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Race, gender, course, and sexual orientation: intersecting axes of inequality and self-rated health in Canada

International Journal for Equity in Health book 10, Article number:3 (2011) Cite this article

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Abstruse

Background

Intersectionality theory, a fashion of agreement social inequalities by race, gender, class, and sexuality that emphasizes their mutually constitutive natures, possesses potential to uncover and explicate previously unknown health inequalities. In this paper, the intersectionality principles of "directionality," "simultaneity," "multiplicativity," and "multiple jeopardy" are applied to inequalities in self-rated wellness by race, gender, class, and sexual orientation in a Canadian sample.

Methods

The Canadian Community Wellness Survey two.1 (N = ninety,310) provided nationally representative data that enabled binary logistic regression modeling on fair/poor self-rated wellness in two analytical stages. The additive phase involved regressing self-rated wellness on race, gender, class, and sexual orientation singly and then every bit a set. The intersectional stage involved consideration of two-manner and three-fashion interaction terms between the inequality variables added to the full additive model created in the previous phase.

Results

From an additive perspective, poor self-rated wellness outcomes were reported by respondents claiming Aboriginal, Asian, or South Asian affiliations, lower class respondents, and bisexual respondents. However, each axis of inequality interacted significantly with at least one other: multiple jeopardy pertained to poor homosexuals and to South Asian women who were at unexpectedly high risks of off-white/poor self-rated wellness and mitigating effects were experienced by poor women and by poor Asian Canadians who were less likely than expected to report fair/poor health.

Conclusions

Although a variety of intersections between race, gender, class, and sexual orientation were associated with especially loftier risks of fair/poor self-rated health, they were not all consistent with the predictions of intersectionality theory. I conclude that an intersectionality theory well suited for explicating health inequalities in Canada should exist capable of accommodating axis intersections of multiple kinds and qualities.

Groundwork

Sizeable wellness inequalities by race [1, ii], gender [3, iv] and class [v] take been recorded in Canada. Consistent with traditional sociological understandings of social inequality, these axes of inequality have for the almost part been considered individually, with researchers only because potential interconnectedness when investigating whether form mediates associations between race and wellness or gender and wellness. Whether class influences health differently for visible minority Canadians and White Canadians or race influences health differently for men and women, for example, has not withal been investigated. When statistical interactions such every bit these accept received analytical attending - for example, whether class influences wellness differently for Canadian men and women [3] - they take not been fairly theorized. Intersectionality theory, an influential theoretical tradition inspired past the feminist and antiracist traditions, demands that inequalities by race, gender, and class (and sexuality likewise) be considered in tandem rather than distinctly. This is because these fundamental axes of inequality in contemporary societies are considered to be intrinsically entwined; they mutually constitute and reinforce ane some other and as such cannot exist disentangled from one another. Intersectionality theory presents a new way of understanding social inequalities that possesses potential to uncover and explain previously unknown health inequalities. This paper describes the results of an original empirical investigation of the caste to which the self-rated health of Canadians varies by race, gender, class, and/or sexual orientation in means that are consistent with predictions of intersectionality theory. The remainder of this background section describes some of the central principles of this theoretical tradition followed past a description of the analytical strategy used to employ these principles in an empirical investigation of inequalities in self-rated health in Canada.

Intersectionality theory

In the forwards to a recent volume on new theories and methods for studying race, course, and gender, Lynn Weber [six] describes how American women of colour in the 1970s and early on 1980s, many from working class backgrounds, came to critique the patriarchy tradition inside gender studies for privileging gender over race and class (and after critiqued the stratification tradition for privileging class over gender and race, etc.). They argued that these axes of inequality are in fact analytically inseparable, and that "the multidimensionality and interconnected nature of race, class, and gender hierarchies were especially visible to those who faced oppression along more i dimension of inequality" [vi:xii]. These scholars envisioned axes of inequality pertaining to gender, race, and form that intersect with 1 another, i.e., that are interlocked, dependent upon one some other, and mutually constituted [seven]. Power relationships along the lines of gender, race, and form were thought to be mutually defining and mutually reinforcing rather than analytically distinct systems of oppression, together forming a "matrix of domination" [viii]. By the mid-1980s, lesbians of color had bridged the gap betwixt gay and lesbian studies and the growing body of race, gender, and class research that had to that bespeak ignored heterosexism [half-dozen], and axes of inequality pertaining to national origin, citizenship status, organized religion, disability, and age besides received some attention. The contributions of these various scholars gave rise to what is now known as "intersectionality theory." Landry [9] notes, nonetheless, that intersectionality theory does not provide a set of propositions that together form an explanation; rather, intersectionality theory currently consists of a loose set up of principles or assumptions that are being applied and tested by many researchers in a variety of contexts.

