1. An introduction to intersectionality: relevance for researching health inequities Dr Anuj Kapilashrami Lecturer, Global Public Health Unit & Centre for South Asian Studies University of Edinburgh anuj.kapilashrami@ed.ac.ukanuj.kapilashrami@ed.ac.uk

2. Outline Historical background Delineations of intersectionality Focus of analysis Applications

3. Historical development of ‘intersectionality’ Roots in - Black feminist critique of the universalising claims of second wave feminism (white and middle class) and anti-racism movements (inherently patriarchal). Kimberle Crenshaw (1989, 1994) Patricia H. Collins (1990) Purpose: to engage with different axes of vulnerability and privilege and systems of oppression in relation to equity and health “Intersectionality has provided a name to a pre-existing theoretical and political commitment” (Jennifer C Nash 2008: 3)

4. What is intersectionality? Concerned with “aspects of social difference and identity and forms of systemic oppression at macro and micro level in ways that are complex and interdependent” - Dhamoon and Hankivsky (2011) Concept Methodology Theory Analytic framework (Dhamoon 2011) research (and policy) paradigm (Hankivsky 2012; Hancock 2007) Focus of analysis Identities or Categories of social position and difference (linked to privilege or oppression) Social processes and institutions that generate, amplify or mitigate inequalities Systems of domination/ oppression

5. Delineations of Intersectionality Distinct from unitary and multiple approaches i.e. Multiple categories that matter equally, are fluid, in an open relationship, and mutually constitutive. (Hancock 2007) Three related strands: Intra-categorical; anti-categorical, inter-categorical (Leslie McCall) : a focus on dynamic forces more than categories – racialisation rather than races, economic exploitation rather than classes, gendering and gender performance rather than genders – and recognize the distinctiveness of how power operates across particular institutional fields. (Kapilashrami, Hill and Meer (2015)

6. Mutually constituting (and not simply additive/ accumulating!) “When multiplication doesn’t equal quick addition” (Hancock 2007) Health experience (access) of Dalit women in western UP is NOT = health experience of being Dalit [AND] health experience of being a woman. Health experience of woman itself differs for dalits and non-dalits. I.e. gender can be constituted differently by cultural meanings, policies and institutional practices (aspects of historical violence) Likewise, ‘dalit’ as a homogenous category has limits

7. Applications & the case for Intersectionality in health research Examples: In the areas of violence, HIV, utilisation of care. (Edited volume by Hankivsky; Doyal) ; Patient clinician interactions and the nature of care provision by integrating analyses of gender, class and race with location and religious orientation (Reimer- Kirkham and Sharma, 2011; Veenstra, 2011). Particular strengths (Kapilashrami et al. 2015)- 1. combines a focus on understanding (i) health disparities for populations from multiple historically marginalised groups (that is, the micro); and (ii) how systems of privilege and oppression (such as racism, hetero-/sexism, classism) intersect at the macro social-structural level to reinforce and maintain health inequalities 2. focus on the social-structural factors allows an in-depth examination of how social systems and resources maintain or even reproduce inequalities 3. move beyond the differences in distribution of resources and entitlements to unpack the processes and structures through which those entitlements are negotiated

8. Contestations “Imperialism of categories” (Menon 2015) Essentialising (hill Collins’) Feminist politics of the global South is distinct: contended with politics of caste, sexuality and religious communality and challenged the commonality of female experience Is intersectionality a theory of marginalised subjectivity or generalised theory of identity? (Nash 2008) Does not recognize the potentially contested nature of the boundaries of identity groupings, and potentially contested political claims for representation of people located in the same positioning (Yuval-Davis 2006) In health inequalities it runs the risk of remaining operable at surface level, perhaps as a semantic device in policy discussion, but without a substantive reconfiguration at the analytical level (Hankivsky 2014) Methodology -