NZ political parties’ transgender health plans

NZ political parties’ transgender health plans

Access to gender affirmation surgery in New Zealand is abysmal, with waiting lists that are decades long. I’ve asked our major political parties what they will do about it if elected.

On the 27th of July, I sent emails to four political parties outlining the issue of access to gender affirmation surgery*. I contacted the healthcare spokespersons for the Green, Labour, and National parties, and the co-leaders of the Māori party since I couldn’t find any health spokesperson for them. They each received a version of this email:

Tēnā koe,

Since the US president Donald Trump announced this morning that transgender Americans would not be allowed to join the US military, saying that their healthcare is too expensive[1], I have been reminded of a similar issue that we face here in New Zealand.

For many transgender people, gender affirmation surgery is potentially life-saving. Transgender people are a minority population in New Zealand who are at higher risk of depression and suicide[2]. It’s important that their needs are not forgotten.

I’m writing to you as the spokesperson for health for the XXXX Party, because this matter is something I want to be sure is addressed in the coming election. It is something I will be considering carefully before choosing which party will receive my party vote.

Currently, gender affirmation surgeries are funded out of the Ministry of Health’s special high cost treatment pool, at an intended rate of one “female to male” surgery and three “male to female” surgeries every two years[3]. However, since New Zealand’s only surgeon who could perform these surgeries retired in 2014[4] the surgeries appear to have stopped.

In response to a request made by Jennifer Shields, the Ministry of Health revealed in May this year that:

“There are currently 71 people waiting for male to female gender reassignment surgery and 19 people waiting for female to male surgery.”[5]

They also noted in their response that:

“There are no plans to increase the rate of surgery. A mathematical calculation suggests that the 71st person on the male to female waiting list will be operated on in around 47 years if the rate remains the same. Similarly, the 19th person on the female to male waiting list will be operated on in 38 years.”[5]

Currently, this situation is fairly untenable. Transgender people seeking gender affirmation surgery are left to pay out of their own pocket to travel overseas for surgery, or wait for decades in the hope that the government might eventually get around to them. It should frankly be cause for international embarrassment.

Which is why I’d like to ask you how the XXXX Party would address the health issues faced by transgender New Zealanders if you are voted into government in September.

I also know many other people who consider this an important issue and would like to know your answer. It would be great if the XXXX Party’s plan on this issue could be released publicly. In any case, I intend to share the response I receive with others who care about this.

Ngā mihi nui,
Mark Hanna

[1] https://www.nytimes.com/2017/07/26/us/politics/trump-transgender-military.html
[2] http://www.sciencedirect.com/science/article/pii/S1054139X13007532
[3] http://www.health.govt.nz/system/files/documents/publications/gender-reassignment-health-services-for-trans-people-in-nz-v3oct14.pdf
[4] http://www.radionz.co.nz/national/programmes/morningreport/audio/20148752/plastic-surgeon’s-retirement-leaves-sex-change-surgery-in-limbo
[5] https://twitter.com/jenkshields/status/867126476675481600

Later, after watching the Rainbow Wellington Election Forum video on Facebook, I also sent the email to Damian Light, the diversity spokesperson of the United Future Party. During the forum, he had mentioned something I hadn’t heard before about this issue:

I stand to be corrected on this if I’m wrong, but I understand that the waiting list [for GRS] could be cleared for as little as five million dollars by using overseas [surgeons]

So as well as asking for his response to the original email, I asked if he was able to point to his source for that statement, since I hadn’t been able to find one.

Though to put that number in a bit of context, ACC spent $8.6 million on acupuncture for lumbar sprain in 2014/15. This is despite their most recent review on acupuncture for musculoskeletal pain in 2011 finding that the evidence in this area was “inconclusive”.

Getting any response from some parties has unfortunately been like getting blood from a stone, and not all have responded by the time this article was published. If I receive more responses in the future, I will update the article to include them.

Here are the responses I have received so far. You can click the links below to jump to a particular party’s response:


Green Party

My email to the Green Party was sent to Julie-Anne Genter, as their spokesperson for health, but it was forwarded to Jan Logie’s office as it’s an issue she’s worked on.

Kia ora Mark,

Apologies for the delay, and thanks so much for your email. Julie Anne’s office passed this to Jan Logie’s office because Jan has been working very hard on issues of healthcare for trans people, but I’m cc-ing in Julie Anne’s EA Stuart as Julie also wants to stay connected to these issues.

Jan and the Green Party agrees with you about the huge, life-saving importance of gender reassignment surgery and that the waiting list is utterly unacceptable.