Founded upon analyses of relations of power in general and inspired past theories of racism, patriarchy, classism, and heterosexism in item, in American intersectionality discourse the disadvantaged groups forth the inequality axes of race, gender, class, and sexual orientation are assumed to exist visible minorities from various backgrounds (especially African Americans), women, members of the lower and working classes, and gays, lesbians, and bisexuals. These incorporate implicit intersectionality assumptions of "directionality."

Intersectionality theorists argue that our identities based on race, gender, course, and sexuality accompany united states of america in every social interaction [7]. The principle of "simultaneity" maintains that all of the axes and their corresponding identities should exist incorporated into social analyses.

"Race, class and gender may all structure a situation but may not be equally visible and/or important in people's self-definitions... This recognition that one category may have salience over some other for a given time and place does not minimize the theoretical importance of assuming that race, grade and gender as categories of analysis structure all relationships" [7:560-1].

That is, while some axes and identities may be more pertinent to a specific social context or issue than are others, simultaneity implies that a social researcher should never discard an axis of inequality earlier investigating its potential relevance for the problem at hand.

Intersections between axes are idea to create complex social locations that are more central to the nature of social experiences than are any of the axes of inequality considered singly.

"People feel race, class, gender and sexuality differently depending upon their social location in the structures of race, class, gender and sexuality. For instance, people of the same race volition experience race differently depending upon their location in the grade structure as working class, professional person managerial class or unemployed; in the gender structure equally female person or male; and in structures of sexuality as heterosexual, homosexual or bisexual" [10:326-7].

Thus "multiplicativity" should supplant additivity [10]. Racism x sexism x classism 10 sexism should replace racism + sexism + classism + sexism [xi, 12]. A lower-class Black lesbian is necessarily all of these things, and their common manifestation represents a unique land of being and a unique set of social experiences and structural constraints.

"Race, course, gender and sexuality are not reducible to individual attributes to be measured and assessed for their separate contribution in explaining social outcomes, an arroyo that Elizabeth Spelman calls "pop-bead metaphysics," where a woman's identity consists of the sum of parts neatly divisible from i another. The matrix of domination seeks to account for the multiple ways that women experience themselves as gendered, raced, classed and sexualized" [10:327].

Experiences of gender are racialized, sexualized, and classed; experiences of class are gendered, racialized, and sexualized, etc.

From the abovementioned principles of directionality, simultaneity, and multiplicativity arise new versions of double jeopardy and triple jeopardy, renamed "multiple jeopardy" by Deborah Male monarch [11], wherein disadvantaged identities experienced in tandem are seen to result in inordinate, i.e., even more than condiment, amounts of disadvantage. Thus complex social locations comprised of disadvantaged identities held in tandem are thought to lead to multiplicative disadvantage; that is, combinations of these identities are thought to have an aggravating rather than a simply cumulative or mitigating effect. In addition, because of the relational nature of intersectional theories, some complex locations, such every bit the one inhabited by wealthy heterosexual White men, in turn feel multiplicative reward.

Despite the immense popularity of intersectionality theory in humanities and social sciences circles and the large and growing body of intersectionality enquiry that includes applications of both qualitative and quantitative methodologies, very picayune quantitative research has explicitly applied intersectionality theory to health outcomes. Withal, many wellness determinants researchers have unintentionally addressed simultaneity and multiplicativity past identifying two-way statistical interactions between axes of inequality in regression modeling. In Canada, Zheng Wu and colleagues [two] identified interactions between race and socioeconomic status for depression. In the United States, Ostrove and colleagues [13] identified interactions between socioeconomic condition and race equally predictors of self-rated health and low, Nomagushi [14] found interactions between race and gender on the effect of marital dissolution on depression, and Read and Gorman [15] determined that the gender gap in health differs widely by racial/ethnic group. Just but a few quantitative studies have explicitly studied illness states associated with complex social positions arising from intersections betwixt three axes of inequality [16–nineteen], none of them Canadian, and no studies have studied intersections betwixt all iv of the principal axes of inequality of intersectionality theory. Given the seeming complicity of all of race [2, twenty–23], gender [3, iv, 24], class [5, 25–29], and sexual orientation [30–33] in North American wellness inequalities, this lack of attending to health inequalities that accrue to multiple combinations of inequality identities represents an important gap in the wellness determinants literature.

