What Is Intersectional Healthcare and Why Is It Important?
Published on Aug 22, 2023. Updated on Aug 29, 2023.
Caring for patients can seem like a straightforward set of skills, but, in reality, it’s a highly complex experience filled with layers of social and interpersonal nuance. Interactions that are acceptable for one patient aren’t necessarily going to work for another, and it’s the responsibility of caregivers and clinicians to learn how to relate to patients in ways that help them feel seen, heard, and accepted as part of their care.
Intersectionality helps caregivers and clinicians interact more effectively with patients by providing them with a way to understand the complexities of each person’s individual identity and how our identities intersect (based on race, gender, class, sexuality, level of ability, etc.) with one another. Each of us goes through unique experiences of marginalization (putting a person or thing in a position of lesser importance, influence, or power) and privilege (having social advantages, benefits, prestige, or respect associated with certain social groups or contexts).
To understand how important intersectionality is to your everyday work, it’s key to recognize the importance of diversity. Each of us is diverse in our own way, and we’ve all had unique lived experiences. The goal of learning and applying intersectional health principles is to get the best possible health outcome by being intentional, informed, and factoring in the uniqueness of each patient.
How Diversity Relates to Intersectionality
Diversity is both an obvious fact of life (a variety of people exist) as well as the conscious practice of including people from a range of backgrounds within a group or society. It goes beyond simply recognizing differences to proactively valuing and respecting those differences as a way to drive cultural, economic, and social vitality and innovation.
Race, sex, gender identity, socioeconomic background, education, social status, disability, nationality, and many other characteristics are referred to as dimensions of diversity. Characteristics such as race and sex are more easily recognized based on physical appearance. However, characteristics such as gender identity, sexual orientation, and neurodivergent conditions such as dyslexia or mental health disorders like anxiety are often hard to recognize, adding to the complexities of being a human being.
To help address those complexities, Marilyn Loden and Judy Rosener developed a conceptual framework in 1990 for thinking about the different dimensions of diversity within individuals and institutions called the Diversity Wheel. The Diversity Wheel represents the many different ways or dimensions in which people can self-identify as they think about backgrounds, belief systems, and values. Those dimensions include personality, internal dimensions, external dimensions, and organizational dimensions.
What Is Intersectionality and How Does It Show Up in Healthcare?
In 1989, critical race scholar, activist, and Black feminist Kimberlé Williams Crenshaw coined the term “intersectionality,” in her groundbreaking article, Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics, setting the stage for more nuanced conversations about diversity and giving voice to millions of people whose multidimensional identities weren’t being taken into consideration: “These problems of exclusion cannot be solved simply by including Black women within an already established analytical structure. Because the intersectional experience is greater than the sum of racism and sexism, any analysis that does not take intersectionality into account cannot sufficiently address the particular manner in which Black women are subordinated.”
For example, a person can identify as a woman who is Black, bisexual, and expecting her first child. This person has at least three layers or dimensions of diversity (her pregnancy could count as a fourth dimension since it’s a form of temporary disability), and the intersection of these identities makes up her lived experience. Not only do these identities help to explain who she is, but understanding her background and experiences enables clinicians to provide her with better patient care.
There are also times when this same person will be discriminated against for being a woman, being Black, being pregnant, being bisexual or all four factors at the same time. Intersectionality is important because it factors in all of the dimensions of this individual and how those factors affect her care. In this same example, an informed provider could familiarize themselves with the proper language to address someone who belongs to the LGBTQIA+ community, as well as take the time to understand and be ready to address Black women’s health, specifically. This enhances the experience for both the patient and the provider because everyone has the common knowledge and language to address her specific health concerns and needs.
It’s also important to keep in mind that seeking medical care for marginalized groups can be intimidating due to fear of discrimination and malpractice. Research shows that unconscious or implicit bias can lead to acts of discrimination, which is why health professionals must consciously check their bias each and every time they’re treating a patient, especially a patient with complexities or “intersections” within their identities.
