Social Determinants and Consequences of Pain: Towards Multilevel, Intersectional, and Life Course Perspectives.

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to: 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macro-level factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider: a) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy and interpersonal conflict; b) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and c) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted intersectional MAIHDA.

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect under interlocking systems of oppression to socially pattern depression among US adults. With cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,722), we conducted design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) under an intersectional framework to predict past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated age-standardized prevalence and excess/reduced prevalence attributable to two-way or higher interaction effects. Models revealed heterogeneity across groups, with prevalence ranging from 1.9-19.7% (past-year) and 4.5-36.5% (lifetime). Approximately 12.7% (past-year) and 12.5% (lifetime) of total individual variance were attributable to between-group differences, indicating key relevance of intersectional groups in describing the population distribution of depression. Main effects indicated, on average, people who were White, women, gay/lesbian, or bisexual had greater odds of MDE. Main effects explained most between-group variance. Interaction effects (past-year: 10.1%; lifetime: 16.5%) indicated a further source of heterogeneity around averages with groups experiencing excess/reduced prevalence compared to main effects expectations. We extend the MAIHDA framework to calculate nationally representative estimates from complex sample survey data using design-weighted, Bayesian methods.

The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis.

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.

Does gender still matter in the pursuit of a career in anaesthesia?

A survey sent to fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) aimed to document issues affecting gender equity in the anaesthesia workplace. A response rate of 38% was achieved, with women representing a greater proportion of respondents (64.2%). On average women worked fewer hours than men and spent a larger percentage of time in public practice; however, satisfaction rates were similar between genders. There was a gender pay gap which could not be explained by the number of hours worked or years since achieving fellowship. The rates of bullying and harassment were high among all genders and have not changed in 20 years since the first gender equity survey by Strange Khursandi in 1998. Women perceived that they were more likely to be discriminated against particularly in the presence of other sources of discrimination, and highlighted the importance of the need for diversity and inclusion in anaesthetic workplaces. Furthermore, women reported higher rates of caregiving and unpaid domestic responsibilities, confirming that anaesthetists are not immune to the factors affecting broader society despite our professional status. The overall effect was summarised by half of female respondents reporting that they felt their gender was a barrier to a career in anaesthesia. While unable to be included in statistics due to low numbers, non-binary gendered anaesthetists responded and must be included in all future work. The inequities documented here are evidence that ANZCA's gender equity subcommittee must continue promoting and implementing policies in workplaces across Australia and New Zealand.

Best Practices for Telehealth in Nurse-Led Care Settings-A Qualitative Study.

The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.

[Intersectionality as a theoretical-analytical tool to study health inequalities in the AmericasA interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas]. / La interseccionalidad como herramienta teórico-analítica para estudiar las desigualdades en salud en las Américas.

Objective: Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Methods: Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. Results: A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. Conclusions: The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.

Objetivo: Analisar desigualdades na autopercepção de saúde entre grupos populacionais localizados nas interseções de identidade de gênero, etnia e nível de escolaridade em países das Américas, classificados pelo nível de renda. Métodos: Foram usados dados em painel da Pesquisa Mundial de Valores referentes ao período de 1990 a 2022. A amostra deste estudo incluiu 58 790 pessoas com idades entre 16 e 65 anos de 14 países das Américas. A variável dependente foi a autopercepção de problemas de saúde, e as variáveis independentes foram gênero, nível de escolaridade e etnia. Para a análise interseccional intercategórica, foi criada uma variável multicategórica de 12 estratos. Foi realizada uma análise da heterogeneidade individual e da precisão do diagnóstico usando cinco modelos de regressão logística ajustados por idade e onda de pesquisa. Resultados: Observou-se um gradiente interseccional claro e persistente para a autopercepção de problemas de saúde em todas as desagregações de países por renda. Em comparação com a categoria mais favorecida (homens de etnia majoritária e com ensino superior), todos os outros grupos apresentaram maior risco de problemas de saúde, com o maior risco para mulheres de etnias minoritárias ou povos indígenas com nível de escolaridade inferior ao ensino médio (três a quatro vezes maior). Além disso, as mulheres tinham um risco maior de problemas de saúde do que os homens em cada um dos pares de estratos interseccionais. Conclusões: A análise interseccional demonstrou a persistência de um gradiente social na autopercepção de problemas de saúde nas Américas.

