Intersectionality, governance and health inequity

Health inequity is one of the most challenging, unjust and urgent global health issues. It refers to systematic differences in health between groups or populations that are often driven by social, economic, political and environmental factors. Effective health governance is particularly critical to addressing health inequity. Health governance

involves instruments, policies, rules and norms that shape and steer strategies and policies influencing health in a certain region. It is driven by a range of actors across governments, bilateral and multilateral bodies, civil society organisations and the private sector. With effective leadership, inter-sectoral coordination and accountability, health

governance presents the potential to structurally address health inequity through mechanisms such as policymaking, priority-setting, resource allocation and regulation. However, the structural drivers of health inequity, such as race and gender, are not unitary; they are overlapping, interconnected and synergistic. This poses theoretical and

technical challenges to health governance that seeks to systematically address health inequity. With a genealogy in Black feminist and critical theory scholarship stretching back over two centuries, intersectionality posits that systems of privilege, discrimination and oppression are interdependent, mutually constitutive and multiplicative. Distinct from a

single-axis analysis that inevitably decomposes human lives into single attributes, intersectionality offers a critical lens to understand the complex interplay between interlocking socio-political structures, e.g. race, gender and class, that (re-)produce complex power relations and processes that shape social locations, identities and

inequalities. Thus, incorporating intersectionality into health governance presents a transformative opportunity for health equity and emancipation. Intersectionality as a framework can enable critical analysis that illuminates interlocking structures that perpetuate health inequity, informing the action - the what, how and why - of health governance to

dismantle those structures. Nevertheless, relatively little about this has been studied. Aim Broadly, this PhD project aims to explore intersectionality in health governance as a means to address structural drivers of health inequity. A particular health inequityrelated challenge (e.g. a health condition or policy) will be chosen as a device for this

enquiry. This project will potentially involve a multi-country partnership led by Global Health 50/50. As an explicitly transdisciplinary project, this work will draw on experts and expertise from health policy, political science, sociology and epidemiology. Methodology This project is envisioned to be multi-/mixed-methods, involving a series of

complementary work packages (WPs) executed using state-of-the-art methods. An overarching theoretical framework will be chosen - or generated - to guide this project. Focusing on the chosen health issue, the following WPs are proposed (subject to change): 1) WP1: A systematic/scoping review exploring the current literature in this field;

2) WP2: An epidemiological analysis using a quantitative intersectionality approach, e.g. the MAIHDA method; 3) WP3: A multi-country comparative policy case study involving documentary analysis and interviews with policy and political elites; 4) WP4: A power/political economy analysis (that draws on insights from previous

WPs); and 5) WP5: Crystallising previous WPs using the theoretical framework of choice and generating policy recommendations. Potential risks include logistical challenges, e.g. travelling and research ethics approval, in undertaking multi-country research. Contribu7ons This is a transdisciplinary endeavour that will yield novel knowledge that has profound

implications - both theoretical and practical - for scholars, policymakers and activists who seek to advance health equit