How I approach intersectionality in hematopoietic stem cell transplantation

In the context of health care, intersectionality refers to a framework that focuses on the ways in which multiple axes of social inequality intersect and compound at the macro and micro levels to produce a broad range of unequal health outcomes. With the aid of tools such as the wheel of power and privilege, this framework can help identify systemic biases hidden in plain sight in the routine diagnostic, therapeutic, and prognostic paradigms used in clinical practice. Hematopoietic stem cell transplantation is a high-cost, highly specialized complex procedure that exemplifies the impact of intersectional identities and systemic biases in health care systems, clinical research, and clinical practice. Examples include the derivation of clinical algorithms for prognosis and risk assessments from data with limited representation of diverse populations in our communities. Transplant clinicians and teams are uniquely positioned to appreciate the concept of intersectionality and to apply it in clinical practice to redress inequities in outcomes in patients with marginalizing social determinants of health. An intersectional approach is the most efficient way to deliver effective and compassionate care for all.