Intersectionality: (Public) Health perspectives

My focus on the intersections of race and gender only highlights the need to account for multiple grounds of identity when considering how the social world is considered.

(Crenshaw, 1991: 1245)

Intersectionality theory, devised by Crenshaw (1989), explained that factors such as sex/gender and race/ethnicity constitute together to lead to multiple marginalisation. Initially, intersectionality was used to theorise the matrix of gender, race, ethnicity and class. It is argued that intersectionality requires more sustained attention towards understanding different logics of social divisions and inequalities and their intersections at the multiple levels (Yuval-Davis, 2006). Recent theoretical developments to understand intersectionality have explored the potential to incorporate several other domains of social positions such as socioeconomic status, caste, age, religion, educational background, sexuality and migration status that lead to the marginalisation and intersect at the same time to experience multiple marginalisations, even so, one does not take priority over another. Since the first introduction of the concept of intersectionality by Crenshaw (1989), several different approaches and perspectives have been used to understand and describe the intersectionality and use it in their respective field. In this thesis, I discuss intersectionality from the public health perspective and use this theory to explain the multiple level of intersections created by ethnicity, caste, gender, parental connectedness, socioeconomic status, sex education, religion, migration and educational background, which is experienced by Nepalese young people towards sexual health, lifestyles and relationships in the contemporary society of the UK.

Knudsen (2006: 61) defined intersectionality as “a theory to analyse how social and cultural categories intertwine”. Collins and Bilge (2016: 25) describes, “Intersectionality is a way of understanding and analyzing complexity in the world, in people and in human experience”. Hancock (2007) considered intersectionality as a research paradigm to study the race, gender, class and other organising structures of society in order to relate it to the standard logic of the identity politics that influence political access, equality and social justice. Hankivsky and Christoffersen (2008) explain that intersectionality seeks to disrupt the linear thinking that prioritises any one category of the social identity. Intersectionality is “a theory of knowledge that strives to elucidate and interpret multiple and intersecting systems of oppression and prievellage” (Ibid., 2008: 275). The theory of intersectionality

stressed complexity with and within different categories, subject formations, positions and identified that it was mixed together; making it difficult to distinguish the level of analysis. Leslie McCall (2005: 1771) explained complexity of intersectionality and defined it as “the relationships among multiple dimensions and modalities of social relations and subject formations”.

McCall identified 3 distinct approaches to demonstrate the complexity of intersectionality on the basis of their stance towards categories and how they understand and use analytical categories to explore the complexity of social positions. She described anti-categorical and inter-categorical as two ends of the continuum with intra-categorical in the middle of it (Ibid., 2005: 1773).

Although McCall described complexity of intersectionality with these 3 different approaches, she acknowledged that all intersectionality research may not fit into these categories and some researchers may cross these boundaries of the continuum to explain their use. This research deconstructs analytical categories and operates with gender, sex, sexualities and culture to avoid fixed structured categories because social life is considered too complex and to make fixed categories to simplify social fictions leads to social inequalities while justifying and producing differences among categories (Yuval-Davis, 2011b). Intersectionality in this research adopts existing analytical categories to examine social categories and demonstrate relationships of social inequalities at multiple and neglected points of intersection in order to reveal the complexity of lived experiences within different social positions (Crenshaw, 1989).

Davis (2008: 79) describes “intersectionality initiates a process of discovery, alerting us to the fact that the world around us is always more complicated and contradictory than we ever could have anticipated. It compels us to grapple with this complexity in our scholarship”. Intersectionality has emerged to demonstrate the relationships between different sociocultural categories or positions such as gender, race, ethnicity, sexuality, class, disability, nationality, education, economic situation; pointing towards the identities of an individual (Hankivsky, 2012). The intersections of these categories in the globalised world can shape the social and political belonging of the people and describe the structure of the society that can influence political access,

equality and social justice (Yuval Davis, 2011a). It shows that the potential of intersectionality is expanded further to be used across disciplines with a wide application to various areas of research. The use of intersectionality in the field of public health and healthcare has the potential to play a critical role in addressing the issue of health disparities and social inequalities (Hankivsky et al., 2010; Veenstra, 2011; Bauer, 2014; Larson et al., 2016). Bowleg (2012:

1267) states “intersectionality provides the discipline of public health with a critical unifying interpretive and analytical framework for reframing how public health scholars conceptualise, investigate, analyse and address disparities and social inequality in health”. The complexities of health disparities in the field of public health can be understood by identifying multiple intersecting identities or social positions of the oppressed groups and understanding systems of privilege and oppression that lead to multiple social inequalities.

Bowleg further describes intersectionality as a theoretical framework where multiple social categories intersect at micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro or sociostructural level (Ibid., 2012). The values of intersectionality theory present a new way to understand social inequalities with the potential to uncover previously unknown silent health inequalities (Veenstra, 2011). The theory requires different social positions to be considered in tandem rather than distinctly. This is because different social positions in contemporary societies are considered to be corroborating each other and intrinsically interwoven in such a way that they cannot be unwinded from one another.

The health policy of any country is largely interrelated to its social, economic and political policies. The use of intersectionality theory for research on immigrant health may help to address the issues related to race, gender or class that create discrimination and inequalities within healthcare (Viruell-Fuentes, Miranda and Abdulrahim, 2012). Crenshaw (1991) noted the difference in structural and political intersectionality but few have become the focus of political and policy attention. The process to integrate structural and political intersectionality remains unclear. However, it can be addressed by noting different categories independently as well as interrelated at the same time but it is important that these categories are not conflated or reduced just

to a separate group (Walby, Armstron and Strid, 2012). The real challenge is to identify whether all intersectional identities or social positions are of equal importance and understand the extent of these intersections. Hancock (2007) considers that intersectional positions are of equal interest, which offer the potential to represent research participants with some of them experiencing marginalisation without experiencing any form of privilege. Brah (1996) acknowledges that different dimensions of social life cannot be separated into discrete or pure strands. Hankivsky et al. (2010) explain there is no predetermined or pre-hierarchical pattern between categories and every category of social identity is necessarily more important than any other.

Intersectionality does not simply bring different categories together but also unpacks them to understand what is created and experienced at the intersection of two or more axes of oppression. It helps to recognise the multidimensional nature and several levels of differences between the social identity categories.

Intersectionality is beneficial in gaining a depth understanding of the social determinants of sexual health, as it considers bringing multiple social categories together simultaneously and mutually to constitute differences and disadvantages among the general population (Crenshaw, 1991; Cole, 2009;

Viruell-Fuentes, Miranda and Abdulrahim, 2012). Intersectionality may be used to analyse changes, variations and processes; focusing on minority cultures or marginalisation (Knudsen, 2006). The aim of the intersectionality in this thesis is to explore the complex structural determinants that influence the sexual health, lifestyles and relationships of Neaplese young people and understand the interrelationships between identity, social positions and systemic oppression such as racism, classism, and sexism.