Intersectional Inequalities Research Articles

Intersectional inequalities in somatic symptom severity in the adult population in Germany found within the SOMA.SOC study

Somatic symptoms are common in a wide range of medical conditions. In severe cases, they are associated with high individual and economic burden. To explore social inequalities in somatic symptom severity (SSS) and to identify social groups with highest SSS, we applied an intersectional research approach. Analyses are based on cross-sectional data of the adult population living in Germany (N = 2413). SSS was assessed with the Somatic Symptom Scale-8. A multiple linear regression model with three-way interaction of gender, income and history of migration and post-hoc pairwise comparison of estimated marginal means was conducted. Analyses revealed intersectional inequalities in SSS along the axis of gender, income, and history of migration. Highest SSS was found in males with low income whose parent(s) immigrated, females with low income who immigrated themselves, and females with low income and no history of migration. Intersectional approaches contribute to a more comprehensive understanding of health disparities. To reduce disparities in SSS, proportionate universal interventions combining universal screening and targeted treatment seem promising.

Subsistence entrepreneurship and intersectional inequalities: a case study of women from Pakistani urban-poor districts

PurposeThe study adopts an intersectional approach to identify the key dimension(s) that reproduce inequalities in women's subsistence entrepreneurship within urban-poor settings in the global south.Design/methodology/approachThe in-depth case study is based on 44 semi-structured interviews and four focus-group discussions with women entrepreneurs based within urban-poor dwellings in the twin cities of Islamabad and Rawalpindi in the Islamic Republic of Pakistan.FindingsThe authors contribute to the literature by identifying how intersecting socio-class and socioeconomic inequalities, and patriarchal norms of izzat (meaning: honour, respect) and purdah (or veil), perpetuate disadvantage for women entrepreneurs producing and/or selling business goods and services.Originality/valueThe findings challenge the view of entrepreneurship as a meritocratic and neutral activity for social emancipation. The authors argue that multiple social hierarchies and inequalities operate simultaneously, but how these are understood, exercised and reproduce disadvantage for women entrepreneurs, depends on their social class. The authors propose a triple bind of domestic, market and societal inequalities as a heuristic framework for understanding intersecting inequalities, patriarchy and subsistence entrepreneurship in Pakistan, specifically the global south.

A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish population

Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18–85 years across 2001–2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001–2009) and post-reform (2010–2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001–2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development.

Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy.

Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection. Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21-26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2-16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income. Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income.

Mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults: A population-based study on the mediating roles of lifestyle behaviors

BackgroundDespite substantial efforts to investigate the inequalities in mental health among people with marginalized identities, most research has concentrated on single social identities rather than complete persons. The current study aimed to explore the mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults. MethodsData for this study came from the National Health and Nutrition Examination Survey waves between 2015 and 2018, including a total of 11,268 US adults. A latent class analysis (LCA) was conducted to identify latent subpopulations based on sex, race/ethnicity, immigrant status, disability, household income, employment status, and education level. Interclass differences in lifestyle factors and depression were examined. Multiple mediation analysis was used to examine the mediating roles of lifestyle behaviors. ResultsLCA identified four potential subpopulations: “least marginalized”, “immigrant minorities”, “disabled, less-educated non-workers”, and “low-income minorities” groups. There was enormous heterogeneity in mental health among immigrant minority individuals. The “disabled, less-educated non-workers” group had the highest rates of depression; in contrast, the “immigrant minorities” group had the best mental health, even better than that of the “least marginalized” group. Distributions of lifestyle factors followed a similar pattern. In addition, lifestyle behaviors significantly mediated the relationship between intersectional social identities and depression. LimitationsThe cross-sectional design prevented establishment of the causality of relationships. ConclusionsThis study suggests that applying a person-centered approach is important when examining intersectional inequalities in mental health and highlights the effects of structural social hierarchies on individuals' health behaviors and mental health.

Can't Catch a Break: Intersectional Inequalities at Work.

The labor market is the site of longstanding and persistent inequalities across race and gender groups in hiring, compensation, and advancement. In this paper, we draw on data from 13,574 hourly service-sector workers to extend the study of intersectional labor market inequalities to workers' experience on the job. In the service sector, where workers are regularly expected to be on their feet for long hours and to contend with workloads that are intense and unrelenting, regular break time is an essential component of job quality and general well-being. Yet, we find that Black women are less likely than their counterparts to get a break during their work shift. Although union membership and laws mandating work breaks are effective in increasing access to breaks for workers overall, they do not ameliorate the inequality Black women face in access to work breaks within the service sector. A sobering implication is that worker power and labor protections can raise the floor on working conditions but leave inequalities intact. Our findings also have implications for racial health inequalities, as the routine daily stress of service sector takes a disproportionate toll on the health of Black women.

