Intersectional Inequalities Research Articles

Intersectional inequality through economic difficulties and lifestyle on body mass index in Sweden

Abstract Background A high body mass index (BMI) is listed among the top five risk factors for the Swedish population. Socially disadvantaged groups, including women, low-educated, and immigrants, are even at higher risk of a high BMI who may also face economic constraints, physical inactivity, and poor-quality diets. However, complex intersectional transmission of inequalities to BMI remains unexplored. Therefore, we aimed to examine intersectional inequalities in BMI mediated by economic strain and lifestyle in the Swedish population. Methods By using the Health on Equal Terms cross-sectional surveys in 2016, 2018, 2020, and 2021 in the Swedish population (n = 44,177 inhabitants aged 24 and over), we performed an intersectional mediation analysis to estimate how inequalities across intersectional strata, by gender (women or men), education (primary, secondary or university), and migration status (Swedish native or migrant), may be sequentially transmitted through economic strain (yes or not in the last 12 months) and unhealthy lifestyle (physical inactivity or inadequate fruit/vegetables consumption) to BMI (continuous). Results Compared with high-educated native men, socially disadvantaged strata experienced more economic strain, which in turn led to poorer health-related lifestyles and ultimately to a higher BMI. Some strata such as high-educated women, despite having a lower BMI, still experienced more pronounced transmissions of inequality on BMI through economic difficulties. Conclusions Not only inequalities in BMI, but also the material and behavioral pathways underpinning the inequalities, act by intersectional patterns. Public health interventions should ensure adequate economic resources to access healthy food and physical activity across all social strata groups. Key messages • Intersectional inequalities in BMI were driven by economic strain and lifestyle. • Economic strain and poorer lifestyles were not only more prevalent in lower stratus but also more detrimental.

Intersectional inequalities in child social-emotional health: a case for proportionate universalism

Abstract Background Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications. Methods This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy. Results Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities. Conclusions This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness. Key messages • Intersecting dimensions of social inequalities are associated with an increased risk of social-emotional problems in children aged 3. • Universal public health policies are needed in addition to policies targeting vulnerable population groups with regards to social-emotional problems in young children.

Welfare governance

This article connects to broader discussions on governance and neoliberal individualisation and advances how activation policies push a focus on labour market participation no matter what the cost – leaving non-citizens vulnerable to exploitative working conditions and termination of their stay permits if they do not participate. This goes along with a responsibilisation of the ‘poor migrant’, individualising their failure to secure their living that provides crucial momentum to drive them out of the national territory. Pointing to the broader context of intersectional (especially gendered and racialised) inequalities, this contribution concludes that precarity (both material and status-wise) is one of the key results characterising the current welfare governance of non-citizens.

Time and space for social-ecological transformation: care-full commoning in and beyond the ecofeminist city

ABSTRACT The relevance of civil society participation is well established in literature on environmental politics. However, the ability to join initiatives or movements actively fighting for a socially just future within biophysical limits is not equally distributed within societies. The configuration of spatial and temporal infrastructures in cities shapes how individuals interact with each other and the environment, thereby reproducing or alleviating intersectional inequalities. We connect literature on care, the commons, feminist time politics, and insurgent planning to discuss spatio-temporal infrastructures that promote space and time for care and participation. Building on feminist critiques of disembedded and disembodied cities, we draw upon examples from European cities to formulate an ‘educated dream’ about what an ecofeminist city could look like. In discussing different forms of scaling (up, out, deep) and bottom-linked transformation, we propose tangible steps towards the realisation of such a concrete utopia.

Intersectional employee voice inequalities and culture care theory: the case of migrant palliative care nurses inSaudi Arabia.

This narrative literature review examines intersectional employee voice inequalities in a non-Western, high power distance context to develop a multilevel conceptual framework. The authors use Leininger's (1997, 2002) culture care model to explore multilevel influences on intersectional voice inequalities. The article applies insights from a review of 31 studies to the specific challenges of migrant palliative care (PC) nurses in Saudi Arabia. The themes identified in the review indicate how better transcultural communications might mitigate voice inequalities that influence migrant employee wellbeing and intentions to quit which result from cultural incongruities. The impact of national culture differences and intersectional inequalities on employee voice has largely been ignored in academic research. This paper offers unique insights drawing on culture care theory into intersectional voice challenges from a non-Western perspective in the underresearched setting of Saudi Arabia which is mid-way through a national transformation program. It starkly contrasts policy ambitions for advancing healthcare with discriminatory practices based on conservative attitudes which stifle migrant worker voices.

