Mapping power through space: The spatial intersectionality health framework and intersectional...

Intersectionality research shows that interacting systems of oppression produce health risks that differ from those of any single system. Spatial health research shows that place shapes health, and spatial intersectionality research demonstrates that the same place affects people differently across intersectional positions. Yet the literature does not specify how relationships between intersectional positions and spatial configurations produce unequal health. We introduce the Spatial Intersectionality Health Framework (SIHF), which specifies three mechanisms linking intersectional positions and spatial configurations to unequal health. The Layered mechanism describes the simultaneous operation of multiple systems of oppression, the Positional mechanism explains why the same spatial configuration produces different experiences across intersectional positions, and the Conditional mechanism explains how protection along one axis may leave another unprotected. We operationalize SIHF through Intersectional Geographically-Explicit Ecological Momentary Assessment (IGEMA), which integrates structural spatial exposure, multilevel modeling, and qualitative mechanism coding. We applied IGEMA to a pilot sample of 32 racially and ethnically diverse sexual and gender minority young adults in New York City. GPS, qualitative, and focal spatial-model analyses drew on smaller subsamples of 19, 18, and 15 participants, respectively. Within the integrated design, we identified records consistent with all three proposed SIHF mechanisms. These findings illustrate the feasibility of operationalizing SIHF through an integrated spatial, quantitative, and qualitative design and provide a framework for specifying how relationships between intersectional positions and spatial configurations shape health.