Analytical strategy

Modeling the primary furnishings of inequality identities (additivity) and then statistical interactions between them (multiplicativity) in multivariate regression models on health can establish whether 2-style or three-way statistical interactions (intersections) between axes of inequality contribute to explaining variability in health above and across the additive approach to health inequalities that currently dominates health determinants research. This paper uses a two-stage analytical strategy, the showtime additive and the second multiplicative, applied to a big representative survey dataset from Canada in order to investigate health outcomes associated with intersections betwixt race, gender, class, and sexual orientation.

Showtime, the forcefulness and direction of the main effects in condiment regression models such as Race + Gender + Form + Sexual Orientation = Wellness addresses the principles of simultaneity and directionality. Simultaneity suggests that all four identities will make pregnant contributions to these models earlier and/or after controlling for one another while directionality implies that non-Whites, women, lower-class people, and non-heterosexuals volition manifest the poorer wellness outcomes.

Second, simultaneity and multiplicativity imply that the inequality identities should interact meaningfully with 1 some other as predictors of health, that is, statistical interactions between the inequality variables of race, gender, course, and sexual orientation should manifest meaning effects above and across their main effects in the abovementioned condiment models. The being of interactions speaks to multiplicativity. The qualities of the interactions themselves speak to multiple jeopardy and directionality. At least three multiplicative scenarios are possible for a given statistical interaction: one. two or more axes of inequality manifest directions of some kind or other in condiment models and then brandish an aggravating outcome in the interaction between them, 2. two or more than axes manifest given directions in condiment models and so display a mitigating event in their interaction, and 3. an interaction manifests itself betwixt two or more axes but not all of the axes display independent furnishings in additive models. Aggravating furnishings support the assumption of multiple jeopardy and reinforce the directionality identified in the additive models whereas non-aggravating furnishings run contrary to the assumption of multiple jeopardy and complicate directionality. Finally, contributions to predicted variability in the models address multiplicativity by providing an indication of the "value added" of the statistical interactions; comparisons of Rii values between regression models with and without the cross-product terms can be used to appraise the magnitude of their contributions to explaining variability in health above and across the contributions of the main effects.

Methods

Survey sample

The Canadian Community Health Survey two.1 dataset was nerveless past Statistics Canada in 2003. The target population for this cross-sectional survey was all persons 12 years of historic period and older residing in Canada, excluding individuals living on Indian Reserves and on Crown Lands, institutional residents, fulltime members of the Canadian Armed Forces, and residents of some remote regions. Sampling considered province or territory and health region of residence and practical 3 sampling frames (a multistage stratified cluster design in an surface area frame, a list frame of telephone numbers, and a random digit dialing frame) to select the sample of households. One person was chosen randomly from each household to complete the survey. A full of 134,072 usable responses were obtained, representing a national response rate of lxxx.vii%. Concluding person interpretation weights were provided by Statistics Canada.

This investigation focuses on survey respondents who were aged 25 and older at the time of the survey. Table 1 describes socio-demographic characteristics of this sample of 109,967 respondents. The logistic regression models were practical to the 90,310 respondents with valid information for the age, race, gender, education, household income, sexual orientation, and self-rated health variables. Household income (N = 15,481) and sexual orientation (Due north = 7,676) were the main contributors to the loss of cases from listwise deletion. In comparing with the working sample, the sample of missing cases was older, poorer, and less educated on average and contained proportionately more widows, non-Whites, and adult immigrants to Canada.

Table 1 Characteristics of the sample (weighted information)

Full size table

Survey measures

Survey respondents were asked the following question: "People living in Canada come from many different cultural and racial backgrounds. Are you: White? Chinese? Due south Asian (east.g., East Indian, Pakistani, Sri Lankan)? Black? Filipino? Latin American? Southeast Asian (due east.1000., Cambodian, Indonesian, Laotian, Vietnamese)? Arab? West Asian (eastward.g., Afghan, Iranian)? Japanese? Korean? Aboriginal (North American Indian, Métis or Inuit)? Other - specify." The interviewer was instructed to read all of the possible responses and record all of them that practical. Due to small sample sizes for some responses this variable was recoded as follows: Aboriginal, Asian (combining the Chinese, Korean and Japanese categories), Blackness, Southward Asian, and White, as well as a residual category created by combining the remaining categories, including the original "other" category, into a single united nations-interpretable category labeled "other."

