Structural Intersectionality as a New Direction for Health Disparities Research
Abstract
This article advances the field by integrating insights from intersectionality perspectives with the emerging literatures on structural racism and structural sexism—which point to promising new ways to measure systems of inequality at a macro level—to introduce a structural intersectionality approach to population health. We demonstrate an application of structural intersectionality using administrative data representing macrolevel structural racism, structural sexism, and income inequality in U.S. states linked to individual data from the Behavioral Risk Factor Surveillance System to estimate multilevel models (N = 420,644 individuals nested in 76 state-years) investigating how intersecting dimensions of structural oppression shape health. Analyses show that these structural inequalities: (1) vary considerably across U.S. states, (2) intersect in numerous ways but do not strongly or positively covary, (3) individually and jointly shape health, and (4) are most consistently associated with poor health for black women. We conclude by outlining an agenda for future research on structural intersectionality and health.
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References
Agénor Madina. 2020. “Future Directions for Incorporating Intersectionality into Quantitative Population Health Research.” American Journal of Public Health 110(6):803–806.
Ailshire Jennifer A., House James S. 2011. “The Unequal Burden of Weight Gain: An Intersectional Approach to Understanding Social Disparities in BMI Trajectories from 1986 to 2001/2002.” Social Forces 90(2):397–423.
Allison Paul D. 2001. Missing Data. Thousand Oaks, CA: SAGE Publications, Inc.
Allison Paul. 2014. “Listwise Deletion: It’s NOT Evil.” Statistical Horizons. https://statisticalhorizons.com/listwise-deletion-its-not-evil.
Aneshensel Carol S. 2005. “Research in Mental Health: Social Etiology Versus Social Consequences.” Journal of Health and Social Behavior 46(3):221–28.
Assari Shervin. 2018. “Health Disparities Due to Diminished Return among Black Americans: Public Policy Solutions.” Social Issues and Policy Review 12(1):112–45.
Assari Shervin, Lankarani Maryam Moghani, Burgard Sarah. 2016. “Black–White Difference in Long-Term Predictive Power of Self-Rated Health on All-Cause Mortality in United States.” Annals of Epidemiology 26(2):106–14.
Bailey Zinzi D., Krieger Nancy, Agénor Madina, Graves Jasmine, Linos Natalia, Bassett Mary T. 2017. “Structural Racism and Health Inequities in the USA: Evidence and Interventions.” The Lancet 389(10077):1453–63.
Boen Courtney, Keister Lisa, Aronson Brian. 2020. “Beyond Net Worth: Racial Differences in Wealth Portfolios and Black–White Health Inequality across the Life Course.” Journal of Health and Social Behavior 61(2):153–69.
Bowleg Lisa. 2012. “The Problem with the Phrase Women and Minorities: Intersectionality—An Important Theoretical Framework for Public Health.” American Journal of Public Health 102(7):1267–73.
Braveman Paula, Gottlieb Laura. 2014. “The Social Determinants of Health: It’s Time to Consider the Causes of the Causes.” Public Health Reports 129(Suppl. 2):19–31.
Brown Tyson H. 2018. “Racial Stratification, Immigration, and Health Inequality: A Life Course–Intersectional Approach.” Social Forces 96(4):1507–40.
Brown Tyson H., Hargrove Taylor W.2018. “Psychosocial Mechanisms Underlying Older Black Men’s Health.” Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 73(2):188–97.
Brown Tyson H., Richardson Liana J., Hargrove Taylor W., Thomas Courtney S. 2016. “Using Multiple-Hierarchy Stratification Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES and Age.” Journal of Health and Social Behavior 57(2):200–22.
Chae David H., Clouston Sean, Martz Connor D., Hatzenbuehler Mark L., Cooper Hannah L. F., Turpin Rodman, Stephens-Davidowitz Seth, Kramer Michael R. 2018. “Area Racism and Birth Outcomes among Blacks in the United States.” Social Science & Medicine 199(2018):49–55.
Chandola Tarani, Jenkinson Crispin. 2000. “Validating Self-Rated Health in Different Ethnic Groups.” Ethnicity & Health 5(2):151–59.
