Intersectionality, governance and health inequity

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Health inequity is one of the most challenging, unjust and urgent global health issues. Itrefers to systematic differences in health between groups or populations that are oftendriven by social, economic, political and environmental factors. Effective healthgovernance is particularly critical to addressing health inequity. Health governanceinvolves instruments, policies, rules and norms that shape and steer strategies andpolicies influencing health in a certain region. It is driven by a range of actors acrossgovernments, bilateral and multilateral bodies, civil society organisations and the privatesector. With effective leadership, inter-sectoral coordination and accountability, healthgovernance presents the potential to structurally address health inequity throughmechanisms such as policymaking, priority-setting, resource allocation and regulation.However, the structural drivers of health inequity, such as race and gender, are notunitary; they are overlapping, interconnected and synergistic. This poses theoretical andtechnical challenges to health governance that seeks to systematically address healthinequity.With a genealogy in Black feminist and critical theory scholarship stretching back overtwo centuries, intersectionality posits that systems of privilege, discrimination andoppression are interdependent, mutually constitutive and multiplicative. Distinct from asingle-axis analysis that inevitably decomposes human lives into single attributes,intersectionality offers a critical lens to understand the complex interplay betweeninterlocking socio-political structures, e.g. race, gender and class, that (re-)producecomplex power relations and processes that shape social locations, identities andinequalities.Thus, incorporating intersectionality into health governance presents a transformativeopportunity for health equity and emancipation. Intersectionality as a framework canenable critical analysis that illuminates interlocking structures that perpetuate healthinequity, informing the action - the what, how and why - of health governance todismantle those structures. Nevertheless, relatively little about this has been studied.AimBroadly, this PhD project aims to explore intersectionality in health governance as ameans to address structural drivers of health inequity. A particular health inequityrelatedchallenge (e.g. a health condition or policy) will be chosen as a device for thisenquiry.This project will potentially involve a multi-country partnership led by Global Health50/50. As an explicitly transdisciplinary project, this work will draw on experts andexpertise from health policy, political science, sociology and epidemiology.MethodologyThis project is envisioned to be multi-/mixed-methods, involving a series ofcomplementary work packages (WPs) executed using state-of-the-art methods. Anoverarching theoretical framework will be chosen - or generated - to guide this project.Focusing on the chosen health issue, the following WPs are proposed (subject tochange):1) WP1: A systematic/scoping review exploring the current literature in this field;2) WP2: An epidemiological analysis using a quantitative intersectionality approach,e.g. the MAIHDA method;3) WP3: A multi-country comparative policy case study involving documentaryanalysis and interviews with policy and political elites;4) WP4: A power/political economy analysis (that draws on insights from previousWPs); and5) WP5: Crystallising previous WPs using the theoretical framework of choice andgenerating policy recommendations.Potential risks include logistical challenges, e.g. travelling and research ethics approval, inundertaking multi-country research.Contribu7onsThis is a transdisciplinary endeavour that will yield novel knowledge that has profoundimplications - both theoretical and practical - for scholars, policymakers and activistswho seek to advance health equit