Choosing as a research community to integrate intersectionality theory in our work is consistent with our own social positioning as well as with the context in which we are embedded. Enjoying a series of privileges associated with working in an academic context does not exclude the possibility that we deal with oppressions -at least some of us- on the basis of our gender, sexual orientation, working class background, or migrant experience. Being embedded in a Western context where severe disruptions are in effect due to the entrenchment of neo-liberalism as dominant ideology (Labonté & Stuckler, 2016) means that we are called to analyze a series of old and new social struggles characterized by complexity and controversies. In times of massive socio-economic changes and political upheaval, a synthesis of intersectional and institutional insights on health inequalities research highlights how certain groups are excluded from health inequalities discourses and enables the simultaneous analysis of the health effects of both vertical (e.g. institutional factors) and horizontal (e.g. individual/ community factors) social stratifications. It has the potential to bridge the different streams of scholarship (i.e. socio-economic, gender, racial inequalities etc.) and brings to the fore the politics of health while it urges researchers to:
• Reframe health inequalities in the light of power relations and interrogate the processes that produce them instead of individual ‘labels.’
• Consider intersections at the institutional level beyond healthcare policy and explore the way they interact with individual positions.
• Avoid conflating categories with distinct socio-historical backgrounds (e.g. race and ethnicity).
• Integrate intersectionality beyond qualitative research to population studies and policy analysis.
• Develop appropriate multifaceted indicators of dimensions of privilege and disadvantage in future data and push for representative data across majorities and minorities and across countries.
• Read existing findings on health inequality with an intersectional lens, reflect upon potential exclusions they may involve (e.g. institutional effects, social categories, marginalized social groups) and develop new research questions accordingly.
• Do research as an inclusive process that involves subjects with differential social positioning and viewpoints during all the research stages.
Such a project implies a shift in our perspectives, aims and methodologies of research which is a political shift where the radical roots of intersectionality can find a fertile ground. Chapters five and six demonstrate how the suggested framework can be applied in a quantitative and a qualitative design respectively.
Chapter Five: Intersectional Migration-Related Health Inequalities in Europe: Exploring the Role of Migrant Generation, Occupational Status & Gender 5.1 Introduction
During the last decades, significant political, socio-economic and demographic developments have taken place within the European region. Internal mobility across European countries (La Parra-Casado et al., 2017) as well as fluctuating migration patterns from regions outside Europe towards Southern, Central and Western European countries (Geddes & Scholten, 2016) have coincided with the gradual European Union enlargement as well as with the recent economic recession of 2008, the socio-economic consequences of which are still felt in countries such as Greece, Ireland, Italy, Spain or the UK (Hermann, 2017; Kohl, 2015). In this context, migrants have been significantly marginalized through different processes that have been operating in parallel (Rechel et al., 2011). Regardless of the differences in citizenship and integration regimes across countries, migrants in Europe have mainly represented the most vulnerable segment of the labor force (Farris, 2015), they have been significantly exposed to material deprivation, and they have endured extensive restrictions regarding their access to social security and welfare, their rights to physical and professional mobility, as well as to a series of civil and political rights. Moreover, they have been subjects of persecution, traumatic experiences, discrimination and racism from local authorities and majorities (Bolzman et al., 2004).
It is therefore not surprising that a multitude of migrants’ health studies show that migrant groups and ethnic minorities in Europe report worse self-assessed health compared to non- migrants (Huijts et al., 2016; La Parra et al., 2016; Levecque et al., 2015; Rechel et al., 2011), underlining that migration as a dimension of social division in Europe affects migrants’ opportunity to achieve their health potential (Link & Phelan, 1995; Thomas, 2015). However, health inequalities between migrants and non-migrants as well as between different migrant groups do not follow a unitary pattern, since migration operates in tandem with other health determinants (Castañeda, 2015; Krieger, 1999). Socio-economic position or class have been often considered as the driving force of such inequalities (Bécares et al., 2009; Nazroo, 1998). However, findings confirm that in many cases, the health disadvantage of migrants persists regardless of socio-economic differences (Nazroo, 2003). Moreover, it seems that whether migrants have been born inside or outside the hosting country influences the direction of inequalities as it has been often found that first-generation migrants in Europe report better
self-rated health than groups of non-migrant origin (Giannoni et al., 2016; La Parra-Casado et al., 2017). Further, migrants’ gender appears as an additional factor intersecting with migration in shaping the range of health inequalities (Eikemo et al., 2018; Gkiouleka et al., 2018; Malmusi et al., 2010).
Building on this evidence and drawing on intersectionality theory (The Combahee River Collective, 1986; Crenshaw, 1989; Davis, 1983; hooks, 1981), I aim to explore health inequalities between migrant and non-migrant groups in Europe taking into account that migration, migrant generation status, gender and socio-economic position operate simultaneously shaping individuals’ position, experience and consequently health. Using a pooled European Social Survey sample across 27 European countries and six survey waves from 2004 until 2014, I employ a quantitative design in order to explore inequalities in self- rated health and hampering conditions among groups as those groups are shaped across the aforementioned categories and their intersections. Beyond comparing outcomes between migrant and non-migrant groups, I further document how gendered health inequalities vary within groups of non-migrant origin, first-, and second-generation migrants and within occupational classes. Further, I highlight which groups are particularly vulnerable to poor health. To the best of my knowledge, this is the first study exploring health inequalities in a representative sample of the residing population in Europe integrating an intersectional approach.