Chen Ying-Yeh, Subramanian S. V., Acevedo-Garcia Doloros, Kawachi Ichiro. 2005. “Women’s Status and Depressive Symptoms: A Multilevel Analysis.” Social Science & Medicine 60(1):49–60.
Cho Sumi, Crenshaw Kimberlé Williams, McCall Leslie. 2013. “Toward a Field of Intersectionality Studies: Theory, Applications, and Praxis.” Signs: Journal of Women in Culture and Society 38(4):785–810.
Choo Hae Yeon, Ferree Myra Marx. 2010. “Practicing Intersectionality in Sociological Research: A Critical Analysis of Inclusions, Interactions and Institutions in the Study of Inequalities.” Sociological Theory 28(2):147–67.
Cohen Philip N. 1998. “Black Concentration Effects on Black-White and Gender Inequality: Multilevel Analysis for U.S. Metropolitan Areas.” Social Forces 23:208–28.
Colen Cynthia G. 2011. “Addressing Racial Disparities in Health Using Life Course Perspectives: Toward a Constructive Criticism.” Du Bois Review: Social Science Research on Race 8(1):79–94.
Colen Cynthia G., Krueger Patrick M., Boettner Bethany L. 2018. “Do Rising Tides Lift All Boats? Racial Disparities in Health across the Lifecourse among Middle-Class African Americans and Whites.” SSM – Population Health 35(6):125–35.
Collins James W., David Richard J. 2009. “Racial Disparity in Low Birth Weight and Infant Mortality.” Clinics in Perinatology 36(1):63–73.
Collins Patricia H. 2000. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York, NY: Routledge.
Collins Patricia H., Bilge Sirma. 2020. Intersectionality. 2nd ed. Medford, MA: Polity Press.
Cotter David A., Hermsen Joan M., Vanneman Reeve. 1999. “Systems of Gender, Race, and Class Inequality: Multilevel Analyses.” Social Forces 78(2):433–60.
Crenshaw Kimberle. 1991. “Mapping the Margins: Identity Politics, Intersectionality, and Violence against Women.” Stanford Law Review 43(6):1241–99.
Cummings Jason L., Jackson Pamela Braboy. 2008. “Race, Gender, and SES Disparities in Self-Assessed Health, 1974–2004.” Research on Aging 30(2):137–67.
Davis Kathy. 2008. “Intersectionality as Buzzword: A Sociology of Science Perspective on What Makes a Feminist Theory Successful.” Feminist Theory 9(1):67–85.
Dill Bonnie T., Zambrana Ruth E. 2009. “Critical Thinking about Inequality: An Emerging Lens.” Pp. 1–21 in Emerging Intersections: Race, Class, and Gender in Theory, Policy, and Practice, edited by Dill B T., Zambrana R. E. Piscataway, NJ: Rutgers University Press.
Frank Mark W. 2014 “A New State-Level Panel of Annual Inequality Measures over the Period 1916–2005.” Journal of Business Strategies 31(1):241–63.
Gee Gilbert C., Ford Chandra L. 2011. “Structural Racism and Health Inequities.” Du Bois Review: Social Science Research on Race 8(1):115–32.
Gkiouleka Anna, Huijts Tim, Beckfield Jason, Bambra Clare. 2018. “Understanding the Micro and Macro Politics of Health: Inequalities, Intersectionality and Institutions—A Research Agenda.” Social Science & Medicine 200 (2018):92–98.
Glenn Evelyn Nakano. 1992. “From Servitude to Service Work; Historical Continuities in the Racial Division of Paid Reproductive Labor.” Signs: Journal of Women in Culture and Society 18(1):1–43.
Green Mark A., Evans Clare R., Subramanian S. V. 2017. “Can Intersectionality Theory Enrich Population Health Research?” Social Science & Medicine 178(2017):214–16.
Grollman Eric Anthony. 2012. “Multiple Forms of Perceived Discrimination and Health among Adolescents and Young Adults.” Journal of Health and Social Behavior 53(2):199–214.
Grollman Eric Anthony. 2014. “Multiple Disadvantaged Statuses and Health: The Role of Multiple Forms of Discrimination.” Journal of Health and Social Behavior 55(1):3–19.
