Intersections of Gender, Ethnicity, and Socioeconomic Position in Health in England: A Mixed Methods Study

Background: Social inequalities in health represent one of the greatest challenges to public health today. Traditionally, studies investigating health inequalities have treated gender, ethnicity, and socioeconomic position as independent and additive explanatory variables. Consequently, important health inequalities that exist at the intersection of social groups remain invisible and unaccounted for. Aim: An intersectionality framework was employed to investigate the role of intersections of gender, ethnicity and socioeconomic position in explaining health inequalities among adults living in England. The objectives of the study were firstly, to establish whether intersections of gender, ethnicity, and socioeconomic position in health are present among adults in England, and secondly, to explore the contextual and explanatory factors perceived to underlie these intersections. Methods: A sequential explanatory mixed methods design comprising a quantitative phase followed by a qualitative phase was employed. In the quantitative phase, data from the Health Survey for England 2004 were analysed to test for significant interaction effects between gender, ethnicity, and socioeconomic indicators, with three measures of subjective health. In the qualitative phase, a subset of significant interactions relating to Pakistani and White English survey participants were explored using semi-structured interviews with 25 Pakistani and White English women recruited in South Yorkshire. Findings: The quantitative analysis identified 15 significant interaction effects (P<0.05). Each dimension of inequality (i.e. gender, ethnicity, socioeconomic position) was found to significantly interact with at least one other on one or more health outcome. The qualitative analysis revealed how overlapping systems of discrimination were perceived to underlie the burden of poor health experienced among Pakistani women living in England. Conclusions: This thesis demonstrates both quantitative and qualitative evidence for intersections of gender, ethnicity, and socioeconomic position in health inequalities in England. These findings highlight the need for policies seeking to reduce social inequalities in health to take account of intersectionality.