Interseccionalidade e marcadores sociais da diferença no acesso à saúde: panorama da produção científica

Abstract

Introduction: Intersectionality and social markers of difference—such as race, gender, class, and territory—shape asymmetries in access to fundamental rights. In the Brazilian health landscape, the overlapping of these forms of oppression creates systemic inequities that challenge the SUS principles of universality and equity, making intersectional analysis indispensable for formulating effective public policies. Objectives: To analyze, from an intersectional perspective, how the interplay of axes of oppression influences access to healthcare and perpetuates inequalities in Brazil, by mapping scientific literature, public policies, and the national epidemiological context. Methods: A systematic literature review (using a mixed-methods approach) was conducted following PRISMA 2020 guidelines and the PCC strategy. Searches were performed in January 2026 across the SciELO, PubMed, Scopus, Web of Science, and LILACS databases (covering the 2015–2025 period). Following screening on the Rayyan platform, 43 studies were selected for thematic synthesis. Results: An expanding body of research was observed—93% of which was domestic, peaking in 2025—with a central focus on the triad of race, gender, and class, appearing in over 70% of the sample. Intersectionality was primarily employed as an analytical tool within Primary Health Care, highlighting gaps between the formal guarantee of rights and the lived experiences of vulnerable populations (Black, *quilombola*, LGBTQIA+, and people experiencing homelessness). Discussion: Structural racism and heteronormativity act as determinants of inequity, fostering institutional violence and invisibility within information systems. The data confirm the "inverse care law," wherein highly vulnerable groups—such as Black women from marginalized urban areas and migrants—receive less care, underscoring the chasm between the legal framework and actual care delivery. Conclusion: Intersectionality represents an ethical-political imperative for the reorientation of the SUS. To realize constitutional principles, an intellectual transformation in professional training, improved quality in the collection of sociodemographic data, and the intersectional integration of public policies are urgently needed, aiming for an egalitarian health system consistent with human dignity.