Olena Hankivsky

Women's health, men's health, and gender and health: implications of intersectionality.

Although intersectionality is now recognized in the context of womens health, mens health, and gender and health, its full implications for research, policy, and practice have not yet been interrogated. This paper investigates, from an intersectionality perspective, the common struggles within each field to confront the complex interplay of factors that shape health inequities. Drawing on developments within intersectionality scholarship and various sources of research and policy evidence (including examples from the field of HIV/AIDS), the paper demonstrates the methodological feasibility of intersectionality and in particular, the wide-ranging benefits of de-centering gender through intersectional analyses.

Intersectionality and the determinants of health: a Canadian perspective

Despite Canadas leadership in the field of population health, there have been few successes in reducing the countrys health inequities. There is an increasing recognition that regardless of the progress made to date, significant gaps remain in comprehending fully the root causes of inequities, including the complex ways in which the determinants of health relate, intersect and mutually reinforce one another. Calls are being made to draw on the theoretical insights of critical social science perspectives to rethink the current framing of health determinants. The aim of this paper is to contribute to the theoretical project of population health by exploring the innovative paradigm of intersectionality to better understand and respond to the ‘foundational’ causes of illness and disease, which the health determinants perspective seeks to identify and address. While intersectionality has taken hold among health researchers in the United States, the United Kingdom and Canada, the transformative potential of this approach in the context of health determinants is largely unexamined.

Intersectionality and Public Policy: Some Lessons from Existing Models

In comparison to research practices, intersectionality is an underdeveloped concept within policy discourse and application. Because of the complexity and relative newness of this approach, policy analysis grounded within an intersectionality framework remains largely undertheorized, and methods for integrating intersectionality into policy processes are in the nascent stages. This article (1) defines intersectionality and demonstrates the need for this approach in public policy, (2) outlines challenges in applying intersectionality to policy making, and (3) describes and evaluates three innovative approaches to applying intersectionality to policy development and analysis.

Gender and health: Relational, intersectional, and biosocial approaches

Much of the research on sex/gender and health has been dominated by two foci: 1) empirical examinations of trends and explanations for sex differences in disease incidence and mortality and 2) sex-specific disease patterns and corresponding, often differential, investments of research and policy attention to “men’s health” and “women’s health” needs. Though these efforts have contributed to understanding the distribution and causes of disease and mortality – and have led to dramatic improvements in allocation of resources and in attention to previously neglected health issues affecting men andwomen – they often do not reflect contemporary gender/feminist theory and inadvertently reinforce outmoded binary constructions of sex (male vs. female) and gender (masculine vs. feminine), as well as treat sex and gender as easily separable. Indeed, the existence ofmale/female differences in health outcomes is often considered self-evident and confirming these differences is often privileged over exploring similarities. In this Special Issue, we strive to move the conceptualization of sex/gender and health away from these dominate foci with scholarship that utilizes contemporary feminist, relational approaches to gender (Connell, 2009; Ferree & Hess, 1987; Ridgeway, 2009; Schofield, Connell, Walker, Wood, & Butland, 2000), as well as prioritizing research on intersectional and biosocial approaches to gender and health (Fausto-Sterling, 2005; Hankivsky & Cormier, 2009; Hankivsky, 2011). By relational constructions of gender, we mean theory and research conceptualizing gender as a pervasive system of stratification that structures relationships and interactions between and among men and women, shapes access to resources and status, and signifies power (Connell, 1987; Scott, 1986). Gender is also conceived of as an agential process, whereby the meaning and expressions of gender are negotiated and “performed,” both shaped by and reproducing of social structure (Butler, 1990; West & Zimmerman, 1987). Hallmarks of these approaches are recognition of gender as dynamic and situational, attention to differences among women and among men, and

Women and Violence: The Effects of Dismantling the Welfare State

In Canada the idea that social entitlements are important components of citizenship and equality is currently being undermined by neo-liberal state values, expressed in federal and provincial policy shifts that favour self-sufficiency and economic competitiveness over a strong welfare state. Although this trend is dangerous for all populations marginalized through poverty, racism and disability, it is especially dangerous for women who are attempting to escape or avoid physical and sexual violence. Drawing on research conducted in the Canadian province of British Columbia, we argue that the dismantling of the social welfare state alongside policy changes that are affecting how the state responds to violence against women is significantly undermining women’s equality, their safety and the feminist anti-violence movement. Strategies for resistance are discussed and we conclude that ending violence against women requires both local and transnational feminist activism and analyses that examine the interconnections between social and economic policies.

