What is intersectionality? Can It Help to Overcome Barriers in Health Care?

This article was exclusively written for The European Sting by Ms. Ezgi Selamet, an enthusiastic 2^nd-year medical student in Turkey, who is especially interested in behavioral psychology and neuropsychiatry. 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.

Intersectionality is a concept offered by Kimberlé Crenshaw in 1989, which aims to include all social attributes while determining the underlying causes of discrimination. These attributes vary and involve many parameters such as gender, sexual orientation, class, race, ethnicity, religion and age. Today, in the health care sector and medical research, discrimination occurs at some level related to social identities and those that are in the intersects of these identities are exposed to the discrimination even more. This situation leads to social injustice and prevents experts from conducting research using data obtained from various sources. Therefore, it might be beneficial to consider applying an intersectional approach to the medical field due to the encompassing nature of intersectionality.

Traditional ways of understanding where a patient stands in the health-care system mainly depend on the individual efforts of the health-care professional. Cultural competence and humility can be addressed to exemplifying these efforts; however, they are inadequate to fully grasp power dynamics and prejudices that could create oppression and inequities. What makes intersectionality unique and distinguishing is that its way of analyzing institutional marginalization and power structures that affect discrimination. Immigrant status and women’s reproductive health at the Turkish border is a decent example in that it reveals how systemic discrimination occurs as a consequence of the lack of intersectionality in government policies. According to a paper published on 22 June 2020 (Çöl et al. Reproductive Health), among Syrian refugees, unwanted pregnancies, unsafe deliveries, early forced marriage and maternal mortality rates are way higher than the Turkish women. This situation not only points to the need for intersectionality but also the necessity of operational gender-biased policies.

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How to Apply Intersectionality into Clinical Practice?

In personal means, as a healthcare professional, being aware of the biases that are embedded in society and confronting them is the first step to take an action. Second, hearing the voice of those who are exposed to the biases the most is very crucial. To illustrate the importance of this approach, LGBTQIA+ communities and restrictions on their access to health care provides a good framework. A survey study was designed by CAP and fielded by GfK SE to understand the experiences of a group of individuals related to health care and health insurance (2018). The survey revealed that mistreatment and discrimination at doctors’ offices due to sexual orientation continue notwithstanding the protections. This attitude discourages LGBTQIA+ people from getting health care services and creates a wide data gap in research fields. Thus, centralizing minorities or disadvantaged groups (mostly those discriminated by society dynamics) in clinical trials might enable these people to feel a little bit comfort and researchers to achieve more convenient sources. 

In conclusion, intersectionality is a functional tool to conceive mechanisms of discrimination, it holds a great potential in that it supports standard procedures and most importantly it is humane.

References

• López, N., and V.L. Gadsden. 2016. Health Inequities, Social Determinants, and Intersectionality. Discussion Paper, National Academy of Medicine, Washington, DC. https://nam.edu/wp-content/uploads/2016/12/ Health-Inequities-Social-Determinants-and-Intersectionality.pdf
• Holman, D., Salway, S., Bell, A. et al. Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. Health Res Policy Sys 19, 97 (2021). https://doi.org/10.1186/s12961-021-00742-w  
• Heard E, Fitzgerald L, Wigginton B, Mutch A. Applying intersectionality theory in health promotion research and practice. Health Promot Int. 2020 Aug 1;35(4):866-876. DOI: 10.1093/heapro/daz080. PMID: 31390472.
• Yolonda Wilson, Amina White, Akilah Jefferson & Marion Danis (2019)

Intersectionality in Clinical Medicine: The Need for a Conceptual Framework, The American Journal of Bioethics, 19:2, 8-19 https://doi.org/10.1080/15265161.2018.1557275

• Çöl, M., Bilgili Aykut, N., Usturalı Mut, A.N. et al. Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives. Reprod Health 17, 99 (2020). https://doi.org/10.1186/s12978-020-00948-1

About the author

Ezgi Selamet, an enthusiastic 2^nd-year medical student in Turkey, who is especially interested in behavioral psychology and neuropsychiatry. She is an author at UluBAT ( National Scientific Research Communities in Turkey) and she has been working for IFMSA and EMSA in several positions. She is drawn to human and trying to improve her understanding in every possible way. Because of that reason, she takes part in volunteer activities in various organizations including Amnesty.