Universal healthcare is central to what defines Canada. Most Canadians believe that everyone deserves access to healthcare based on our needs—regardless of who we are, where we live or how much money we have.
Our Pink Paper on LGBTQ2S+ health reveals that universal access does not exist for queer people in this country. Queer and trans Canadians are significantly less healthy, and have much reduced access to healthcare, compared to their cis and straight Canadian counterparts. Our research reveals that these disparities are stark—and that they grow even starker as we look at different demographics within our communities.
LGBTQ2S+ people experience anxiety and depression on average about 50 percent more than non-queer people. Worryingly, more than a third of queer respondents indicated that, at the time they were being surveyed, they’d had thoughts that they would be better off dead, or had thoughts of hurting themselves in some way, on at least several days in the past two weeks.
When broken down to examine our various identities, the research finds that health outcomes are much worse for some of us. Trans, intersex, asexual, questioning and pansexual people fare especially poorly. These groups experience more anxiety and depression—up to twice the rate of non-queer people. At the same time, those identifying as gay report the lowest rates of mental-health-related challenges in our communities—sometimes closer to those of the non-queer respondents.
The report reveals other factors that have a bearing on our health outcomes. Quality of life, for example, is poorer for rural, Black and Two-Spirit respondents, and poorest for lower-income and less-educated queers. Meanwhile, cancer rates are more than doubled in gay and asexual respondents (compared to non-LGBTQ2S+ respondents).
Our community healthcare experience is similarly alarming. Forty percent of us report habitual discrimination from healthcare professionals due to sexuality, more than four times the rate of non-queer respondents. About a quarter of us report a change in how we are treated by healthcare professionals after disclosing our sexual or gender identity or partner status—with that change being overwhelmingly negative. (For comparison, only 8 percent of non-queer respondents report a change, with that change being overwhelmingly positive.)
We report feeling unsafe in medical environments, sometimes having to hide or misrepresent our sexuality or gender identity—which is evidently not a scenario conducive to health or to competent care. And we report denial of care, which is often experienced as healthcare providers being unequipped or untrained to competently assess or treat our health concerns, and often unable to provide referrals or alternatives. A dead end.
For too many of us, the healthcare experience is broken.
The good news in this report is that gay men, by some but not all measures, are doing well. Their health outcomes are approaching those of straight people when it comes to several areas, including rates of anxiety and depression.
There are many factors at play here, including gender bias in healthcare, and evolving visibility and social acceptance. But our unique history of community healthcare is key.
AIDS organizations were some of the first institutions created by our communities. Importantly, these organizations became—and some continue to be—foundational to our sense of community.
To use a Toronto example, the 1981 bathhouse riots are seen as a turning point in our history, the moment we fought back and became a political force. The first cases of AIDS were identified in the city within a year of the riots, and the AIDS Committee of Toronto (ACT) was founded within another year, in 1983. In 2025, ACT announced its permanent closure.
Xtra Magazine has published excellent reporting on the need for “third spaces”—gathering places that are neither home nor work. In the 1980s, bars, bookstores and AIDS service organizations were where we came together. Today, all of these spaces are in decline.
The crisis back in those founding moments was acute due to the almost universal ostracism and fear of our community. We were truly on our own. But the upside was the birth of health organizations built by and for us, on our own terms.
Thanks to grassroots organizing, gay and bi men continue to have a shared understanding of sexual health, one that extends beyond individuals and strives for the health of the community as a whole. Decades later, even as HIV has become a more manageable condition, we saw the sustained impact of this mindset when Mpox arrived just a few years ago. Information was shared and risks and responsibilities were understood. Men lined up around the block to get their vaccines. This is the legacy of our community health response.
Today, trans, non-binary and gender-diverse people face the heaviest burden of a swelling backlash. At the same time, queer healthcare has moved beyond the grassroots, and is often managed by mainstream institutions with mandates beyond our communities. This represents progress but also a challenge.
As we seek solutions to the problems the Pink Paper raises, history suggests some pathways. Solutions are best determined by our grassroots communities, not imposed from the outside. Collective response remains an effective model, and we are wise to create venues and opportunities to come together to solve our problems. Healthcare institutions must respond to the challenges, but our communities—led by those most at risk—must drive those responses.
Mainstream healthcare institutions may have good intentions when it comes to diversity, but our findings show they are not delivering for LGBTQ2S+ Canadians.
Our people are suffering and our healthcare system is offside with one of its foundational principles: “First, do no harm.” The Pink Paper on health is a wake-up call.
