Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, K201 Kresge Bldg, London, Ontario, Canada N6A 5C1.
Soc Sci Med. 2014 Jun;110:10-7. doi: 10.1016/j.socscimed.2014.03.022. Epub 2014 Mar 25.
Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation of intersectionality can promote the creation of evidence that is directly useful in population-level interventions such as policy changes, or that is specific enough to be applicable within the social contexts of affected communities.
交叉性理论旨在解决性别/性别和种族/族裔影响的非加性问题，但可扩展到其他领域，使我们有可能在不同的身份、社会地位、压迫或特权过程以及政策或机构实践的交叉点上研究健康和疾病。交叉性有可能通过提高有效性和更加关注影响的异质性和产生健康不平等的因果过程，丰富人口健康研究。此外，交叉人口健康研究可以既是检验也是产生新理论的手段。然而，迄今为止，它在健康研究中的实施主要是通过定性研究。本文提出或扩展了将交叉性纳入人口健康研究中的挑战。这些挑战包括：1）混淆理论工作中隐喻性使用的定量术语与类似 sounding 的统计方法；2）所有交叉性位置是否具有同等价值，甚至是否具有足够的研究价值的问题；3）区分交叉身份、社会地位、过程以及政策或其他结构性因素；4）在衡量和分析压迫和特权过程时反映体现；5）理解和利用交互作用在回归模型中的适当尺度；6）构建交互作用或风险修饰以最佳传达效果；7）避免在分析设计中假设等距或单一级别。在概念化和规划研究以及进行分析的过程中解决这些挑战，有可能提高研究人员更具体地记录不同交叉位置不平等的能力，并研究可能导致这些观察到的不平等的个体和群体层面的潜在原因。更多和更深入地纳入交叉性可以促进创建直接用于人口干预（如政策变化）的证据，或者创建足够具体适用于受影响社区社会背景的证据。
