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

International Journal for Equity in Health An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity Olena Hankivsky 0 Daniel Grace 1 2 Gemma Hunting 7 Melissa Giesbrecht 6 Alycia Fridkin 5 Sarah Rudrum 4 Olivier Ferlatte 9 Natalie Clark 3 8 0 School of Public Policy, Simon Fraser University , Vancouver, British Columbia (BC) , Canada 1 Dalla Lana School of Public Health, University of Toronto , Toronto, Ontario , Canada 2 London School of Hygiene & Tropical Medicine , London , UK 3 School of Public Policy, Simon Fraser University , Vancouver, BC , Canada 4 Institute for Gender , Race, Sexuality and Social Justice, UBC, Vancouver, BC , Canada 5 Interdisciplinary Studies Graduate Program, University of British Columbia (UBC) , Vancouver, BC , Canada 6 Geography, Simon Fraser University , Vancouver, BC , Canada 7 Institute for Intersectionality Research & Policy , Vancouver, BC , Canada 8 School of Social Work , UBC, Vancouver, BC , Canada 9 Faculty of Health Sciences, Simon Fraser University , Vancouver, BC , Canada 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. Intersectionality; Equity; Policy analysis; Reflexivity; Health - Introduction In the field of health, numerous frameworks (e.g., sex and gender based analysis, health equity impact assessments) have emerged over the last fifteen years, all attempting to advance better understandings of the differential impacts of health policies and to produce inclusive and socially just health outcomes [1-6]. Despite progress made to date, there is still much work to be done to better understand how policy affects diverse populations, including precisely identifying who is benefiting and who is excluded from health policy goals, priorities and related resource allocation. As part of the ongoing efforts to move forward work in this field, there is a growing interest in the theory of intersectionality and its potential to improve current equity-driven health policy analyses [7-10]. To date, however, this potential has not been realized, largely due to the fact that few methods have been developed to operationalize intersectionality in the context of health policy. In this paper, we describe an innovation for policy analysis that fills this gap: the Intersectionality-Based Policy Analysis (IBPA) Framework. Developed and refined through an iterative, participatory process inclusive of multiple sectors, IBPA is intended to capture and respond to the multi-level interacting social locations, forces, factors and power structures that shape and influence human life and health. Its aim as a policy tool is to better illuminate how policy constructs individuals and groups relative power and privileges vis--vis their socio-economicpolitical status, health and well-being. Significantly, we also present a synthesis of seven health-related policy case studies based on this Framework. The purpose of this synthesis is not to provide a detailed overview of each case study, which is available elsewhere [11] but rather to clearly and succinctly distill the value and benefit of conducting IBPA in relation to these diverse areas of policy. As such, 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. The aim of this paper is to inspire policy practitioners and 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. Intersectionality Rooted in a long and deep history of Black feminist writing, Indigenous feminism, third world feminism, and queer and postcolonial theory [12-16], intersectionality has emerged as a widely respected, albeit variously defined research and policy paradigm [17]. Nevertheless, there are a number of central tenets that capture the unique nature of this paradigm. These are: human lives cannot be reduced to single characteristics; human experiences cannot be accurately understood by prioritizing any one single factor or constellation of factors; social categories/locations, such as race/ethnicity, gender, class, sexuality and ability, are socially constructed, and dynamic social locations are inseparable and shaped by interacting and mutually constituting social processes and structures, which, in turn, are shaped by power and influenced by both time and place; and the promotion of social justice and equity are paramount [8,11]. Intersectionality encourages critical reflection that allows researchers and decision makers to move beyond the singular categories that are typically favoured in equitydriven analyses (e.g., sex and gender in sex and gender based analysis) and also beyond the kind of enumerated list of determinants of health often found in health impact assessments to consider the complex relationships and interactions between social locations such as Indigeneity, sexuality, gender expression, immigration status, age, ability and religiona. This enables an examination of the simultaneous impact of and resistance to systems and structures of oppression and d (...truncated)