When we’re talking about health inequalities or inclusion, it’s important to also have an understanding of intersectionality - a key concept that helps us understand how different people might experience discrimination and how their identities impact how they navigate society.

What is intersectionality?

Intersectionality was coined by Kimberlé Crenshaw in 1989 as a framework to understand how someone with multiple political and social identities might face compounding and different discrimination. Crenshaw originally framed this around Black women, who face misogyny and racism simultaneously.

In her original text on the subject, she said this was needed because there is a tendency to treat race and gender as ‘mutually exclusive categories of experience’. Mutually exclusive means two things which cannot be true at the same time, so what she means here is that people talk about race and gender as completely separate, not acknowledging how Black women experience multiple forms of discrimination.

Now, reference to ‘intersectionality’ tends to refer to experiencing more than one form of discrimination more generally. This might include the protected characteristics, such as race, gender, sexuality, or religion, or other socially excluded groups like being a refugee or asylum seeker.

It is important to acknowledge that intersectionality is not only about experiencing multiple forms of discrimination at once, like racism and sexism, but also about the unique discrimination of the combination, also.

Identities are not only personal

It can be easy to think that identities we hold or marginalised groups we are part of are just part of ourselves or our personality. But the reality is, most aspects of our identity are political, social, economic and more, and most of these factors also impact our health.

For example, as an autistic person, I am often less likely to receive the healthcare I need because I communicate differently to how the professional would expect someone to in that scenario, such as reacting less to pain.

This is where intersectionality comes in: for autistic women who are struggling with conditions like endometriosis, there are two different aspects at play. Menstrual pain and menstrual health conditions are less likely to be believed, but parts of their autism like reacting differently or not showing the same body language might also impact their treatment.

Similarly, studies show that Black people are less likely to be given pain medications (or receive less medication) than white patients. Conditions like lupus are more likely to be faced by Black women, but diagnosis times are lengthy and they might get worse treatment when they are eventually diagnosed.

Our identities or characteristics can have endless implications for our health, and our experiences of every aspect of society.

Health is more than individual

Sometimes when society discusses ‘health’, it can make it look like everything to do with health is up to us as individuals, but there is so much more to health than what we personally do day-to-day.

Experiencing discrimination can have lots of different impacts on our health. Some of these impacts are about healthcare itself - like receiving unequal, poorer, or delayed care - but some are also about the way discrimination impacts our health in other ways, like causing poorer mental health, stress, or causing use of substances (as examples).

Intersectionality can mean this is compounded, due to the multiplied experience of bias, discrimination, or lack of inclusion. It is important to remember that sometimes, these are unconscious, where they are not intended by the person or system causing it, but this does not make it less harmful.

For example, during Covid-19, Black people and other people of colour were more likely to die from the illness. Some disabled people faced Do Not Resuscitate orders being placed on them without their knowledge. A Black, disabled person might have faced these health inequalities combining.

For more people to experience ‘good health’, we need to understand all the different ways that health can be supported or undermined by different parts of individual and collective care: it’s almost like different cogs in a huge machine.

Health and social care professionals must understand the way they might have different biases, and ask people they are caring for about what sort of inequalities and intersectional factors (or cogs!) they might need support with.