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Understanding Intersectionality and Its Impact on Health Care

By Carolyn Q

Imagine entering a room or sending a resume for a job, and people only see one part of your identity. They might see your race but overlook your gender, notice your disability but ignore your ethnicity. This limited and fragmented view fails to capture the many identities we claim as individuals and the complexity of each person’s experiences and challenges. This is known as intersectionality theory, a term coined by Kimberlé Crenshaw in 1989. It describes how various social identities such as race, gender, socioeconomic status, sexuality, and ability intersect and overlap, creating unique experiences of oppression and privilege. Crenshaw’s work continues efforts that began 200 years ago by Black women such as Sojourner Truth, who fought to highlight the oppression experienced by Black women. Thanks to these pioneers, August is recognized as intersectionality month.

The Impact of Intersectionality on Health

Health is profoundly affected by the interplay of multiple social identities and the impact that systems and institutions have on sustaining practices or policies that do not allow individuals to feel safe, have upward mobility, or have equal access to essential services. Consider the story of Ivett (name changed for privacy), whom I met while volunteering at a community health clinic in Baltimore. Ivett, a 27-year-old Afro-Caribbean woman from the Dominican Republic, came to the clinic with severe abdominal pain and heavy bleeding.

During our conversation, Ivett expressed relief that I was assigned as her Spanish translator, as she had struggled to communicate her symptoms and pain in English during her previous visit. The week prior, her doctor had identified her symptoms as an irregular period with menstrual cramps and sent her home. However, with better communication, we discovered that she had traveled from New York with only $50, was experiencing shortness of breath now and then, which was making it hard to work and take care of her kids, and that her bleeding was significant. Tests and imaging later revealed she had anemia and large fibroids requiring surgery. Finally, a visit with a mental health practitioner resulted in a diagnosis of panic attacks. Ivett’s intersecting identities race, ethnicity, gender, economic status, language barrier, and immigrant status had been overlooked, impacting her ability to receive the correct diagnosis and treatment.

Thankfully, colleagues and I were able to earn some trust with Ivett over ensuing visits and to advocate for her to gain access to a unique fund for surgical interventions for recent immigrants to Baltimore. Ivett could also continue being seen by the mental health practitioner at the community clinic.

Improving Experiences:

  • Whole-person care: This means looking at all aspects of Ivett’s life, not just her immediate medical issues. For instance, this could have included a protocol that screens all patients for social determinants of health, which may have highlighted Ivett’s social needs and connected her to resources for those needs.
  • Person-centered language: This involves active listening and valuing Ivett’s descriptions of her symptoms and experiences in her language. Instead of dismissing her pain as just menstrual cramps, the provider could have asked more detailed questions and ensured she felt heard and understood with the assistance of a translator. Additionally, asking more motivational interviewing questions, such as, “Why are you concerned about these pains? How are these pains different from other menstrual pains you have experienced?” would have allowed her to be more involved in her care.
  • Linguistically competent care: This means providing care that respects and responds to Ivett’s language needs. Having a Spanish translator available was crucial. This could involve creating a language plan for the clinic that identifies the language needs of the population it serves, establishes backup sources when an in-person translator is unavailable, and outlines document translation policies.

Recognizing and Using Power and Privilege:

  • Translator role: As a translator, I recognized my role in this situation, specifically being the individual to bridge the communication gap between Ivett and her health care team. This realization and responsibility allowed me to advocate for her needs more effectively. I used my linguistic skills to ensure that Ivett’s concerns were accurately conveyed and understood, which was crucial in obtaining the correct diagnosis and treatment.
  • Professional network: At the time, I worked for Johns Hopkins International and collaborated closely with the doctor and staff who advocated for and created the fund for surgical interventions for new immigrants to Baltimore. I was able to share Ivett’s needs with the director and work with her care team to present Ivett’s case to the committee that decided how funds would be awarded.
  • Community resources: I introduced Ivett to various community organizations that cater to the Hispanic community and serve new immigrants in Maryland.
  • Building trust: Through the trust that Ivett and I built, I encouraged her to share with the doctor who cared for her the first time what she had felt during her first visit and how it could have been better. I also served as a convener to ensure that the meeting took place.
  • Expert recommendation: I recommended a colleague and friend who is an expert in linguistically competent care. She agreed to create the language plan for the clinic pro bono in exchange for feedback from the clinical team for the training she was developing on linguistically competent care.
  • United States health care system navigation: I used my experience working for a large health care system and being a patient in the U.S. health care system to help Ivett navigate referrals, primary and specialty care, and how to question a provider and advocate for yourself in the U.S. system.

While Ivett’s case had unique circumstances that allowed for extended contact and trust-building, these steps highlight important practices for improving health care experiences. Not every patient will have the advantage of extended interactions or an advocate within the clinic. Therefore, it’s crucial for health care systems to integrate these principles universally to ensure all patients receive comprehensive and compassionate care.

By adopting these practices, health care professionals can ensure that individuals like Ivett receive the thorough and respectful care they deserve. This can help address health disparities and promote equity within the health care system.

Taking Action: Roles for Individuals and Health Care Professionals:

  1. Create and invest in safety nets: Acknowledge that health care experiences are often characterized by brief interactions where individuals are expected to share deeply personal topics. However, due to experiences that may not have been positive, feeling rushed, pressured, or frustrated, and lack of safe spaces, individuals may not feel able to share their whole truth. Employing community health workers and navigators who have lived experiences and are trusted community partners can help individuals navigate the health care system and provide continuity of care between those brief interactions. Learn more:
  1. Data equity: Implement inclusive data practices to ensure that health care data reflects patients’ diversity and experiences. Learn more here.
  2. Advocacy: Support policies and initiatives that promote equity in health care, such as 1115 waivers, anti-discrimination laws, and increased funding for marginalized communities.
  3. Inclusive Practices: Use individual or group privilege to:
    • Create or advocate for hiring policies and procedures that are equal for all individuals.
    • Ensure representation and opportunities for marginalized groups to be primary investigators on research projects and see that research protocols and study designs include all races, ethnicities, and genders and account for social determinants of health. Learn more here.
    • Secure or advocate funding for translation services and language plans at the state and county levels.
    • Build and support networks providing safe spaces for individuals to express their identities without fear of judgment or discrimination, such as community groups, online forums, or support services within health care settings. In Colorado, the Center for Health Progress works to create health equity and provide support for marginalized communities.

Steps to Raise Self-Awareness of Intersectionality

  1. Self-Reflection: Reflect on your own identities and how they intersect. Consider how your race, gender, socioeconomic status, and other factors influence your experiences and interactions. Consider using the wheel of privilege and power as a resource.
  2. Educate Yourself: Read books, watch documentaries, and attend workshops on intersectionality and social justice. Here are a couple of resources:

Intersectionality offers a vital lens through which we can understand and address health disparities. By acknowledging the complexity of identities and the compounded effects of various forms of oppression, we can work towards a more equitable health care system that truly serves all individuals. By embracing education, advocacy, inclusive practices, and fostering resilient communities, we can leverage the strengths emerging from these challenges to cultivate a healthier, more just world.

Sources

  1. Crenshaw, K. (1989). “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Politics.” University of Chicago Legal Forum.