Gender and health inequities: A comment on the Final Report of the WHO Commission on the Social Determinants of Health

The Final Report of the World Health Organization (WHO) Commission on the Social Determinants of Health is a substantial and important contribution to understanding the social factors that shape global health inequities. Although gender is highlighted as a key social determinant of health, the reports conceptual approach inappropriately equates gender and health with womens health. This essay discusses the analytic and policy implications of this shortcoming.

Attributing Selected Costs to Intimate Partner Violence in a Sample of Women Who Have Left Abusive Partners: A Social Determinants of Health Approach

Cet article rend compte d’une étude qui nous a permis d’évaluer certains coûts associés à la violence conjugale au sein d’un échantillon de 309 femmes qui avaient quitté leur conjoint abuseur depuis 20 mois en moyenne. Nous estimons ces coûts – c’est-à-dire les dépenses publiques et privées associées à la violence conjugale – à 13 162,39

Rethinking Care Ethics: On the Promise and Potential of an Intersectional Analysis

par femme en moyenne. Si l’on considère l’ensemble des femmes canadiennes de 19 à 65 ans ayant un conjoint abuseur, les coûts associés à la violence conjugale se chiffrent donc à 6,9 milliards de dollars, et à 3,1 milliards si l’on considère les femmes victimes de violence conjugale au cours des trois dernières années. Ces résultats indiquent que la violence conjugale implique des coûts qui persistent longtemps après la séparation des conjoints. Il est donc important, en matière de politiques de lutte contre la violence conjugale, que les décideurs tiennent compte du fait que la séparation ne met pas un terme à cette violence.

Critically examining diversity in end-of-life family caregiving: implications for equitable caregiver support and Canada’s Compassionate Care Benefit

This article contributes to current debates and discussions in critical social theory about diversity, inclusion/exclusion, power, and social justice by exploring intersectionality as an important theoretical resource to further develop and advance care ethics. Using intersectionality as a critical reference point, the investigation highlights two key shortcomings of care ethics which stem from this ethics’ prioritization of gender and gendered power relations: inadequate conceptualizations of diversity and power. The article draws on concrete examples related to migrant domestic work to illustrate how an intersectionality lens can advance new theoretical insights for understanding caring practices (or lack of them), and generate new methodological and practical strategies for confronting and transforming the deeply entrenched interlocking power inequities that undermine the realization of care in an increasingly complex context of national and international policy and politics.

Gender mainstreaming in Canada and Australia: A comparative analysis

IntroductionFamily (i.e., unpaid) caregiving has long been thought of as a ‘woman’s issue’, which ultimately results not only in gendered, but also financial and health inequities. Because of this, gender-based analyses have been prioritized in caregiving research. However, trends in current feminist scholarship demonstrate that gender intersects with other axes of difference, such as culture, socio-economic status, and geography to create diverse experiences. In this analysis we examine how formal front-line palliative care providers understand the role of such diversities in shaping Canadian family caregivers’ experiences of end-of-life care. In doing so we consider the implications of these findings for a social benefit program aimed at supporting family caregivers, namely the Compassionate Care Benefit (CCB).MethodsThis analysis contributes to a utilization-focused evaluation of Canada’s CCB, a social program that provides job security and limited income assistance to Canadian family caregivers who take a temporary leave from employment to provide care for a dying family member at end-of-life. Fifty semi-structured phone interviews with front-line palliative care providers from across Canada were conducted and thematic diversity analysis of the transcripts ensued.ResultsFindings reveal that experiences of caregiving are not homogenous and access to services and supports are not universal across Canada. Five axes of difference were commonly raised by front-line palliative care providers when discussing important differences in family caregivers’ experiences: culture, gender, geography, lifecourse stage, and material resources. Our findings reveal inequities with regard to accessing needed caregiver services and resources, including the CCB, based on these axes of difference.ConclusionsWe contend that without considering diversity, patterns in vulnerability and inequity are overlooked, and thus continually reinforced in health policy. Based on our findings, we demonstrate that re-framing categorizations of caregivers can expose specific vulnerabilities and inequities while identifying implications for the CCB program as it is currently administered. From a policy perspective, this analysis demonstrates why diversity needs to be acknowledged in policy circles, including in relation to the CCB, and seeks to counteract single dimensional approaches for understanding caregiver needs at end-of-life. Such findings illustrate how diversity analysis can dramatically enhance evaluative health policy research.