Doctoral Dissertation Research: The Public Provision of Healthcare Under Changing Conditions in North and South America

University Of California-San Francisco, San Francisco CA

Investigators

Abstract

Contested forms of health care or diagnosis inevitably involve deliberations about proper definition and treatment, and these debates are all the more polarized where public funding is concerned. Activists and health care providers comprise two central groups with a stake in how certain forms of care are included or excluded from public coverage. Taking a comparative approach, this dissertation examines how health care providers and social movement activists in the U.S. and Argentina conceptualize the public provision of contested forms of health care. Addressing the example of transgender health care (a highly contested and emergent field of practice) it asks how two different approaches to public coverage for transgender health care have unfolded in New York City and in Buenos Aires. Both cities are host to health care providers and social movement activists who characterize themselves as leaders in transgender health. The project will examine how health care providers and social movement activists in these places work to define or redefine diagnoses and how they navigate systems of public coverage for transgender health care. The data collection involves interviews with 60 to 90 healthcare providers, patients, and social movement actors in New York City and Buenos Aires, combined with a content analysis of relvant documents and legislation associated with transgender healthcare at both sites. A secondary analysis will also examine the current revision of the World Health Organization's International Classification of Diseases, in which a number of older diagnoses are being reworked, replaced, and redefined. A working group of global experts, including individuals from Argentina and the U.S., are proposing major changes to diagnoses associated with transgender health care, and transnational activist networks are also providing ongoing feedback. In analyzing these processes, this dissertation also asks how multiple transnational actors with ranging expertise coordinate or conflict in the process of diagnostic revision. This project stands to improve the well-being of individuals in society by revealing how health care providers and activists shape public policy and definitions of diagnostic classifications.