Teacher Stereotypes and Teacher Expectations at the Intersection of Student Gender and Socioeconomic Status

Abstract: Gender and family socioeconomic status (SES) are central dimensions of educational inequality and may interact in shaping inequality. This study addresses teacher expectations and stereotypes that possibly contribute to intersectional inequality. The study relies on two samples of teachers and students in German primary schools (sample 1: NTeachers=69, 94 % female, NStudents= 1,049 (German language)/1,027 (mathematics), 48 % female; sample 2: NTeachers= 698 (German language)/614 (mathematics), 94 % female; NStudents= 4,732 (German language)/4,117 (mathematics), 51 % female). Two-level regression analyses revealed additive gender and socioeconomic bias in teacher expectations in German language and mathematics but no intersectional bias (i. e., constant gender bias along family SES and similar socioeconomic bias for girls and boys). Further, teachers with more traditional gender stereotypes showed stronger gender bias, while SES-related stereotypes were unrelated to teacher expectations. We discuss how additive teacher expectation biases relate to the broader concept of intersectionality, potentially shaping unique educational experiences at the intersection of gender and SES.

I Need to Pee! Gender Inequalities and (In-)Accessibility of Public Restrooms in London

When analysing how cities and public facilities – especially public bathrooms – are designed, gendered perspectives are often neglected. This paper investigates the eff ects of the inaccessibility of public bathrooms on women's lives in London. Informed by a feminist lens, the research shows that many public bathrooms are inaccessible and unsafe, making it women's priority to avoid bathrooms throughout the day. This has effects on women's health and their understanding of bodily sensations. This inaccessibility leads women to plan ahead, limiting their ability to be spontaneous within public spaces, and using 'just in case' visits to bathroom facilities before leaving a place to minimize the risk of having to look for one later in the day. (In-)accessibility of public bathrooms is a long-lasting issue which has been translated into the creation of a cross-generational, non-formal bathroom education between women of diff erent generations. Overall, tensions and difficulties arising from women's (in-)accessibility to decent bathroom facilities means that their basic human rights are often denied, and their everyday life signi ficantly aff ected. As a response to such intersectional inequalities, women develop adaptative strategies, fostering their resilience as they reclaim their urban and public life.

Blinded by sunspots: Revealing the multidimensional and intersectional inequities of solar energy in India

Studies of energy transitions have historically lacked a holistic, multi-scalar and multi-site accounting of social and environmental impacts of projects. Scholars increasingly point to the need for integrated studies that highlight impacts at various stages of lifecycles and scales of governance in the normative pursuit of energy justice. In this study, we examine the social and environmental inequities within the solar PV value chain in India from multiple scales using an original dataset and comparative case study approach, including multiple site visits and embedded ethnography. We utilized a mixed methodological approach to data collection that included household surveys (n = 120), semi-structured interviews (n = 43), focus group discussions (n = 6) and naturalistic observation (n = 9 site visits over 24 days) across the states of Uttar Pradesh, Karnataka, Rajasthan, Delhi and Tamil Nadu at six different locations. We buttress recent work examining solar injustices from a ‘whole systems’ perspective, taking a multidimensional approach through an intersectional lens. Drawing from fieldwork and the literatures of energy justice and political ecology, we ask : What are the social and ecological impacts or equity concerns of each stage of the solar photovoltaic value chain in India? At each solar node, there are demographic, spatial, interspecies and temporal inequities occurring. Demographic inequities include resource dispossession, loss of livelihoods and hazards exposure for marginalized groups. Spatial inequities include distributional injustices for capital and electricity, rural land enclosures and substandard infrastructure. Interspecies inequities include ecosystem contamination, habitat destruction and imperiling wildlife. Temporal inequities include time burdens placed on marginalized groups, multi-decadal time horizons for inequitable projects to pay off and the long-term degradation of the environment. We conclude by reflecting on the stakes of solar development in India and offering policy recommendations that could engender a more equitable solar sector and chart future research agendas.

