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An Intersectionality-Based Policy Analysis Framework: Critical Reflections on a Methodology for Advancing Equity

  • Olena HankivskyEmail author
  • Daniel Grace
  • Gemma Hunting
  • Melissa Giesbrecht
  • Alycia Fridkin
  • Sarah Rudrum
  • Olivier Ferlatte
  • Natalie Clark
Chapter
Part of the The Politics of Intersectionality book series (POLI)

Abstract

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. This chapter presents the development of an important contribution to these efforts—an Intersectionality-Based Policy Analysis (IBPA) Framework that 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, this chapter presents the application of the IBPA Framework in seven priority health-related policy case studies. The aim of this chapter 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.

References

  1. Adelson, N. (2005). The Embodiment of Inequity: Health Disparities in Aboriginal Canada. Canadian Journal of Public Health, 96(Suppl 2), S45–S61.Google Scholar
  2. Armstrong, P., & Armstrong, H. (1996). Wasting Away: The Undermining of Canadian Health Care. Toronto, ON: Oxford University Press.Google Scholar
  3. Benoit, C., Carroll, D., & Millar, A. (2002). But Is It Good for Non-urban Women’s Health? Regionalizing Maternity Care Services in British Columbia. Canadian Review of Sociology, 39(4), 373–395.  https://doi.org/10.1111/j.1755-618X.2002.tb00626.x.CrossRefGoogle Scholar
  4. Bishwakarma, R., Hunt, V. H., & Zajicek, A. (2008). Beyond One-Dimensional Policy Frameworks: A Practical Guide for an Intersectional Policy Analysis. Himalayan Research Bulletin, 27(1–2), 19–30.Google Scholar
  5. Bowleg, L. (2008). When Black + Lesbian + Woman ≠ Black Lesbian Woman: The Methodological Challenges of Qualitative and Quantitative Intersectionality Research. Sex Roles, 59, 312–325.  https://doi.org/10.1007/s11199-008-9400-z.CrossRefGoogle Scholar
  6. British Columbia Aboriginal Maternal Health Project. (2006). Aboriginal Maternal Health in Canada: A Toolbox (Draft). Victoria, BC: BC Ministry of Health.Google Scholar
  7. British Columbia Centre for Disease Control. (2009). Annual Surveillance Report: HIV and Sexually Transmitted Infections 2009. Vancouver, BC: British Columbia Centre for Disease Control, STI/HIV Prevention and Control.Google Scholar
  8. British Columbia Perinatal Health Program [BCPHP]. (2010). BCPHP Obstetric Guideline 19: Maternity Care Pathway. Vancouver, BC: BCPHP.Google Scholar
  9. Bryant, T. (2009). An Introduction to Health Policy. Toronto, ON: Canadian Scholar’s Press.Google Scholar
  10. Bunjun, B. (2010). Feminist Organizations and Intersectionality: Contesting Hegemonic Feminism. Atlantis, 34(2), 115–126.Google Scholar
  11. Carstairs, S. (2005, June). Still Not There. Quality End-of-Life Care: A Progress Report. Retrieved from http://www.chpca.net/media/7883/Still_Not_There_June_2005.pdf.
  12. Clark, N. (2012). Perseverance, Determination and Resistance: An Indigenous Intersectional-Based Policy Analysis of Violence in the Lives of Indigenous Girls. In O. Hankivsky (Ed.), An Intersectionality Based Policy Analysis Framework (pp. 133–159). Vancouver, BC: Institute for Intersectionality Research & Policy, Simon Fraser University.Google Scholar
  13. Cole, E. (2008). Coalitions as a Model for Intersectionality: From Practice to Theory. Sex Roles, 59, 443–453.  https://doi.org/10.1007/s11199-008-9419-1.CrossRefGoogle Scholar
