Intersectionality, governance and health inequity

Health inequity is one of the most challenging, unjust and urgent global health issues. It
refers to systematic differences in health between groups or populations that are often
driven by social, economic, political and environmental factors. Effective health
governance is particularly critical to addressing health inequity. Health governance
involves instruments, policies, rules and norms that shape and steer strategies and
policies influencing health in a certain region. It is driven by a range of actors across
governments, bilateral and multilateral bodies, civil society organisations and the private
sector. With effective leadership, inter-sectoral coordination and accountability, health
governance presents the potential to structurally address health inequity through
mechanisms such as policymaking, priority-setting, resource allocation and regulation.
However, the structural drivers of health inequity, such as race and gender, are not
unitary; they are overlapping, interconnected and synergistic. This poses theoretical and
technical challenges to health governance that seeks to systematically address health
inequity.
With a genealogy in Black feminist and critical theory scholarship stretching back over
two centuries, intersectionality posits that systems of privilege, discrimination and
oppression are interdependent, mutually constitutive and multiplicative. Distinct from a
single-axis analysis that inevitably decomposes human lives into single attributes,
intersectionality offers a critical lens to understand the complex interplay between
interlocking socio-political structures, e.g. race, gender and class, that (re-)produce
complex power relations and processes that shape social locations, identities and
inequalities.
Thus, incorporating intersectionality into health governance presents a transformative
opportunity for health equity and emancipation. Intersectionality as a framework can
enable critical analysis that illuminates interlocking structures that perpetuate health
inequity, informing the action - the what, how and why - of health governance to
dismantle those structures. Nevertheless, relatively little about this has been studied.
Aim
Broadly, this PhD project aims to explore intersectionality in health governance as a
means to address structural drivers of health inequity. A particular health inequityrelated
challenge (e.g. a health condition or policy) will be chosen as a device for this
enquiry.
This project will potentially involve a multi-country partnership led by Global Health
50/50. As an explicitly transdisciplinary project, this work will draw on experts and
expertise from health policy, political science, sociology and epidemiology.
Methodology
This project is envisioned to be multi-/mixed-methods, involving a series of
complementary work packages (WPs) executed using state-of-the-art methods. An
overarching theoretical framework will be chosen - or generated - to guide this project.
Focusing on the chosen health issue, the following WPs are proposed (subject to
change):
1) WP1: A systematic/scoping review exploring the current literature in this field;
2) WP2: An epidemiological analysis using a quantitative intersectionality approach,
e.g. the MAIHDA method;
3) WP3: A multi-country comparative policy case study involving documentary
analysis and interviews with policy and political elites;
4) WP4: A power/political economy analysis (that draws on insights from previous
WPs); and
5) WP5: Crystallising previous WPs using the theoretical framework of choice and
generating policy recommendations.
Potential risks include logistical challenges, e.g. travelling and research ethics approval, in
undertaking multi-country research.
Contribu7ons
This is a transdisciplinary endeavour that will yield novel knowledge that has profound
implications - both theoretical and practical - for scholars, policymakers and activists
who seek to advance health equit