Intersectionality, governance and health inequity

健康不公平是最具挑战性、最不公正和最紧迫的全球健康问题之一。它指的是群体或人群之间的系统性健康差异，通常由社会，经济，政治和环境因素驱动。有效的卫生治理对于解决卫生不平等问题尤为重要。卫生治理涉及制定和指导影响某一区域卫生的战略和政策的手段、政策、规则和规范。它由政府、双边和多边机构、民间社会组织和私营部门等一系列行为体推动。在有效领导、部门间协调和问责制的支持下，卫生治理有可能通过政策制定、优先事项设定、资源分配和监管等机制从结构上解决卫生不平等问题。然而，卫生不平等的结构性驱动因素，如种族和性别，并非单一的，而是相互重叠、相互关联和协同作用的。这对寻求系统解决健康公平问题的健康治理提出了理论和技术挑战。黑人女权主义者的谱系和批判理论学术可以追溯到两个多世纪以前，交叉性假设特权、歧视和压迫系统是相互依存、相互构成和倍增的。与不可避免地将人类生活分解为单一属性的单轴分析不同，交叉性提供了一个关键的透镜来理解相互关联的社会政治结构之间的复杂相互作用，例如种族，性别和阶级，（重新）产生复杂的权力关系和塑造社会位置，身份和不平等的过程。将交叉性纳入卫生治理为卫生公平和卫生解放提供了一个转型机会。交叉性作为一个框架可以进行批判性分析，阐明使卫生公平永久化的连锁结构，为卫生治理拆除这些结构的行动-什么、如何和为什么-提供信息。然而，相对较少关于这已经studyed.Aimbroadly，这个博士项目的目的是探索在卫生治理的手段，以解决卫生不公平的结构性驱动因素的交叉性。将选择一个与卫生不公平相关的特定挑战（例如，健康状况或政策）作为本调查的工具。本项目可能涉及由全球卫生50/50领导的多国伙伴关系。作为一个明确的跨学科项目，这项工作将借鉴专家和专业知识，从卫生政策，政治学，社会学和epidemiology.MethodologyThis项目被设想为多/混合方法，涉及一系列的互补工作包（WP）使用国家的最先进的方法执行。将选择或产生一个新的理论框架来指导这个项目。（可修改）：1）WP 1：探索该领域现有文献的系统性/范围性综述;2）WP 2：使用定量交叉性方法（如MAIHDA方法）进行的流行病学分析;3）WP 3：多国政策比较案例研究，包括文献分析和对政策和政治精英的访谈;4）WP 4：权力/政治经济学分析（借鉴了以前WP的见解）;和5）WP 5：使用选择的理论框架来结晶以前的WP并产生政策建议。潜在的风险包括后勤挑战，例如旅行和研究伦理批准，这是一项跨学科的努力，将产生新的知识，对寻求促进卫生公平的学者、政策制定者和活动家具有深远的理论和实践意义。

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