Perceived discrimination and refraining from seeking physician’s care in Sweden: an intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA)

BackgroundDiscrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician’s care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician’s care.MethodsWe analysed nine annual National Public Health Surveys (2004, 2007–2014) in Sweden including 73,815 participants. We investigated the risk of refraining from seeking physician’s care across 64 intersectional strata defined by sex, education, age, country of birth, and perceived discrimination. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI), and the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy (DA).ResultsDiscriminated foreign-born women aged 35–49 with a low educational level show a six times higher risk (PR = 6.07, 95% CI 5.05–7.30) than non-discriminated native men with a high educational level aged 35–49. However, the DA of the intersectional strata was small (AUC = 0.64). Overall, discrimination increased the absolute risk of refraining from seeking physician’s care, over and above age, sex, and educational level.ConclusionsAIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician’s care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Discrimination impairs access to healthcare.

Long COVID and Health Inequalities: What's Next for Research and Policy Advocacy?

Organised by the 'Qualitative Long Covid Network', a workshop for qualitative Long COVID (LC) researchers, LC charity representatives and people with LC took place in June 2023, where research on the intersectional inequalities affecting LC prevalence, recognition and care was shared and discussed. Five key themes were drawn up from presentations, discussions and reflections during the workshop, which are presented in this study. The following five themes are discussed: the unfairness of LC, difficulties in accessing care, mistrust of the healthcare system, a lack of understanding of LC and experiences of stigma and discrimination. Factors that widen or narrow inequalities related to LC were identified. A call to action is proposed to investigate and address inequalities through a robust LC research agenda that speaks with conviction to policy and decision-makers. We argue that there needs to be a strong investment in research and evidence-based policy and practice to mitigate the worst effects of the condition and address the inequalities in experience, treatment and support, which are experienced more often and more acutely by some of society's most vulnerable and disadvantaged individuals. Projects included in this article had PPI ongoing activity to inform their research. A member of the CONVALESCENCE PPI group presented at the QLC Network 'Long Covid and Health Inequalities' workshop, as did members of Long COVID Kids, Long COVID Support and Long COVID SOS charities. They were all invited to be co-authors of this article.

The transmission of social inequalities through economic difficulties and lifestyle factors on body mass index: An intersectional mediation analysis in the Swedish population

Body mass index (BMI) has increased in Sweden, disproportionally for socially disadvantaged groups, including women, low-educated, and immigrants, who may also face economic constraints, physical inactivity, and poor-quality diets. Intersectional public health research aims to unravel such complex social inequalities, but the intersectional transmission of inequalities to BMI remains unexplored. We aimed to examine intersectional inequalities in BMI mediated by economic strain and health-related lifestyle in the Swedish population. By using the Health on Equal Terms cross-sectional surveys in 2016, 2018, 2020, and 2021 (n = 44,177 inhabitants aged 25 and over), we performed an intersectional mediation analysis to analyze how inequalities across social intersectional strata (by gender, education, and migration status) may be transmitted through economic strain and unhealthy lifestyle (physical inactivity or inadequate fruit/vegetables consumption) to BMI. Our findings showed a sequential transmission that indicates the fact that socially disadvantaged strata (compared with high-educated native men) experienced more economic strain, which in turn led to poorer health-related lifestyles and ultimately to a higher BMI. We also found that certain intersectional strata, such as high-educated women, were more vulnerable to economic strain, despite having lower BMI than high-educated native men. Additionally, the highest BMI and unhealthy lifestyle risk was observed among low- and middle-educated men. In conclusion, not only inequalities in BMI, but also the economic and behavioral pathways underpinning the inequalities, act by intersectional patterns. Public health interventions should provide economic security, particularly for women and migrant population as well as promoting a healthy lifestyle in lower-educated strata, especially among men, to achieve healthy BMI levels.

