Pro-trans court ruling does little for Naval healthcare worker

On June 30, the Supreme Court ruled 6-3 that states can ban transgender girls and women from participating in girls’ and women’s sports teams. Justice Brett Kavanaugh wrote that states could retain these teams for “biological women” and set eligibility by “biological sex.” The country will now spend several days debating fairness on the ground. We discuss race times, records, and who made the roster.

I would like to change the direction of this conversation. Because I’m researching something else and the frame we decided on is missing something important.

I’m a public health researcher. My research focuses on how people’s living environments enter the body and influence lifelong health. I’m talking about conditions such as laws, policies, and the everyday atmosphere of approval or rejection.

Two features of this judgment deserve more attention than sports combat gives them. It is a question that even a “close” decision has lifelong costs, and that the court has refused to decide.

Let’s start with how such a verdict reaches the body. Because that pathway is what makes this a public health story. My field of research has a term for what such laws lead to: “structural stigma.” This is how an entire group can be marked as inferior by laws and court decisions, and in doing so can become a chronic stressor for all members of that group.

The overwhelming majority of transgender kids will never compete for a state title. They still learned from the nation’s highest court that their attribution was conditional. The stress that comes from this lesson is associated with higher rates of depression, anxiety, and poor health across the LGBTQ population. A consistent finding in this literature is that social acceptance can disrupt such harmful trajectories. However, this ruling will push the country in a different direction.

What I want to emphasize is that issues of equity are important and the girls and women who raise them deserve to be heard. However, this judgment does not resolve this issue. It will flatten it.

The science behind athletic performance and gender transition is truly complex and individual. It varies from sport to sport, person to person, age to age, and life environment. Courts based their decisions on biological sex but refused to consider what biology indicates. The West Virginia teen at the center of the case had been taking puberty blockers before male puberty began. The advantages that the law claims for the police never developed in her. Rules that treat her as an adult athlete ignore biology.

This is where policy-minded readers should pay attention. For decades, the central legal question regarding transgender Americans has been: If a government treats transgender people differently, how legitimate must the reasons be? Courts do not judge all discrimination in the same way. States must provide strong justifications when laws classify people by race or gender, but many such laws do not work. But when the law attempts to make the usual distinctions, such as who is eligible for a license, judges tend to ignore them for a reasonable purpose. The jury is still out on whether laws identifying transgender people will be met with skepticism — what lawyers say will increase scrutiny — or whether they will simply pass. And this judgment, despite its subject matter, remained inconclusive.

How did the court avoid the questions it raised in its own case?Following last year’s decision, scumetti (Gender Affirming Care Case), the court stated that these laws draw the line by biological sex, not transgender status. Courts long ago upheld single-sex teams. Separate teams are the reason women’s sports exist. So while laws framed as “sex” boundaries will land on grounds already approved by the courts, “transgender” boundaries will have to be met with skepticism or easily passed. The court chose a framework that allowed for silence.

That silence creates exposure for transgender people. The way the word is used in my field of public health is a condition that puts the entire population at risk. The same unanswered questions now hang over health care, employment, identification, public accommodations, and all areas where the level of scrutiny makes all the difference. And the court read Title IX, the federal statute that prohibits sex discrimination in schools, through the same lens with its “biological sex” endpoint. Advocates are right to see protections that extend far beyond sports as newly weakened.

This is the most disturbing aspect of my own research. I study LGBTQ adults in their 60s, 70s, and 80s who came of age in a much more hostile America. Their lives illustrate the mounting costs of stigma. Chronic stress develops under the skin and surfaces years or decades later. Researchers are recognizing these harmful consequences in new studies like mine that examine mental health, physical health, and brain aging. Therefore, we need to understand this decision for what it is. That is, the long-term health decisions that countries are making on behalf of generations of children.

In fact, the ruling does not force any country to do anything. The bill would tell the more than 20 states that have passed these bans that they stand strong and send the rest of the fight back to statehouses and school boards, where transgender youth and their families often have little power. The ruling comes just over a year after a court barred the state from providing the medical care many of these young people depend on. Each law is a single stressor. Both of these are dangerous environments.

We know what protects these children. Acceptance, inclusion, and the dignity of being treated like you belong. The court made all three of these presentations difficult and left open the question of determining how difficult. It is the children who needed this protection who will bear the cost during this sports season and for the rest of their lives.

harry barbieis an assistant professor at the Johns Hopkins Bloomberg School of Public Health who studies LGBTQ health, aging, and public policy.