The Relations between Systems of Oppression and Oral Care Access in the United States.

We applied a structural intersectionality approach to cross-sectionally examine the relationships between macro-level systems of oppression, their intersections, and access to oral care in the United States. Whether and the extent to which the provision of government-funded dental services attenuates the emerging patterns of associations was also assessed in the study. To accomplish these objectives, individual-level information from over 300,000 respondents of the 2010 US Behavioral Risk Factor Surveillance System was linked with state-level data for 2000 and 2010 on structural racism, structural sexism, and income inequality, as provided by Homan et al. Using multilevel models, we investigated the relationships between systems of oppression and restricted access to oral health services among respondents at the intersections of race, gender, and poverty. The degree to which extended provision of government-funded dental services weakens the observed associations was determined in models stratified by state-level coverage of oral care. Our analyses bring to the fore intersectional groups (e.g., non-Hispanic Black women and men below the poverty line) with the highest odds of not seeing a dentist in the previous year. We also show that residing in states where high levels of structural sexism and income inequality intersect was associated with 1.3 greater odds (95% confidence interval, 1.1-1.5) of not accessing dental services in the 12 mo preceding the survey. Stratified analyses demonstrated that a more extensive provision of government-funded dental services attenuates associations between structural oppressions and restricted access to oral health care. On the basis of these and other findings, we urge researchers and health care planners to increase access to dental services in more effective and inclusive ways. Most important, we show that counteracting structural drivers of inequities in dental services access entails providing dental care for all.

Rethinking Oral Health in Aging: Ecosocial Theory and Intersectionality.

Poor oral health affects the health and well-being of older adults in many ways. Despite years of international research investigating poor oral health among older adults, it has remained a largely unresolved problem. The aim of this article is to explore the combination of 2 key frameworks, ecosocial theory and intersectionality, to guide our exploration and understanding of oral health and aging and help inform research, education, policy, and services. Proposed by Krieger, ecosocial theory is concerned with the symbiotic relationship among embodied biological processes and social, historical, and political contexts. Building on the work of Crenshaw, intersectionality explores how social identities such as race, gender, socioeconomic status, and age interconnect in ways that can enhance privilege or compound discrimination and social disadvantage. Intersectionality offers a layered understanding of how power relations reflected in systems of privilege or oppression influence an individual's multiple intersecting social identities. Understanding this complexity and the symbiotic relationships offers an opportunity to reconsider how inequities in oral health for older adults can be addressed in research, education, and practice and increase the focus on equity, prevention, interdisciplinary care, and use of innovative technology.

Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted MAIHDA.

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4-31.4% (past-year) and 6.7-47.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay/lesbian, or bisexual had greater odds of MDE. Additive effects of race/ethnicity, sex/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess/reduced prevalence. For both outcomes, sexual orientation main effects (42.9-54.0%) explained a greater proportion of between-group variance relative to race/ethnicity (10.0-17.1%) and sex/gender (7.5-7.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.

The intersections of socioeconomic position, gender, race/ethnicity and nationality in relation to oral conditions among American adults.

OBJECTIVE: The objective of the study was to evaluate how gender, socioeconomic position (SEP), race/ethnicity and nationality intersect to structure social inequalities in adult oral health among American adults. METHODS: Data from adults aged 20 years or over who participated in the National Health and Nutrition Examination Survey (NHANES) 2009-2018 were analysed. The outcomes were poor self-rated oral health and edentulism among all adults (n = 24 541 and 21 446 participants, respectively) and untreated caries and periodontitis among dentate adults (n = 16 483 and 9829 participants, respectively). A multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted for each outcome, by nesting individuals within 48 intersectional strata defined as combinations of gender, SEP, race/ethnicity and nationality. Intersectional measures included the variance partition coefficient (VPC), the proportional change in variance (PCV) and predicted excess probability due to interaction. RESULTS: Substantial social inequalities in the prevalence of oral conditions among adults were found, which were characterized by high between-stratum heterogeneity and outcome specificity. The VPCs of the simple intersectional model showed that 9.4%-12.7% of the total variance in the presentation of oral conditions was attributed to between-stratum differences. In addition, the PCVs from the simple intersectional model to the intersectional interaction model showed that 84.1%-97.1% of the stratum-level variance in the presentation of oral conditions was attributed to the additive effects of gender, SEP, race/ethnicity and nationality. The point estimates of the predictions for some intersectional strata were suggestive of an intersectional interaction effect. However, the 95% credible intervals were very wide and the estimations inconclusive. CONCLUSIONS: This analysis highlights the value of the intersectionality framework to understand heterogeneity in social inequalities in oral health. These inequalities were mainly due to the additive effect of the social identities defining the intersectional strata, with no evidence of interaction effects.