Groos Maya, Wallace Maeve, Hardeman Rachel, Theall Katherine P. 2018. “Measuring Inequity: A Systematic Review of Methods Used to Quantify Structural Racism.” Journal of Health Disparities Research and Practice 11(2):190–206.
Hargrove Taylor W. 2018. “Intersecting Social Inequalities and Body Mass Index Trajectories from Adolescence to Early Adulthood.” Journal of Health and Social Behavior 59(1):56–73.
Harnois Catherine E, Luiz Bastos João, Keith Verna, Campbell Mary. 2019. “Measuring Perceived Mistreatment across Diverse Social Groups: An Evaluation of the Everyday Discrimination Scale.” Social Science & Medicine 232(2019):298–306.
Harnois Catherine E., Bastos João Luiz, Shariff-Marco Salma. 2020. “Intersectionality, Contextual Specificity and Everyday Discrimination: Assessing the Difficulty Associated with Identifying a Main Reason for Discrimination among Racial-Ethnic Minority Respondents.” Sociological Methods & Research.
Hart Chloe Grace, Saperstein Aliya, Magliozzi Devon, Westbrook Laurel. 2019. “Gender and Health: Beyond Binary Categorical Measurement.” Journal of Health and Social Behavior 60(1):101–18.
Hatzenbuehler Mark L., McLaughlin Katie A., Keyes Katherine M., Hasin Deborah S. 2010. “The Impact of Institutional Discrimination on Psychiatric Disorders in Lesbian, Gay, and Bisexual Populations: A Prospective Study.” American Journal of Public Health 100(3):452–59.
Hicken Margaret T., Kravitz-Wirtz Nicole, Durkee Myles I., Jackson James S. 2018. “Racial Inequalities in Health: Framing Future Research.” Social Science & Medicine 199:11–18.
Hill Terrence D., Jorgenson Andrew. 2018. “Bring out Your Dead!: A Study of Income Inequality and Life Expectancy in the United States, 2000–2010.” Health & Place 49(2018):1–6.
Homan Patricia. 2019. “Structural Sexism and Health in the United States: A New Perspective on Health Inequality and the Gender System.” American Sociological Review 84(3):486–516.
hooks bell. 1984. Black Women Shaping Feminist Theory. ProQuest Information and Learning.
Hudson Darrell L., Puterman Eli, Bibbins-Domingo Kirsten, Matthews Karen A., Adler Nancy E. 2013. “Race, Life Course Socioeconomic Position, Racial Discrimination, Depressive Symptoms and Self-Rated Health.” Social Science & Medicine 97(2013):7–14.
Idler Ellen L., Benyamini Yael. 1997. “Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies.” Journal of Health and Social Behavior 38(1):21–37.
Idler Ellen, Cartwright Kate. 2018. “What Do We Rate When We Rate Our Health? Decomposing Age-Related Contributions to Self-Rated Health.” Journal of Health and Social Behavior 59(1):74–93.
Jackson Pamela Braboy, Williams David R. 2006. “The Intersection of Race, Gender, and SES: Health Paradoxes.” Pp. 131–62 in Gender, Race, Class, & Health: Intersectional Approaches, edited by Schulz A. J., Mullings L. New York: Jossey-Bass/Wiley.
Jacoby Sara F., Dong Beidi, Beard Jessica H., Wiebe Douglas J., Morrison Christopher N. 2018. “The Enduring Impact of Historical and Structural Racism on Urban Violence in Philadelphia.” Social Science and Medicine 199(2018):87–95.
Jylhä Marja, Guralnik Jack M., Ferrucci Luigi, Jokela Jukka, Heikkinen Eino. 1998. “Is Self-Rated Health Comparable across Cultures and Genders?” Journals of Gerontology Series B: Psychological Sciences and Social Sciences 53(3):S144–52.
Kavanagh Shane A., Shelley Julia M., Stevenson Christopher. 2017. “Does Gender Inequity Increase Men’s Mortality Risk in the United States? A Multilevel Analysis of Data from the National Longitudinal Mortality Study.” SSM – Population Health 3(2017):358–65.