Highest educational attainment and household income were used to assess grade standing. Statistics Canada asked a series of survey questions pertaining to educational attainment to generate the teaching variable described in Tabular array 1. To assess household income, respondents were asked: "What is your best gauge of the full income, before taxes and deductions, of all household members from all sources in the by 12 months?" Follow-up questions determined the range within which their household income fell for those respondents unable or unwilling to provide a precise dollar value.

Sexual orientation was assessed as follows: "Practice y'all consider yourself to exist: Heterosexual? (sexual relations with people of the contrary sex); Homosexual, that is lesbian or gay? (sexual relations with people your own sex activity); Bisexual? (sexual relations with people of both sexes)" Approximately 0.half dozen% of women and 0.v% of men cocky-reported as bisexual and 0.7% of women and ane.2% of men cocky-reported equally homosexual, values that are slightly lower than numbers reported past similar studies in the United States [32], Commonwealth of australia [34], and the Netherlands [35] where approximately 2-3% of the full general population reported being homosexual or bisexual.

Global self-rated wellness, a variable known to encompass both physical and mental well-existence and to reliably predict other, more objective, measures of wellness [36] besides as mortality [37], was assessed as follows: "I'll starting time with a few questions about your health in full general. In general, would you lot say your wellness is: First-class? Very skilful? Practiced? Off-white? Poor?"

Regression modeling

Self-rated wellness was dichotomized and so that off-white and poor responses were contrasted with practiced, very skillful, and excellent responses and binary logistic regression modeling was then used to predict off-white/poor health. Each nominal independent variable in a regression model was treated equally a fix of dummy variables with one (missing) dummy variable serving every bit the reference. Because the N for a reference category should be big in lodge to provide a stable reference point, "White" was assigned the reference category for race and "heterosexual" was assigned the reference category for sexual orientation. In addition, "male" was assigned the reference category for gender and "postgraduate degree" was assigned the reference category for education. This strategy facilitated ready interpretation of how the other identities fare relative to what are mostly considered the more privileged identities in Canadian society. Nagelkerke pseudo R2, a rough measure of the proportion of variability explained by a logistic regression model, was presented for each additive model.

Introducing cross-product terms to hierarchically well-ordered models is a common approach to investigating statistical interactions in the context of logistic regression [38]. Alpha was set at 0.05 with regards to the contributions of main effect terms in additive logistic regression models but at 0.ten for the interaction terms considering of the lesser power of tests of significance for interactions in general (some of the variation in the dependent variable explained by the interaction may be already captured past the main issue examination, measurement fault in the individual factors becomes compounded in an interaction term, etc.).

The logistic regression models were implemented in SPSS xv.0. Considering the sampling design for the CCHS 2.1 was circuitous, the 500 bootstrapping weights and BOOTVAR plan created for the CCHS 2.1 past Statistics Canada were used to generate more reliable variance estimates and thus more reliable tests of significance and confidence intervals for individual variables within regression models. Due to the limitations of BOOTVAR, results from omnibus tests of significance for chiselled variables and interaction terms comprised of sets of dummy variables and Model Chi-square tests of significance for logistic regression models in their entirety could not be generated.

Results

Condiment models

Table 2 describes the central features of a fix of additive binary logistic regression models on self-rated health. With regards to race, Table ii indicates that Aboriginals, Asians, and South Asians were significantly more likely than Whites to written report fair/poor self-rated health. The women of the sample were slightly more probable than the men to report fair or poor self-rated health, decision-making for age, but upon additionally controlling for the other inequality variables gender was not significantly related to self-rated wellness. Educational attainment and household income were both significantly associated with self-rated health, in the expected directions, earlier and subsequently controlling for the other variables. Finally, self-identified bisexual respondents were more than likely than heterosexuals to report fair or poor self-rated health, belongings age constant, although the association weakened to the betoken of not-significance afterwards controlling for the other inequality variables. The decline in effect size for Aboriginal identity compared to White identity from Model I to Model Five was mostly due to differences in educational activity and income whereas the declines in effect sizes for female compared to male identity and bisexual orientation compared to heterosexual orientation were primarily due to differences in income (results non shown).