The Green Party agrees with the recommendations made by a coalition of groups to the panel of MPs on the International Day against Homophobia, Biphobia and Transphobia on May 17th this year, which were the following:

  • Require district health boards to ensure trans and gender diverse people’s access to gender affirming health services available in NZ, based on an informed consent model of healthcare
  • Provide sufficient funding to enable timely access to gender reassignment surgeries not provided through the NZ public health system
  • Support the development of training and resources on an informed consent model of healthcare for trans and gender diverse people, and provide information and resources for communities and individuals about accessing gender affirming services.

We also note that the aim should be to create a New Zealand based national surgical service for gender reassignment surgery, and to ensure that we have this specialist knowledge in New Zealand (as well as the interim measure of funding being available for people to travel for the surgery).

You might be interested to read the Green Party minority report on the select committee report on a petition around trans health care from 2015: https://www.parliament.nz/resource/en-NZ/51DBSCH_SCR69574_1/1911770f0cb53490fadba8dbcfb09d7c24955763

Jan is really passionate about this issue and will continue to work to advocate to ensure transgender and gender nonconforming people get access to the healthcare they need.

Please feel free to get in touch with any further questions.

Kind regards

Jessie Dennis, Senior Executive Assistant to Jan Logie MP

I also sent a follow-up question about what “timely access” means more precisely, after Jennifer Shields raised the question on Twitter:

Hi Mark,

I talked with Jan about this. As far as numbers, just like any urgently needed surgery, the ideal wait time is none at all. Of course, while that might not always be realistic, we’d work to get it as close to that as possible.

Many Thanks

Jessie Dennis, Senior Executive Assistant to Jan Logie MP

The Green Party also has a Sexual Orientation and Identity Policy.

At the time I wrote this section, that policy was last updated in 2014 and does not mention the issue of access to gender affirmation surgery. However I believe some updates are being worked on so there may now be a more recent version.


Labour Party

I’ve yet to hear back from Labour. Originally I contacted their health spokesperson Dr David Clark, but after seeing Grant Robertson speak on the topic at the Rainbow Wellington Election Forum I forwarded the email to him on the 23rd of August. I’ve had an acknowledgement from his EA, but no response yet.

Update 2017/09/21 I’ve heard back from Grant Robertson about this. Here is his response:

Hi Mark

Apologies that you have not had a detailed reply, it is the result of a bit of confusion over who was responding and then just general busyness. As you said in your email you are aware of our Rainbow Policy. Here is the link again for ease of reference. http://www.labour.org.nz/rainbow

It is worth pointing out the specifics of that in terms of transgender health issues in particular

  • improve access to affordable primary care based on the informed consent model, particularly for younger, trans, and intersex New Zealanders. This also includes training and resources for health professionals about sexual orientation and gender diversity
  • provide targeted suicide prevention funding to build capacity of rainbow community support organisations and mainstream crisis support and services.
  • increase resourcing for youth mental health
  • support and ensure all district health boards reduce barriers for trans and gender diverse people to access gender affirming healthcare, transition related medical support (including hormones, social support and other cosmetic interventions), and an assessment of the need for gender reassignment surgery as an elective service
  • ensure fair access to publicly funded gender affirming surgical options for trans and gender diverse people based on need.

Labour has allocated an additional $8 billion over four years to the health sector to meet these, and other, priorities. We will invest in the high cost treatment pool so that we are able to send people to get the surgery they need but we will also focus on building capacity back up in New Zealand to perform surgery, because we need to do both to make an impact on the waiting list.

I hope that answers your questions.

Regards

Grant

Grant Robertson

While waiting for my response, an article was published in the New Zealand Herald that gave some detail around Labour leader Jacinda Ardern’s response to a question from a student about access to gender affirmation surgery:

One of the students asked Ardern what Labour’s stance was on helping more people have sex reassignment surgery, and providing other support.

The Labour leader agreed greater support was needed, at which point [Annette] King added that one problem was a lack of specialist surgeons in New Zealand, and more training was needed.

“I also was married to a transgender person,” King said.

“So I understand very much the issues for transgender people, and the need to have access to surgery and to counselling and drugs and support. We are very supportive of that in our policy.”

NZ Herald

Labour has a Rainbow policy, which has this to say on access to gender affirmation surgery and other healthcare for trans New Zealanders:

Labour will:

  • improve access to affordable primary care based on the informed consent model, particularly for younger, trans, and intersex New Zealanders. This also includes training and resources for health professionals about sexual orientation and gender diversity
  • support and ensure all district health boards reduce barriers for trans and gender diverse people to access gender affirming healthcare, transition related medical support (including hormones, social support and other cosmetic interventions), and an assessment of the need for gender reassignment surgery as an elective service
  • ensure fair access to publicly funded gender affirming surgical options for trans and gender diverse people based on need.