NPR reports, “Research has shown that racism, discrimination, and unconscious bias continue to plague the US healthcare system and can cause unequal treatment for racial and ethnic minorities.” Intersectional thought processes and proper education can help combat unfair treatment within society and the healthcare system. Intersectionality in healthcare is not just a theoretical approach but a hands-on, practical application of theory that enables and empowers caregivers and health providers to consider all the factors that may impact someone seeking medical attention and/or advice. For example, studies show that members of the LGBTQIA+ community are less likely to seek care due to discrimination. Data from a nationally representative CAP survey from 2017 validates their concerns, reporting, “21% of Transgender people said a doctor or other health care provider used harsh or abusive language when treating them”. This can be an incredibly discouraging and disheartening experience, especially when patients desire informed and educated professionals to provide quality care.
Intersectionality in healthcare is specifically important as we know that bias can lead to racial profiling or perpetuating stereotypes when it comes to proper and accurate patient care. For example, as the Journal of Testing, Psychometrics, Methodology in Applied Psychology reports in Racial Biases in Medicine and Healthcare Disparities, “The direct cause of the disparity in physicians’ recommendations was the perception that relative to their White patients, their Black patients were less well-educated and less likely to engage in physical activity after the surgery.”
Understanding how bias manifests in everyday patients looks a little something like this:
Adults with disabilities are more likely to be obese, smoke, have heart disease, and suffer from diabetes. And up to one in four (27%) adults in the US have some type of disability. (CDC)
Black women are three times more likely to die after giving birth than white women in the US. (NPR)
Health conditions that primarily affect women are underfunded in comparison to the burden (the measure of how much death and disability it causes). (Nature)
Latina women have a higher mortality rate than non-Latina women from cervical and breast cancers but are less likely to receive regular pap tests and mammograms in the US. (NIH/NLM)
Another area where unconscious bias directly affects patient care is in who, specifically, cares for them. According to The Lancet, "Unconscious bias can contribute to systematic underestimation of the capabilities of qualified applicants," resulting in less diverse staffing.
Without proper education, awareness, and a clear understanding of intersectional approaches, providers can impact patients negatively, if unintentionally, by coming across as offensive or biased toward some aspect of a patient’s identity. The first step to addressing this issue is choosing to hire health professionals who are members of marginalized groups and aware of some of the challenges patients in that group regularly face.
In addition to putting patients from those groups more at ease, diverse and inclusive workplaces are linked to better team performance, and organizations with greater gender and racial diversity often financially outperform the competition. And in providing foundational knowledge, education, and a clear understanding of how bias manifests within the healthcare system, each of us can help create constructive change.
What Are the Benefits of Intersectional Healthcare?
Healthcare should not be a one-size-fits-all approach because every person is unique, with their own special set of complexities and concerns. Consciously practicing inclusive behaviors allows providers and clinicians to accommodate and administer the best possible care because it takes a patient’s full identity and background into account. Inclusive behaviors lead to improved health equity by making sure procedures, policies, and treatments are created with everyone in mind.
Embracing inclusive behaviors empowers us to challenge systems that have historically catered to specific groups (based on race, gender, sexual orientation, level of ability, etc) with a fresh perspective. By questioning the status quo, caregivers and clinicians can develop enhanced pathways to patient care that transcend boundaries and respect each patient’s unique identity.
How to Implement Intersectional Healthcare
Implementing intersectional healthcare involves recognizing that each patient’s health experiences are shaped by multiple intersecting factors such as race, gender, socioeconomic status, sexual orientation, level of ability, and more. To ensure equitable care, providers can follow these steps:
Implement Cultural Competence Training
Provide ongoing training to healthcare staff on cultural competence, sensitivity, and awareness to address diverse patient needs effectively.
Collect Data on Every Patient
Gather comprehensive patient data that includes demographic, socioeconomic, and identity-related information to identify disparities and tailor interventions.
Create Personalized Care Plans
Develop individualized care plans that acknowledge the unique intersectional experiences of each patient and cater to their specific needs.
