Advancing Health Equity through Labor Inclusion: Evidence from Trans, Travesti and Non-Binary People in Brazil
Based on a 2023 community-based study of 237 transgender, travesti, and non-binary individuals in Brazil, this paper demonstrates that precarious occupational insertion is a prevalent structural manifestation of health inequities driven by intersecting factors like race, gender identity, and education, thereby highlighting equitable labor inclusion as essential for advancing health equity.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Health is not merely the absence of illness; it is the result of the conditions in which people live, work, and grow. When societies organize themselves so that some groups face constant barriers to education, income, and safety, the health of those groups suffers. This concept, known as the social determinants of health, suggests that a person's well-being is shaped as much by their job security and social standing as by the medicine they receive. For transgender, travesti, and non-binary people—individuals whose gender identity differs from the sex they were assigned at birth—these structural barriers are often severe. In many places, discrimination limits their access to stable work, forcing them into unstable or dangerous economic situations. Understanding how this lack of stable employment connects to health is crucial, yet most research on this topic has focused on wealthy nations with different legal and social systems.
A new study from Brazil seeks to fill this gap by examining the lives of transgender, travesti, and non-binary people in the Baixada Santista region, a metropolitan area near São Paulo. The researchers wanted to understand how these individuals enter the workforce and whether their jobs are stable or precarious. They defined precarious work not just as low pay, but as a state of vulnerability where a person has no social security, works without a formal contract, is unemployed, or relies on unstable income sources like sex work. By looking at who ends up in these precarious situations, the study aimed to see if these employment patterns were random or if they followed specific social lines, such as race, gender identity, or education. The team worked directly with the community, using a method where community members helped recruit participants, ensuring the data reflected the real experiences of people who are often overlooked by official statistics.
The study gathered information from 237 people living in the region, with a deeper analysis focused on 160 participants who were either working or actively looking for work. The results painted a stark picture of exclusion. Precarious work was the norm rather than the exception for this group. The vast majority of participants found themselves in unstable economic situations, with many reporting no income at all or earning only the minimum wage. The researchers found that this instability was not evenly distributed across the community; instead, it clustered around specific groups facing multiple layers of disadvantage. People with lower levels of education, those who reported facing barriers when trying to find a job, and those who had experienced violence or mental health struggles were significantly more likely to be in precarious work.
When the researchers adjusted for these overlapping factors to see which characteristics stood out on their own, two specific patterns emerged clearly. First, the study found that people who identified as brown, a category used in Brazil to describe mixed-race heritage, were much more likely to be in precarious work compared to those who identified as white. Second, the type of gender identity played a significant role. Participants who identified as trans men or transmasculine were less likely to be in precarious work compared to those who identified as non-binary. Interestingly, the study did not find that income or education alone explained the difference once other factors were considered; instead, these elements seemed to work together as a system of disadvantage. For instance, while lower education was linked to precarious work in initial checks, this link became less distinct when race and gender were taken into account, suggesting that these social forces are deeply intertwined.
The researchers also looked at the experiences of Indigenous and Yellow-identified participants, but the number of people in this group was too small to draw firm conclusions, so they treated those findings with caution. What remained clear was that precarious employment for transgender, travesti, and non-binary people is not simply a result of individual choices or a lack of skills. Instead, it appears to be the visible outcome of a system where racism, gender discrimination, and economic inequality combine to limit opportunities. The study suggests that when a person is pushed out of stable work, it is not just an economic loss but a structural condition that shapes their entire life, including their health.
This research highlights that solving health inequities requires more than just better medical care; it demands changes in how society treats people in the workplace. By showing that stable employment is a key part of health equity, the study argues that policies must address the structural barriers that keep these communities in precarious situations. The findings from Brazil add a vital perspective to the global conversation, proving that in middle-income countries, the struggle for fair work is a central battle for health and dignity. The evidence suggests that until these structural inequalities are addressed, the cycle of exclusion and poor health will continue for these populations.
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