While transgender people have increasingly received public recognition, there has been little concerted effort to support and improve their health, according to a Harvard T.H. Chan School of Public Health researcher and other authors of a special Series published in The Lancet. Compiled with input of members of the transgender community, the Series provides an assessment of the health of transgender people worldwide and offers a framework for improvement.

The Series was published on June 17, 2016.

The authors estimate that there are around 25 million transgender people worldwide. They say that laws and policies that deny transgender people recognition can damage their mental and physical health and make accessing care more challenging.

The Series reports that transgender people suffer high rates of depression—up to 60 percent—and are at greater risk of engaging in risky behavior. Transgender people are at almost 50 times greater risk of HIV than the general population, and are at risk for violence, according to the authors. There were 2,115 documented killings of transgender people worldwide between 2008 and 2016.

“There are huge gaps in our understanding of transgender health stemming from a fundamental challenge of defining this diverse group and a failure to recognize gender diversity. Nevertheless, we know enough to act,” co-author Sari Reisner, a research fellow in the Department of Epidemiology at Harvard Chan who also is affiliated with Harvard Medical School and Boston Children’s Hospital, said in the journal’s press release.

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