Also, the minority view on a petition on this topic noted in Jan Logie’s response from the Green Party was apparently from both the Green and Labour parties (it’s written from the perspective of the Green Party but in the heading it notes it’s also the view of the Labour Party): https://www.parliament.nz/resource/en-NZ/51DBSCH_SCR69574_1/1911770f0cb53490fadba8dbcfb09d7c24955763


Māori Party

I contacted Māori Party co-leaders Marama Fox and Te Ururoa Flavell, and received this response from Marama Fox:

Tēnā koe Mark

Thank you for your letter to me regarding the health issues faced by New Zealand’s transgender community. I appreciate you writing to me and I apologise for the delay in responding.

Regarding the concerns you note about the availability of gender affirmation surgery, I too share your concerns as this leaves many of our whanaunga in an untenable position. As such I have referred your email to the Minister of Health, Hon Dr Jonathan Coleman for his response.

Mark, the Māori Party has not developed a specific transgender policy or a wider LGBT policy for the 2017 General Election. However I note that as a Party born of the dreams and aspirations of tangata whenua, a large proportion of whom identify with the LGTB and transgender communities, the Māori Party seeks to engage with all whānau to enable them meet their aspirations whatever they may be, as well as address any problems that they may be experiencing. To this end we welcome organisations and individuals that wish to engage with our party so that we may better support the transgender and LGBT communities.

Thank you again for writing to me and again I apologise for the delay in responding from you. I look forward to hearing from you in the future.

Nāku noa, nā

Marama Fox
Co-leader of the Māori Party and List MP for Ikaroa-Rāwhiti

I received this response as a PDF and wasn’t able to copy/paste text from it, so typed it out by hand. Please assume any mistakes in the above text are mine.


National Party

I contacted Health Minister Dr Jonathan Coleman about this. I was told he had asked Ministry of Health officials to advise him on the topic before he responded, and though I haven’t received his response yet I was told on the 28th of August that I should have it within “the next week or so”.

If the National Party has an LGBT-specific policy, I haven’t been able to find it.

Update 2017/09/11 I’ve heard back from Dr Jonathan Coleman about this. Here is his response:

Dear Mr Hanna

Thank you for your email of 27 July 2017 about transgender health services.

The Ministry of Health considers that transgender health services are best organised and developed on a regional basis. I am advised that the Ministry is aware of developments being undertaken by some district health boards.

The Northern region in particular has been putting effort into this, and the Ministry supports the approach being taken. The region’s intention is to develop a linked health service for transgender people, creating clear pathways for health by putting forward a plan based on collaboration across the region and through levels of community, specialist and hospital health services.

Work to date has included establishing a regional transgender steering group and clinical and consumer advisory group, and appointing a Clinical Lead and Project Manager. A series of consumer workshops have been held across the Auckland metropolitan region, and care pathways and service specifications are being developed. A Northern Region Transgender Health Work Plan has recently been adopted in order to progress this work.

As the Northern region makes progress, the Ministry will encourage other regions to observe this and to strengthen their own regional approach to transgender services.

Thank you for writing.

Yours sincerely

Hon Dr Jonathan Coleman
Minister of Health


United Future Party

I emailed Damian Light, as the United Future Party’s spokesperson for diversity, after seeing him speak at the Rainbow Wellington Election Forum. As well as sending him a version of the same email other parties received, I asked him if he would be able to send me the source for a statement he made during the forum:

I stand to be corrected on this if I’m wrong, but I understand that the waiting list [for GRS] could be cleared for as little as five million dollars by using overseas [surgeons]

Damian Light

He was quick to respond with a link to the United Future Party’s LGBT policy:

Thanks Mark,

As spokesperson for diversity I had the pleasure of launching our policy on 8 August (31 year anniversary of the homosexual law reform coming into effect).

We’ve published it on our website under policies (http://unitedfuture.org.nz/lgbt/) but here are the key points around healthcare;

  • Ensure health providers have appropriate plans, practice standards and funding to responsiveness to the health needs of rainbow communities.
  • Ensure trans and gender diverse people’s access to gender affirming health services based on an informed consent model of healthcare. Where not available in New Zealand, provide sufficient funding to enable timely access.

The $5m detail came from an article online but I can’t find it right now (away from my Pc with all my files used to create our policies).

I’ll try track it down and send it through.

Kind regards,

Damian Light
Party Leader + Candidate for Botany
Spokesperson for Auckland Issues and Diversity

Update 2017/09/10 After following up, I’ve been told that Damian Light hasn’t been able to find the source for the $5m statement. If anyone else knows where this number might have come from, it would be great if you could share a link in the comments or email me about it.


I should also mention that Claire Black has published an article about various parties’ approaches to trans rights as part of Andrew Chen’s A Policy A Day series. Claire looked at the issues of trans healthcare in New Zealand and amending the Human Rights Act to explicitly outlaw discrimination on the basis of gender identity. She also included more of the minor political parties that I haven’t contacted. You can find her article here: A Policy A Day: Trans Rights

* Often referred to as “gender reassignment surgery” or GRS, I prefer not to use this term because of its false implication that someone’s gender can be changed through surgery. Alternatives include “gender confirmation surgery” and “gender affirmation surgery”. I prefer the latter because I think it carries less of an implication that it is somehow necessary for trans people to have surgery in order to “confirm” their gender.

