Inequality in health, social determinants, and intersectionality: a systematic review/Desigualdade em saúde, determinantes sociais, e interseccionalidade: uma revisão sistemática

Olinda do Carmo Luiz, Marcia Thereza Couto, Elda de Oliveira, Marco Antonio Separavich


The intersectionality seek to expand the explanations for inequalities in health in contemporary society. This study sought to map the conceptual and methodological approach of intersectionality using quantitative data analysis studies on health inequalities. Systematic review was held in April 2017 using multiple sources of information. In-clusion criteria were articles that converged with the themes of health care dispari-ties, gender identity, ethnic groups, social class, and public health and that simulta-neously applied the concept of intersectionality in the analysis. Exclusion criteria were articles that only mentioned intersectionality without discussing its applicability and articles exclusively theoretical and conceptual or with a qualitative methodolog-ical approach. The search strategy resulted in 1,763 articles. After removing the du-plicates and articles by titles and abstracts, 20 articles composed the corpus of analysis of the review. The methodological resources most often used in the intersec-tional analyses were stratification of social markers of difference, interaction analysis, multivariate regression models, and multilevel analysis. The perspective of inter-sectionality allows for a greater specificity in mapping health disparities. However, caution is required in the subdivision of the population arising from the stratification of variables, without forgetting to focus on the interactive systems of power at the source of health inequalities.


ethnicity, gender, health Inequality, intersectionality, race, social determinants

Full Text:



Marmot M, Allen JJ. Social Determinants of Health Equity. Am J Public Health. 2014; 104(Suppl 4): S517–S519.

Lima BM. Health inequalities: a global perspective. Ciênc. saude coletiva. 2017;22(7):2097-2108.

Barreto ML. Desigualdades em Saúde: uma perspectiva global. Ciênc. saude coletiva. 2017;22:2097-2108.

Bhugra D. Commentary: Social determinants, social discrimination, social justice, and social responsibility. Int J Epidemiol. 2017;46(4):1333–1335.

Caiola C, Docherty S, Relf, M, Barroso, J. Using an intersectional approach to study the impact of social determinants of health for African American mothers living with HIV. Adv Nurs Sci. 2017; 37(4):287-98.

Nygren KG, Olofsson A. Intersectional approaches in health-risk research: A critical review. Sociol Compass. 2014;8(9):1112-26.

Koh HH, Oppenheimer SC, Massin-Short SB, et al. Translating Research Evidence into Practice to Reduce Health Disparities: A Social Determinants Approach. Am J Public Health. 2010;100(Suppl 1):S72-S80.

Donkin A, Goldblatt P, Allen J, Nathanson V, et al. Global action on the social determinants of health. BMJ Glob Health. 2017; 3:e000603.

Ravindran TKS. Commentary: Beyond the socioeconomic in The Health Gap: gender and intersection-ality. Int J Epidemiol. 2017;46(4):1321–1322.

Viruell-Fuentes EA, Miranda PY, Abdulrahim S. More than culture: structural racism, intersectionality theory, and immigrant health. Soc Sci Med. 2012;75:2099–106.

Bambra C. Health inequalities and welfare state regimes: theoretical insights on a public health ‘puzzle’. J Epidemiol Community Health. 2011; 65(9):740-5.

Weber L, Parra-Medina D. Intersectionality and womens health: charting a path to eliminating health dispari-ties. In: Segal MT, Demos V, Kronenfeld JJ (eds). Gender Perspectives on Health and Medicine: New York: Emerald Group; 2003. p. 181–230

Roura M. Unravelling migrants’ health paradoxes: a transdisciplinary research agenda J Epidemiol Community Health. 2017;71:870-873.

Bowleg L. The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Public Health. 2012;102(7):1267-73

Hankivsky O, Cristoffersen A. Intersectionality and the determinants of health: a Canadian perspective. Crit Public Health. 2008; 108(3): 271-83.

Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc. Sci. Med. 2014;110:10-17.

