5th TGEU Council
Depath Workshop
Dave Scamell - Presentation Outline
Background
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International Classification of Diseases (ICD) is published and revised by WHO, used by member
states
Covers all areas of diseases, disorders, and injuries, and health conditions; diagnostic standard
for medicine and health systems
Last revision took place in 1990, and in current process of 11th revision by 2017, when WHA is
expected to approve.
Steps in Revision Process
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Working Group Review and draft recommendations; field-testing & public consultation; Review
and modification by secretariat; Approval by WHA
Currently in third phase – field-testing
Will go through each phase
Phase 1: Working Group and draft recommendations
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Working Group on Sexual Health and Sexual Disorders looked at a number of F categories, but
will focus on their F64 recommendations
Principle of moving away from pathologization, but still enable access to non-coerced healthcare
for trans people, respects human rights and will be acceptable to transgender people, health
care professionals, researchers, and Member States
Three key proposals
o Move from transsexualism to gender incongruence of adolescence and adulthood
 Transexualism (ICD 10) – Very prescriptive definition –focused on discomfort
with body and anatomic sex, and prescribed treatment within definition – HRT
and surgery to make body congruent
 GIAA (ICD-11) – Introduced marked and persistent, and a spectrum of ways in
which to achieve congruence between experienced gender and assigned sex.
o Move from gender identity disorder in childhood to gender incongruence in childhood
 Proposed diagnosis expands on criteria, and includes list of gender variant
behavior as one of the criterion, though alone is not sufficient for diagnosis.
o Move both GIAA and GIC out of F chapter – Mental health chapter
 Stand alone? Sexual health? Factors influencing health status (X)? Endocrine
chapter?
 Still debate, though leaning towards Sexual Health Chapter within WHO.
Stakeholder Input
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GATE had two expert meetings
 Hague 2011 – led to “Its Time for Reform” – agreed to remove F.64
transexualism and childhood diagnosis, provided options for replacement using
a starfish model – multiple sources for codes – Z, E/N, new F codes
 Presented to WG in January 2012
 Buenos Aires 2013 WPATH
 San Francisco 2013 – Agreement on removal of diagnosis from mental health
chapter, but no consensus on where to place. Also no consensus on name for
GIAA
 Most contentious was issue of GIC -14 for, 14 against
Phase 2: Field Testing and Public Consultation
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WHO needs to test out the proposed revisions, which includes three mentioned as well as a
range of other codes related to gender, sexual health: three ways –field testing, Global Clinical
Practice Network and general public comment through website.
WHO Field testing done through international field study centers (academic institutions) in
Mexico, South Africa, Lebanon, Brazil and India. Country teams containing a range of health
professionals/experts, including representation from patient group (i.e trans community).
Parallel field testing taking place in Netherlands, UK, Germany, Sweden that will feed into WHO
process.
Testing clinical utility and validity – do the revised codes correctly, accurately identify and
diagnose a health condition and correctly facilitate appropriate treatment?
Field testing in five WHO countries also includes a legal and policy analysis of revised codes.
Global Clinical Practice Network- 10,000 participants registered globally, once a month for
30minutes
Public Comment on WHO Beta Platform – still to be uploaded – main reason being undecided on
where revised codes should be placed. However, information has been shared through J
Drescher article, limited sharing with key stakeholders and public presentations such as WPATH
meeting.
GATE has presented at WPATH Symposium
Will release a report in May on Argentinian law and connection with ICD reform, along with
video
STP and GATE campaigning this year on childhood diagnosis and plans to publish a series of
articles in peer-review journals
20 activists in GATE WG
These processes will take place over 2014-205
Phase 3: Secretariat review and modification
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Will take input and make final revisions before submitting full revised ICD to WHO Executive
Board
35 member states voting
The EB is likely to be where political discussions on revisions will take place.
Should take place towards second half of 2016
Phase 4: Approval by WHA
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By time it gets to WHA should just be an up/down vote, and should be approved.
Sometime in 2017, looking at later in year.
Once approved, becomes ICD 11 and WHO then has to disseminate through regional and
country offices, member states.