Intersectionality as a theoretical-analytical tool to study health inequalities in the AmericasA interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas

Abstract

Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.