HEALTH CARE CIVIL RIGHTS: How Discrimination Law Fails Patients

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Structural features of our system, the role of insurance companies, and what I most want the public to know: my blog conversation with Prof. Alicia M. Walker

More about HEALTH CARE CIVIL RIGHTS

Health inequalities in the U.S. persist despite lots of concern about them. Civil rights are being quickly dismantled, even though we know, for example, that pulse oximeters don't read as well on darker skin. In my new book, HEALTH CARE CIVIL RIGHTS: How Discrimination Law Fails Patients (University of California Press, 2025), I tell the stories of success and failure in implementing health care civil rights through on-the-ground research. From insurance denials to dismissive bureaucrats, this book gets down to real life stories of enforcing and using health care civil rights. 

When health care civil rights battles get to the courts, it gets hot very fast. Most legal remedies for these claims have been gutted. Religious conservatives claim that anti-discrimination protections for trans patients amount to discrimination against them and their beliefs. The Supreme Court is about to decide if banning gender-affirming care for minors is illegal discrimination. Insurance companies use the byzantine complexity of our healthcare system and toothless laws to avoid accountability.

​There are things we can do at every level--in patient care, in insurance, and in our laws--to use civil rights to protect health again. HEALTH CARE CIVIL RIGHTS is the book to explain this moment.

​The troubles with civil rights in health care reveal deep divides and competing interests that reverberate through patient experiences, insurance claims, and courtroom arguments. In HEALTH CARE CIVIL RIGHTS, I explain what health care civil rights are, how they are supposed to work to protect against discrimination based on gender identity, how they work in practice at all levels, and how to strengthen them.

This book is based on 118 in-depth interviews with people in charge of implementing civil rights regulations in healthcare settings, advocates and policy leaders, trans and non-binary people navigating their health insurance policies, care providers, and health care staff, as well as analysis of hundreds of health insurance benefit documents, court cases, legal briefs, and archival materials.

​Praise for HEALTH CARE CIVIL RIGHTS

“Health Care Civil Rights brilliantly reveals how anti-discrimination law’s lofty goals are no match for the US health care system’s pathologies. Providing more than just a captivating read on trans patients’ fates, Anna Kirkland offers a blueprint for studying minority rights and the political economy of health.”--Joanna Wuest, author of Born This Way: Science, Citizenship, and Inequality in the American LGBTQ+ Movement  
 
“This innovative book considers how health care civil rights can be upheld in the US health care system by examining how civil rights are actually implemented on the ground. Informed by extensive fieldwork, Health Care Civil Rights is written in a refreshingly engaging style that makes room for both an intellectually incisive argument and crystal-clear, practical pointers for correcting discriminatory patterns that harm vulnerable patients.”--Colleen Grogan, author of Grow and Hide: The History of America’s Health Care State

“Health Care Civil Rights is a meticulously documented, theoretically poignant, and exquisitely written study of the insufficiency of civil rights policy in addressing systemic health inequalities. But structures can change and so can our ways of thinking about enduring social problems baked into every level of healthcare. Kirkland’s astute work concludes with sound recommendations for alleviating the failures of health policy and practice.” –stef m. shuster, author of Trans Medicine: The Emergence and Practice of Treating Gender

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Previous books

Vaccine Court: The Law and Politics of Injury

What are vaccine injuries, and how do we come to recognize them? What does it mean to transform these questions into a legal problem and funnel them through a special national vaccine court, as we do in the U.S.? What does justice require for vaccine injury claims, and how can we deliver it?

Read the Introduction here.

The book focuses most upon the primary site in the contemporary U.S. for adjudicating vaccine injury causation and compensation, the so-called vaccine court in the Court of Federal Claims. Letting judges and lawyers decide medical claims about vaccines may seem ill-advised, and many scholars lament how political interests and adversarial lawyering only distort the truth in court. In this book, I argue that our political and legal response to vaccine injury claims over the last few decades, though much criticized by social movement activists, shows how legal institutions can handle specialized scientific matters well.

Vaccine Court is based on participant observations at the vaccine court and in government committees, analysis of primary source documents (including 26 years of meeting minutes describing governance of the vaccine injury compensation program and 5,000 pages of court transcripts from the autism trials) and court cases, and interviews with lawyers and judges.

"Highly recommend this book to anyone interested in contemporary vaccine hesitancy and refusal, and, more broadly, in questions about the intersection of science, law, and public policy in democratic societies." ― Journal of the History of Medicine and Allied Sciences

"Vaccine Court provides historical, political, and social context to our countrys unprecedented attempt to resolve the conflict between those certain of vaccine harms and the science that may or may not support their claims. In a compelling and sympathetic manner, Kirkland explores the murky netherworld between science, where truths are often determined by decades of study, and court, where truths are determined after a few weeks of testimony." -- Paul A. Offit, MD, author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All

"In her highly original and meticulously researched book, Anna Kirkland takes us into the little-known but highly contested federal court system responsible for not just compensating individuals and families injured by vaccines, but also adjudicating competing claims of risk, science, and expertise. Vaccine Court exposes the myriad ways law must simultaneously build consensus and create dissent. Skillfully presented with detailed analysis and compelling examples, this book is a powerful vindication of the state as imperfect, indispensable to efforts to ensure public health, and in dire need of new ways to create greater access and equity for all." -- Jennifer Reich, University of Denver

"Drawing on rich original data, Kirkland examines how the specialized vaccine court addresses enduring tensions between science and law, popular beliefs and expertise, and fair process and desired outcomes, and how the right to sue is both an inspiration and a constraint on social movements. Vaccine Court is timely, fascinating, and important." -- Charles Epp, The University of Kansas

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Fat Rights: Dilemmas of Difference and Personhood

​America is a weight-obsessed nation. There's been an explosion of concern in the U.S. about people getting fatter. Plaintiffs are now filing lawsuits arguing that discrimination against fat people should be illegal. Fat Rights addresses debates about adding weight to lists of currently protected traits like race, gender, and disability.

​Is body fat an indicator of a character flaw or of incompetence on the job? Does it pose risks or costs to employers they should be allowed to evade? Or is it simply a stigmatized difference that does not bear on the ability to perform most jobs? Could we imagine fatness as part of workplace diversity? Considering fat discrimination prompts us to rethink these basic questions that lawyers, judges, and ordinary citizens ask before a new trait begins to look suitable for anti-discrimination coverage.

Fat Rights is based on a survey of legal claims about fatness across American law including tort law, employment discrimination law, and disability rights law. 

“Provides a much-needed conceptual map for making sense of how we in the U.S. talk about difference, discrimination, and rights generally. The result is an imaginative, insightful, savvy, and unusually accessible inquiry that should be required reading for anyone interested in the politics of civil rights. Highly recommended!" -- Michael McCann, University of Washington