Immigration, domestic labor, and earnings inequality among native-born women in the US

ABSTRACT The wage effects of immigration have been widely studied, yet much of the research has focused on competitive threats to low-skilled native-born men. In contrast, this paper applies a gender lens to explore possible complementary relationships between immigration-induced outsourcing of domestic work and the earnings of native-born women, while recognizing the classed and racialized nature of domestic labor. Empirically, this article examines subgroup variations in earnings among full-time employed native-born women by education and race/ethnicity in relation to the state share of immigrants in the domestic service sector. The analysis combines data from the 2012 American Community Survey with state-level work-family policy data collected for 2010, accounting for compositional differences and selection into the labor force. Likely due to increased availability of affordable domestic services, the results show a higher immigrant share is associated with greater earnings for native-born women overall. However, education and race/ethnicity moderate this association, indicating that highly educated non-Hispanic white women benefit more than other women because the labor process and outsourcing of household production are classed and racialized. Hence, states with a higher share of immigrants filling domestic services exhibit wage dispersion patterns that reinforce intersectional inequality among native-born women.

Intersectional equity in Brazil's remote rural municipalities: the road to efficiency and effectiveness in local health systems.

The Brazilian remote rurality has been classified more reliably only recently, according to demographic density, proportion of urban population, and accessibility to urban centers. It comprises 5.8% of the municipalities, in nearly half of the states, with a population of 3,524,597 (1.85%). Remote rural localities (RRL) have reduced political/economic power, facing greater distances and barriers. Most health strategies are developed with the urban space in mind. We aim to understand how RRL are positioned concerning efficiency/effectiveness in health, compared to other urban-rural typologies of Brazilian localities, focusing on Primary Health Care (PHC), and its organizational models. We evaluated the efficiency and effectiveness of the organizational models using the health production model, from 2010-2019, gradually deepening the immersion into the RRL reality. We analyzed the human and financial resources dimensions, emphasizing teams, the results of PHC actions, and health levels. We used the fixed effects model and data envelopment analysis, cross-sectioned by intersectional inequities. We compared the Brazilian states with and without RRL, Brazilian municipalities according to rural-urban typologies, and RRL clusters. Brazilian RRL states show superior resource/health efficiency through services utilization according to health needs. The remote rural typology demonstrated greater efficiency and effectiveness in health than the other typologies in the RRL states. The organizational models with the Family Health Strategy (FHS) teams and the Community Health Worker (CHW) visits played a key role, together with local per capita health expenditures and intergovernmental transfers. Thus, financial resources and health professionals are essential to achieve efficient/effective results in health services. Among the RRL, the Amazon region clusters stand out, denoting the importance of riverine and fluvial health teams, the proportion of diagnostic/treatment units in addition to the proportion of illiteracy and adolescent mothers along with the inequity of reaching high levels of schooling between gender/ethnicity. Hopefully, these elements might contribute to gains in efficiency and effectiveness, prioritizing the allocation of financial/human resources, mobile FHS teams, availability of local diagnosis/treatment, and basic sanitation. Finally, one should aim for equity of gender/ethnicity in income and education and, above all, of place, perceived in its entirety.

Critical geographies of disaster, and the geographical imagination

This paper combines assemblage theory, feminist ethics of care and decolonial theory to build on recent work in disaster studies that seeks to address the systematic and intersectional inequalities that underlie the emergence of disaster. We argue that Western logics of “risk” do not always have traction with communities, and so researchers must “stay with the trouble” in engaging with tensions between lifeworlds. We suggest that geographical imaginaries provide a means to analyze the diverse ways of being and knowing that are involved in this process.

Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis

BackgroundThis study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences.MethodsOur cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees.ResultsRacialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities.ConclusionTargeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.

Instability and inequality in the British state

Abstract The UK state has been through many periods of perceived crisis, but the instability of the last decade has shaken some of the foundational institutions of British politics. Our main argument is that the rise of political instability relates to the failure of British politics to respond to structural inequality in society and politics. This includes growing economic and geographic disparities, as well as destabilizing divisions over long-standing social injustices. The infusion of these trends into the political process is the subject of the ‘asymmetric power model (APM)’, which acts as the theoretical underpinning of this paper and the special issue it introduces. In this editorial to the Parliamentary Affairs Special Issue on ‘Instability and inequality in the British state’, we elaborate these arguments and provide a brief overview of the eight papers in the issue, which cover the APM, the constitution, the UK Union, the Conservative Party, public policymaking, gender inequalities, intersectional inequalities, and geographical inequalities. Together, the papers identify the causes and features of the UK’s troubling inequality-instability dialectic and offer various practical and theoretical ways forward.

