Beyond Economic Barriers: Intersectionality and Health Policy in Low- and Middle-Income Countries

Abstract

Intersectionality—a framework for understanding how multiple sources of power and disadvantage intersect and influence behaviours, practices, and outcomes—increasingly drives a growing body of research the world over. More recent work also focuses on translating these concepts and evidence into the policy sphere. This chapter explores the concepts of deep poverty, hyper entitlements, rationing, and leveraging as linked to the positionality and voice of different groups in the intersectional socioeconomic order. Both positionality and voice are important in determining what policies are enacted, how they come into being and are implemented, and what their impact might be on specific groups. The authors argue that for groups at both extremes of the socioeconomic order, important sources of inequality tend to reinforce each other, albeit in opposing directions. Synergies of this kind do not hold for groups in the middle of the order for whom different sources of advantage and disadvantage may work against each other. These differences also account for the shifting positionality and voice of particular groups across geographic locales and time. They shape the fluidity of relations among groups, as manifested in complex politics of accommodation, negotiation, collaboration, and opposition, with important implications for policy formulation and implementation.