An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity

International Journal for Equity in Health

Natalie Clark⁴  Olivier Ferlatte³  Sarah Rudrum⁶  Alycia Fridkin⁷  Melissa Giesbrecht¹  Gemma Hunting⁸  Daniel Grace²  Olena Hankivsky⁵ 

[1] Geography, Simon Fraser University, Vancouver, BC, Canada;Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada;School of Social Work, UBC, Vancouver, BC, Canada;School of Public Policy, Simon Fraser University, Vancouver, British Columbia (BC), Canada;Institute for Gender, Race, Sexuality and Social Justice, UBC, Vancouver, BC, Canada;Interdisciplinary Studies Graduate Program, University of British Columbia (UBC), Vancouver, BC, Canada;Institute for Intersectionality Research & Policy, Vancouver, BC, Canada

关键词: Health;    Reflexivity;    Policy analysis;    Equity;    Intersectionality;   

Others  :  1146107
DOI  :  10.1186/s12939-014-0119-x

 received in 2014-08-13, accepted in 2014-11-26,  发布年份 2014

【 摘 要 】

Introduction

In the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts – an Intersectionality-Based Policy Analysis (IBPA) Framework.

Methods

Developed over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies.

Results

The analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks.

Conclusion

The aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.

【 授权许可】

   
2014 Hankivsky et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Cole BL, Fielding JE: Health impact assessment: a tool to help policy makers understand health beyond health care. Annu Rev Public Health 2007, 28:393-412.
• [2]Haber R: Health Equity Impact Assessment: a primer. Wellesley Institute, Toronto, Ontario; 2010.
• [3]Health Canada: Sex and Gender-Based Analysis (SGBA). 2010. http://www.hc-sc.gc.ca/hl-vs/gender-genre/analys/gender-sexes-eng.php.
• [4]Mahoney M, Simpson S, Harris E, Aldrich R, Stewart Williams J: Equity focused Health Impact Assessment Framework. The Australasian Collaboration for Health Equity Impact Assessment, Sydney, Australia; 2004.
• [5]Signal L, Martin J, Cram F, Robson B: Health Equity Assessment Tool: a user’s guide. New Zealand Ministry of Health, Wellington; 2008.
• [6]Simpson S, Harris E, Harris-Roxas B: Health impact assessment: an introduction to the what, why and how. Health Promot J Austr 2004, 15(2):162-167.
• [7]Hankivsky O: Health inequities in Canada: intersectional frameworks and practices. UBC Press, Vancouver, BC; 2011.
• [8]Hankivsky O, Cormier R: Intersectionality: moving women’s health research and policy forward. Women’s Health Research Network, Vancouver; 2009.
• [9]Sen G, Iyer A, Mukherjee C: A methodology to analyse the intersections of social inequalities in health. J Hum Dev Capab 2009, 10(3):397-415.
• [10]Weber L, Fore ME: Race, ethnicity, and health: an intersectional approach. In Handbooks of the sociology of racial and ethnic relations. Edited by Vera H, Feagin JR. Springer, New York; 2007:191-218.
• [11]Hankivsky O: An Intersectionality-Based Policy Analysis Framework. Institute for Intersectionality Research and Policy, Simon Fraser University, Vancouver, BC; 2012.
• [12]Bunjun B: Feminist organizations and intersectionality: contesting hegemonic feminism. Atlantis 2010, 34(2):115-126.
• [13]Collins PH: Black feminist thought: knowledge, consciousness, and the politics of empowerment. Routledge, New York; 1990.
• [14]Crenshaw K: Demarginalizating the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. U Chi Legal F 1989, 1989:139-167.
• [15]Crenshaw K: Mapping the margins: intersectionality, identity politics, and violence against women of color. S L Rev 1991, 43(6):1241-1299.
• [16]Van Herk KA, Smith D, Andrew C: Identity matters: Aboriginal mothers’ experiences of accessing health care. Contemp Nurse 2011, 37(1):57-68.
• [17]Hancock AM: When multiplication doesn’t equal quick addition: examining intersectionality as a research paradigm. Perspect Polit 2007, 5(1):63-78.
• [18]Grace D: When oppressions and privileges collide: a review of research in health, gender and intersectionality in late (post) modernity. Can J Hum Soc Sci 2010, 1(1):20-24.
• [19]Bowleg L: When black + lesbian + woman ≠ black lesbian woman: the methodological challenges of qualitative and quantitative intersectionality research. Sex Roles 2008, 59:312-325.
• [20]Collins PH: Black feminist thought: knowledge, consciousness, and the politics of empowerment. 2nd edition. Unwin Hyman, New York; 2000.
• [21]Weber L, Parra-Medina D: Intersectionality and women’s health: charting a path to eliminating health disparities. Adv Gend Res 2003, 7(3):181-230.
