Intersectionality is an approach that recognises the complex interplay of social identities like gender, ethnicity, and social position, among others, with oppressive and discriminatory systems of power (eg. sexism, classism). It’s a theoretical and practical tool for deep analysis of health inequalities, essential for crafting effective interventions, equitable programs, and policies.

While the origins of intersectionality can be traced back to the activism of Black women and scholars like Kimberlé Crenshaw and Patricia Hill Collins in the Global North, it is essential to acknowledge that similar ideas had already taken root in Latin America as well. Indeed, early notions of intersectionality in Latin America can be traced back to the activism of Black women at the “Congresso das Mulheres Negras Brasileiras” in 1975 (Congress of Black Brazilian Women), where  participants discussed how racism, sexism, labor exploitation, domestic violence,  forced sterilization and other forms of oppression are interconnected and cannot be tackled separately. More recently,  the conceptualisation of “coloniality of power” by Anibal Quijano,  offers a complementary viewpoint to intersectionality by analyzing the enduring impact of colonial structures on social and racial hierarchies in the region. These perspectives are crucial for understanding health inequalities in Latin America, linking them to historical and current colonial legacies. Along the same lines, the 2019 PAHO document Sociedades Justas (Just Societies)  highlighted how the power dynamics established during the colonial era continue to shape contemporary society and health outcomes, offering a more progressive and conceptually richer approach for the region, compared to WHO’s Social Determinants of Health approach.

Which health related intersectionalities have been analysed so far in Latin America?

Studies on intersectionality and health are still relatively scarce in the region. Quantitative studies by Krause and Ballesteros (2022) and Medrano Buenrostro et al. (2017) highlight health inequalities from a quantitative  intersectional perspective, focusing on the combined effect of factors like gender, income, education, and ethnicity on self-perceived health in Argentina, and  the differences in treatment received by female victims of violence in different healthcare services in Mexico, respectively. Meanwhile, qualitative studies by Aizenberg, Cardoso et al. (2019) and Oliveira et al. (2020) explore intersectionality in health, revealing cultural biases in healthcare for migrant women, complex vulnerabilities in mental health of children and adolescents, and intertwined inequalities in young men from peri-urban areas.

What have we added to the knowledge? 

While qualitative methodologies predominantly reign in the realm of intersectionality and health, recent advancements in quantitative approaches incorporating intersectionality theoretical frameworks offer new insights. A study we published in September stands as the Latin American region’s first to  analyze health inequalities through an intersectional lens using these emerging quantitative methodologies. It sheds light on how the intersection of gender, ethnicity, and education influences self-perceived health in the Americas. The study, based on the World Values Survey (1990-2022) covered 58,790 individuals from 14 countries. Unlike traditional analyses of risk averages that consider a single social dimension, this study created  intersectional groups by integrating social categories (gender, ethnicity, and education), thus leading to a multi-categorical variable with 12 strata. Our reference point was ‘men from the majority ethnic group with higher education’, against which we contrasted the health risks of other intersectional groups. This approach enabled us to precisely identify which groups are most impacted by health inequalities.

The intersectional quantitative analysis revealed that women, particularly those from minority or indigenous ethnic groups with low educational levels (i.e. less than secondary), face the highest risk of poor self-perceived health. This trend persists across various income levels of countries. Moreover, the study showed that women experience more significant health inequalities compared to male counterparts in each intersecting stratum analyzed (e.g. ‘women from minority or ethnic groups with low educational levels’ vs. ‘men from minority or ethnic groups with low educational levels’) .

Conclusion 

Our research highlights the need for strengthening (and effectively applying) health policies in Latin America, to be responsive to the needs of historically marginalized groups, especially women from minority ethnic backgrounds with limited education. It’s essential to address the deep-rooted influences of colonialism, patriarchy and capitalism, which are pivotal in perpetuating health inequalities.

Incorporating insights on colonialism, we recognise the enduring impact of colonial legacies in shaping current health disparities. Addressing these influences is essential for equitable health outcomes. Policies should be inclusive and respectful of diverse cultural and historical contexts, focusing on the most affected groups and using intersectionality as a critical framework for policy analysis and development. To date, studies, including ours,  have primarily analyzed health inequalities descriptively using an intersectional lens. There is a critical need for analytical studies that elucidate the causal patterns behind these inequalities, utilizing population-wide data. This will in turn enable the development of more targeted and effective policy interventions, ensuring no one is left behind and moving towards fairer health systems in a region that is still deeply influenced by its colonial  and patriarchal history.