Bureaucracy and burden: An Intersectionality-Based Policy Analysis of social welfare policy with consequences for carers of people with life-limiting illness.

BACKGROUND: For informal carers of people with life-limiting illness, social welfare policy related to income support and housing has been associated with varied psychosocial issues, yet remains relatively under-explored. An intersectional approach offers potential to illuminate diverse experiences and implications. AIM: To explore the way in which caring in the context of life-limiting illness is framed within welfare policy, to articulate inequities encountered by carers, and to identify policy and practice recommendations. DESIGN: The Intersectionality-Based Policy Analysis (IBPA) Framework was used to situate findings of a broader qualitative study. SETTING/PARTICIPANTS: Data were collected via semi-structured interviews with participants who were bereaved carers (n = 12), welfare workers (n = 14) and palliative care workers (n = 7), between November 2018 and April 2020, in an Australian region associated with socioeconomic disadvantage. Five elements of IBPA were applied to the products of analysis of this data. RESULTS: Use of the IBPA Framework revealed that representations of carers and causes of their welfare needs in policy were underpinned by several assumptions; including that caring and grieving periods are temporary or brief, and that carers have adequate capacity to navigate complex systems. Policy and processes had differentiated consequences for carers, with those occupying certain social locations prone to accumulating disadvantage. CONCLUSIONS: This intersectional analysis establishes critical exploration of the framing and consequences of welfare policy for carers of people with life-limiting illness, presented in a novel conceptual model. Implications relate to intersectoral development of structural competency, responsiveness to structurally vulnerable carers in clinical practice, and needed policy changes.

Pressupostos epistemológicos das cidades amigas das pessoas idosas: revisão de escopo / Presupuestos epistemológicos de las ciudades amigables con las personas mayores: revisión de alcance / Epistemological assumptions of age-friendly cities: a scoping review

Resumo Objetivo Identificar os conceitos e perspectivas teóricas que fundamentam os estudos sobre Cidade Amiga da Pessoa Idosa. Métodos Revisão de escopo utilizando seis bancos de dados para identificar estudos publicados em revistas indexadas entre 2007 e 2021 usando as palavras-chave 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Resultados Foram encontrados 2.975 estudos que após aplicação de critérios de exclusão resultaram em 227. Observou-se ampla variação no conceito do termo, porém muitos autores o fizeram replicando a OMS, sendo que em 59,5% dos estudos não houve menção de nenhuma perspectiva teórica. A teoria ecológica foi o referencial mais frequente (26%), sendo o termo usado como um equivalente a envelhecimento ativo. Autores de quatro países respondem pela maioria dos artigos (61%). Conclusão É necessário articular o conceito de Cidade Amiga da Pessoa Idosa com uma abordagem teórica e cultural para compreender mais profundamente as perspectivas do urbano e do social sob a lógica do envelhecimento populacional principalmente para a América Latina. A análise teórica nestes estudos e na gerontologia favorecerão discussões mais críticas sobre o envelhecimento, o idadismo e a crescente desigualdade social em curso.

Resumen Objetivo Identificar los conceptos y perspectivas teóricas que fundamentan los estudios sobre Cuidades Amigables con las Personas Mayores. Métodos Revisión de alcance utilizando seis bancos de datos para identificar estudios publicados en revistas indexadas entre 2007 y 2021, con las palabras clave 'age-friendly' OR 'age friendly' OR 'ciudad amigable'. Resultados Se encontraron 2975 estudios que, luego de aplicar los criterios de exclusión, quedaron 227. Se observó una amplia variación del concepto del término, aunque muchos autores replicaron a la OMS. En el 59,5 % de los estudios no se mencionó ninguna perspectiva teórica. La teoría ecológica fue la referencia más frecuente (26 %), y el término se usó como un equivalente al envejecimiento activo. La mayoría de los artículos (61 %) son de autores de cuatro países. Conclusión Es necesario unir el concepto de Cuidades Amigables con las Personas Mayores con un enfoque teórico y cultural para comprender más profundamente las perspectivas de lo urbano y lo social de acuerdo con la lógica del envejecimiento poblacional, principalmente en América Latina. El análisis teórico en estos estudios y en la gerontología permitirán discusiones más críticas sobre el envejecimiento, el edadismo y la creciente desigualdad social en curso.