• [22]Hankivsky O, Grace D, Hunting G, Ferlatte O: Introduction: why intersectionality matters for health equity and policy analysis. In An Intersectionality-Based Policy Analysis Framework. Edited by Hankivsky O. Institute for Intersectionality Research and Policy, Simon Fraser University, Vancouver, BC; 2012:7-30.
• [23]Hankivsky O, Cormier R: Intersectionality and public policy: some lessons from existing models. Polit Res Q 2011, 64(1):217-229.
• [24]Phoenix A, Pattynama P: Intersectionality. Eur J Womens Stud 2006, 13:187-192.
• [25]Rönnblom M: Policy, power and space: towards an intersectionality methodology in policy analysis. Paper presented at the POWER Conference: September 2008; Tampere, Finland; 2008
• [26]Yuval-Davis N: Intersectionality and feminist politics. Eur J Womens Stud 2006, 13(3):193-209.
• [27]Bishwakarma R, Hunt VH, Zajicek A: Beyond one-dimensional policy frameworks: a practical guide for an intersectional policy analysis. Himalaya Res Bull 2008, 27(1–2):19-30.
• [28]Parken A, Young H: Integrating the promotion of equality and human rights for all. 2007.
• [29]Parken A: A multi-strand approach to promoting equalities and human rights in policy making. Policy Polit 2010, 38(1):79-99.
• [30]Peterson WE, Medves JM, Davies BL, Graham ID: Multidisciplinary collaborative maternity care in Canada: easier said than done. J Obstet Gynaecol Can 2007, 29(11):880-886.
• [31]Maternity Care Enhancement Project: Supporting local collaborative models for sustainable maternity care in British Columbia: recommendations from the Maternity Care Enhancement Project. BC Ministry of Health, Victoria, BC; 2004.
• [32]British Columbia Aboriginal Maternal Health Project: Aboriginal maternal health in Canada: A toolbox (draft). BC Ministry of Health, Victoria, BC; 2006.
• [33]British Columbia Perinatal Health Program [BCPHP]: BCPHP Obstetric Guideline 19: Maternity Care Pathway. BCPHP, Vancouver, BC; 2010.
• [34]Benoit C, Carroll D, Millar A: But is it good for non-urban women’s health? Regionalizing maternity care services in British Columbia. Can Rev Soc 2002, 39(4):373-395.
• [35]Gagnon, AJ, Wahoush O, Dougherty G, Saucier JF, Dennis CL, Merry L, Stanger E, Stewart DE: The childbearing health and related service needs of newcomers (CHARSNN) study protocol. BMC Pregnancy Childbirth 2006, 6(31). doi:10.1186/1471-2393-6-31
• [36]Carstairs S: Still not there. Quality end-of-life care: a progress report. June 2005. [http://www.chpca.net/media/7883/Still_Not_There_June_2005.pdf]
• [37]Skinner MW, Rosenberg MW: Co-opting voluntarism? Exploring the implications of long-term care reform for the nonprofit sector in Ontario. Environ Plann C 2005, 23(1):101-121.
• [38]Stajduhar KI: Examining the perspectives of family members involved in the delivery of palliative care at home. J Palliative Care 2003, 19:27-35.
• [39]Quality End of Life Care Coalition of Canada: Blueprint for action 2010 to 2020. A progress report. 2010 [http://www.qelccc.ca/media/3749/eng_progress_report_20102012-07-10_2.pdf]
• [40]Seale C: Constructing death: the sociology of dying and bereavement. Cambridge University Press, Cambridge; 1998.
• [41]Exley C: Review article: the sociology of dying, death and bereavement. Sociol Health Ill 2004, 26(1):110-122.
• [42]Williams AM, Crooks VA, Whitfield K, Kelley ML, Richards JL, Dykeman S: Tracking the evolution of hospice palliative care in Canada: a comparative case study analysis of seven provinces. BMC Health Serv Res 2010, 10:147. doi:10.1186/1472-6963-10-147 BioMed Central Full Text
• [43]Turner BS: Medical power and social knowledge. Sage, London; 1995.
• [44]Armstrong P, Armstrong H: Wasting away: the undermining of Canadian health care. Oxford University Press, Toronto, ON; 1996.
• [45]Canada H: It’s your health: Fetal Alcohol Spectrum Disorder. Health Canada, Ottawa, ON; 2006.
• [46]Hunting G, Browne AJ: Decolonizing policy discourse: reframing the ‘problem’ of Fetal Alcohol Spectrum Disorder. Women’s Health Urban Life 2012, 11(1):35-53.
• [47]Salmon A: ‘It takes a community’: constructing Aboriginal mothers and children with FAS/FAE as objects of moral panic in/through a FAS/FAE prevention policy. J Assoc Res Mothering 2004, 6(1):112-123.
• [48]Dej E: What was once sick is now bad: the shift from victim to deviant identity for those diagnosed with Fetal Alcohol Spectrum Disorder. Can J Sociol 2011, 36(2):137-160.
• [49]Fiske J, Browne AJ: Paradoxes and contradictions in health policy reform: implications for First Nations women. Women’s Health Report for the BC Centre of Excellence for Women’s Health [BCCEWH]. BCCEWH, Vancouver, BC; 2008.
• [50]Tait CL: Simmering outrage during an “epidemic” of Fetal Alcohol Syndrome. Can Woman Stud 2008, 26(3/4):69-76.
