Want to Disrupt Healthcare? Break the Binary
By Stephanie J.B. Hoeler
SVP, Experience Strategy
For over 10 years, I have loved healthcare advertising. I believe it is an art and a science. In my role as a strategist, I often focus on deriving insights from audience behavior so my team can better reach or portray them. I strive for representation. I am a Black American millennial woman. I am begrudgingly accustomed to underrepresentation, lack of inclusion, and empty hashtags. I acknowledge some privilege. I am an American-born, heterosexual, cisgender person with above-average income using expected pronouns. But in my personal and professional life, I work for change, including in myself and how I view the world For most of my life, I thought pronouns were fixed. Relationships challenged, then changed, my view.
Enter Gwyn Dylan Krueger. We became friends when they moved into our quaint New Jersey suburb from Brooklyn with his wife and son. We have much in common: A sense of humor. Sons we adore. A love of the outdoors—we are going camping on Assateague Island in August. And a 50% chance of developing cancer. Why? We were assigned female at birth. Gwyn is a non-binary trans person who uses they/them and he/him pronouns. Should I develop cancer, I will face systemic barriers and bias. He will face different obstacles. Chief among them is simply being recognized. In this land of the free, he must be brave, because today, in America and much of the world, he lacks the privilege of an irrefutable identity. Things can be different. Armed with knowledge, the willing can learn more to bring about change.
The Healthcare World, Today
All of healthcare uses gendered language. It is common to see “Women’s Health” describe gynecology, contraception, breast issues, and certain cancers. Similarly, “Men’s Health” focuses on the prostate, ED, and other specific cancers. Gendered titles are found on LinkedIn profiles, press releases, and job postings. They are found on materials helping physicians and patients communicate. Gendered language is prevalent and pervasive. But the norm is changing, and therein lies the opportunity. Gillette featured young trans men shaving. Always removed the feminine symbol from packaging. Big box stores removed “girls” and “boys” signage from toy departments. Can the healthcare industry afford to remain stuck?
Today, there are about 1.4 to 1.7 million transgender adults in the US. In 2060, the number will be nearly 7 million. A shocking 94% have considered suicide and 39% took physical actions to carry it out. There will be millions of people with a gender identity that differs from the sex they were assigned at birth. Overlooking a population’sreality narrows the pool of potential patients. It is not sound business. The American Medical Association urged governors to veto legislated bans of medical care being offered, and administered, to transgenderpeople who sought gender affirming care. They called the bans a “dangerous governmental intrusion into the practice of medicine.” They believe that affirming care is a matter of life and death.
Affirming care is a recognition of reality. Today, roughly 1% of breast cancer cases occur in people assigned male at birth (AMAB). Not all people with the potential to develop breast, cervical, or ovarian cancer identify as female. The issue is not new. The first #TransHealthFail tweet appeared on July 30, 2015. In under 2 weeks, 10,000 more tweets with that hashtag were posted. In 140 characters or fewer, the trans community described their struggles to find culturally competent healthcare. That is not an anomaly, as care of transgender and non-binary people is not taught in conventional medical curricula. Few physicians have the knowledge and familiarity needed for adequate healthcare provision.
Call to Action
A small WildType/TBWA survey of 20 trans and non-binary individuals, the majority of whom were assigned female at birth, found 83% of respondents felt it is the responsibility of pharma companies to improve health outcomes for non-binary and trans people. This is especially important, as 95% of them did not feel represented within healthcare literature and advertising, and 77% said they would temporarily assimilate into their assigned gender at birth to receive better treatment from a provider. Pharmaceutical companies and healthcare advertising agencies must help all of healthcare break the binary. Recognize “sex” and “gender” as distinct. Affirm all gender identities irrespective of assigned sex. Include trans and gender non-conforming (GNC) people in advertising strategy, messaging, and media placement considerations.
The Roles and Responsibilities
HCPs are The Treaters, yet because they don’t learn it in medical school, few HCPs have the knowledge and familiarity needed to treat transgender and non-binary people. The audience is growing, as is the supportive community. Yet, they are 66% more likely to report severe mental distress (often tied to discrimination and lack of acceptance) when trying to find an understanding healthcare professional. Studies show 23% reported not seeking needed healthcare, fearing mistreatment. Why? More than 29% said a doctor or other healthcare provider refused to see them because of their actual or perceived gender identity. Another 23% said a provider intentionally misgendered them or used the wrong name, and 21% said harsh or abusive language was used when treating them. This is disastrous for their potential health outcomes.
Pharmaceutical companies are The Educators. The pharma companies are already able to dictate the appropriate patients for a particular treatment. They can take it further and be more inclusive. Pharma can acknowledge that our perception of gender identity is informed by cultural norms, often the result of colonialism. Thus, what we label as “gender” is really the collective agreement, the systemic recognition, of a set of behaviors and expressions. Gender is not static. The equivalency of sex and gender identity is problematic in that it accurately depicts some people’s experiences yet does not correctly reflect the full spectrum of experiences. Pharma companies are inadvertently limiting their audiences by appealing solely to the most common denominator. They can start by sponsoring CME courses on gender identity.