Table ii Binary logistic regression models on off-white/poor self-rated wellness

Full size table

Comparisons of odds ratios and Nagelkerke R2 values point that educational activity and income followed by race were the strongest predictors of self-rated health. Education and income were also implicated in some of the "hidden" explained variability in the regression models (results non shown). Regarding the overall contributions of the main effects to predicted variability in health, as a fix the five inequality variables produced an increase in Nagelkerke Rii of 0.061 over the regression model on self-rated health containing age alone.

In summary, the additive models of Table 2 described poorer health outcomes for bisexual respondents, non-White respondents, and respondents of lower class standing. The wellness effects of gender were minimal and the health scores of homosexuals did not differ significantly from those of heterosexuals. Class was the strongest distinct predictor of health of the four axes of inequality. With regards to the principle of simultaneity, these results propose that sexual orientation, race, and form are specially relevant intersectionality axes of inequality in this national context, with directions that point to the negative wellness experiences of bisexuals, members of lower classes, and Canadians claiming Aboriginal, Asian, or S Asian identities in particular.

Multiplicative models

2-way and three-way interactions between the five inequality variables were individually added to the concluding additive model of Tabular array 2. Interactions that included didactics and income, the two indicators of class, were non considered. Insufficiently big cell sizes precluded investigation of the 2-way interaction betwixt race and sexual orientation and the three-manner cross-production terms that included sexual orientation and necessitated apply of a dichotomized version of education (has a university degree or not) in the two-style and 3-way interactions that included education and race. Table 3 contains odds ratios and p-values for the statistically pregnant interactions. Figure 1 depicts predicted probabilities for statistically significant interactions; the probabilities labeled "additive" were generated from additive models that did not contain whatsoever interaction terms and the probabilities labeled "multiplicative" were generated from models that additionally contained the interaction terms of interest. These visual depictions of predicted probabilities aid in determining whether aggravating furnishings (multiplicative advantage or disadvantage) or non-aggravating furnishings (such as mitigating effects) pertained to the multiplicative scenarios.

Table three Statistical interactions on self-rated health

Full size tabular array

Figure one
figure 1

Predicted Probabilities of Fair/Poor Self-rated Wellness. A: Income by gender; B: Income by sexual orientation; C: Income past race; D: Race by gender.

Full size image

Neither of the 3-style interactions had a statistically significant effect on self-rated wellness. All the same, each of gender, race, and sexual orientation manifested meaning 2-way interactions with class and gender interacted significantly with race (Table iii). Consider outset the interaction between gender and income. Tabular array 3 indicates that income manifested a stronger association with self-rated health among men (OR = 0.439) than among women (OR = 0.502) and that the ratio of the two odds ratios differed significantly from 1 (p = .011). Figure 1A depicts additive predicted probabilities of 0.305 for the poorest women, 0.295 for the poorest men, 0.066 for the richest women and 0.063 for the richest men. These predicted probabilities reflect the weak gender result and strong income effect evident in the final additive model of Table 2. The plot also contains predicted probabilities from a multiplicative model incorporating the interaction between gender and income. Here we see that the predicted probability of fair/poor health among the poorest women (0.286) was somewhat lower than we would expect from an additive perspective. The interaction between gender and income on self-rated health therefore represents a mitigating effect for lower-class women.

The marked change for the worse in risk of fair/poor wellness from the condiment model to the multiplicative model for poor homosexuals depicted in Effigy 1B is an aggravating upshot in the form of multiplicative disadvantage experienced past poor homosexuals. The self-rated health of Asians was much less influenced past income than was the cocky-rated health of Whites; in particular, the risk of self-rated wellness depicted in Figure 1C was much lower than expected for the poorest Asians, a mitigating effect. Finally, South Asian women were more probable than White women to report fair/poor cocky-rated wellness while South Asian men were no more likely than White men to do so (Table three). The increase in risk of fair/poor self-rated wellness among South Asian women from the additive model to the multiplicative model depicted in Figure 1D seemingly represents a case of multiplicative disadvantage experienced by South Asian women.