  14. Cole, B. L., & Fielding, J. E. (2007). Health Impact Assessment: A Tool to Help Policy Makers Understand Health Beyond Health Care. Annual Review of Public Health, 28, 393–412.  https://doi.org/10.1146/annurev.publhealth.28.083006.131942.CrossRefGoogle Scholar
  15. Community-Based Research Centre. (2006). Setting the Agenda: Report on the First Gay Men’s Health Summit in British Columbia. Vancouver, BC: Community-Based Research Centre.Google Scholar
  16. Crenshaw, K. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Politics. The University of Chicago Legal Forum, 1989, 139–167.Google Scholar
  17. Crenshaw, K. (1991). Mapping the Margins: Intersectionality, Identity Politics, and Violence Against Women of Color. Stanford Law Review, 43(6), 1241–1299.  https://doi.org/10.2307/1229039.CrossRefGoogle Scholar
  18. Dej, E. (2011). What Was Once Sick Is Now Bad: The Shift from Victim to Deviant Identity for Those Diagnosed with Fetal Alcohol Spectrum Disorder. The Canadian Journal of Sociology, 36(2), 137–160.Google Scholar
  19. Dowsett, G. W., Bollen, J., McInnes, D., Couch, M., & Edwards, B. (2001). HIV/AIDS and Constructs of Gay Community Researching Educational Practice Within Community-Based Health Promotion for Gay Men. International Journal of Social Research, 4(3), 205–223.  https://doi.org/10.1080/13645570121259.CrossRefGoogle Scholar
  20. Eppley, K. (2009). Rural Schools and the Highly Qualified Teacher Provision of No Child Left Behind: A Critical Policy Analysis. Journal of Research in Rural Education, 24(4), 1–11.Google Scholar
  21. Exley, C. (2004). Review Article: The Sociology of Dying, Death and Bereavement. Sociology of Health & Illness, 26(1), 110–122.  https://doi.org/10.1111/j.1467-9566.2004.00382.x.CrossRefGoogle Scholar
  22. Fiske, J., & Browne, A. J. (2008). 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]. Vancouver, BC: BCCEWH.Google Scholar
  23. Fredericks, B., Adams, K., & Edwards, R. (2011). Aboriginal Community Control and Decolonizing Health Policy: A Yarn from Australia. In H. Löfgren, M. Leahy, & E. D. Leeuw (Eds.), Democratizing Health: Consumer Groups in the Policy Process (pp. 81–96). Northampton, MA: Edward Elgar Publishing, Inc.Google Scholar
  24. Fridkin, A. J. (2012). Addressing Health Inequities Through Indigenous Involvement in Health-Policy Discourses. The Canadian Journal of Nursing Research, 44(2), 108–122.Google Scholar
  25. Gagnon, A. J., Wahoush, O., Dougherty, G., Saucier, J. F., Dennis, C. L., Merry, L., et al. (2006). The Childbearing Health and Related Service Needs of Newcomers (CHARSNN) Study Protocol. BMC Pregnancy Childbirth, 6(31).  https://doi.org/10.1186/1471-2393-6-31.
  26. Grace, D. (2010). When Oppressions and Privileges Collide: A Review of Research in Health, Gender and Intersectionality in Late (Post) Modernity. The Canadian Journal of the Humanities and Social Sciences, 1(1), 20–24.Google Scholar
  27. Grace, D. (2012). Reconceiving the ‘Problem’ in HIV Prevention: HIV Testing Technologies and the Criminalization of HIV Non-disclosure. In O. Hankivsky (Ed.), An Intersectionality Based Policy Analysis Framework (pp. 161–187). Vancouver, BC: Institute for Intersectionality Research & Policy, Simon Fraser University.Google Scholar
  28. Grace, D. (2013). Legislative Epidemics: The Role of Model Law in the Transnational Trend to Criminalise HIV Transmission. Medical Humanities, 39(2), 77–84.  https://doi.org/10.1136/medhum-2012-010336.CrossRefGoogle Scholar
