Intersectionality theory is a concept birthed from black feminist tradition. Officially coined by law professor Kimberle Crenshaw in the context of legal studies, it is a vital theory and politics of liberation that unveils the multidimensional nature of social identities alongside equally multifaceted experiences of discrimination under prevailing systems of power. The ubiquity of intersectionality is reflected in its adoption across liberatory movements concerned with race, gender, sexuality, legal status and dis/ability and many more across the globe.
Inclusion health is an approach focused on addressing and improving the most extreme of health inequalities that are observed within the socially excluded members of society as a result of their circumstance and/or identity. Within this framework, there are key populations that have been identified as inclusion health groups, which include but are not limited to: sex workers, asylum seekers, victims of modern slavery, people experiencing homelessness, traveller communities, people in contact with the criminal justice system and people with drug/alcohol dependency. As illustrated in the official framework published by NHS England, people in inclusion health groups tend to experience complex overlapping needs due to a clustering of risk factors and vulnerabilities such as poverty, violence and complex trauma that further exacerbate greater mortality and morbidity compared to the rest of the population.
The complexities of experiences are further compounded when also recognising that historically marginalised communities, such as women, queer and trans folk and racialised minorities, are disproportionately represented in inclusion health groups. And thus, the risk factors associated with inclusion health groups are intertwined further with identity when experienced by a historically marginalised community, for example, in the form of gendered and transphobic violence.
This is where the need for intersectionality in inclusion health is highlighted. Inclusion health groups do not exist in a vacuum, and neither does practice and policy. So to what extent can we truly address (the most extreme) health inequities when our data collection methods and frameworks fail to capture the political underpinnings of the conditions of those we claim to serve? The Intersectional Minority Stress Theory is a helpful tool in demonstrating the interconnected nature of minority status (and the stressors associated) with environmental circumstance and mental and physical health outcomes. Using this model in conjunction with the Social Determinants of Mental Health (developed by Ruth Shim) reveals the role of these stressors and subsequent outcomes in the context of the unjust distribution of power and opportunity.
Social exclusion, fundamentally, is a system of power that perpetuates minority status and stress through stigma, violence and discrimination that can take effect before an individual is even born through intergenerational transmission of maternal health, for example. So is it the task of inclusion health to take into account the political underpinnings of their patients’ experiences? I would say absolutely. But obviously this is an incredibly ambitious task considering the capacity of our health care systems and professionals; also politics in medicine is a very sticky subject. But I definitely think it is one that needs to be had more often because if we are to serve patients with dignity and honesty, I do believe that we need to be more frank about where the sources of these health inequalities are truly coming from (power asymmetries in our systems of care), otherwise it becomes counterintuitive in my opinion.
Without challenging the politics that healthcare systems operate under, we maintain the status quo and perpetuate extreme health inequities within society. We continue to operate under the false guise of progress only for the most marginalised of people to perpetually be underreported in the data that goes on to influence policy guidance and decisions.
Ultimately this is the task that an intersectional approach brings and I believe it to be the most important one in whatever endeavours we take for the betterment of society’s wellbeing.
Written by Teni
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