Intersectionality and chronic disease inequalities
This programme of research illustrates how an intersectional lens can be applied to diverse sources of secondary data to reveal previously hidden dimensions of inequality; how secondary sources can illuminate the intersection between biological markers of ill health and structural drivers of inequality. This team are also developing innovative ways to disseminate their findings working with policy makers and other stakeholders to explore the policy and practice implications.
Daniel Holman and colleagues have applied an intersectional perspective to the area of chronic disease inequality in later life. Chronic diseases are the key drivers of later life health inequalities and hugely costly to the economy and the individuals and families affected. This challenge will only become more pressing as the population ages, and its importance has been brought into sharp relief by the pandemic which has been fuelled by existing chronic disease inequalities.
Intersectionality is particularly relevant to understanding later life (50+) chronic disease inequalities because separately, socioeconomic position, gender, ethnicity and age are all strongly related to chronic disease outcomes. It is therefore highly likely that these axes of inequality overlap and intersect with each other to result in heterogenous inequalities in chronic disease. Further, by later life, systems of discrimination such as sexism and racism will have likely had time to ‘bed in’ and affect the health of those who have been subject to them across the life course (so-called biological ‘weathering’). An intersectional perspective opens up the possibility that policies and interventions can be intersectionally targeted and tailored, and/or that the intersectional effects of existing policies and interventions can be considered.
To research this topic, Holman and colleagues have been analysing secondary data sources – the UK national survey data and UK Biobank data – as well as working closely with policy and practice partners. The quantitative analysis has focussed on exploring granular inequalities in biomarkers of healthy ageing, to understand how cross-cutting inequalities ‘get under the skin’. So far, the work has suggested that inequalities are more complex and granular than is often assumed in the ‘single axis’ model of inequalities. For example, although we know that on average those from minority ethnic backgrounds have a higher blood pressure than non-minority ethnic groups, minority ethnic groups in high socio-economic positions have lower blood pressure levels than some non-minority ethnic groups. Further, minority ethnic groups in lower socio-economic positions have particularly high blood pressure.
Holman and colleagues are also analysing the role of neighbourhood deprivation in chronic disease inequalities and its relative importance compared with age, gender, ethnicity and socio-economic position. In upcoming work, they will examine the life course factors that lead to later life chronic disease inequalities using longitudinal cohort data, with a particular focus on institutional discrimination given that institutions are keys sites of the reproduction of social inequality. This might suggest points of intervention which would have the greatest life-long effects.
The project has also been working with policy and practice stakeholders to understand how an intersectional perspective can be applied in policy and the barriers to its wider uptake. They have run workshops and webinars, and co-produced a policy paper exploring some of the promising opportunities and challenges including policy suggestions often present in the literature around targeting and tailoring interventions and policies.
All project outputs and activities can be found on the website http://intersectionalhealth.org