“Know every student by name and by story.” Students at WashU have had the phrase engraved into their minds after hearing it many times over. However, while students know the phrase, do they truly understand it? While most people can learn someone’s name fairly easily, knowing their story is more complicated. A story can include many things: family, friends, education, environment and the list goes on and on. In order to fully understand someone, you have to know their complete story—not just one part of it. This is the basis for the newly emerging intersectionality theory.
Prior to the emergence of intersectionality theory, health research was centered in two primary types of models: biomedical and embodied health models (1). The biomedical model focuses on proximal biological and behavioral indicators of disease and illness. Care based on this model places emphasis on the symptoms and biological processes that characterize a patient’s health condition. However, researchers Bruce Link and Jo Phelan identified shortcomings in the biomedical model: “[The model] overlooks important sociological processes and…[limits] our ability to improve the nation’s health” (2). In response, the embodied health model was developed to incorporate the influence of social conditions on health. The model prioritizes indirect causes of disease which are generally institutional and social determinants of patients’ health, unlike the biomedical model which emphasizes direct causes of disease. Studies in the embodied health model examine health disparities across race, gender, socioeconomic status and other social conditions. According to Dr. Paula Braveman, “[embodied health analyses] lead to more effective policies by increasing understanding of how social disparities in health are created and perpetuated” (3).
Despite the strides made by the embodied health model, the framework still could not explain certain differences observed between populations over time. The failure of an embodied health framework is illustrated through a case study of black men in the United States. Embodied health studies of black men’s health and potential intervention policies “[tend] to fall between research on racial and ethnic health disparities and men’s health,” said author Keon Gilbert, DrPH, and associate professor at St Louis University (4).
Gilbert’s research on black men’s health has illustrated the influence of social factors aside from race. His study found that the gender gap in life expectancy between black men and women (6.1 years) is wider than the racial gap among men (4.4 years) or among women (3.0 years) (4). There is a larger life expectancy disparity between black men and women than between black men and white men. Contrary to the common notion that race is the primary social determinant of black men’s health, Gilbert’s findings support the significant influence of both gender and race on the health of black men. It is this intersection of multiple social conditions that leads to distinctive patterns of health, such as the distinct causes of mortality affecting the population of black men. A 2015 report by the CDC reported that the top three causes of mortality among men overall were heart disease, cancer, and unintentional injuries; however, black men are the only race by gender group for which homicide is a top-five cause of death (5).
Black men report leading causes of death that are unique from both white men and black women. These results indicate that it is not black men’s race or gender that influences their health, but rather the intersection of their race, gender and other social conditions. These observations have led to the emergence and acceptance of intersectionality theory.
Intersectionality can be summed up in ten words: “the whole is greater than the sum of its parts.” Intersectionality is a framework for health research that examines the combined effect of multiple social relations on disparate health care treatment among patients and populations. By examining the complex interactions of multiple social conditions on health, researchers can accurately identify fundamental causes of health disparities and enact effective interventions to reduce such disparities. According to Time author Arica Coleman, “failing to acknowledge this complexity…is failing to acknowledge reality” (6).
Recent studies that examine intersectionality in health outcomes have produced surprising, but insightful, results. One such study was conducted on discrimination and health disparities facing LGBT groups by PhD professor Hyun-Jun Kim. Her study’s objective was to identify the role of race/ethnicity in the health disparities experienced by older LGBT adults.
The study found that day-to-day discrimination and victimization affected LGBT groups equally across race. On the other hand, it found disparities in identity affirmation and identity stigma across race (7). These findings will encourage interventions aimed at bolstering self-image rather than countering discrimination, which has little effect on disparities across LGBT groups. An intersectionality approach allows health researchers to discover the specific health-promoting and health risk factors affecting specific population groups, enabling increasingly effective interventions to reduce health disparities.
Intersectionality is a theory that is seeing increasing prominence in sociology and health research fields (8). The theory shows promise as a framework for health research as more comprehensive studies are being conducted upon an intersectionality framework. One such study is the U.S. Transgender Survey (USTS) carried out by the National Center for Transgender Equality. This survey, conducted in 2015, recorded data on the experiences of transgender groups across race encompassing a wide variety of social determinants such as family, faith, income, housing and police interactions (9). The sheer extensiveness of the USTS illustrates the depth of population analysis available through an intersectionality framework. This depth of information will allow researchers to identify the health risk factors and intervening mechanisms causing health disparities between groups at the intersection of multiple social conditions.
An increasing number and depth of studies prove that intersectionality is an effective approach to health disparity studies. However, the beliefs underlying intersectionality also have applications in non-professional or non-research areas. A survey of nearly 1600 participants in both corporate and non-corporate settings reported that “almost 58 percent said they were highly on guard at work.” Ignorance of intersectionality can lead to worries about bias and damage trust, and students at Washington University are no exception. Understanding other students’ complete stories is an important step towards maintaining healthy relationships and enabling openness. By adopting intersectionality into our mindset, we can foster openness and genuinely appreciate each other’s names and stories.
Edited by: Daniel Berkovich
Illustrated by: Eugenia Yoh