Intersectionality as the driver for health care inequalities

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This article was exclusively written for The European Sting by Ms. Carolina Barbosa Veloso, a twenty-one-year-old woman and a fourth-year medical student at the Nova Medical School – Faculdade de Ciências Médicas (NMS – FCM), in the center of Lisbon, Portugal. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


For a long time, there was a problem with no name, destined to remain unseen while ignoring the ones who are the most vulnerable and marginalized within our societies.

Did you know that New York City records a higher number of performed tests for COVID-19 in areas with an increasingly white racial composition? And that the highest proportion of positive tests are recorded in nonwhite neighborhoods, with those numbers firing among communities with a lower socioeconomic status? (Lieberman-Cribbin et al., 2020)

What do you think about the fact that African American patients are more likely than Whites to receive an older, less-expensive and riskier blood thinner, which is linked to a higher mortality from COVID-19? (Kirkup et al., 2021)

And what about the holes in the data? For instance, in the US, there was no information regarding the patient survival for 36% of Hispanics, 29% of Blacks and 26% of Asians among COVID-19 hospitalized patients.

Now picture yourself as a homosexual black woman from a low-income family, living in the state of Pennsylvania as a working scholar, trying to keep on with your studies, while helping to take care of your younger siblings. How would you feel? Scared of being a black person in one of the States with the higher percentage of white population? Insecure for being a woman? Embarrassed for coming out to be a lesbian? Hopeless for your future and dreams? Worried with your own and the health of your loved ones?

When we think about racism, we most often think about black men, as when we think about sexism, we give a better focus on white women, and the same thing occurs with ageism, classism, heterosexism, ableism… And this is something that happens not only on our minds, but also in the laws and policies against discrimination, leaving a huge gap for a much more complex problem to take place and continue to grow in a very dangerous way.

And the truth is that when it comes to health care this turns out to be a much more dangerous topic, that is certainly in the origin of the inequalities observed nowadays. Therefore, a more open vision of the different processes of stigmatization, as described by the concept of intersectionality, is needed to tackle these barriers. By focusing on the deep-seated structures of discrimination and its upstream determinants, while trying to reveal the interconnected systems of vulnerability that together influence people’s life opportunities, intersectionality “provides a scalpel for policies rather than the current hatchet”. (Holman et al., 2020)

So, it’s now time to build a universal tool, a very powerful but simple framework that guides the professional stakeholders to create the policies and programs that best fits the three most important questions: Whom to protect? What to promote? Why to step in?

Fortunately, the problem finally has a name, so we must scream it until it echoes worldwide and make it part of our lives, because while it continues to exist it should never be ignored again.

References

Holman, D., Salway, S., Bell, A., Beach, B., Adebajo, A., Ali, N., & Butt, J. (2020). Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. MedRxiv, 1–21.

Kirkup, C., Pawlowski, C., Puranik, A., Conrad, I., O’Horo, J. C., Gomaa, D., Banner-Goodspeed, V. M., Mosier, J. M., Zabolotskikh, I. B., Daugherty, S. K., Bernstein, M. A., Zaren, H. A., Bansal, V., Pickering, B., Badley, A. D., Kashyap, R., Venkatakrishnan, A. J., & Soundararajan, V. (2021). Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry. Journal of Medical Virology, 93(7), 4303–4318. https://doi.org/10.1002/jmv.26918

Lieberman-Cribbin, W., Tuminello, S., Flores, R. M., & Taioli, E. (2020). Disparities in COVID-19 Testing and Positivity in New York City. American Journal of Preventive Medicine, 59(3), 326–332. https://doi.org/10.1016/j.amepre.2020.06.005

About the author

Carolina Barbosa Veloso is a twenty-one-year-old woman and a fourth-year medical student at the Nova Medical School – Faculdade de Ciências Médicas (NMS – FCM), in the center of Lisbon, Portugal. She has two main goals in life: help others and live sustainably. Motivated by compassion, she has already participated in multiple volunteering initiatives in her country, with the big dream of going abroad and be able to integrate a humanitarian mission one day. She has the will to fight for a world with more quality, justice, peace and opportunities for everyone everywhere.

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