Abstract Objective To identify the concepts and theoretical perspectives that underlie studies on age-friendly city. Methods This is a scoping review using six databases to identify studies published in indexed journals between 2007 and 2021 using the keywords 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Results A total of 2,975 studies were found, which, after applying the exclusion criteria, resulted in 227. There was wide variation in the concept of the term, but many authors did so by replicating the WHO, and in 59.5% of studies there was no mention of any theoretical perspective. The ecological theory was the most frequent reference (26%), the term being used as an equivalent to active aging. Authors from four countries account for most articles (61%). Conclusion It is necessary to articulate the concept of age-friendly city with a theoretical and cultural approach to understand more deeply the urban and social perspectives under the logic of population aging, mainly for Latin America. Theoretical analysis in these studies and in gerontology will favor more critical discussions about aging, ageism and the growing social inequality in progress.

Obesidade e interseccionalidade: análise crítica de narrativas no âmbito das políticas públicas de saúde no Brasil (2004-2021) / Obesity and intersectionality: critical analysis of narratives within public health policies in Brazil (2004-2021) / Obesidad e interseccionalidad: análisis crítico de narrativas en el ámbito de las políticas públicas de salud en Brasil (2004-2021)

Resumo: Objetivou-se realizar uma análise crítica da narrativa das políticas públicas de saúde brasileiras no cuidado da obesidade a partir de uma perspectiva interseccional. Trata-se de estudo qualitativo exploratório, documental e analítico, baseado na abordagem "What's the problem represented to be?" ["Qual é o problema representado para ser?"], conhecida como WPR. Tal abordagem se configura como uma ferramenta metodológica de análise crítica de políticas públicas a partir de seis perguntas norteadoras. Foram selecionados dez documentos, publicados entre 2004 a 2021 pelo governo brasileiro. A análise crítica resultou em três categorias: (i) causas da obesidade e narrativa dominante: quais são os problemas representados?; (ii) narrativa dominante e cuidado em saúde: quais são os efeitos para as pessoas com obesidade?; e (iii) obesidade e interseccionalidade: onde estão os silêncios? O consumo de alimentos e o sedentarismo foram a narrativa dominante como causas da obesidade. A interseccionalidade, mediada pelas categorias de gênero/sexo, raça/cor e classe social, foi identificada como um silêncio na narrativa das políticas públicas de saúde. Tais categorias não foram consideradas como causas atreladas à obesidade, tampouco foram incluídas de forma efetiva nas ações propostas pelas políticas públicas de saúde. Os silêncios encontrados no estudo destacam a necessidade de inclusão da interseccionalidade na elaboração e execução de políticas públicas de saúde e no cuidado das pessoas com obesidade. Tendo em vista as intersecções de gênero/sexo, raça/cor e classe social e suas formas de opressão com o surgimento e agravo da obesidade, são de extrema relevância análises críticas sobre as narrativas simplistas nas políticas públicas de saúde para problematização das lacunas que repercutem no cuidado dos usuários com obesidade.

Abstract: This study aimed to critically analyze the narrative of Brazilian public health policies in obesity care based on an intersectional approach. This is a qualitative exploratory, documentary, and analytical study based on the "What's the problem represented to be?" approach (WPR). This approach constitutes a methodological instrument for critical analysis of public policies based on six guiding questions. A total of ten documents were selected, published from 2004 to 2021 by the Brazilian government. The critical analysis resulted in three categories: (i) obesity causes and the dominant narrative: what problems are represented?; (ii) dominant narrative and health care: what are the effects for people with obesity?; (iii) obesity and intersectionality: where are silences? The consumption of food and sedentary lifestyle were the dominant narrative as causes of obesity. Intersectionality, mediated by the categories of gender/sex, race/skin-color, and social class, was identified as silenced in the narrative of public health policies, not being associated as linked causes of obesity, nor effectively included in the proposed actions of the policies. The silences found in the study highlight the need to include intersectionality in the elaboration and execution of public health policies and in the care of people with obesity. Considering the intersections of gender/sex, race/skin-color, and social class and their forms of oppression in the emergence and aggravation of obesity, critical analyses of simplistic narratives in public health policies are extremely relevant to problematize gaps affect the care of users with obesity.