  29. Grace, D., & McCaskell, T. (2013). We Are Not Criminals: Activists Working to Address the Criminalization of HIV Non-disclosure. In R. A. Smith (Ed.), Global HIV/AIDS Politics, Policy, and Activism (pp. 353–375). Santa Barbara, CA: Praeger.Google Scholar
  30. Grande, S. (2004). Red Pedagogy: Native American Social and Political Thought. Toronto, ON: Rowman & Littlefield Publishers, Inc.Google Scholar
  31. Haber, R. (2010). Health Equity Impact Assessment: A Primer. Toronto, ON: Wellesley Institute.Google Scholar
  32. Hancock, A. M. (2007). When Multiplication Doesn’t Equal Quick Addition: Examining Intersectionality as a Research Paradigm. Perspectives on Politics, 5(1), 63–78.  https://doi.org/10.1017/S1537592707070065.CrossRefGoogle Scholar
  33. Hancock, A. M. (2011). Solidarity Politics for Millennials: A Guide to Ending the Oppression Olympics. New York: Palgrave Macmillan.CrossRefGoogle Scholar
  34. Hankivsky, O. (2011). Health Inequities in Canada: Intersectional Frameworks and Practices. Vancouver, BC: UBC Press.Google Scholar
  35. Hankivsky, O. (2012). An Intersectionality-Based Policy Analysis Framework. Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University.Google Scholar
  36. Hankivsky, O., & Cormier, R. (2009). Intersectionality: Moving Women’s Health Research and Policy Forward. Vancouver: Women’s Health Research Network.Google Scholar
  37. Hankivsky, O., & Cormier, R. (2011). Intersectionality and Public Policy: Some Lessons from Existing Models. Political Research Quarterly, 64(1), 217–229.  https://doi.org/10.1177/1065912910376385.CrossRefGoogle Scholar
  38. Hankivsky, O., Reid, C., Cormier, R., Varcoe, C., Clark, N., Benoit, C., et al. (2010). Exploring the Promises of Intersectionality-Type Methodologies for Advancing Women’s Health Research. International Journal for Equity in Health, 9(5), 1–15.Google Scholar
  39. Hankivsky, O., Grace, D., Hunting, G., & Ferlatte, O. (2012). Introduction: Why Intersectionality Matters for Health Equity and Policy Analysis. In O. Hankivsky (Ed.), An Intersectionality-Based Policy Analysis Framework (pp. 7–30). Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University.Google Scholar
  40. Health Canada. (2006). It’s Your Health: Fetal Alcohol Spectrum Disorder. Ottawa, ON: Health Canada.Google Scholar
  41. Health Canada. (2010). Sex and Gender-Based Analysis (SGBA). Retrieved from http://www.hc-sc.gc.ca/hl-vs/gender-genre/analys/gender-sexes-eng.php.
  42. Hill Collins, P. (1990). Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York: Routledge.Google Scholar
  43. Hill Collins, P. (2000). Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. 2. New York: Unwin Hyman.Google Scholar
  44. Hunting, G., & Browne, A. J. (2012). Decolonizing Policy Discourse: Reframing the ‘Problem’ of Fetal Alcohol Spectrum Disorder. Women’s Health Urban Life, 11(1), 35–53.Google Scholar
  45. Loppie-Reading, C., & Wien, F. (2009). Health Inequalities and Social Determinants of Aboriginal Peoples’ Health. National Collaborating Centre for Aboriginal Health: Prince George, BC.Google Scholar
  46. Mahoney, M., Simpson, S., Harris, E., Aldrich, R., & Stewart, W. J. (2004). Equity Focused Health Impact Assessment Framework. Sydney, Australia: The Australasian Collaboration for Health Equity Impact Assessment.Google Scholar
  47. Marchand, R. (2001). Moving Ahead: Assessing Gay Men’s HIV Prevention in BC. Vancouver, BC: British Columbia Centre for Disease Control.Google Scholar