Kawachi Ichiro, Kennedy Bruce P., Gupta Vanita, Prothrow-Stith Deborah. 1999. “Women’s Status and the Health of Women and Men: A View from the States.” Social Science & Medicine 48(1):21–32.
King Deborah K. 1988. “Multiple Jeopardy, Multiple Consciousness: The Context of a Black Feminist Ideology.” Signs: Journal of Women in Culture and Society 14(1):42–72.
Koenen Karestan C., Lincoln Alisa, Appleton Allison. 2006. “Women’s Status and Child Well-Being: A State-Level Analysis.” Social Science & Medicine 63(12):2999–3012.
Krieger Nancy. 2014. “Discrimination and Health Inequities.” International Journal of Health Services 44(4):643–710.
Krieger Nancy. 2020. “Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm—An Ecosocial Analysis.” Annual Review of Public Health 41:37–62.
Lichter Daniel T., Parisi Domenico, Taquino Michael C. 2015. “America’s Segregated States.” Pp. 30–36 in Pathways: Poverty and Inequality Report 2015, edited by Grusky D., Varner C., Mattingly M. Palo Alto, CA: Stanford Center on Poverty and Inequality.
Phelan Jo C., Link Bruce G. 2015. “Is Racism a Fundamental Cause of Inequalities in Health?” Annual Review of Sociology 41:311–30.
Lucas Samuel Roundfield. 2013. Just Who Loses? Philadelphia, PA: Temple University Press.
Lukachko Alicia, Hatzenbuehler Mark L., Keyes Katherine M. 2014. “Structural Racism and Myocardial Infarction in the United States.” Social Science & Medicine 103(2014):42–50.
Massey Douglas S., Denton Nancy A. 1993. American Apartheid: Segregation and the Making of the Underclass. Cambridge, MA: Harvard University Press.
McCall Leslie. 2005. “The Complexity of Intersectionality.” Signs: Journal of Women in Culture and Society 30(3):1771–800.
McGee Daniel L., Liao Youlian, Cao Guichan, Cooper Richard S. 1999. “Self-Reported Health Status and Mortality in a Multiethnic US Cohort.” American Journal of Epidemiology 149(1):41–46.
Mesic Aldina, Franklin Lydia, Cansever Alev, Potter Fiona, Sharma Anika, Knopov Anita, Siegel Michael. 2018. “The Relationship between Structural Racism and Black-White Disparities in Fatal Police Shootings at the State Level.” Journal of the National Medical Association 110(2):106–16.
Metzl Jonathan. 2019. Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland. New York: Basic Books.
Montez Jennifer Karas, Hayward Mark D., Wolf Douglas A. 2017. “Do U.S. States’ Socioeconomic and Policy Contexts Shape Adult Disability?” Social Science & Medicine 178(2017):115–26.
Montez Jennifer Karas, Hayward Mark D., Zajacova Anna. 2019. “Educational Disparities in Adult Health: U.S. States as Institutional Actors on the Association.” Socius: Sociological Research for a Dynamic World 5.
Montez Jennifer Karas, Zajacova Anna, Hayward Mark D. 2016. “Explaining Inequalities in Women’s Mortality between U.S. States.” SSM – Population Health 2(2016):561–71.
Muller Christopher, Wildeman Christopher. 2016. “Geographic Variation in the Cumulative Risk of Imprisonment and Parental Imprisonment in the United States.” Demography 53(5):1499–509.
Pearson Jay A. 2008. “Can’t Buy Me Whiteness: New Lessons from the Titanic on Race, Ethnicity, and Health.” Du Bois Review: Social Science Research on Race 5(1):27–47.
Pickett Kate E., Wilkinson Richard G. 2015. “Income Inequality and Health: A Causal Review.” Social Science & Medicine 128(2015):316–26.
Pirtle Whitney N. Laster, Wright Tashelle. 2021. “Structural Gendered Racism Revealed in Pandemic Times: Intersectional Approaches to Understanding Race and Gender Inequalities in COVID-19.” Gender & Society 35(2):168–79.
Ragin Charles C., Fiss Peer C. 2017. Intersectional Inequality: Race, Class, Test Scores, and Poverty. Illustrated ed. Chicago, IL: University of Chicago Press.