Moher D, Liberati A, Tetzlaff J, et al. Preferred Reporting Itens for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLos Med. 2009; 6(6): e1000097.

Austin SB, Nelson LA, Birkett MA, et al. Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students. Am J Public Health. 2013 Feb;103(2):e16-22.

Bengiamin MI, Capitman JA, Ruwe MB. Disparities in initiation and adherence to prenatal care: impact of insurance, race-ethnicity and nativity. Matern Child Health. J 2010; 14(4):618-24.

Blom N, Huijts T, Kraaykamp G. Ethnic health inequalities in Europe. The moderating and amplifying role of healthcare system characteristics. Soc. Sci. Med. 2016; 158:43-51.

Brown TH, Richardson LJ, Hargrove TW, et al. Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age. J Health Soc Behav. 2016;57(2):200-22.

Collins TW, Grineski SE, Chakraborty J, et al. Understanding environmental health inequalities through comparative intra categorical analysis: Racial/ethnic disparities in cancer risks from air toxics in El Paso County, Texas. Health Place. 2011; 17:335-44.

Cummings JL, Jackson PB. Race, gender, and SES disparities in self-assessed health, 1974-2004. Res Aging. 2008;30(2):137-68.

Etherington N. Race, Gender, and the Resources That Matter: An Investigation of Intersectionality and Health. Women Health. 2015;55(7):754-77.

Hinze SW, Lin J, Andersson TE. Can we capture the intersections? older black women, education, and health. Womens Health Issues. 2012;22(1):e91-e8.

Joe W. Intersectional inequalities in immunization in India, 1992-93 to 2005-06: a progress assessment. Health Policy Plan. 2015;30(4):407-22.

LeVasseus MT, Kelvin EA, Grosskopf NA. Intersecting Identities and the Association Between Bullying and Suicide Attempt Among New York City Youths: Results From the 2009 New York City Youth Risk Behavior Survey. Am J Public Health. 2013;103(6):1082-1089.

Millard AD, Raab G, Lewsey J et al. Mortality differences and inequalities within and between 'protected characteristics' groups, in a Scottish Cohort 1991-2009. Int J Equity Health. 2015; 14:142.

Novak NL, Geronimus AT, Martinez CAM. Change in birth outcomes among infants born to Latina mothers after a major immigration raid. Int J Epidemiol. 2017;46(3): 839–849.

Patterson AC, Veenstra G. Black-White health inequalities in Canada at the intersection of gender and immigration. Can J Public Health. 2016;107(3):e278-e84.

Sen G, Iyer A, Mukherjee C. A Methodology to Analyse the Intersections of Social Inequalities in Health. J Hum Dev Capab. 2009;10(3):397-415.

Sen G, Iyer A. Who gains, who loses and how: Leveraging gender and class intersections to secure health entitlements. Soc. Sci. Med. 2012;74(11):1802-11.

Veenstra G, Patterson AC. South Asian-White health inequalities in Canada: intersections with gender and immigrant status. Ethn Health. 2016;21(6):639-48.

Veenstra G. Race, gender, class, and sexual orientation: Intersecting axes of inequality and self-rated health in Canada. Int J Equity Health. 2011;10(1):3.

Warner DF, Brown TH. Understanding how race/ethnicity and gender define age-trajectories of disability: An intersectionality approach. Soc. Sci. Med .2011;72(8):1236-48.

Wemrell M, Mulinari S, Merlo J. Intersectionality and risk for ischemic heart disease in Sweden: Categorical and anti-categorical approaches. Soc. Sci. Med. 2017;177:213-22.

Lopes LP, Carvalho MGF, Araújo LMB. Diversidade de gênero e acesso à saúde: concepção dos estudantes de medicina e enfermagem do centro universitário de Patos de Minas. Braz J Hea Ver. 2019; 2(4): 3286-3302.

Richardson LJ, Brown TH. (En)gendering racial disparities in health trajectories: A life course and intersectional analysis. SSM Popul Health. 2016;2:425-35.



  • There are currently no refbacks.