The paper examines the ways in which healthcare systems, despite formal commitments to universality and equality, reproduce structural inequalities that marginalize people who escape heteronormativity, whether through non-normative gender identities, sexual orientations, or embodied expressions. The analysis situates these dynamics within a global perspective, highlighting how access to affirming care varies across geographical, political, and cultural contexts. Empirical evidence from international statistics and studies illustrates that disparities in healthcare access and outcomes are shaped by the intersection of structural stigma, socio-economic marginalization, and the persistence of pathologizing medical frameworks. The paper devotes particular attention to Italy, using data from the Istituto Superiore di Sanity (ISS) on the health status and healthcare experiences of transgender and non-binary people. These findings reveal marked inequalities in mental health, preventive care uptake, and exposure to discrimination, underscoring the gap between the formal promise of the national healthcare service and the lived realities of access. The discussion argues for a shift from rhetorical inclusion toward structural transformation, identifying key areas for change: destructuring medical epistemologies, reconfiguring the spatial organization of care, transforming professional education, and embedding institutional accountability. The conclusion reflects on the politics of resistance within healthcare systems, emphasizing that confronting normative structures is important for creating environments that are not only accessible, but queer-informed and just.

Health beyond norms: Queer access, resistance, and the reimagining of care

Salvatore Monaco
2026-01-01

Abstract

The paper examines the ways in which healthcare systems, despite formal commitments to universality and equality, reproduce structural inequalities that marginalize people who escape heteronormativity, whether through non-normative gender identities, sexual orientations, or embodied expressions. The analysis situates these dynamics within a global perspective, highlighting how access to affirming care varies across geographical, political, and cultural contexts. Empirical evidence from international statistics and studies illustrates that disparities in healthcare access and outcomes are shaped by the intersection of structural stigma, socio-economic marginalization, and the persistence of pathologizing medical frameworks. The paper devotes particular attention to Italy, using data from the Istituto Superiore di Sanity (ISS) on the health status and healthcare experiences of transgender and non-binary people. These findings reveal marked inequalities in mental health, preventive care uptake, and exposure to discrimination, underscoring the gap between the formal promise of the national healthcare service and the lived realities of access. The discussion argues for a shift from rhetorical inclusion toward structural transformation, identifying key areas for change: destructuring medical epistemologies, reconfiguring the spatial organization of care, transforming professional education, and embedding institutional accountability. The conclusion reflects on the politics of resistance within healthcare systems, emphasizing that confronting normative structures is important for creating environments that are not only accessible, but queer-informed and just.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11369/485922
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