Actively Develop Accessible and Inclusive Communication Practices
Ensure clear and culturally sensitive communication between healthcare providers and patients, considering language preferences per communities (such as LGBTQIA+ or People with Disabilities, as an example) along with accessibility requirements.
Consciously Create and Value a Diverse Workforce
Recruit and retain a diverse healthcare workforce, including clinicians, administrators, and support staff from diverse backgrounds, to foster a more inclusive care environment.
Practice Community Engagement
Collaborate with local communities to understand their health care needs and co-create solutions that reflect and enhance their experiences and preferences.
Institute Anti-Bias Practices and Training
Implement training and protocols that address unconscious bias and discrimination within healthcare delivery, promoting fair treatment for all patients.
Create Robust Health Equity Policies
Develop policies that explicitly target health disparities across intersecting identities and promote equal access to care and resources.
By taking these steps, healthcare systems and caregivers can work toward providing intersectional care that honors the complexities of patients' lives and ensures better health outcomes for everyone.
Glossary of Terms
Bias: Thoughts that can shape our perceptions and decisions, often leading to unfair advantages or disadvantages for certain groups.
Diversity: A spectrum of different types of people from various backgrounds and identities.
Discrimination: Unfair treatment of individuals or groups based on their perceived characteristics.
Equity: Addressing historical and systemic disparities to rectify imbalances and achieve the fair and equitable distribution and access of resources, opportunities, and benefits, ensuring everyone has the support they need to achieve their full potential, regardless of their background or identity.
Equality: Treating all individuals fairly and impartially, providing them with the same opportunities and resources without taking any other factors into consideration. It aims to eliminate discrimination and biases by providing everyone with an equal starting point. However, equality best practices often neglect to address existing disparities or account for varying needs, whereas equity focuses on rectifying these imbalances to achieve genuine fairness for all.
Exclusion: The act of leaving out certain individuals due to their differences, hindering their access to resources and opportunities. Inclusion seeks to eliminate exclusionary practices and ensure equal participation.
Gender Identity: An individual's deeply felt identity of self and understanding of their own gender, which may not align with traditional binary concepts. Recognizing and respecting diverse gender identities is vital for an inclusive society.
Identity: The multifaceted aspects that make each person unique, including cultural, racial, and gender identities. Embracing and celebrating diverse identities strengthens the fabric of an inclusive community.
Implicit (Unconscious) Bias: Snap judgments and subconscious attitudes that affect our interactions and decisions, often leading to unequal treatment. Often associated with our unconscious mind or the amygdala (a part of our brains that’s closely associated with fear, emotions, and motivations). Understanding and consciously addressing these biases are essential steps toward achieving equity.
Inclusion: Creating an environment where all individuals, regardless of their identity, feel valued, respected, and empowered to contribute fully. Inclusion goes beyond diversity by ensuring equitable opportunities for all.
Intersectional: Recognizing that individuals have overlapping social identities, such as race, gender identity, sexual orientation, level of ability, and socio-economic status, which influence their experiences and need to be considered collectively to ensure fairness.
Marginalization: The systemic relegation of certain groups to the edges of society, limiting their access to resources and opportunities. Equity seeks to dismantle these barriers and empower marginalized voices.
Neurodivergent: Refers to individuals whose neurological makeup differs from the norm, emphasizing the value of diverse cognitive perspectives and promoting inclusivity for all types of minds.
Privilege: Unearned advantages that some individuals or groups have due to their societal position. Recognizing privilege is important for fostering empathy, sharing resources, and leveling the playing field.
Profiling: A form of bias that unjustly targets individuals based on their perceived characteristics. Most commonly associated with someone’s racial or ethnic background, profiling also applies to other dimensions of diversity. Addressing profiling is a crucial step toward creating an equitable and just society.
Sexual Orientation: An individual's romantic, emotional, and sexual attraction to others. Fostering an inclusive environment means respecting and affirming diverse sexual orientations.
Stereotype: Oversimplified assumptions and beliefs about certain groups that can perpetuate bias and discrimination. Promoting equity involves challenging and dismantling harmful stereotypes.