Abstract
Intersectionality has recently gained traction in health inequality research emphasizing multiple intersecting dimensions of inequality as opposed to the traditional unidimensional approaches. In this study inequalities in mental health were estimated across intersections of gender, income, education, occupation, country of birth, and sexual orientation. The outcomes and inequalities of intersectional strata were disentangled analogously to the possibilities described by intersectionality theory; as a result of either of the two inequality dimensions, as a result of the sum the dimensions, or as a unique outcome not equaling the sum. Furthermore the study examined the discriminatory accuracy of the six inequality dimensions as well as the intersectional space comprising 64 strata. The study population (N = 52,743) consists of a yearly random sample of the Swedish population 26–84 years between 2010 and 2015, from The Health on Equal Terms survey. Mental health was measured through a self-administered General Health Questionnaire (GHQ)-12, and sociodemographics through survey and linked register data. Intersectional inequalities in mental health were estimated for all pairwise combinations of inequality dimensions by joint inequalities, excess intersectional inequalities and referent inequalities. The findings of the study found that the sum of dimensions contributed to the overall (joint) inequality in mental health rather than a reinforced adverse effect of multiple disadvantages or the contribution by a single dimension. Nevertheless, the dimension of income was found to be the most important in terms of relative contribution. The discriminatory accuracy was low indicating that policy action targeting mental health should be universal rather than focusing on particular groups. The results highlight the unpredictable inequality patterns revealed by an intersectional approach, even for a single health outcome and within one country, and illustrate the need for empirical investigations into the actual population patterns in health that appear in the intersections of multiple disadvantages.
Highlights
A global commitment to reduce health inequalities has been affirmed and proclaimed through declarations and agreements, such as the 2030 Agenda for Sustainable Development (United Nations, 2015), the 2009 World Health Assembly Resolution (World Health Organization, 2009), and the Health For All strategy (World Health Organization, 1981), and remains an ongoing struggle
In order to describe the overall distribution of poor mental health, the prevalence across the 15 intersectional spaces were estimated
The findings of this study found very sparse evidence for a reinforced adverse effect of multiple disadvantages on mental health across a broad range of intersectional spaces among Swedish adults, challenging the universality of the multiple jeopardy hypothesis
Summary
A global commitment to reduce health inequalities has been affirmed and proclaimed through declarations and agreements, such as the 2030 Agenda for Sustainable Development (United Nations, 2015), the 2009 World Health Assembly Resolution (World Health Organization, 2009), and the Health For All strategy (World Health Organization, 1981), and remains an ongoing struggle. For example, is multidimensional and encompasses biolog ical, cultural, economic, and environmental factors, but is at the same time enmeshed in other power structures, such as class, age, ethnicity, and sexuality. This complexity has paved the way for intersectionality as a new research paradigm gaining traction in health inequality research A. Green et al, 2017; Kapilashrami and Hankivsky, 2018, Merlo, 2018)
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