Resumen: Este estudio tuvo como objetivo realizar un análisis crítico de la narrativa de las políticas públicas de salud brasileñas en el cuidado de la obesidad con base en un enfoque interseccional. Estudio cualitativo exploratorio, documental y analítico. Basado en el enfoque "Whats the problem represent to be?" [¿Cuál es el problema representado?], conocido como WPR. Tal enfoque se configura como una herramienta metodológica para el análisis crítico de las políticas públicas con base en seis preguntas rectoras. Se seleccionaron 10 documentos, publicados entre el 2004 y el 2021 por el gobierno brasileño. El análisis crítico resultó en tres categorías: (i) causas de la obesidad y la narrativa dominante: ¿Qué problemas se representan?; (ii) narrativa dominante y el cuidado en salud ¿Cuáles son los efectos para las personas con obesidad?; (iii) obesidad e interseccionalidad ¿Dónde están los silencios?. El consumo de alimentos y el sedentarismo fueron la narrativa dominante como causas de la obesidad. La interseccionalidad, mediada por las categorías de género/sexo, raza/color y clase social fue identificada como un silencio en la narrativa de las PPS, sin asociarlas como causas vinculadas a la obesidad ni incluirlas de forma efectiva en las acciones propuestas por las políticas públicas de salud. Los silencios encontrados en el estudio resaltan la necesidad de incluir la interseccionalidad en la elaboración y ejecución de las políticas públicas de salud y en el cuidado de las personas con obesidad. Considerando las intersecciones de género/sexo, raza/color y clase social y sus formas de opresión con el surgimiento y agravamiento de la obesidad, es sumamente relevante realizar análisis críticos sobre las narrativas simplistas en las políticas públicas de salud, para problematizar las brechas que repercuten en el cuidado de los usuarios con obesidad.

La interseccionalidad como herramienta teórico-analítica para estudiar las desigualdades en salud en las Américas / Intersectionality as a theoretical-analytical tool to study health inequalities in the Americas / A interseccionalidade como ferramenta teórico-analítica para estudo das desigualdades em saúde nas Américas

RESUMEN Objetivo. Analizar las desigualdades en la salud autopercibida entre grupos de población situados en las intersecciones de identidad de género, grupo étnico y nivel de educación en países de las Américas, clasificados según su nivel de ingreso. Métodos. Se utilizaron datos en panel de la Encuesta Mundial de Valores en el período comprendido entre los años 1990 y 2022. La muestra de este estudio incluyó 58 790 personas entre 16 y 65 años, provenientes de 14 países del continente americano. La variable dependiente fue la mala salud autopercibida, las variables independientes fueron el género, el nivel de educación y el grupo étnico. Para el análisis interseccional intercategórico se creó una variable multicategórica de 12 estratos. Se realizó un análisis de heterogeneidad individual y precisión diagnóstica mediante cinco modelos de regresión logística ajustados por edad y ola de encuesta. Resultados. Se observó un claro y persistente gradiente interseccional para la mala salud autopercibida en todas las desagregaciones de países por su ingreso. Comparados con la categoría más aventajada (hombres de etnia mayoritaria y educación superior), los demás grupos incrementaron el riesgo de mala salud, con el mayor riesgo en las mujeres de etnia minoritaria o pueblos indígenas con nivel de educación inferior a secundaria (tres a cuatro veces mayor). Además, las mujeres tuvieron mayor riesgo de mala salud respecto a los hombres en cada uno de los pares de estratos interseccionales. Conclusiones. El análisis interseccional demostró la persistencia de un gradiente social de la mala salud autopercibida en el continente americano.

