We talk a lot about inclusion in healthcare – but are we really designing systems that reflect the full complexity of people’s lives?

Intersectionality is a concept that helps us make sense of that complexity.

What is Intersectionality, and Why Does it Matter in Healthcare?

Coined by civil rights scholar Kimberlé Crenshaw in 1989, intersectionality is “a way of thinking about identity and its relationship to power.” It recognises that people’s experiences are shaped by overlapping aspects of their identity—like gender, race, class, disability, sexual orientation, migration history—and the systems that surround them: colonialism, patriarchy, ableism, and more (UN Women, 2022).

In healthcare, this isn’t just an academic idea. It’s a critical lens for understanding how inequity plays out in practice.

Health is shaped by more than symptoms or diagnoses – it’s influenced by people’s life experiences, identities, and environments.

When Categories Don’t Reflect Real Lives

Many health systems are designed and commissioned around siloed categories – programs or streams for older adults, First Nations, LGBTQIA+ communities, people with disability, or culturally diverse populations. These categories are often created by funders, policymakers, and service designers trying to simplify complex needs into manageable targets.

But this well-meaning segmentation comes at a cost.

When someone belongs to multiple groups, they’re often forced to navigate fragmented services that don’t reflect their full identity – or worse, they fall through the cracks entirely. This can lead to inconsistent care, delayed treatment, or complete disengagement from services that feel irrelevant or unwelcoming.

Systems built around single-issue identities may be administratively tidy, but they rarely match the lived experience of real people.

Equity requires more than service availability – it requires co-design that recognises the complexity of people’s lives. At Larter, we’re applying this thinking through our work in community-led healthcare design, where we support local voices to shape the systems that serve them. It’s not just about being heard; it’s about building structures that reflect real-world diversity and intersectional realities.

Picture a culturally diverse older woman, newly arrived in Australia. She’s living with disability, caring for a partner, does not have a vehicle, and is struggling financially. On paper, she may be eligible for multiple support services – but in practice, where does she turn?

She may approach the NDIS for disability supports, but how does she know which providers are culturally inclusive, or whether they offer interpreting services in her language? She may need respite or help caring for her partner. However as a new arrival, how does she even know what’s available – let alone which services are accessible by public transport or affordable on a limited income?

These are the invisible barriers that standard systems miss. They’re not clinical issues – they’re issues of access, navigation, trust, and inclusion.

Beyond Labeling: Understanding the True Complexity of Patient Needs

And here’s something else we can overlook:
Just because someone belongs to a particular group doesn’t mean that identity is central to their experience – or the most relevant factor in their care. People are more than the boxes they tick. An individual might meet the criteria for several priority groups, but that doesn’t mean those labels reflect what matters most to them. Nor do they know what shapes their health journey, or what kind of support they actually want.

In fact, leaning too heavily on visible identity markers can sometimes backfire. A health service covered in rainbow flags might aim to be inclusive- but for someone with same-sex attraction who is not openly part of the LGBTQIA+ community, this could deter them from accessing support if they fear being outed. What they really need is a service that feels safe, non-judgemental, and confidential.

Similarly, a culturally specific health service may seem like the obvious access point for someone from that background. But if the service is run by a close-knit group or community leaders, some individuals may actively avoid it due to concerns about privacy, stigma, or previous experiences. They still need culturally inclusive care—but perhaps from a different provider that offers interpreting support and a neutral, safe environment.

Intersectionality reminds us that identity is not only complex – it’s contextual. Services must be designed not just with groups in mind, but with people in mind.

Larter is currently exploring the design of intersectional personas, drawing on both qualitative and quantitative insights to help Public Health Networks better understand the nuanced needs of the communities they serve. These personas aim to reflect real-world complexity, moving beyond siloed categories to inform more inclusive, human-centred public health planning.

While health system planners and service designers often overlook intersectionality, frontline practitioners- like GPs, primary care nurses and social workers – encounter it every day. They’re acutely aware that people rarely fit into neat diagnostic boxes or predictable pathways. Patients present with layered and often conflicting needs—medical, psychological, cultural, social—and those needs don’t follow a template.

What we’re calling for isn’t news to clinicians; in fact, it’s a recognition that the complexity they navigate daily needs to be reflected in the systems built around them. However, right now too much of healthcare planning assumes a linear or standardised journey. Intersectionality reminds us that’s rarely the case.

Applying an Intersectional Approach in Healthcare

At Larter, we have been reflecting on how to work alongside clients to apply an intersectional lens to healthcare. This may apply to, say, health needs assessments, service codesign, and review of intake and triaging systems. In these contexts we feel that applying an intersectional approach means:

• Recognising that every person brings a unique set of intersecting experiences that affect their health.
  
• Care that is respectful of and responsive to people’s intersecting identities, for example by using non-assumptive communiation, and ensuring comprehensive access.
  
• Co-designing with people who live complex, layered realities.
  
• Valuing diversity in our workforce to better reflect the people we serve.
  
• Training for inclusive practice that cuts across all dimensions of identity, power, and experience—embedding cultural responsiveness, anti-bias awareness, and respectful communication at every level.
  
• Partnering with communities through codesign.
  
• Improving how we collect, document, and act on identity data – not just to tick boxes, but to understand and act (for example if we don’t know how many clients are queer First Nations peoples, how can we design care that works for them?)

The benefits of intersectional care are clear: consumers feeling heard and valued, more equitable access, and better health outcomes through systems that work for everyone.

Intersectionality is messy. It doesn’t conform to a neat protocol – but neither do people.

And our systems need to reflect that, because inclusion without complexity isn’t real inclusion – it’s performative.

How do you approach intersectionality in your work? We’d love to hear your thoughts.