Shannon Geordan, Morgan Rosemary, Zeinali Zahra, Brady Leanne, Couto Marcia Thereza, Devakumar Delan, Eder Ben, Karadag Ozge, Mukherjee Mala, Peres Maria Fernanda Tourinho, Ryngelblum Marcelo, Sabharwal Nidhi, Schonfield Amos, Silwane Pamela, Singh David, Van Ryneveld Manya, Vilakati Siyasanga, Watego Chelsea, Whyle Eleanor, Muraya Kui
Institute for Global Health, University College London, London, UK.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancet. 2022 Dec 10;400(10368):2125-2136. doi: 10.1016/S0140-6736(22)02304-2.
Intersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.
交叉性理论是解决健康不平等问题的一项有用工具，它能帮助我们理解并应对多种权力体系相互交织所产生的个体和群体影响。交叉性理论摒弃了不平等是由单一、独特因素导致的观念，而是关注那些造成不平等的重叠过程之间的关系。在本系列论文中，我们采用交叉性方法来突出种族主义、仇外心理和歧视与其他压迫体系的交叉点，这种交叉如何影响健康，以及对此可采取何种措施。我们展示了来自全球不同地区的五个案例研究，这些案例勾勒出基于种姓、族裔和移民身份、原住民身份、宗教及肤色的不同维度的歧视情况。尽管经历各不相同，但这些案例研究揭示了歧视影响健康和幸福的共同方式：历史因素和殖民性如何塑造当代的种族和种族主义经历；种族主义如何跨越不断变化的身份和特权界限导致隔离和等级制度；种族主义和歧视如何在系统层面制度化并嵌入法律、法规、实践和卫生系统；歧视、少数化和排斥如何成为受显性因素和隐性知识影响的种族化过程；以及种族主义如何成为一种结构性暴力形式。这些见解使我们能够开始阐明基于正义的行动的起点，这些行动要解决根本原因，超越卫生部门开展工作，并鼓励跨国团结。