  48. Maternity Care Enhancement Project. (2004). Supporting Local Collaborative Models for Sustainable Maternity Care in British Columbia: Recommendations from the Maternity Care Enhancement Project. Victoria, BC: BC Ministry of Health.Google Scholar
  49. Ministry of Children and Family Development. (2003). Child and Youth Mental Health Plan for BC. Victoria, BC: Government of BC.Google Scholar
  50. Ministry of Children and Family Development. (2008). Fetal Alcohol Spectrum Disorder: Building on Strengths. A Provincial Plan for 2008–2018. Vancouver, BC: Ministry of Children and Family Development.Google Scholar
  51. Parken, A. (2010). A Multi-strand Approach to Promoting Equalities and Human Rights in Policy Making. Policy and Politics, 38(1), 79–99.  https://doi.org/10.1332/030557309X445690.CrossRefGoogle Scholar
  52. Parken, A., & Young, H. (2007). Integrating the Promotion of Equality and Human Rights for All. Unpublished report for the Welsh Assembly Government and Equality and Human Rights Commission. Cardiff, Wales: Towards the Commission of Equality and Human Rights.Google Scholar
  53. Patterson, L. L. (2006). Aboriginal Roundtable to Kelowna Accord: Aboriginal Policy Negotiations, 2004–2005. Ottawa, ON: Parliamentary Information and Research Service, Library of Parliament.Google Scholar
  54. Peterson, W. E., Medves, J. M., Davies, B. L., & Graham, I. D. (2007). Multidisciplinary Collaborative Maternity Care in Canada: Easier Said Than Done. Journal of Obstetrics and Gynaecology Canada, 29(11), 880–886.CrossRefGoogle Scholar
  55. Phoenix, A., & Pattynama, P. (2006). Intersectionality. European Journal of Women’s Studies, 13, 187–192.  https://doi.org/10.1177/1350506806065751.CrossRefGoogle Scholar
  56. Quality End of Life Care Coalition of Canada. (2010). Blueprint for Action 2010 to 2020. A Progress Report. Retrieved from http://www.qelccc.ca/media/3749/eng_progress_report_20102012-07-10_2.pdf.
  57. Reimer-Kirkham, S., & Anderson, J. M. (2010). The Advocate-Analyst Dialectic in Critical and Postcolonial Feminist Research: Reconciling Tensions Around Scientific Integrity. Advances in Nursing Science, 33(3), 196–205.  https://doi.org/10.1097/ANS.0b013e3181e4a7d3.CrossRefGoogle Scholar
  58. Representative for Children and Youth & Office of the Provincial Health Officer. (2009). Kids, Crime and Care: Health and Well-Being of Children and Care. Youth Justice Experiences and Outcomes. Victoria, BC: Representative for Children and Youth.Google Scholar
  59. Rönnblom, M. (2008, September). Policy, Power and Space: Towards an Intersectionality Methodology in Policy Analysis. Paper presented at the POWER Conference, Tampere, Finland.Google Scholar
  60. Salmon, A. (2004). ‘It Takes a Community’: Constructing Aboriginal Mothers and Children with FAS/FAE as Objects of Moral Panic in/Through a FAS/FAE Prevention Policy. Journal of the Association for Research on Mothering, 6(1), 112–123.Google Scholar
  61. Seale, C. (1998). Constructing Death: The Sociology of Dying and Bereavement. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  62. Sen, G., Iyer, A., & Mukherjee, C. (2009). A Methodology to Analyse the Intersections of Social Inequalities in Health. The Journal of Human Development and Capabilities, 10(3), 397–415.  https://doi.org/10.1080/19452820903048894.CrossRefGoogle Scholar
  63. Signal, L., Martin, J., Cram, F., & Robson, B. (2008). Health Equity Assessment Tool: A User’s Guide. Wellington: New Zealand Ministry of Health.Google Scholar