Adding all of the 2-mode cantankerous-product terms to the last model of Table two produced an increase of 0.007 in the Nagelkerke Rii. Two-way interactions between the four axes of inequality therefore contributed less than one per centum predicted variability in self-rated health.

In summary, each of the four axes of inequality interacted significantly with at least i other, suggesting that all four axes vest to the pantheon of intersectionality axes of inequality that contribute to wellness inequalities in Canada. The just instances of multiplicative disadvantage pertained to poor homosexuals and to South Asian women who were at an especially high risk of fair/poor self-rated health. Mitigating effects pertained to lower class women and to poorer Asians who were less likely to report fair/poor health than expected. Lastly, the multiplicative models contributed relatively little to overall predicted variability in self-rated wellness over and above the contribution of the total additive model.

Discussion

From the perspective of intersectionality theory, by focusing on a subset of the inequality identities or past treating multiple axes of inequality as distinct rather than intersected processes, a social researcher is in danger of misunderstanding the nature of social experiences and identities manifested in specific contexts and thus in danger of producing results and interpretations that are as misleading every bit they are incomplete. If this is true then much of the literature on health furnishings of inequalities pertaining to race, gender, grade, and/or sexual orientation is incomplete, and some of it may even exist misleading.

The Canadian Customs Health Survey dataset is peculiarly well suited to investigating the applicability of intersectionality theory to wellness disparities in Canada. It is the kickoff and merely Statistics Canada survey dataset to assess sexual orientation, distinguishing between bisexuals, homosexuals, and heterosexuals, and dissimilar nearly Canadian survey datasets it is big enough to produce a multi-category mensurate of race. The analysis described herein is therefore unique by virtue of its consideration of intersections between all four key inequality axes of intersectionality theory, its consideration of bisexual identities as well as homosexual and heterosexual identities, and its consideration of racialized identities such equally Aboriginal, Asian, and South Asian likewise as Black and White. In addition, the application of central principles of intersectionality theory to Canada, close neighbor to the United States, can contribute to hereafter speculation well-nigh the portability of intersectionality assumptions across borders. Cross-contextual comparisons are essential in light of the fact that institutionalized race relations, gender relations, etc. are historically and contextually specific [39]. However, several important limitations of the report require acknowledgment. The validity of the sexual orientation survey question is of some business organization. The modest pct of people who chose a non-heterosexual orientation in general suggests that many survey respondents may have been unwilling to reveal a historically stigmatized identity to interviewers. The especially small percentages of people reporting a not-heterosexual orientation in several of the not-White groups speaks to cultural differences in professing stigmatized non-heterosexual orientations, a knotty measurement problem for any study that seeks to investigate intersections between sexual orientation and race. Lastly, by virtue of excluding Indian Reserves from the sampling procedure the survey sample does not represent on-reserve Ancient people in Canada who are known to have fifty-fifty poorer health than off-reserve Aboriginal Canadians [40].

The intersectionality principle of simultaneity maintains that all four axes of inequality should exist considered in an analysis while the principle of multiplicativity maintains that intersections between axes should overshadow or supplant the individual axes themselves in their effects. Although we carry our identities into every social situation, not all of them are necessarily salient in or relevant to a detail encounter [7]. Withal, race, gender, class, and sexual orientation all manifested independent relationships with health at the condiment phase of my analysis and each of the four axes intersected meaningfully with at to the lowest degree one other axis, suggesting that all 4 of these intersectionality axes of inequality were operative for better or for worse in many of the social situations encountered by survey respondents in their everyday lives. In short, the principles of simultaneity and multiplicativity founded upon the inequality foursome of race, gender, class, and sexual orientation announced to be relevant for disparities in health in Canada.

The intersectionality assumption of multiple jeopardy maintains that meaningful intersections manifest multiplicative - inordinate amounts of - disadvantage or advantage. While two intersections were to indeed to the farther detriment of certain complex social locations, i.eastward., of poor homosexuals and South Asian women, two demonstrated a mitigating quality for certain complex locations, i.e., for lower class women and poor Asian Canadians. Many other possible interactions were non large or statistically significant. It therefore appears that, with regards to self-rated health in Canada at to the lowest degree, multiple jeopardy tin can be more or less than (or near often simply equal to) cumulative double or triple jeopardy. This multiplicity of multiplicative possibilities demands a kind of conceptual fluidity that is not accommodated by the principle of multiple jeopardy as it is depicted information technology in the introduction to this paper.

