The Crisis of Healthcare Access
How Systemic Oppression Creates Barriers for Marginalized Communities
What’s happening in healthcare isn’t a series of isolated incidents or unfortunate oversights. It’s systemic oppression by design. An intentional web of intersecting barriers that disproportionately affect marginalized communities and those who hold multiple marginalized identities. During my career, I’ve witnessed firsthand how these systems create devastating barriers to basic care.
Fat Bodies Are Under Siege!
The so-called “War on Ob*sity” isn’t a public health campaign aimed at weight loss, despite how it’s framed by policymakers and institutions. In truth, it functions as a systematic and calculated assault on fat people themselves. Not just our bodies but our very liveliehoods. This prejudice is particularly evident in healthcare settings, where fat patients frequently experience discrimination that directly impacts their medical care.
I’ve personally spoken to hundreds of Fat people around the world who report having their health concerns dismissed or attributed to their weight without proper examination, while others face delays or denials of routine screenings and treatments that would be readily provided to thinner patients. And I’ve been there myself.
Fat people endure constant pressure to pursue harmful weight loss interventions even though there isn’t a shred of evidence that these will improve our health outcomes in the long term. We are often told to “lose weight and come back” for conditions entirely unrelated to body size. Even the physical spaces and equipment in medical settings frequently fail to accommodate diverse body sizes.
Asa result, Fat people delay seeking care to avoid shame and discrimination, leading to preventable conditions going undiagnosed. Minor issues become severe emergencies. Each negative experience reinforces the trauma, until trust in the healthcare system erodes completely.
This issue extends far beyond concerns about doctors’ bedside manner or their claims of “telling hard truths.” Lives are at stake. When doctors inflict harm through their biases—whether through delayed diagnoses, dismissed symptoms, or denied treatments—they create worse health outcomes for their Fat patients. Then, in a cruel twist, they blame these very outcomes on their patients’ weight, perpetuating a cycle of medical neglect and discrimination.
The “War on Ob*sity” creates a self-fulfilling prophecy for Fat people, and the medical profession is to blame.

Systemic Racism in Healthcare
For Black people and other people of color, the healthcare system continues to perpetuate deep-rooted and intentional inequities. I’d go so far as to say that modern medical system is designed to oppress Black, Brown and Indigenous people. We see pain and symptoms being dismissed or undertreated, longer wait times for essential treatments, and significantly higher maternal mortality rates. Cultural and language barriers to care are hardly ever addressed, while medical racism hides behind the facade of “clinical judgment.” Yeah right 🙄
These systemic barriers create compounding harm that echoes through generations. Preventable conditions become life-threatening as care is delayed or denied. Generational trauma around medical care deepens with each negative experience. Communities understandably lose trust in the healthcare systems, creating further disaprities. And so the cycle of inadequate care perpetuates itself.
The fault lies squarely with both the system and those who perpetuate it, while the consequences fall disproportionately on Black communities and other communities of color. You’ll find racism embedded in the very foundations of the medical profession. Like termites consuming a building from within, racism has eaten away at medicine’s foundations since its inception. The facade may appear intact, but the structure is compromised at its core—unsafe and fundamentally unfit for those it claims to serve.
It’s not a system that can be repaired with superficial fixes; it was built on rotten foundations.

The Battle for Trans Healthcare
Trans patients face an increasingly hostile healthcare landscape. Not that it was ever sunshine and roses, mind you! But as right wing politicians and the gender-critical movement continue to scapegoat the Trans community, things are gettinh harder and harder. Trans people encounter outright denial of gender-affirming care, which has proven to be life-saving. Why? So that politicians can score points with biggots.
It doesn’t appear to matter to anyone that Transgender individuals have a three‐ to four‐fold elevated risk of suicide compared with the general population. A statistic, by the way, that is taken from a Dutch cohort, despite the fact that the Netherlands is “known for its tolerance toward sexual minority groups in comparison to most countries in the world”.
In addition to denial of treatment, Trans people face routine harassment and misgendering in medical settings, and requirements for unnecessary psychiatric evaluations. Insurance companies exclude essential treatments and limit access to knowledgeable providers, and the constant fight for basic dignity devastates both individual and community health.
Medical stigma and trauma drive trans people away from traditional healthcare and into unofficial care networks—not by choice, but by necessity. While these community-based networks often provide vital support, forcing people to rely solely on unregulated care leaves them vulnerable to potential exploitation. Meanwhile, the cascade of consequences continues: mounting discrimination intensifies mental health struggles, while paying out-of-pocket for basic care depletes financial resources. Health conditions worsen as treatment delays stretch on, creating a vicious cycle of escalating medical and personal crisis.
Every medical visit becomes a potential battle for respect, and Trans people are tired of fighting.

