Knowledge diversification in public health through intersectionality

Abstract: BackgroundKnowledges about health inequalities and their causes are a central concern in public health. Generally, these relate to the social patterning of health and the forces that affect health conditions in daily life. However, public health decision making has been criticized for excluding knowledges of particular importance for health equity. This poses a challenge since knowledges and understandings shape what policies and interventions are viewed as relevant, reasonable or even possible to think of. If certain knowledges are left out, there is a risk that both knowledge making and decision making with respect to health inequalities will exclude important measures.Since intersectionality encompasses a wide range of knowledge-making practices centered around social justice, it may contribute diverse knowledges of importance to health equity. Intersectionality has recently gained traction within public health and represents an important shift in conceptualizing how different dimensions of inequalities, such as sexism, classism and racism, interlock to generate social exclusion and marginalization instead of working separately, one by one.AimThe overall aim of this thesis is to explore the possibility of using intersectionality as a tool for knowledge diversification within public health. The specific research question is:What knowledges and understandings of health inequalities do the inter-categorical (studies I and II) and post-categorical (studies III and IV) approaches to intersectionality contribute and how are such contributions made?Material and methodsThe method of the cover story can be understood as a way of studying science or as a retrospective self-reflection based on the four individual studies, making up the material of the thesis. Specifically, the material was reassembled and retold in order to show how certain intersectional approaches generate different types of knowledges and understandings of health inequalities by involving different ways of operationalizing inequalities and managing categories.In study I, a scoping review of the quantitative international literature was undertaken with the aim of mapping and describing inter-categorical inequalities in mental health. Study II was a quantitative analysis of a population-based survey with the aim of mapping inter-categorical inequalities in mental health in the Swedish adult population. Study III was a policy analysis of a government bill that proposes a national strategy on alcohol, drugs, tobacco and gambling with the study aim to examine the equity-perspective of the bill through an intersectional lens. Study IV was a post-qualitative inquiry based on participatory observations and interviews with the study aim to explore the becoming of social divisions among seniors as they participate in health-promoting activities.ResultsThe inter-categorical approach to intersectionality (applied in studies I and II) generated knowledges about health inequalities as quantitative mean differences between population groups, and highlighted unexpected patterns and unpredictable inequalities in mental health. This implies the importance of building responsive systems that regularly monitor inequalities across different intersectional positions and contexts so that services can be directed and adapted to those most in need.The post-categorical approach to intersectionality (applied in studies III and IV) generated knowledges about health inequalities as processes of marginalization, resistance, exclusion, or inclusion, and highlighted difficult trade-offs with respect to public health policy and practice. This enables a transformative way of thinking by providing the possibility of doing things differently in everyday practices in which marginalization and resistance becomes.ConclusionDifferent approaches to intersectionality contribute diverse knowledges and understandings about health inequalities. This is important since it expands the possibilities for fair decision making and health equity through different outlooks on social justice. Knowledge diversification through intersectionality could be particularly useful to release tension due to the restrictive forces of public health decision making and to increase accountability for the multiple social interests of the population. Thus, it has the potential to make public health decision making more flexible, transparent, reflexive, and democratic.