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New Zealand should not regulate naturopaths

New Zealand should not regulate naturopaths

Naturopaths can kill, but regulating them is not the answer.

Over the weekend, the Sunday Star Times published an article by Simon Maude on an unnamed naturopath whose inept attempts at cancer treatment led to the death of an Auckland woman last year: Naturopathy under microscope after cancer sufferers speak from under shadow of death

At the same time, an article syndicated to Stuff from the Sydney Morning Herald detailed a court case in which a naturopath in Australia nearly killed a baby through their dietary advice for the infant’s eczema: Australian naturopath admits ‘raw food’ diet advice endangered baby’s life

As a result, the question has been raised of whether or not naturopaths should be regulated in the same way as medical doctors, pharmacists, and chiropractors.

In the Sunday Star Times article, vice president of the New Zealand Society of Naturopaths Sharon Erdrich laments what she sees as the root of the problem:

New Zealand Society of Naturopaths vice-president Sharon Erdrich says the society wants tighter regulations.

“In Germany, naturopaths are very heavily regulated, there’s regulation in the United States and Australia has some controls.”

Even though there is “potential for harm, basically anyone in New Zealand can call themselves a naturopath,” Erdich says.

(As an aside, Ms Erdrich’s clinic offers such bogus health services as quantum reflex analysis and live blood analysis, and an article she published in 2016 says “The first, and most important thing you can do” if you have cancer is to book an appointment with a naturopath.)

This argument was continued in an editorial in The Press this morning: New Zealand should require naturopaths to be registered

Here is the root of the argument, as expressed in that editorial:

Naturopathy is also enabled by tertiary institutes offering courses which are recognised by the official New Zealand Qualifications Authority framework.

This means that, even though anyone can claim to be a naturopath in New Zealand (there is no law stopping them), practitioners can arm themselves with diplomas and degrees and present themselves as equal to other health professionals.

That being the case, safeguards should be put in place for the public.

The most useful of these would be to require naturopaths to be registered, and made subject to similar disciplinary processes demanded of other health professionals when they can’t make good on their promises.

NZQA approving courses on quackery, such as their Certificate in Acute Prescribing with Homeopathy, is a real problem. But these calls for naturopaths to be registered are missing the point, I think.

The problem is not that “anyone can claim to be a naturopath in New Zealand”; the problem is that naturopathy is quackery. We already have regulation to address quackery, the real problem is that the existing regulation is not adequately enforced. Both the Fair Trading Act 1986 and the Medicines Act 1981 prohibit the misleading claims which are the basis of the practice of naturopathy.

For example, the Fair Trading Act prohibits the use of any “unsubstantiated representations”, as well as “conduct that is misleading or deceptive or is likely to mislead or deceive”, in trade. The Medicines Act prohibits the use of health testimonials (which can be both very convincing and entirely misleading), and claims to treat serious illnesses such as cancer, in advertisements.

The Sunday Star Times article also notes that naturopaths, despite not being subject to specific regulation, are still subject to the Health and Disability Code of Rights:

Regulation is not being considered as the ministry has not received an application from naturopaths to become regulated under the Health Practitioners Competence Assurance Act 2003.

Health practitioners including naturopaths remain subject to the Health and Disability Code of Rights, “whether they are regulated or not”.

Consumers may complain to the Health and Disability Commissioner about care.

The Health Practitioners Competence Assurance Act 2003, which regulates professions such as medical doctors and pharmacists, also prohibits anyone from claiming or implying that they are registered as or qualified to be registered as any type of regulated health professional. This is the provision that could prevent anyone not registered from calling themselves a naturopath.

We have already seen, here in New Zealand, that regulating a health profession prone to making misleading claims does not stop that practice. In research conducted by myself and Mark Honeychurch in 2016, we found that the majority of New Zealand chiropractors who advertise online make misleading claims about what they can treat. Including them in the regulatory scheme has not stopped this behaviour at all, rather it has just allowed them to continue misleading patients from a position of authority, able to use the protected title of “Dr”.

The Health Practitioners Competence Assurance Act sets up authorities to regulate each health profession that is composed of members of that profession. The Medical Council, the Pharmacy Council, and the Chiropractic Board are all examples of this.

But a Naturopathy Board filled with naturopaths would not be able to effectively regulate naturopaths. Quacks can’t regulate quacks effectively. All regulating them would do is give them the appearance of legitimacy and authority.

The real problem with all of this regulation is that it is not enforced. The solution, therefore, should be simple: enforce it.