Bart Landry [9] argues that while the notion of oppression is useful and undoubtedly reflects real experiences, for intersectionality theory to realize its full potential in social enquiry it must accommodate more neutral experiences of differences or variations in experiences across social locations that are not inherently oppressive. The plight of poor homosexuals may indeed reverberate a multiple jeopardy that accrues at the intersection of the oppressive forces of heterosexism and capitalism. All the same, the interaction between gender and race reported hither suggests that sure characteristics of Due south Asian communities are detrimental for the health of women and beneficial for the health of men. If patriarchal gender relations within South Asian families are culpable [41] then inequality by gender is conspicuously a factor here but race relations perhaps are not. The interaction between gender and form in turn points to the particularly heavy penalization paid past lower course men; hither class inequality among men [24] may be more than pertinent than gender relations between men and women. These provocative findings indicate to the importance of applying to health disparities in Canada a version or understanding of intersectionality theory that can adapt intersections of different kinds and qualities.

The theory of "invisible intersectionality" has this potential. Valerie Purdie-Vaughns and Richard Eibach [42] debate that people with multiple subordinate-group identities who do non fit the prototypes of their elective groups are "marginal members of marginal groups" who are relegated to positions of "astute social invisibility." While there are certainly disadvantages to holding multiple subordinate-group identities, they argue that there can be advantages to social invisibility in that marginal members of marginal groups may exist able to elude the more active forms of oppression which are directed at "prototypical" members of marginal groups. The multiplicity of multiplicative possibilities described in my analyses begs for further investigation from an intersectional invisibility perspective. For example, characteristics of workplaces and occupations, health behaviors, residential segregation, experiences with systemic, institutional, and interpersonal bigotry, adherence to different norms of masculinity and femininity, and encounters with the health care system may identify advantages and disadvantages adhering to diverse complex social locations and explicate varying risks of poor health in Canada by intersecting axes of inequality. However, acknowledging with Weber and Parra-Medina [43] that intersectionality theory should focus on the social construction of complex identities in specific times and places and that survey data cannot explain the ways in which relations of power operate in private lives, some of these explanations may be amenable to investigation by manner of survey research but others undoubtedly require other modes of investigation. Ethnographic investigation spanning interpersonal relations and institutional/structural arrangements may also be needed to substantiate and explicate the results described hither.

Conclusions

From an condiment, non-intersectional perspective, poor cocky-rated wellness outcomes were reported by respondents challenge Aboriginal, Asian, or South Asian affiliations, lower class respondents, and bisexual respondents. However, from an intersectional perspective, each axis of inequality interacted significantly with at least ane other: multiple jeopardy pertained to poor homosexuals and (mayhap) South Asian women who were at an unexpectedly high risk of fair/poor self-rated wellness and mitigating furnishings were experienced past poor women and by poor Asians who were less likely than expected to written report fair/poor health. I conclude from these varied results that the intersectionality theory best suited for explicating health inequalities in Canada should be theoretically capable of accommodating centrality intersections of multiple kinds and qualities.

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Acknowledgements

Gerry Veenstra is financially supported by a Senior Scholar career investigator award from the Michael Smith Foundation for Health Research (2007-2012). Access to the master file of the Canadian Community Health Survey 2.one was facilitated past the Canadian Initiative on Social Statistics which is jointly administered by the Social Sciences and Humanities Research Council of Canada, the Canadian Institutes of Health Research, and Statistics Canada. Special thanks go to Lee Grenon and Cheryl Fu at Statistics Canada's Research Data Center at UBC and to the Vancouver chapter of the Schiesse Lodge. Cheryl Hon helped to review and summarize the Canadian health determinants literatures pertaining to race, gender, class, and sexual orientation.

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  1. Section of Sociology, University of British Columbia, Vancouver British Columbia, canada

    Gerry Veenstra

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Correspondence to Gerry Veenstra.

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Veenstra, Yard. Race, gender, class, and sexual orientation: intersecting axes of inequality and self-rated health in Canada. Int J Equity Health ten, 3 (2011). https://doi.org/10.1186/1475-9276-10-3

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Keywords

  • Sexual Orientation
  • Inequality Variable
  • Health Inequality
  • Mitigate Upshot
  • Canadian Customs Health Survey

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