Pronouns Are a Public Health Issue

In their study published in this issue of AJPH, Perales et al. (p. 482) drew from a 2020 Australian data set to demonstrate a significant association between the use of inclusive language in the workplace and a multidimensional measure of well-being at work in a sample of more than 400 trans- and gender-diverse (TGD) people (including transgender, nonbinary, agender, and other gender minority people) working for more than 100 unique employers. This study is notable both for its relatively large sample size (given the underresearched and often invisible nature of this population) and for its inclusion of workplace-level data (i.e., indicators of inclusive language use from both TGD and cisgender employees in each workplace setting). The resulting findings are the first, to our knowledge, to empirically establish the relationship between trans-inclusive language and mental well-being at work, and they offer important extensions to our knowledge of the contribution of employment-related discrimination to the health ofTGD people.1Why is trans-inclusive language in the workplace (and beyond) a public health issue? Work and working conditions are widely accepted as important components ofthe social determinants of health (https://bit.ly/3qsb6Qv). Although less formally acknowledged, many scholars and advocates argue that gender identity, meaning one's internal experience and sense of gender, should also be considered a social determinant of health: TGD people experience profound health inequities, often associated with exposure to gender-related stigma and discrimination.2 Indeed, these disparities are so stark that, in recent years, special sections have been devoted to TGD health in both AJPH and the Lancet3,4These health inequities are linked to economic and other structural inequities. For example, highlighting the disproportionately high prevalence of HIV in TGD populations, Becasen et al. have noted the relevance of recognizing social and economic vulnerabilities systemically affecting this population as factors that likely increase HIV risk.5 Indeed, structural and interpersonal discrimination, experienced byTGD people as cisnormativity and transphobia, limit TGD people's access to the health benefits of work. A national US study identified that TGD people were more than twice as likely to be living in poverty (29%) as cisgender people; this is likely attributable to unemployment rates that are three times the national average, earning lower wages than th