Advancing Health Equity through Labor Inclusion: Evidence from Trans, Travesti and Non-Binary People in Brazil
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Health equity cannot be achieved without addressing the structural conditions that shape opportunities for social and economic participation. Among transgender, travesti , and non-binary (TTNB) populations, exclusion from protected labor markets represents a persistent form of structural disadvantage, yet its role in producing health inequities remains insufficiently investigated, particularly in middle-income countries. This study examined the social patterning of precarious occupational insertion among TTNB populations, considering labor precarity as one expression of the structural conditions that shape health equity. Methods This cross-sectional analytical study used data from the community-based MapTrans Project conducted in 2023 with 237 transgender, travesti , and non-binary individuals living in the Baixada Santista Metropolitan Region, São Paulo, Brazil. Precarious occupational insertion was defined as unemployment, informal labor, sex work, or unstable income-generating activities. Descriptive analyses and crude and adjusted logistic regression models were performed to examine associations between occupational precarity and sociodemographic characteristics, educational attainment, income, race/color, and perceived barriers to employment. Results Precarious occupational insertion was highly prevalent and concentrated among participants experiencing multiple dimensions of structural disadvantage, including low educational attainment, low income, barriers to employment, psychosocial distress, and experiences of violence. After adjustment, self-identified brown race/color was associated with higher odds of precarious occupational insertion (aOR = 2.54; 95% CI: 1.03–6.26), whereas trans men/transmasculine participants had lower odds compared with non-binary participants (aOR = 0.26; 95% CI: 0.09–0.81). An inverse association was also observed for the Indigenous/Yellow category, although this finding should be interpreted cautiously because of the very small number of participants in this subgroup. Conclusions Our findings indicate that precarious occupational insertion among TTNB populations should not be interpreted simply as an employment outcome but as an empirical manifestation of the structural conditions that shape health equity. By providing community-based evidence from a middle-income country, this study expands the international literature on structural labor inequalities affecting gender-diverse populations and highlights equitable labor inclusion as an essential component of strategies aimed at reducing health inequities, placing health equity at the center of equitable development strategies.
Source: Research Square
Institutions: Universidade Federal de São Paulo, Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Fundação de Amparo à Pesquisa do Estado de São Paulo, Associação Paulista para o Desenvolvimento da Medicina, Universidade de São Paulo, Universidade Federal da Paraíba, Universidade Federal Fluminense
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7204647232