I said, our listeners, and me, too, are all communicators. We want to communicate health information in ways that are informative, appropriate, respectful and clear.

Why do these issues of sexual orientation, gender identity and expression and all these myriad of other issues matter in health communication? Even more so, what we can do about it to make it better?

Jaime Collins: Great question. As human beings, we all have this brain in our heads, and this brain is automatically biased. We have grown up in the environments that we have, and the environments dictate that this gender binary is a real thing and that all of these characteristics are essential to our identities and the way society works.

We all grow up, essentially, with an unconscious bias. That is something that we think on a daily basis, on an every-moment-to-moment basis, but we don’t really ever think about. They’re automatic mental shortcuts that we use to process information and make decisions quickly. They’re based on attitudes, stereotypes and things that affect our understanding and decision-making, really, in an unconscious manner.

That unconscious bias permeates our society based on these stereotypes, and it’s incredibly harmful to the transgender community and the gender-nonconforming community.

We all know likely about the social determinants of health. These things and the discrimination, violence and just the everyday interactions we experience as transgender folks out in the world, and all the media that we absorb, deeply impacts those social determinants in very profound ways, but often very insidious ways as well. Most of us don’t see that, recognize it or even know it’s there.

Helen Osborne: I would like, if you’d be willing, to give an example in healthcare. I have this fantasy that all of us in healthcare don’t do that. How is this a problem specifically about health communication, these biases?

Jaime Collins: I’ve got some numbers, actually, that come from the 2015 US Transgender Survey. That’s one of the most recent massive surveys that have been done on the transgender community, and an important source of information.

It states 24% of transgender folks experience unequal treatment in healthcare of one kind or another.

Helen Osborne: Wow.

Jaime Collins: Nineteen percent experience refusal of care altogether in one way, shape or form.

Helen Osborne: Oh my goodness.

Jaime Collins: Fifty percent of transgender people report that they’ve taught basic transgender care to their healthcare professional. In other words, their healthcare professional has not known the very basic things about caring for a transgender person.

As a result, at least a third of us don’t seek regular preventive care. There are vastly higher rates of mental health struggles, lower rates of routine and preventive care and quite a number of other health disparities there.

Helen Osborne: Those numbers certainly make that clear and overwhelming. Thank you for that.

You explained what we’re talking about. You made very clear why this is a problem in day-to-day care. Mostly, I want to hear about what we, as health communicators, can do to make this better.

Jaime Collins: This is the part that I really love talking about. There are so many things we can all do.

For me, it all starts with creating a more welcoming environment. Even when people are walking into our facility or looking at our web pages or whatever, it’s the little visual indicators, a little rainbow flag somewhere on the door, a sticker on the door, a sign.

At the entrances of the the hospital that I work at, I put up a very large banner that welcomes patients in four different languages.

On that, I also put the transgender and the rainbow flags just as a tiny little symbol that most people will not see, but my community will instantly recognize that and say, “They’re thinking about me. This is a safe place for me.”

Helen Osborne: That’s doable. What else could we be doing?

Jaime Collins: That is the most doable of all of these things.

Review policies of our institutions. There may be new policies that we need to enact to outline expectations for our staff. There are probably existing policies that may need to be adjusted.

Take a look at intake forms, for example. Most likely, each of our clinics or other registration areas have these intake forms. They may have male and female listed there and no other options.

Helen Osborne: Oh, in the little checkbox when you see a new provider, “Are you male or female?”

Jaime Collins: Yes. Automatically, we’re erased from the population there. We have to check one or the other. There isn’t another alternative.

Our electronic medical records are another potential source of conflict there, too. They may or may not have fields for us to identify alternative names for people.

If I change my gender, I’m likely to change my name. Most people have to do that. There is a name in there may be my legal name that the system may need to know and is required to know, but I may go by a different name.

If I was originally named Bob and now I’m Sandra, and the nurse calls me in and asks for Bob and I have to stand up dressed as a woman, that’s problematic. That is sort of outing somebody in that very public environment.

Our electronic medical records need to be able to deal with these things, too, and have fields that provide the right information to caregivers.

Helen Osborne: Thank you for that. You talked about welcoming environments and policies and e-health records. I know in my work I don’t deal with big-picture issues like that. Are there any tips or recommendations you’d give those of us who are doing that daily communication? How can we communicate in a more respectful and appropriate way?

Jaime Collins: There are environmental and behavioral things, there’s just basic understanding and empathy and then there’s the quality kind of stuff, too.

To some extent, you’re right, we don’t always get a chance to deal with signage, policies and so on. But we can suggest that to other leaders in our organization and be part of that change in that way.

For those folks just dealing with patients on a day-to-day basis, establishing some trust with a transgender patient or a gender-nonconforming patient, or even a basic LGBT patient, is really important.

I’ll suggest when you first sit down with a patient like that, of maybe ambiguous gender and you’re not sure, just state, “I want to establish trust with you.”

Helen Osborne: Oh, really? Use those words?

Jaime Collins: Yes, I’ll suggest using those words. That sets the stage for the communication between these two people.

Another way to do that is to just state, “My pronouns are she/her. What are your pronouns?”

Pronouns are a tricky issue sometimes for people. We’re often afraid to ask somebody about pronouns. I’m giving everybody license here to go ahead and ask about pronouns. This is the way to do that. “My pronouns are she/her. What are yours?” We need to normalize this offering of our own pronouns and asking pronouns too.

Helen Osborne: You offered so much. We have such a limited time on this podcast. Are there sources for people who want to learn more about this, as I certainly do?

Jaime Collins: Sure. There are speakers on these issues that you can invite in and do cultural competency training within your organizations. The web has a wealth of information. The HRC, the Human Rights Campaign, or other major not-for-profit organizations dedicated to equality and equity for LGBTQ folks are really great sources as well.

Helen Osborne: Let’s include a few of those on your Health Literacy Out Loud web page.

Jaime, I want to thank you so much for teaching me and others about the issues involved in communicating clearly with everybody and consideration of sex, gender and expression of the above. I’ve certainly learned a lot, and I’ve got to keep learning. I thank you for teaching all of us, and thank you for being a guest on Health Literacy Out Loud.

Jaime Collins: Thank you, Helen. It’s been my pleasure. I’m on a lifelong learning journey myself, and we’ve all got a lot to learn.

Helen Osborne: As we just heard from Jaime Collins, it’s important to be respectful and inclusive to all our audience, regardless of issues of gender, sexual expression and all the many things that we bring as human beings. But doing so is not always easy.

For help clearly communicating your health message, please take a look at my book Health Literacy from A to Z. You might be especially interested in the chapters I have about knowing your audience.

Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out every few weeks. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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