I argue that this is not an adequate solution.
Intersectionality” is a sociological theory coined by Kimberlé Crenshaw
in 1989.1 The theory postulates that multiple axes of identity
contribute simultaneously to a person’s experience of oppression and
discrimination. The typical
manifestations of oppression - sexism, racism, classism, biphobia, homophobia,
transphobia, and belief/ cultural-based prejudice – cannot be examined
independently because they contribute to inequality in a way that is interconnected
and interrelated. Instead, intersectionality offers a holistic framework to
evaluate the impact of multiple identities contributing to a person’s
experience of inequality.1 Borrowing the concept of
intersectionality, it can be applied in health professional education and used
to help students see the multiple determinants contributing simultaneously to a
patient’s experience of health.
This figure illustrates various axes of human identity converging to a point of intersection
Similar to identity, the origin of poor health is
cannot be examined through a singular lens. Pathophysiologic and psycho-social
determinants of health are interconnected and interrelated. While interprofessional
approaches provide a different perspectives, from ability (physical therapy),
family and income status (social work), to mental health (psychology,
psychiatry), and others, it is imperative for pharmacists to be able to incorporate
these health determinants when making therapeutic decisions in the absence of consulting
other professions. In healthcare education, intersectionality can be applied to
patient cases with the realization that health is not determined by any one
thing. Through addressing psycho-social health determinants and discussing
their impact on pharmacotherapeutic decision-making, intersectionality can
provide students with a more complex understanding of health in order to
address the needs of diverse patient populations.2
- What does lifestyle modification look like in a patient with diabetes
on a fixed-income, with limited access to reliable electricity and heat, and
sporadic medication adherence due to transportation issues
- In a patient with metabolic syndrome, depression, and anxiety that loses
insurance coverage and can only afford half of her medications, which 5 of
10 medicationsare the most important in maintaining her health?
- What preventative care and screening recommendations do you make for male, female or transgender patients lacking primary care providers?
Adding layers of complexity regarding the human experience to patient cases can aid students in making the transition from the classroom to practice. Using
intersectionality to address health disparities and improve health
outcomes will also lead to more encompassing, holistic healthcare.3
Intersectionality provides a framework for pharmacy education that takes into
account the complexity of health and human experience rather than reinforcing barriers-to-care
as the responsibility of other health professionals and, in effect, perpetuates
- Sumi C, Crenshaw K, McCall L. Toward a Field of Intersectionality Studies: Theory
,Applications, and Praxis. Signs: Journal of Women in Culture & Society. Summer 2013;38 (4) :785-810.
- McGibbon E, Rochester C. Applying Intersectionality & Complexity Theory to Address the Social Determinants of Women’s Health. Women's Health & Urban Life. May 2011;10(1):59-86.
- Hankivsky O. Women’s
health, men’s health, and gender and health: Implications of
intersectionality. Social Science & Medicine. June 2012;74:1712-1720.