Olena Hankivsky discusses the inadequacies of traditional health inequity frameworks, advocating for intersectionality to better understand health disparities influenced by multiple social factors. By recognizing the dynamic interplay of identities and power relations, intersectionality offers a more nuanced view that can aid policymakers in providing effective health services. The concept emphasizes the complexity of lived experiences and the need for comprehensive approaches to address marginalization in health research.

1. Olena Hankivsky, PhD Simon Fraser University November 25, 2010

2. The problem: Growing sense that current approaches to understanding health inequities are insufficient for increasing the understanding of multi-factoral and multi-level complexities of health disparities and for identifying the most effective strategies to reduce them in the real world. WHY? Exploring the Promises of Intersectionality

3. Traditional approaches: Fragment vulnerabilities into distinct categories such as sex, gender, race/ethnicity, socio-economic, sexuality, geography, or disease status P rioritize one category over others L ump people into static and homogeneous groupings (e.g. ‘women’ & ‘men’) Fail to fully consider and analyze the context and influence of social power inequities. Exploring the Promises of Intersectionality

4. Health Determinants Approach income and social status; social support networks; education and literacy; employment/working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; biology and genetic endowment; health services; gender; and culture (Public Health Agency of Canada 2008) Exploring the Promises of Intersectionality

5. Social determinants of health – that is the conditions in which people are born, grow, live, work and age, including the health care system – are mostly responsible for health inequities (WHO, 2008). According to the WHO, it is only through action on the social determinants of health that the lives and in particular health of the world citizen’s can be improved . Exploring the Promises of Intersectionality

6. SDH approaches and intersectionality both recognize the multiple dynamic factors that influence the lives of individuals and the need to better understand and respond to these in working towards the elimination of inequalities BUT : SDH - finite number of categories, lack of attention to relationships among determinants, lack of understanding of wider context of structural inequities in which determinants are embedded, and insufficient attention to power. Exploring the Promises of Intersectionality

7. In comparison: Intersectionality is concerned with simultaneous intersections between different aspects of social difference and identity (e.g. as related to meanings of race/ethnicity, Indigeneity, gender, class, sexuality, geography, age, disability/ability, migration status, religion); and Different forms of systemic oppression (e.g. racism, classism, sexism, ableism, homophobia) at macro and micro levels in ways that are complex, interdependent and reflect intersecting systems of power relationships. Exploring the Promises of Intersectionality

8. Exploring the Promises of Intersectionality PUT SIMPLY: Health inequities are never the result of singular, distinct explanatory factors but the outcome of intersections of different social locations, power relations and experiences

9. Exploring the Promises of Intersectionality Intersectionality - new and developing area of inquiry insofar as original and innovative conceptual frameworks, theoretical approaches, and cases have emerged over the last ten years However, this is against a backdrop of a rich history in social struggles and writings by feminists of colour Areas of influence : women’s health, men’s health, Aboriginal health, immigrant health, HIV/AIDS, mental health, dementia, violence, CVD, diabetes and obesity.

10. Intersectionality moves beyond single or typically favoured categories of analysis (e.g. sex, gender, race and class) to consider simultaneous interactions between different aspects of social identity …as well as the impact of systems and processes of oppression and domination (e.g. patriarchy, capitalism, colonialism, homophobia) Experiences of race, class, gender, sexuality, geography, immigration status, and ability (among others) intersect to produce social locations that are equal to more than just the sum of its parts. Any individual experiences different forms of privilege and subordination, depending on their race, class, gender, sexuality, and ability (among others). Exploring the Promises of Intersectionality

11. Social categories are dynamic and socially constructed (e.g. sexuality , gender & race/ethnicity are fluid and flexible) No one category of social identity is necessarily more important than any other Each issue or problem under investigations may require the consideration of a different constellation of factors (e.g. sometimes it might be sexuality, race/ethnicity and class other times it may be geography, sexuality and ability, etc). Exploring the Promises of Intersectionality

12. Exploring the Promises of Intersectionality What is the appeal? Probes beneath ‘single’ identities to reveal other factors that may be present and contributing to a situation of disadvantage – key is attention to interaction not just adding or layering... Highlights the complex and multifaceted nature of human lives – micro, meso and macro levels of analysis Produces more accurate knowledge and evidence about how people actually live their lives

13. Example: Women’s Health What has been left out of researchers’ analysis because of the conceptualizations that have been used? Growing critiques about systematic exclusion/marginalization of the experiences of many different groups of women and by default, focusing on the most privileged women (white, middle class, able-bodied, heterosexual) Organizing around category of woman has resulted in excluding women who are constructed as ‘different’ from whatever it is that unites that particular sub-group of women who are unaware of the privilege their class, race, heterosexual, national, able-bodied position confers. Exploring the Promises of Intersectionality

14. Women’s Health cont’d Within the broad category of women, intersectionality reveals that it is possible to be both privileged and marginalized – social relations are so complex that nearly everyone is privileged in some ways and disadvantaged in others Doesn’t mean that everyone is EQUALLY advantaged and disadvantaged. Growing recognition that the field needs to better integrate the various and intersecting factors that influence health among women – central to COMPREHENSIVE understanding of women’s health. Exploring the Promises of Intersectionality

15. Questions for Gay Men’s Health How is gay men’s health currently conceptualized and defined? What are implications if the focus is primarily on gay men as a homogenous group? (e.g. does the struggle focus on the experiences of upper class white men, marginalizing less-privileged queer people? – is there for example, race, class bias? ) What are implications of focusing primarily on sexuality and sexual orientation or heterosexism and homophobia to the exclusion of other considerations? Exploring the Promises of Intersectionality

16. Questions for Gay Men’s Health cont’d What are implications of only considering issues of gender in addition to sexuality? What are the relevant axes for understanding differentially situated gay men and their health needs and experiences? The struggle over which differences to consider is one of POWER – who determines whether and which intersectional differences will be addressed in research and policy formulations (Crenshaw 1992) How can gay men refrain from participation in “oppression olympics” and instead identify strategic coalitions for advancing their health needs and concerns? Exploring the Promises of Intersectionality

17. Implications in terms of Gay Men’s Health Important Realities: Who are the winners and who are the losers in how gay men’s health is currently conceptualized? Gay men are not a homogenous group – complexities cannot be afterthoughts but must be interwoven into the design of research, policy and practices Many factors at play – e.g. geography, race/ethnicity, ability, age, sexuality, religion, immigration status Gay men’s health also structured along a range of axes other than the ones typically considered within intersectionality frameworks – e.g. HIV status, co-morbid health issues, relationship status and life stage, including critical transitions Exploring the Promises of Intersectionality

18. Exploring the Promises of Intersectionality Power of Intersectionality in this context Need to look at both individual social locations, interpersonal relations but also the intersection of social structures; Draws attention to the often unacknowledged heterogeneity among gay men and their communities; Encourages strategic coalition building among other groups experiencing a range of health inequities.

19. Exploring the Promises of Intersectionality Conclusion Intersectionality illuminates that human lives are embedded in multiple contexts – historical, cumulative and interlocking. It shows how different socially-situated perspectives will not only provide more precise information but also yield greater insights into systems of marginalization and oppression. Intersectionality assists policy makers and services providers alike to deliver more effective and efficient programs and services to better meet the needs of those individuals and groups most disadvantaged by social inequities. Intersectionality - still under development in health research and policy - it is the way of the future.