  64. Simpson, S., Harris, E., & Harris-Roxas, B. (2004). Health Impact Assessment: An Introduction to the What, Why and How. Health Promotion Journal of Australia, 15(2), 162–167.CrossRefGoogle Scholar
  65. Skinner, M. W., & Rosenberg, M. W. (2005). Co-opting Voluntarism? Exploring the Implications of Long-Term Care Reform for the Nonprofit Sector in Ontario. Environment and Planning C, 23(1), 101–121.  https://doi.org/10.1068/c0434.CrossRefGoogle Scholar
  66. Smith, J. D., & Yee, J. (2009). Building a Highway of Hope. Toronto, ON: The Highway of Tears Initiative.Google Scholar
  67. Stajduhar, K. I. (2003). Examining the Perspectives of Family Members Involved in the Delivery of Palliative Care at Home. Journal of Palliative Care, 19, 27–35.Google Scholar
  68. Tait, C. L. (2008). Simmering Outrage During an ‘Epidemic’ of Fetal Alcohol Syndrome. Canadian Woman Studies, 26(3/4), 69–76.Google Scholar
  69. Turner, B. S. (1995). Medical Power and Social Knowledge. London: Sage.Google Scholar
  70. Van Herk, K. A., Smith, D., & Andrew, C. (2011). Identity Matters: Aboriginal Mothers’ Experiences of Accessing Health Care. Contemporary Nurse, 37(1), 57–68.  https://doi.org/10.5172/conu.2011.37.1.057.CrossRefGoogle Scholar
  71. Weber, L., & Fore, M. E. (2007). Race, Ethnicity, and Health: An Intersectional Approach. In H. Vera & J. R. Feagin (Eds.), Handbooks of the Sociology of Racial and Ethnic Relations (pp. 191–218). New York: Springer.CrossRefGoogle Scholar
  72. Weber, L., & Parra-Medina, D. (2003). Intersectionality and Women’s Health: Charting a Path to Eliminating Health Disparities. Advances in Gender Research, 7(3), 181–230.  https://doi.org/10.1016/S1529-2126(03)07006-1.CrossRefGoogle Scholar
  73. Williams, A. M., Crooks, V. A., Whitfield, K., Kelley, M. L., Richards, J. L., & Dykeman, S. (2010). Tracking the Evolution of Hospice Palliative Care in Canada: A Comparative Case Study Analysis of Seven Provinces. BMC Health Services Research, 10, 147.  https://doi.org/10.1186/1472-6963-10-147.CrossRefGoogle Scholar
  74. Wilson, D. P. (2012). HIV Treatment as Prevention: Natural Experiments Highlight Limits of Antiretroviral Treatment as HIV Prevention. PLoS Medicine, 9(7), e1001231.  https://doi.org/10.1371/journal.pmed.1001231.CrossRefGoogle Scholar
  75. Yuval-Davis, N. (2006). Intersectionality and Feminist Politics. European Journal of Women’s Studies, 13(3), 193–209.  https://doi.org/10.1177/1350506806065752.CrossRefGoogle Scholar

Copyright information

© The Editor(s) (if applicable) and The Author(s), under licence to Spring Nature Switzerland AG, part of Springer Nature 2019

Authors and Affiliations

  • Olena Hankivsky
    • 1
    Email author
  • Daniel Grace
    • 2
  • Gemma Hunting
    • 3
  • Melissa Giesbrecht
    • 4
  • Alycia Fridkin
    • 5
  • Sarah Rudrum
    • 6
  • Olivier Ferlatte
    • 7
  • Natalie Clark
    • 8
  1. 1.School of Public Policy, Institute for Intersectionality Research and PolicySimon Fraser UniversityVancouverCanada
  2. 2.University of TorontoTorontoCanada
  3. 3.Institute for Intersectionality Research and PolicySimon Fraser UniversityVancouverCanada
  4. 4.University of VictoriaVictoriaCanada
  5. 5.Provincial Health Services AuthorityVancouverCanada
  6. 6.Acadia UniversityWolfvilleCanada
  7. 7.British Columbia Centre on Substance UseVancouverCanada
  8. 8.Faculty of Education and Social WorkThompson Rivers UniversityKamloopsCanada

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