Holman, D., Bell, A., Green, M. and Salway, S. (2022) Neighbourhood deprivation and intersectional inequalities in biomarkers of healthy ageing in England. Health & Place.

While social and spatial determinants of biomarkers have been reported, no previous study has examined both together within an intersectional perspective. We present a novel extension of quantitative intersectional analyses using cross-classified multilevel models to explore how intersectional positions and neighbourhood deprivation are associated with biomarkers, using baseline UK Biobank data (collected from 2006 to 2010). Our results suggest intersectional inequalities in biomarkers of healthy ageing are mostly established by age 40–49, but different intersections show different relationships with deprivation. Our study suggests that certain biosocial pathways are more strongly implicated in how neighbourhoods and intersectional positions affect healthy ageing than others.

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Holman, D., Salway, S., Bell, A., Beach, B., Adebajo, A., Ali, N., and Butt, J. (2020) Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. Health Research Policy and Systems.

The concept of “intersectionality” is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the United Kingdom and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field.
In this paper we seek to address that gap, drawing upon a consultation survey and face-to-face workshop (n = 23) undertaken in the United Kingdom. The survey included both researchers (n = 53) and policy and practice professionals (n = 20) with varied roles and levels of engagement in research and evaluation. Topics included familiarity with the term and concept “intersectionality”, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions: intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. The workshop aims were to share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approaches.
Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalized methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them.
We position intersectionality within the wider context of health inequalities policy and practice, suggesting potential ways forward for the approach in the context of the United Kingdom. The views of policy and practice professionals suggest that intersectionality has far to travel to help counter individualistic narratives and to encourage an approach that is sensitive to subgroup inequalities and the processes that generate them. Examples of promising practice, albeit mostly in North America, suggest that it is possible for intersectionality to gain traction.

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Holman, D. and Walker, A. (2020) Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses. European Journal of Ageing.

This paper aims to illustrate how intersectionality might be synthesised with a life course perspective to deliver novel insights into unequal ageing, especially with respect to health. From the intersectionality literature, it focusses on the concepts of intersectional subgroups, discrimination, categorisation, and individual heterogeneity, and from the life course literature, roles, life stages, transitions, age/cohort, cumulative disadvantage/advantage, and trajectories. Synergies between these concepts hold exciting opportunities to bring new insights to unequal ageing.

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Holman, D., Bell, A. and Salway, S. (2020) Mapping intersectional inequalities in biomarkers of healthy ageing and chronic disease in older English adults. Nature Scientific Reports.

This paper analyses intersectional inequalities in biomarkers of healthy ageing and chronic disease, in older adults using data pooled from the English Longitudinal Study of Ageing and the UK Household Longitudinal Study. It finds granular inequalities that vary according to biomarker. These inequalities are additive rather than multiplicative in nature and have significant clinical implications.

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Bell, A., Holman, D. and Jones, K. (2019) Using multilevel models to understand intersectionality: a simulation study and guide for best practice. Methodology.

This paper uses simulations to test a novel multilevel approach (termed ‘MAIHDA’) to intersectionality, comparing it with conventional regression approaches which typically use interaction terms. It finds that although this new approach needs further work and development to improve its statistical properties, it is overall an improvement on conventional approaches.

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