ABSTRACT Objective. Analyze inequalities in self-perceived health among population groups located at the intersections of gender identity, ethnicity, and education level in countries of the Americas, classified by income level. Methods. Panel data from the World Values Survey were used for the period 1990-2022. The study sample included 58 790 people between 16 and 65 years of age from 14 countries in the Americas. The dependent variable was poor self-perceived health, and the independent variables were gender, education level, and ethnicity. A multi-categorical variable with 12 strata was created for the intercategorical intersectionality analysis. An analysis of individual heterogeneity and diagnostic accuracy was performed using five logistic regression models, adjusted by age and by survey wave. Results. A clear and persistent intersectional gradient for poor self-perceived health was observed in all country disaggregations by income. Compared to the category with the most advantage (men of majority ethnicity and higher education), the other groups had increased risk of poor health, with the highest risk among women of minority ethnicity and in Indigenous peoples with less than secondary education (three to four times higher). In addition, women had a higher risk of poor health than men in each pair of intersectional strata. Conclusions. The intersectional analysis demonstrated a persistent social gradient of self-perceived ill health in the Americas.

RESUMO Objetivo. Analisar desigualdades na autopercepção de saúde entre grupos populacionais localizados nas interseções de identidade de gênero, etnia e nível de escolaridade em países das Américas, classificados pelo nível de renda. Métodos. Foram usados dados em painel da Pesquisa Mundial de Valores referentes ao período de 1990 a 2022. A amostra deste estudo incluiu 58 790 pessoas com idades entre 16 e 65 anos de 14 países das Américas. A variável dependente foi a autopercepção de problemas de saúde, e as variáveis independentes foram gênero, nível de escolaridade e etnia. Para a análise interseccional intercategórica, foi criada uma variável multicategórica de 12 estratos. Foi realizada uma análise da heterogeneidade individual e da precisão do diagnóstico usando cinco modelos de regressão logística ajustados por idade e onda de pesquisa. Resultados. Observou-se um gradiente interseccional claro e persistente para a autopercepção de problemas de saúde em todas as desagregações de países por renda. Em comparação com a categoria mais favorecida (homens de etnia majoritária e com ensino superior), todos os outros grupos apresentaram maior risco de problemas de saúde, com o maior risco para mulheres de etnias minoritárias ou povos indígenas com nível de escolaridade inferior ao ensino médio (três a quatro vezes maior). Além disso, as mulheres tinham um risco maior de problemas de saúde do que os homens em cada um dos pares de estratos interseccionais. Conclusões. A análise interseccional demonstrou a persistência de um gradiente social na autopercepção de problemas de saúde nas Américas.

Intersectionality Theory, Challenges for Empirical Research and Contributions to Psychology / Teoria da Interseccionalidade, Desafios para Pesquisas Empíricas e Contribuições para a Psicologia / Teoría de la Interseccionalidad, Desafíos para la Investigación Empírica y Aportes a la Psicología

Abstract The Theory of Intersectionality is an important contribution from feminist epistemologies to the scientific field. This narrative literature review aims to discuss methodological possibilities and challenges in producing and analyzing empirical evidence based on the Theory of Intersectionality, as well as its contributions to Psychology. While this theory is increasingly being cited as the basis for empirical research, articulating its assumptions in knowledge production processes is still a difficulty. Qualitative approaches prevail in the field, but advancements in statistical analysis methods allow for an intersectional interpretation in quantitative studies. Intersectionality contributes to understanding psychological processes and challenging dominant and exclusionary assumptions in the field of Psychology. Embracing this theory requires a commitment to the imperative of social transformation and entails placing claims, values, practices, and power relations at the core of scientific knowledge production, regardless of the field under study.

Resumo A Teoria da Interseccionalidade é uma importante contribuição das epistemologias feministas para o campo científico. Este estudo de revisão narrativa da literatura teve como objetivo discutir possibilidades e desafios metodológicos na produção e análise de evidências empíricas embasadas na Teoria da Interseccionalidade e suas contribuições para a Psicologia. Embora essa teoria esteja crescentemente sendo citada como base de pesquisas empíricas, ainda se identifica a dificuldade de articular seus pressupostos nos processos de produção de conhecimento. As abordagens qualitativas são predominantes no campo e observa-se avanços em métodos de análises estatísticas que permitem uma leitura interseccional em estudos quantitativos. A interseccionalidade contribui para compreender processos psicológicos e desafiar suposições dominantes e excludentes no campo da Psicologia. Adotar essa teoria requer uma implicação com o imperativo de transformação social e implica tornar reivindicações, valores, práticas e relações de poder como cerne da produção de conhecimento científico, independentemente do campo estudado.