• [51]Ministry of Children and Family Development: Fetal Alcohol Spectrum Disorder: building on strengths. A provincial plan for 2008–2018. Ministry of Children and Family Development, Vancouver, BC; 2008.
• [52]Hankivsky O, Reid C, Cormier R, Varcoe C, Clark N, Benoit C, Brotman S: Exploring the promises of intersectionality-type methodologies for advancing women’s health research. Int J Equity Health 2010, 9(5):1-15.
• [53]Loppie-Reading C, Wien F: Health inequalities and social determinants of Aboriginal peoples’ health. National Collaborating Centre for Aboriginal Health, Prince George, BC; 2009.
• [54]Adelson N: The embodiment of inequity: health disparities in Aboriginal Canada. Can J Pub Health 2005, 96(Suppl 2):S45-S61.
• [55]Eppley K: Rural schools and the highly qualified teacher provision of No Child Left Behind: a critical policy analysis. J Res Rural Educ 2009, 24(4):1-11.
• [56]Reimer-Kirkham S, Anderson JM: The advocate-analyst dialectic in critical and postcolonial feminist research: reconciling tensions around scientific integrity. Adv Nurs Sci 2010, 33(3):196-205.
• [57]Bryant T: An introduction to health policy. Canadian Scholar’s Press, Toronto, ON; 2009.
• [58]Patterson LL: Aboriginal roundtable to Kelowna Accord: Aboriginal policy negotiations, 2004–2005. Parliamentary Information and Research Service, Library of Parliament, Ottawa, ON; 2006.
• [59]Fridkin AJ: Addressing health inequities through Indigenous involvement in health-policy discourses. Can J Nurs Res 2012, 44(2):108-122.
• [60]Fredericks B, Adams K, Edwards R: Aboriginal community control and decolonizing health policy: a yarn from Australia. In Democratizing health: consumer groups in the policy process. Edited by Löfgren H, Leahy M, Leeuw ED. Edward Elgar Publishing, Inc, Northhampton, MA; 2011:81-96.
• [61]Representative for Children and Youth & Office of the Provincial Health Officer: Kids, crime and care: health and well-being of children and care. Youth justice experiences and outcomes. Representative for Children and Youth, Victoria, BC; 2009.
• [62]Ministry of Children and Family Development: Child and youth mental health plan for BC. Government of BC, Victoria, BC; 2003.
• [63]Clark N: Hankivsky O (Ed): Perseverance, determination and resistance: an Indigenous Intersectional-Based Policy Analysis of violence in the lives of Indigenous girls In An Intersectionality Based Policy Analysis Framework. Institute for Intersectionality Research & Policy, Simon Fraser University, Vancouver, BC; 2012:133-159.
• [64]Grande S: Red pedagogy: Native American social and political thought. Rowman & Littlefield Publishers, Inc, Toronto, ON; 2004.
• [65]Smith JD, Yee J: Building a Highway of Hope. The Highway of Tears Initiative, Toronto, ON; 2009.
• [66]Grace D, McCaskell T: We are not criminals: activists working to address the criminalization of HIV non-disclosure. In Global HIV/AIDS Politics, Policy, and Activism. Edited by Smith RA. Praeger, California; 2013:353-375.
• [67]Grace D: Legislative epidemics: the role of model law in the transnational trend to criminalise HIV transmission. Med Humanities 2013, 39(2):77-84.
• [68]Grace D: Reconceiving the ‘problem’ in HIV prevention: HIV testing technologies and the criminalization of HIV non-disclosure. In An Intersectionality Based Policy Analysis Framework. Edited by Hankivsky O. Institute for Intersectionality Research & Policy, Simon Fraser University, Vancouver, BC; 2012:161-187.
• [69]Marchand R: Moving ahead: assessing gay men’s HIV prevention in BC. British Columbia Centre for Disease Control, Vancouver, BC; 2001.
• [70]Community-Based Research Centre: Setting the agenda: report on the first Gay Men’s Health Summit in British Columbia. Community-Based Research Centre, Vancouver, BC; 2006.
• [71]British Columbia Centre for Disease Control: Annual surveillance report: HIV and sexually transmitted infections 2009. British Columbia Centre for Disease Control, STI/HIV Prevention and Control, Vancouver, BC; 2009.
• [72]Wilson DP: HIV Treatment as prevention: natural experiments highlight limits of antiretroviral treatment as HIV prevention. PLoS Med 2012, 9(7):e1001231.
• [73]Dowsett GW, Bollen J, McInnes D, Couch M, Edwards B: HIV/AIDS and constructs of gay community researching educational practice within community-based health promotion for gay men. Int J Soc Res 2001, 4(3):205-223.
• [74]Cole E: Coalitions as a model for intersectionality: from practice to theory. Sex Roles 2008, 59:443-453.
• [75]Hancock AM: Solidarity politics for millenials: a guide to ending the Oppression Olympics. Palgrave Macmilliam, New York; 2011.