This blog accompanies the Lancet Commission on Gender and Global Health seminar series. The series accompanies the development of the Commission, inviting Commissioners and Co-Chairs to discuss a key topic, question, or challenge that the Commission hopes to tackle. The series aims to involve a range of stakeholders and voices in its work and to promote discussion and debate on gender and health.
In the second seminar of the Lancet Commission on Gender and Global Health series, Olena Hankivsky elucidated the need to adopt an intersectional lens across global health policy and research while also acknowledging the complexities of this challenge. As an esteemed researcher in this field, Olena serves as a Lancet Commissioner and as the Director of the Centre for Health Equity at the Melbourne School of Population and Global Health (currently on leave). She was joined on February 17, 2021, by Sarah Hawkes, a Lancet Commission Co-Chair from University College London, other Lancet Commissioners, and a public audience via YouTube live stream. Hankivsky presented and participated in a discussion on how intersectionality has been implemented in global health, its importance, and how an intersectional lens can be applied most effectively.
Hankivsky began with the strong case that intersectionality is essential in global health. She defined intersectionality as:
“[moving] beyond examining individual factors such as biology, socioeconomic status, sex, gender, and race. Instead, it focuses on the relationships and interactions between such factors, and across multiple levels of society, to determine how health is shaped across population groups and geographical contexts.” (Kapilashrami and Hankivsky, 2018).
She further explained that traditionally marginalised groups are not homogenous, and as such, people can experience concurrent privilege and oppression. Hence, an intersectional lens is needed to understand how nuances in social positioning affect individuals’ healthcare access and outcomes. She also argued that an intersectional lens is key for the achievement of the United Nations’ Sustainable Development Goals. Research interests in intersectionality have gained traction over recent years and have accelerated in the face of the many inequities of the COVID-19 response, but intersectionality in global health generally is still vastly underexplored.
Ambiguity remains about the principles and proper implementation of intersectionality. Hankivsky clarified the “key tenets” of intersectionality, stating that it requires sociodemographic characteristics to be perceived in relation to one another; no one characteristic should be prioritised from the beginning as being more or less significant. Intersectionality promotes understandings between individual-level experiences and broader processes and structures of power, taking into account the context of time and place. Finally, Hankivsky emphasised that this lens is self-reflexive and “must be oriented towards social justice.”
Often falling short of these tenets, however, Hankivsky critiques current intersectionality research for implementing an additive approach, for using gender as an a priori entry point of analysis, and for not adequately acknowledging intersectionality’s origins within black activism and scholarship. Suitable standards for intersectionality in global health are needed, but Hankivsky pragmatically noted the difficulties of, and resistance to, mobilising this shift; the time required, degree of analysis, stakeholder involvement, and data disaggregation required for meaningful intersectional analyses are demanding. Conceding fully that factors other than gender may be just as, or perhaps more, important as gender in shaping and sustaining inequities is often resisted.
Other mindset shifts are required. Global health professionals may tend to think of sociodemographic characteristics as categorical, an impediment to effective intersectional analysis. Hankivsky explained that intersectionality tasks researchers with challenging implicit biases and warrants rigorous analysis that extends beyond an incorrect or superficial treatment of intersectionality in research and policy.
In closing, Hankivsky left listeners with four prerequisites to properly adopt an intersectional approach:
• Conceptual clarity: Clearly understand the relationship and differences between gender and intersectionality to advise effective research and policy.
• Resist lip service/ deficient models of intersectionality: Avoid and correct incomplete applications that ignore the complexities of power.
• Interrogate who holds power in bringing intersectionality into global health: Hold those who are making decisions accountable for their interpretations and approaches.
• Act and advocate to build back better: Use a robust intersectionality framework that includes but does not necessarily begin with or always centres gender.
Implications for the Commission
The Lancet is allied with Hankivsky’s push for intersectionality in global health research and policy. Earlier this year in the Lancet Global Health, Yam et al. (2021) wrote:
“The deep wellspring of learnings intersectionality affords remains underused in mainstream initiatives on gender and global health.”
There is little doubt that employing an intersectional lens will be required if the Gender and Global Health Commission is to address the many inequities that exist within the global health. How that is done is the challenge that the Commission now has to address. Ultimately, what Prof. Hankivsky’s presentation showed us was the importance of staying committed to thinking about how gender in the context of global health is challenged from an intersectional perspective.
Amanda Dorsey is an Intern at the United Nations University International Institute for Global Health.