Disability and Medical Gaslighting
Disabled patients face relentless challenges in healthcare settings. They encounter gaslighting about symptoms and experiences, inaccessible medical facilities and equipment, and dismissal of their expertise about their own conditions. This is nothing new. Especially for those with invisible disabilities.
Symptoms such as chronic pain and faitgue are blamed on stress or low mood. People with mental health conditions are advised to lose some weight or go for a walk, instead of addressing the very real systemic and environmental issues that are impacting their wellbeing. Mental health and Austism services are woefully underfunded. Many Disabled people face forced medical interventions and denial of necessary accommodations.
Thanks to Purdue Pharma and the Opioid Epidemic, people with chronic pain are denied adequate analgesia and are forced to live in abject misery. In countries like Canada, you will be offered MAiD (Medical Assistance in Dying) before your healthcare professionals attempt to offer you the support and accomodations neceessary for your wellbeing.
Doctors haven’t just failed the disabled community—they’ve actively participated in its persecution, from implementing eugenics programs to conducting forced sterilizations, culminating in atrocities like the Nazi T-4 program, where doctors actively participated in mass murder. This isn’t merely a historical footnote; it’s evidence of medicine’s longstanding role in systematically harming disabled people.
The constant invalidation of the Disabled experience means energy is wasted fighting for basic care, while trauma accumulates from repeated medical gaslighting. Disabled people do not have energy to spare! People lose agency over their own bodies and treatment decisions. The physical toll of delayed or denied care compounds, all while the exhaustion of constant self-advocacy grows.
The very system meant to help the Disabled commuity becomes another barrier to wellness.

The Assault on Reproductive Rights
The current healthcare landscape includes escalating restrictions on reproductive healthcare, forced pregnancy and birth, limited access to contraception, dismissal of pain, and denial of sterilization choices. The impact is far-reaching and profound. Even if you live in a country where abortion is legal, the medical profession continues to discriminate against you because you were born with a uterus and ovaries.
There has been very little investment in repodcutive and gynaecological care over the last 100 years. Education is lacking, and many doctors know very little about menstrual disorders, contraception or menpoause. That’s something their OBGYN colleagues can deal with, afterall! Then there’s the gatekeeping of essential care such as contraception, abortion, pain relief, fertility medicine, and HRT.
The escalating restrictions that we are seeing in countries like the USA create cascading harm throughout people’s lives. Life-threatening delays in essential care become common as providers fear legal consequences. Pregnancy outcomes face increasing criminalization. Mental health deteriorates and maternal mortality rates increase significantly. All the while, the economic consequences of forced pregnancy create lasting hardship. Lather, rinse, repeat.
When politicians involve themselves in medical matters that simply don’t concern them, people start dying and trust between doctors and patients erodes even further.
Forced birth is nothing to do with being “pro-life”. It’s about stripping people of their bodily autonomy and basic human dignity.

It All Adds Up
It’s essential that we understand the following: These systems of oppression don’t exist in isolation. They intersect and compound. For those who hold multiple marginalized identities, healthcare barriers multiply exponentially. Each additional marginalized identity adds another layer of complexity to accessing basic healthcare. So if you happen to be a Fat, Black, Disabled Trans person in need of healthcare, you’re least likely to get it.
In fact, chances are you’ll experience tremendous amounts of harm at the hands of the medical profession. Sure, your income and insurance coverage will make a difference. So will the area that you live in and your parents level of education. But that’s not enough to counteract the realities that I’ve laid out (as well as those I haven’t covered).
Conversely, if you’re a thin, white, cisgender man without any disabilities who is in need of healthcare, you’re in luck! You’re most likely to get the care that you need. Now your income, insurance coverage, address etc will impact you too. Without money, healthcare gets harder to access across the board.
However, staistically speaking, you have the highest income, live in the better neighbourhood, and have access to the best hospitals. You also don’t need to worry about stigma, because you’re the top dog. Congratulations! How very fortunate of you.
One might go as far as to say that you are more privilged than the rest of us 😉
The Path Forward
If you’ve gotten this far, you may well be ready to give up. If the dice are loaded, the deck is stacked against you, and the house always wins, why bother? I hear you. I see you. And I want to offer this:
When the system is so unjust and unfair, community support and advocacy become essential. Our only option is to fight these systems together, share resources and strategies, and support each other in navigating these challenges. I know you’re exahusted. I am too. Alone, there’s very little we can do. But together we can accomplish a lot.
The path to transforming healthcare requires both individual advocacy and collective action.
As a Fat doctor committed to weight-inclusive, intersectional healthcare, I have witnessed both the damage these systems cause and the power of community in fighting back. When we come together, share our experiences, and support each other’s advocacy efforts, we begin to create cracks in these oppressive systems.
This is why spaces like The Weighting Room are so crucial – they provide not just support, but the collective strength needed to demand and create change. The crisis in healthcare access isn’t inevitable. It’s the result of systemic oppression, but systems can be changed. Through community, advocacy, and collective action, we can work toward a healthcare system that truly serves everyone, regardless of size, race, gender identity, disability status, or any other aspect of identity.