Ragin Charles C., Fiss Peer C. 2020. “The Logic of Intersectionality.” Paper Presented at the Annual Meeting of the American Sociological Association, August 10, virtual conference.
Reskin Barbara. 2012. “The Race Discrimination System.” Annual Review of Sociology 38:17–35.
Richardson Liana J., Brown Tyson H. 2016. “(En)gendering Racial Disparities in Health Trajectories: A Life Course and Intersectional Analysis.” Social Science & Medicine: Population Health 2(2016):425–35.
Roberts Helen. 1997. “Socioeconomic Determinants of Health: Children, Inequalities, and Health.” BMJ 314(7087):1122–25.
Schulz Amy J., Mullings Leith, eds. 2006. Gender, Race, Class, and Health: Intersectional Approaches. San Francisco, CA: Jossey-Bass.
Sewell Abigail A. 2016. “The Racism–Race Reification Process: A Mesolevel Political Economic Framework for Understanding Racial Health Disparities.” Sociology of Race and Ethnicity 2(4):402–32.
Szymanski Albert. 1976. “Racial Discrimination and White Gain.” American Sociological Review 41(3):403–14.
Taylor Catherine J. 2019. “Health Consequences of Laws and Public Policies that Target, or Protect, Marginalized Populations.” Sociology Compass 14(2):1–13.
Turner R. Jay, Brown Tony N., Hale William B. 2017. “Race, Socioeconomic Position, and Physical Health: A Descriptive Analysis.” Journal of Health and Social Behavior 58(1):23–36.
Veenstra Gerry. 2013. “Race, Gender, Class, Sexuality (RGCS) and Hypertension.” Social Science & Medicine 89(2013):16–24.
Wallace Maeve, Crear-Perry Joia, Richardson Lisa, Tarver Meshawn, Theall Katherine. 2017. “Separate and Unequal: Structural Racism and Infant Mortality in the US.” Health & Place 45(2017):140–44.
Weber Lynn. 2010. Race, Class, Gender, and Sexuality: A Conceptual Framework. New York: Oxford University Press.
Weber Max. [1922] 1946. “Class, Status, Party.” Pp. 180–95 in From Max Weber: Essays in Sociology, edited by Gerth H. H., Mills C. W. Reprint, New York: Oxford University Press.
Warner David F., Brown Tyson H. 2011. “Understanding How Race-Ethnicity and Gender Define Age-Trajectories of Disability: An Intersectionality Approach.” Social Science & Medicine 72(8):1236–48.
Whitfield Keith E., Allaire Jason, Belue Rhonda, Edwards Christopher L. 2008. “Are Comparisons the Answer to Understanding Behavioral Aspects of Aging in Racial and Ethnic Groups?” Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 63B(5):P301–308.
Wilkinson Richard G., Pickett Kate E. 2009. “Income Inequality and Social Dysfunction.” Annual Review of Sociology 35:493–511.
Biographies
Patricia Homan is an assistant professor of sociology and an associate of the Pepper Institute on Aging and Public Policy and the Center for Demography and Population Health at Florida State University. Her research uses social structural and life course perspectives to understand how gender, socioeconomic, and racial inequalities in American society shape health and well-being. Her recent work has been published in American Sociological Review, Demography, Social Forces, Social Science & Medicine, The Gerontologist, and The Journals of Gerontology: Series B.
Tyson H. Brown is an associate professor of sociology at Duke University, where he also directs the Center on Health & Society. As a race scholar and medical sociologist, he investigates the who, when, and why questions regarding ethnoracial inequalities in health. Professor Brown is currently working on several projects examining how structural racism and psychosocial mechanisms shape population health. He has authored numerous articles in leading sociology and population health journals, and his research contributions have been recognized with awards from the American Sociological Association.
Brittany King received her PhD in sociology at Florida State University in 2020. Her research uses interdisciplinary theories such as the convoy model of social support, socioemotional selectivity theory, and the life course perspective to explore the connections between social relationships and health and how they can be influenced by later life transitions. Her recent work has been published in The Gerontologist and The Journals of Gerontology: Series B.
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Article first published online: August 6, 2021
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