Why a feminist ethics of care and socio-ecological justice lens matter for global, interdisciplinary research on water security

In this conceptual analysis, we set out some of the negotiations and tensions that emerge when we try to build a shared understanding of water (in)security through the dual lenses of a feminist ethics of care and socio-ecological justice. We further reflect on how these theoretical lenses shape our work in practice—how do we actualise them in an international, interdisciplinary partnership? We actively seek to engage all our colleagues in how we understand the function of power and inequality in relation to the distribution of water resources and the ways in which intersectional inequalities shape access to, and availability of, water. We conclude that our international partnership will only add value to our understanding of water (in)security if we are able to identify not just how intersectional inequalities circumscribe differential access to water itself in a range of diverse contexts, but the ways socio-ecological justice and a feminist ethics of care are understood and in turn shape how we work together to achieve greater water security across diverse contexts.

An Intersectional Analysis of Moral Distress and Intention to Leave Employment Among Long-Term Care Providers in British Columbia.

Objectives: In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in Long-Term Care (LTC) in British Columbia, Canada. Methods: This was a cross-sectional and retrospective study. We assessed moral distress, of 1678 respondents, using a modified Moral Distress Scale, and an equivalent distress mitigation score, at the intersections of gender and racial/ethnic identity. Then, we explored which worker attributes were more predictive of intention to leave work. Results: We found notable difference in experiences of moral distress across intersecting identities, including high moral distress scores among Indigenous men and women, and white women. Significant differences in mitigation scores were also found by intersectional identities. Discussion: Moral distress was the most important predictor of intention to leave work. The differences across racial and gender identity groups suggest the need for tailored interventions to address moral distress among LTC providers.

Technology, Time And Communication: Exploring Postgraduate Students' Experiences Of Online Supervision During The Pandemic

Doctoral supervision is both a rewarding and challenging experience for supervisors and doctoral students, while effective supervision and research practice is of crucial importance for the developmental process and both students’ and supervisors’ careers. Although several challenges in the research journey are strictly research-focused, supervision is a human activity where intersectional aspects influence actions and activities. Power dynamics are involved in supervisor and research student interactions, many of which link affective with intellectual domains, and many are based on differences, of gender, age, race, or intersectionality. Here, we are mainly concerned with how to tackle challenging issues that grow from gender differences and intersectionality. Within the complex landscape of doctoral supervision, this paper is based on both research and educational development practice, since as authors and practitioners we are engaged with this. We use research, policy, widely available literature, and professional practice to underpin, build and share our developing “gender equality toolkit”. We use case studies to support constructive policies and practices and engage colleagues in reflective and practical development aimed at tackling issues concerning gender and intersectional inequalities in doctoral experiences and supervision.

Tackling Gender Inequality In Doctoral Supervision - An Intersectional Toolkit Involving Hearts, Minds, Policies, And Practices

Doctoral supervision is both a rewarding and challenging experience for supervisors and doctoral students, while effective supervision and research practice is of crucial importance for the developmental process and both students’ and supervisors’ careers. Although several challenges in the research journey are strictly research-focused, supervision is a human activity where intersectional aspects influence actions and activities. Power dynamics are involved in supervisor and research student interactions, many of which link affective with intellectual domains, and many are based on differences, of gender, age, race, or intersectionality. Here, we are mainly concerned with how to tackle challenging issues that grow from gender differences and intersectionality. Within the complex landscape of doctoral supervision, this paper is based on both research and educational development practice, since as authors and practitioners we are engaged with this. We use research, policy, widely available literature, and professional practice to underpin, build and share our developing “gender equality toolkit”. We use case studies to support constructive policies and practices and engage colleagues in reflective and practical development aimed at tackling issues concerning gender and intersectional inequalities in doctoral experiences and supervision.

Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States.

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

105 Intersectional Inequities in Emergency Medicine Resident Performance Assessments by Race and Sex

105 Intersectional Inequities in Emergency Medicine Resident Performance Assessments by Race and Sex

Intersectional inequalities in temperature-related mortality risk in South Korea

Intersectional inequalities in temperature-related mortality risk in South Korea

Reciprocity and intimate capital in household work: Exchanging love and care for labor rights in contemporary Buenos Aires

AbstractIn 2013, Argentina promulgated Law 26844, transforming household workers’ juridical status from “servants,” with almost nonexistent labor rights, to “workers,” with rights virtually equal to all other workers under the law. This article examines how household workers in Buenos Aires who share amicable or kin‐like relationships with their employers and the people they care for experience the transition from a discriminatory normative order of patronage and servanthood into an egalitarian normative order of full labor rights. The article shows, first, that rather than adopting a purely contractual rationality of labor rights and obligations, workers instead often make claims to labor rights in the registers of reciprocal obligation extant in their relationships with their employers and the people they care for. Second, the article shows that, as a type of social capital, the intimate capital that workers accrue in their relationships with their employers and the people they care for, in the form of relational ties with them, sometimes enables workers to access labor rights. Thus, the article demonstrates how household workers claim and access their legal equality against the backdrop of enduring intersectional inequalities between them and their employers in a context of widespread violation of household workers’ labor rights.

