Public health researchers are asking what happens when healthcare stops treating heterosexuality, cisgender identity and standard categories as the default. A growing Queering Health Systems project, highlighted by SRHM and the University of the Western Cape, is examining how policy, data, training and services can better recognise diverse communities and challenge the structures that leave people unseen.

Essential Takeaways

  • It goes beyond inclusion: Queering health systems means questioning the assumptions built into healthcare, not simply adding LGBTQI+ patients to existing plans.
  • Data matters: Forms, surveys and health records can either make diverse identities visible or quietly erase them.
  • Care must be affirming: Better services depend on trained staff, respectful language and systems designed around real experiences.
  • Community leadership is vital: Grass-roots groups often fill gaps when official services are inaccessible, unsafe or underfunded.
  • The work is intersectional: Sexuality and gender overlap with racism, disability, class, migration and other inequalities.

Public health is starting with a more uncomfortable question

The most important shift is simple but powerful: instead of asking how LGBTQI+ people can fit into existing healthcare, researchers are asking whether the system itself needs changing.

That was the focus of a session organised by the University of the Western Cape School of Public Health with Sexual and Reproductive Health Matters. The discussion formed part of the 18th World Congress on Public Health 2026 and helped introduce a planned collaboration on Queering Health Systems.

The phrase can sound academic, but its practical meaning is surprisingly clear. It means examining the assumptions behind waiting-room forms, clinical guidance, funding decisions and research priorities. If a system assumes every patient is heterosexual, cisgender and easily classified, some people will inevitably find care colder, harder or less relevant.

This isn't an 'add LGBTQI+ and stir' exercise

A rainbow poster may signal welcome, but it can't repair a service that still uses narrow categories or leaves staff unsure how to respond to patients. The emerging approach described by SRHM is more demanding: it challenges cisnormative and heteronormative foundations across governance, financing, data collection, workforce training and service delivery.

Research on queering health and biomedicine has similarly explored how medical knowledge is shaped by social expectations and institutional power. That matters because labels aren't neutral tools. They can help identify unmet needs, but they can also reduce complex lives to categories designed without the people being measured.

The result is a useful test for policymakers: who created this form, indicator or service model, and whose experience does it assume? Those questions can feel awkward, but awkwardness is often where meaningful reform begins.

Better data should mean more than extra boxes

Healthcare depends on information, yet data collection can easily become a source of exclusion. A form that offers no suitable gender options, or a survey that treats sexual orientation as irrelevant, can make a population disappear from the evidence used to allocate care.

That doesn't mean collecting every possible detail. Poorly designed questions can create privacy risks, invite misclassification or make people feel exposed. Data justice is about asking what is needed, explaining why it matters, protecting confidentiality and involving affected communities in decisions about collection and use.

Work on sexual and gender diversity in health research has also highlighted the importance of context, terminology and representation. In practice, that could mean community-reviewed questionnaires, better staff guidance and research teams that understand the populations they hope to serve.

From affirming care to workforce change

A welcoming service is built through everyday encounters. Staff need the confidence to use a patient's name and pronouns, understand relevant health risks without stereotyping, and recognise when a person's reluctance to seek care may come from previous discrimination.

The planned SRHM issue groups this work alongside several connected themes, including structural barriers, queer-affirming care, workforce transformation, community accountability and visibility in data. Together, they show why a single training session won't be enough. Policies, supervision, referral pathways and leadership need to reinforce the same message.

There is a human point beneath all the framework language. People shouldn't have to educate a clinic from scratch while they're ill, frightened or seeking intimate care. A system that gets the basics right can make an encounter feel ordinary, rather than like a test of courage.

Community agency is part of the solution

The discussion also recognised that communities often respond long before institutions do. Community-led monitoring, self-care approaches and digital health tools can offer information and support where formal services are unsafe, unavailable or simply not designed with local realities in mind.

That leadership matters particularly as anti-rights movements, shifting political attitudes and funding pressures affect health programmes. Queering health systems isn't only about identifying barriers; it's also about understanding the strategies people already use to survive and organise.

The forthcoming knowledge platform is expected to bring together journal articles, blogs, podcasts and webinars. That broader mix could prove valuable, because public health needs both rigorous evidence and stories that show what exclusion feels like on the ground.

A fairer system starts by challenging the default

The six emerging themes for the SRHM issue point towards a wider ambition: not merely improving access for a defined group, but rethinking what health systems are for and who gets to shape them.

Related scholarship on queering research and medicine has helped establish this as a serious field of enquiry, while the new collaboration gives it a practical public-health focus. The next step will be turning principles into budgets, training, measures and services that communities can actually feel.

When healthcare questions its defaults, it has a better chance of seeing the people those defaults have missed.

Explore health systems that put equity, dignity and community knowledge at the centre.

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