3.2 Intersectionality

The SDHs overlap and intersect to create specific experiences.

Intersectionality examines how different social factors and power relationships interact to create different experiences of privilege, vulnerability and marginalisation. The concept of intersectionality was coined by Kimberlé Crenshaw (2013) as a response to what she saw as the ‘tendency to treat race and gender as mutually exclusive categories of experience and analysis’ and to consider interactions between different aspects of social identity (Hankivsky et al., 2009; Crenshaw, 2013). Simpson’s intersectionality wheel (Figure 3) illustrates how every individual is positioned in the centre of multiple, overlapping forms of identity. These are in turn influenced and shaped by broader social and structural processes, including discrimination (Larson et al., 2016).

From the centre outwards the circles in the intersectionality wheel represent:

  • an individual’s unique circumstances
  • aspects of collective identity
  • different types of discrimination, ‘–isms’ and attitudes that impact identity
  • larger forces and structures that work together to reinforce exclusion.

The intersectionality wheel is not exhaustive, but it includes illustrative examples within each of the circles.

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Figure 3 Simpson’s intersectionality wheel (Simpson, 2009).
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A figure showing a series of concentric circles labelled with various terms. The centre circle is labelled ‘Unique circumstances of power, privilege and identity’. The second circle is labelled ‘Indigeneity’, ‘Education’, ‘Age’, ‘Gender’, ‘Occupation’, ‘Class’, ‘Caste’, ‘Social status’, ‘Background’, ‘Income’, ‘Geographic location’, ‘Sexuality’, ‘Spirituality’, ‘Life experience’, ‘Skin colour’, ‘HIV status’, ‘Disability’, ‘Refugee status’, ‘Family status’, ‘Housing situation’, ‘Work history’, ‘Experience of racialisation’, ‘Citizenship status’ and ‘Religion’. The third circle is labelled ‘Racism’, ‘Discrimination’, ‘Heterosexism’, ‘Sexism’, ‘Classism’, ‘Ethnocentrism’, ‘Transphobia’, ‘Ageism’, ‘Homophobia’ and ‘Ableism’. The fourth and final circle is labelled ‘Politics’, ‘Globalisation’, ‘Capitalism’, ‘War’, ‘Education system’, ‘Immigration system’, ‘Historical forces’, ‘Social forces’, ‘Economy’, ‘Legal system’ and ‘Colonisation’.

Figure 3 Simpson’s intersectionality wheel (Simpson, 2009).

In Activity 4, you will explore how gender and intersectionality impacts infectious diseases and access to healthcare.

Activity 4: Exploring intersectionality

Timing: Allow about 10 minutes

Now watch Video 2, in which Margaret Gyapong from GEAR up (Gender Equity within Antimicrobial Resistance) discusses gender and intersectionality in infectious diseases.

  • Consider the points she raises around access to health facilities and the patient–provider links.
  • Reflect on the ways in which the health system is gendered and make notes on anything that surprises you.
Video 2 Gender and intersectionality in infectious diseases (TDR, 2024).
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Discussion

You can see that experiences of health systems are gendered. For example, young women face stigma and discrimination when seeking healthcare, which in turn creates gendered barriers to health-seeking.

Optionally if you would like to learn more on the origins of intersectionality, you may like to watch Kimberlé Crenshaw’s video on the origins of intersectionality (TED, 2016).

Next let’s explore more about how social determinants influence AMR.

3.1 Gender analysis frameworks

4 The social drivers of AMR