Resumen La Interseccionalidad es una importante contribución de las epistemologías feministas al campo científico. Este artículo de revisión narrativa tiene como objetivo discutir las posibilidades y desafíos metodológicos en la producción y análisis de evidencia empírica basada en la Interseccionalidad y sus contribuciones a la Psicología. Aunque esta teoría se cita cada vez más como base de investigaciones empíricas, aún se identifica la dificultad de articular sus supuestos en los procesos de producción de conocimiento. Los enfoques cualitativos predominan en el campo y se observan avances en métodos de análisis estadístico que permiten una lectura interseccional en estudios cuantitativos. La interseccionalidad contribuye a comprender los procesos psicológicos y desafiar suposiciones dominantes y excluyentes en el campo de la Psicología. Adoptar esta teoría requiere una implicación con el imperativo de transformación social e implica poner las demandas, valores, prácticas y relaciones de poder en el centro de la producción de conocimiento científico, independientemente del campo estudiado.

Interseccionalidade e transexualidade no processo discriminatório: uma revisão integrativa / Intersectionality and transsexuality in the process of discrimination: an integrative review / Interseccionalidad y transexualidad en el proceso discriminatorio: una revisión integradora

Objetivo: identificar na literatura acadêmica as principais discriminações interseccionais vividas por mulheres trans e discutir o seu processo de estabelecimento nesse grupo populacional. Método: estudo de revisão integrativa de literatura conduzida em duas bases e três bibliotecas virtuais durante o ano de 2021 e revisada em 2022. Foi realizada análise lexicográfica por meio do software IRAMUTEC. Resultados: foram identificados 486 manuscritos, selecionando-se 15 para análise. Emergiram três categorias analíticas: (1) Interseccionalidade como multiplicador de opressões, (2) Dificuldade de acesso ao cuidado e a precarização da saúde e (3) Necessidade de Políticas Públicas Específicas e o enfrentamento da InJustiça. Conclusão: as condições estruturais do racismo, sexismo, etnofobia e violências correlatas se sobrepõem, e na base da pirâmide discriminatória se encontram as mulheres transexuais negras. Pesquisas adicionais são necessárias para levar a melhores intervenções a esta população em risco de violência.

Objective: to identify, in the academic literature, the main intersecting discriminations experienced by trans women and to discuss process by which it is established related to this population group. Method: this integrative literature review study was conducted in two databases and three virtual libraries during 2021 and then revised in 2022. Lexicographic analysis was performed using the IRAMUTEC software. Results: 486 manuscripts were identified and 15 were selected for analysis. Three analytical categories emerged: (1) Intersectionality as a multiplier of oppression; (2) Difficulty in accessing care and increasingly precarious health; and (3) Need for specific public policies and addressing injustice. Conclusion: the structural conditions of racism, sexism, ethnophobia, and related violence overlap, and black transsexual women are at the base of the pyramid of discrimination. Additional research is needed to lead to better interventions for this population at risk of violence.

Objetivo: identificar en la literatura académica las principales discriminaciones interseccionales experimentadas por mujeres trans, así como discutir su proceso de implantación en este grupo poblacional. Método: estudio de revisión integradora de literatura realizado en dos bases de datos y tres bibliotecas virtuales durante el año 2021 y revisado en 2022. El análisis lexicográfico se realizó mediante el software IRAMUTEC. Resultados: se identificaron 486 manuscritos y se seleccionaron 15 para su análisis. Surgieron tres categorías de análisis: (1) Interseccionalidad como multiplicador de la opresión, (2) Dificultad de acceso a la atención y precarización de la salud, y (3) Necesidad de Políticas Públicas Específicas y el enfrentamiento a la InJusticia. Conclusión: las condiciones estructurales del racismo, el sexismo, la etnofobia y las violencias relacionadas se superponen, y en la base de la pirámide de discriminación se encuentran las mujeres negras transgénero. Se necesita investigaciones adicionales para conducir a mejores intervenciones para esta población en riesgo de violencia.