Impact of Gender Equality Policies on Women’s Career Mental Health and Well-Being

This paper examines the impact of gender equality policies on women’s career mental health and well-being in Canada. Over the past few decades, Canada has implemented a variety of legislative measures aimed at promoting gender equality, including pay equity, parental leave, and anti-discrimination laws. These policies have been instrumental in creating more inclusive and supportive workplace environments, improving job satisfaction, and enhancing overall mental health for women. However, despite significant progress, challenges such as persistent wage gaps, underrepresentation in leadership roles, and workplace harassment continue to hinder the full realization of gender equality. Using a qualitative research approach, this study explores the experiences of women across different industries and backgrounds to understand how these policies impact their mental health and career progression. The findings highlight the importance of strengthening policy implementation, promoting cultural change within organizations, and addressing intersectional inequalities to further improve the mental health and well-being of women in the workforce. Recommendations for policymakers and organizations are provided to enhance the effectiveness of gender equality policies and create more equitable workplaces.

The Impact of Gendered Ageism and Related Intersectional Inequalities on the Health and Well-being of Older Women

Gendered ageism contributes to invisibility and homogenization of older women, harming their health, quality of life and limiting their social participation. Health issues related to aging have received increasing attention in the scientific literature. However, studies on aging that include a gender dimension or ethnic aspects remain scarce. This article presents the results of a systematic review on older women’s health and wellbeing, gender inequalities, age discrimination experienced by older women and their intersections with other forms of discrimination. Between January and February 2023, we conducted a literature review using PRISMA in the Web of Science Core Collection, MEDLINE and SciELO Citation Index. We selected 43 empirical studies from different countries focusing on women over 65 years. The findings show the incidence of discrimination and inequality in health care experienced by older women, ageist attitudes among health care providers and other professionals, experiences of abuse and gender-based violence among older women. Additionally, the study examines the impact of ageism and other forms of discrimination on the health of LGBTQ+ older people, ethnic minorities, older women with disabilities, and other non-traditional groups.

Access to medicines, the Unified Health System, and intersectional injustices.

To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

Climate-resilient aquatic food systems require transformative change to address gender and intersectional inequalities

The adverse impacts of climate change on aquatic food systems (AFS) and the people who depend on AFS for livelihood security are inequitably distributed between and within countries. People facing the highest risks and experiencing the severest impacts of climate change are those who already experience multidimensional inequalities in their lives, particularly because of their gender, class, age, indigeneity, ethnicity, caste, religion, and the physical and political conditions that can create additional vulnerabilities. In this paper, we conducted a scoping review of the literature that explores the links between climate change, gender, and other social identities, and AFS. The review was complemented by an analysis of representative data on women and men aquaculture farmers in Bangladesh from 2018 to 2019. We also analysed data from the 2019 Illuminating Hidden Harvest project. The study relied on the gendered agrifood system and aquatic food climate risk frameworks to guide on literature search, review, and data analyses. Our findings show that intersecting identities disadvantage certain AFS actors, particularly young women from minority ethnic groups, and create challenge for them to manage and adapt to climate shocks and stresses. Examples of gender-responsive and transformative interventions are highlighted from our review to showcase how such intersectional disadvantages can be addressed to increase women’s empowerment and social and gender equality.

Intersectional inequalities in trust in the police in England

Intersectional inequalities in trust in the police in England

Intersektionales Handeln zwischen Fremderwartungen und pädagogischer Selbstermächtigung

Young imams are confronted with intersectional inequalities in their pedagogical actions. In these relations, the action-guiding and structuring power of socially constructed categories of difference such as language and generation becomes apparent. Against this background, the article focuses on the question of how these relations can be analysed from an intersectional perspective and which self-empowerment strategies professionals use in their pedagogical actions. For this purpose, mosques are considered as pedagogical spaces and imams as pedagogical leaders, which have so far been insufficiently considered in the educa-tional studies. Using intersectionality as an analytical perspective together with the documentary method, the empirical material can be reconstructed and intersectional fields of tension can be described. Based on these insights, the question is discussed how intersectional action can be understood as a specific form of pedagogical action in the sense of a pedagogical self-empowerment strategy.

Unequal uptake of skilled maternal health care services in Ethiopia: cross-sectional data analyses informed by the intersectionality theory

ObjectiveTo investigate intersectional inequality encompassing socioeconomic, geographical and demographic variables in the use of competent birth and postnatal care services in Ethiopia.DesignData for the study came from a series of...