Health Inequalities, Intersectionality, and Justice

Policy Points Population health science that uses large data sets to study health inequalities increasingly draws on intersectionality, the idea that overlapping forms of disadvantage shape health inequalities. This approach is essential to the pursuit of health equity because it provides a more complete and sound evidence base for population health policy. As this approach has gained traction, it has drifted from intersectionality's founding ideas about social power and justice. This Perspective develops a framework of justice for the field that consists of a multidimensional account of unjust power relations and an egalitarian standard to guide population health research and interventions.

Research that examines multiple forms of marginalization simultaneously, referred to herein as quantitative intersectional analysis, is an important trend in population health science. This approach can identify otherwise hidden health inequalities and a fuller array of social drivers, creating a more complete evidence base for intervention. The practice of quantitative intersectional analysis, however, has strayed from intersectionality's founding ideas about interconnecting power relations and social justice. Some researchers have called for the rebuilding of those connections.

This Perspective interprets and adapt key features of Nancy Fraser's critical theory with the aim of developing a framework of justice and illustrating its value as an ethical resource for quantitative intersectional analysis and population health policy.

The proposed framework is well suited to quantitative intersectional analysis in three respects. First, it's critical vantage point foregrounds precisely the kinds of power relations and social structures that are well-documented drivers of health inequalities, including maldistribution in economic relations, misrecognition in cultural relations, and misrepresentation in political relations. Second, the framework is adaptable and can be extended, as recommended here, to include care relations. Third, the framework articulates a positive standard of justice-participatory parity-that can be interpreted to provide both moral justification for the view that some health inequalities constitute health inequities and ethical guidance for population health policy.

The proposed framework of justice supports deep engagement with ideas about social power and justice in four ways. It expands the social categories and systems of inequality typically subject to analysis, enhances conceptual clarity and theorization about the nature of the harms under study, identifies health inequalities that merit investigation, and provides an ethical standard for population health policy that protects against the use of stigmatization as a policy tool and supports a broad and inclusive concept of health equity.