Healthcare advertising agencies serves as The Connectors. Agencies serve to connect pharmaceutical companies to their audiences of patients and physicians. They help the other players communicate and connect. Authentic communication involves mutual understanding. Agencies must help pharma keep pace and stay at the forefront. A J. Walter Thompson intelligence report found 81% of Gen Z strongly believe gender does not define a person as much as it did in the past.
The Healthcare World, Tomorrow
Gen Z will help comprise the core of our patient population. They embrace the idea of gender nonconformity, as approximately 60% believe medical forms should include options besides “man” or “woman.” A 2017 Havas Group survey of parents across the world found 61% of women and 46% of men believe children should be raised in as gender-neutral environments as possible to guard them from stereotypes. The healthcare industry’s future audience will find heavily gendered language alarming.
In 2021, health insurance provider Aetna expanded gender-affirming surgery coverage for transgender women. They now cover gender-affirming breast augmentation in most of their commercial plans. Their decision was “consistent with many changes we have made over the years to better serve the needs of the LGBTQ community,” said Dr. Jordan Pritzker, Senior Director of Clinical Solutions for Aetna, in a press release announcing the change.” She went further, saying, “We appreciate the collaborative nature of this process, which allowed us to make an evidence-based change to our coverage policies regarding important care for members of the LGBTQ community.” The rest of the industry will be well served by joining them.
Given that the new language and visuals are likely new to those embarking on the journey, it is wise to partner with others well acquainted with the transformative process of inclusion. Pharma companies seeking to change HCP dialogue can look into World Professional Association for Transgender Health (WPATH) resources, made to support transgender people in their search for culturally competent health providers. The Johns Hopkins’ Center for Transgender Health offers patient care, education of HCPs, and research. Comprehensive resources for physicians to provide affirming care, including a discussion guide, have also been released by the National LGBT Health Education Center.
A common worry during times of transition is the alienation of the original, and likely larger, audience. This is understandable. Fortunately, about 75% of Americans ages 18 to 29 have heard of non-binary pronouns, as have 65% of those 30 to 49 and 54% of those 50 to 64. A subfield of linguistics sociology called Language Policy and Planning teaches that the more institutional support language proposals have (especially in media), the more people accept them. Geena Davis, founder of the G.D. Institute on Gender in Media, agrees. She said, “Representation in advertising is especially influential in shaping societal values, given the sheer volume of ads we are exposed to each day.” The language inclusion proposal already has support of the 61% of Americans 18 to 29 who are comfortable using gender-neutral pronouns to refer to someone if asked.
Another consideration before making a significant change is the population size of the impacted audience. To do good, it would seem logical to focus directly on the majority. Yet, it is as prudent to pursue advertising messaging tailored for the general public as it is to invest in treatment of any of the 7,000+ rare diseases that affect less than 200,000 people each. It is time to break the binary. On the low end, around 1.4 million US adults are gender non-conforming. These numbers consistently rise, especially among the young. There is a return on investing in non-binary individuals’ health. Not only would they be direct beneficiaries, but everyone would benefit. Organizations with above-average gender diversity outperform companies with below-average diversity and engagement by 46% to 58%.
Steps to Break the Binary
To ensure tonality and visual representations are accurate, and to avoid error, include a member of the non-binary/trans community within the following process.
- Baseline the Bias: Audit media and creative, beginning with ads that are externally facing. Prioritize those with the highest reach and/or targeted to Gen X, Millennial, and Gen Z audiences.
- More than Cis Storytelling: Include “they/them” as additional singular pronoun alternatives. Use inclusive imagery in visuals, setting precedent for use of non-binary models.
- Agency Pivot: Conduct internal training (led by a non-binary or transgender individual) on inclusive language, design, and practices, so communications are reflective of the community.
- Educate Experts: Develop pharma-led training to assist physicians, pharmacists, and support staff in becoming sensitive to, and inclusive of, non-binary/trans identity in treatment and practices.
- Measure Media: Agree to key performance indicators for “Break the Binary” efforts. Adopt a minimum percentage of gender inclusion within the written word and visual creative.
Healthcare advertising agencies can future-proof their offerings with the creation of messaging that honors the breadth of gender identities—representing men, women, gender non-conforming, and trans people. Pharmaceutical companies can broaden patient pools and embody thought leadership by educating the ecosystem of healthcare professionals and staff. HCPs are integral as front-line affirming care workers. All can include community contributions to their work and build on established precedent for communicating in an inclusive manner. If ever there was a business imperative to have an authentic audience-first approach, this era, with its demands for meaningful inclusion, is the time. For over 10 years, I have loved healthcare advertising. It is an art and a science undergoing evolution—a transformation culminating in greater representation, and health care, for my friend Gwyn and the 1 million+ Americans like him.
Originally Appeared Here