Healthy ageing at the intersections: research and policy perspectives

CHRONIC DISEASE AND HEALTHY AGEING AT THE INTERSECTIONS�

• Chronic diseases costly and entail health inequity.
• Single disease model does not match real world complexity.
• Move from ‘one size fits all’ to ‘what works for whom’.
• Two year ESRC funded project, involved methodological, empirical, conceptual and stakeholder work.
• Today’s audience is diverse: range of organisations/roles both academic and non-academic.
• This is an end of project event, but its not the end! http://intersectionalhealth.org.
• We gratefully acknowledge support from the ESRC and thank all our collaborators, policy and practice partners, respondents, participants and advisory board members.

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Intersectionality in a life course perspective

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Aims

1. Give a brief overview of the life course and intersectionality.
2. Explore how the frameworks speak to each other conceptually.
3. Discuss some policy implications of an intersectional life course approach.

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The Life Course Framework

Halfon et al 2014

Example concepts:

Social roles e.g. mother, employee

Life stage e.g. retirement

Transitions e.g. first job

Socio-historical contexts e.g. growing up in the pandemic.

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Example patterns of inequality:

Age/cohort – ageing in different time periods.

Trajectory – paths of change & development

Cumulative dis/advantage – diverging/converging inequality with age

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Two fundamental components of intersectionality

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Subgroup heterogeneity according to how gender, ethnicity, socioeconomic position, age inequalities (and potentially many other social markers) overlap/interact. Originally a focus on Black Women (Kimberlé Crenshaw).

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Social power. The power structures and processes that result in diverse intersectional outcomes. In particular, social discrimination via institutions such as schools, prisons, pensions, the family etc. that systematically exclude, marginalise and disadvantage on the basis of social characteristics.

The Intersectional Life Course

Heterogeneity

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Social roles

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Trajectories

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Transitions

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Socio-historical context

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Intersectionality

The life course

A chief concern with gender and ethnicity, later socioeconomic position (but rarely age)

A chief concern with age and gender, ethnicity, SEP (but rarely together)

Different intersectional ‘locations’ are associated with different identities and social roles

We pass through different roles as we age – different identities, expectations,

Trajectories are the result of life-long experiences of social factors/context

Mostly absent; has rarely considered trajectories of inequality

Critical points in one’s life story and trajectory

Often entail institutional/policy encounters e.g. education, family work, pensions

Different contexts entail different configurations of discrimination ‘the matrix of domination’

Life experiences and ageing more generally strongly shaped by historical time period

Empirical examples

• Aisenbrey and Fasang (2018) examine work and family life courses and career outcomes; find that high prestige careers are mainly only accessible for Black men if they are in stable relationships with a maximum of one child.
• Richardson and Brown (2016) find a synergistic effect of ethnicity and gender on hypertension risk trajectories.
• Becares and Zhang (2018) accumulated interpersonal discrimination has a negative effect on the mental health of older ethnic minority women.
• Dressel and Barnhill (1994): For African American grandmothers age not a prominent source of social identity in the face of lifelong experiences of poverty, racism, sexism.

Policy implications

• Overall, an intersectional life course perspective suggests we should find the points in the life course where inequalities are established and widened and concentrate policy action there.
• Policy contexts such as the covid response and commercial determinants might be expected to result in widening intersectional inequalities.
• A powerful approach would be to use causal inference analysis to provide strong evidence that particular policies have resulted in widening intersectional inequalities e.g. welfare, tax, health & social care or pensions.
• People are impacted in different ways by multiple overlapping policies depending on their intersectional positions (‘institutional imbrication’) (Beckfield et al 2015).
• An empirical challenge: given imbrication and that the effects of institutional/policy exposure ripple across the life course, we are left with a complex picture.

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Conclusion

• An intersectional life course perspective offers powerful new possibilities to understand and generate action on inequalities.
• The basic tenets of such a perspective are that inequalities are cross-cutting (heterogenous) and have a time dimension (the lifecycle and historical time).
• Not all research can or should incorporate all elements at the same time but should consider their potential importance.
• There are good existing empirical examples, but many rich new possibilities.
• A priority should be to identify policies and institutional arrangements that result in intersectional inequality across the life course (policy levers).