Making the invisible visible: examining Black women in Black Lives Matter

The Black Lives Matter (BLM) movement was created by three women in 2013 after George Zimmerman was acquitted for the murder of teenager Trayvon Martin. Since inception, BLM has gained national attention through its organization of and participation in numerous social movement activities, many of which have been driven by Black women. However, previous research and the persistent existence of racism and sexism indicate that Black women may be marginalized and made invisible within mainstream news media that discusses social movement activities. Mass media continues to be a powerful agent of socialization within society; therefore, it is critical to examine how various forms of media portrays different groups. The current paper examines how newspaper media portrays Black women engaged in Black Lives Matter movement activities. We utilize content analysis to analyze 645 newspaper articles that discuss BLM. We use intersectional inequality along with Patricia Hill Collins' controlling images as guiding theoretical frameworks to analyze our data and interpret the findings. Overall, findings show that Black women are largely invisible within newspaper articles discussing Black Lives Matter. This occurs in a variety of ways, such as focusing on protester response to police violence against Black men and using gender-neutral language when discussing individuals engaged in movement activities. Moreover, findings indicate that newspaper media utilize all of Collins' controlling images in their depiction of Black women in BLM; however, the utilization of controlling images in not equal. We discuss these findings in detail in addition to providing directions for future scholarly research.

Elizabeth Holmes: Silicon Valley, unicorns, and the limits of visibility

ABSTRACT The media narrative around the exceptional rise and fall of Elizabeth Holmes is crafted out of the ideological interplay between the logics of American neoliberal capitalism and popular feminism within the microcosm of Silicon Valley—itself machinated by venture capital, fueled by libertarian techno-determinism, and Sheryl Sandberg’s Lean In appropriation of feminism. Holmes’s celebrity, coinciding with the proliferation of national discourse around the “gender problem” in STEM, placated neoliberal and popular feminism’s calls for representation in a space that, per these ongoing discourses on diversity and inclusion, needed her visibility. Holmes’s media visibility grafted over the void of women’s representation within the notorious boys’ club of Silicon Valley under the American veneer of meritocracy. Holmes’s celebrity making, subsequent unmasking, and continued retelling through various fictional portrayals point to the inherent tensions in neoliberal logics and the superficiality of visibility, furthering the erasure of structural, material, and intersectional inequalities.

Intersectional Inequalities and Invisibilization in Organizations: The Case of Indian Beauty and Wellness Services

Discourses on social inequalities and the processes that sustain, reproduce, and reify them have been a long-standing area of scholarship. This paper focuses its attention on intersecting inequalities at workplaces and the organizational processes that support and enable their invisibilization. Building on this idea of invisibilization, we take a critical look at the active and conscious work done to keep inequalities hidden within organizations. In doing so, we understand and advance invisibilization as a twin concept that is primarily framed as a power equation but also acts as a visual illusion that obfuscates inequalities. We discuss this obfuscation by exploring intersectional inequalities within the Indian beauty and wellness services (BWS), a majorly unorganized sector that has a visible workforce of women migrants belonging to indigenous communities from the northeast region of the country. Using frameworks of Intersectionality, New Racism, and Othering, we argue that hiring within the BWS normalizes a heteropatriarchal-savarna gaze of the indigenous other, where women are routinely racialized and sexualized to be inducted within the industry. Further, this case study exemplifies how visible frames of gender inequalities invisibilize other ethno-racial, and regional inequalities within workplaces. Building on these findings, we suggest that organizations invisibilize inequalities by (a) co-opting a progressive vocabulary; (b) performing a normalizing function; (c) creating obfuscation; and (d) building a visual facade. Finally, this study contributes by broadening our theoretical understanding of invisibilization, especially in the context of intersectional inequalities, wherein inequalities are normalized through everyday practices within organizational hiring and training, among others.