Desafios metodológicos na mensuração da interseccionalidade e seu papel na investigação das disparidades em saúde bucal:
uma revisão de literatura
DOI:
https://doi.org/10.22456/2177-0018.137551Palavras-chave:
Enquadramento interseccional, Saúde bucal, Iniquidades em saúdeResumo
Objetivo: Descrever as complexidades subjacentes à quantificação da interseccionalidade, visando contribuir e fortalecer a capacidade de identificar as iniquidades presentes na esfera da saúde bucal. Revisão de literatura: A literatura sugere que a interseccionalidade representa uma ferramenta analítica que visa a compreensão dos impactos resultantes da interação de sistemas de opressão superpostos, tais como o racismo, o sexismo, o classismo e outras formas de desigualdade. No entanto, apesar dessa abordagem auxiliar na compreensão dos sistemas de desigualdade, além de estudar como as múltiplas posições sociais de um indivíduo interagem para moldar a saúde, apresenta desafios significativos quando aplicada à pesquisa quantitativa de disparidades em saúde. Discussão: O consenso na forma de se mensurar a interseccionalidade ainda é incerto. Ao revisar a literatura é possível destacar alguns fatores que poderiam melhor integrar a interseccionalidade na investigação quantitativa de disparidades em saúde. Conclusão: A abordagem interseccional desempenha papel fundamental na compreensão mais profunda das vulnerabilidades existentes e também oferece subsídios para o desenvolvimento de políticas públicas eficazes. Assim, embora haja ausência de um consenso claro na forma de mensurar a interseccionalidade, ao analisar a literatura, emergem direções promissoras que podem aprimorar a integração dessa ferramenta na investigação quantitativa de disparidades em saúde bucal, contribuindo, desse modo, na promoção do bem-estar e da saúde para toda população, principalmente aos grupos em situação de vulnerabilidade.
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Referências
McCartney G, Dickie E, Escobar O, Collins C. Health inequalities, fundamental causes and power: towards the practice of good theory. Sociol Health Illn. 2021 Jan;43(1):20-39. doi: 10.1111/1467-9566.13181. Epub 2020 Nov 22. PMID: 33222244; PMCID: PMC7894306.
DiPrete TA, Eirich GM. Cumulative Advantage as a Mechanism for Inequality: A Review of Theoretical and Empirical Developments. Annu Rev Sociol. 2006;32(1):271-297. doi:10.1146/annurev.soc.32.061604.123127.
Choo HY, Ferree MM. Practicing Intersectionality in Sociological Research: A Critical Analysis of Inclusions, Interactions, and Institutions in the Study of Inequalities. Sociological Theory. 2010;28(2):129-149. doi:10.1111/j.1467-9558.2010.01370.x.
Bauer GR, Scheim AI. Methods for analytic intercategorical intersectionality in quantitative research: Discrimination as a mediator of health inequalities. Soc Sci Med. 2019;226:236-245. doi:10.1016/j.socscimed.2018.12.015.
Bowleg L. The Problem With the Phrase Women and Minorities: Intersectionality—an Important Theoretical Framework for Public Health. Am J Public Health. 2012;102(7):1267-1273. doi:10.2105/AJPH.2012.300750.
Green MA, Evans CR, Subramanian SV. Can intersectionality theory enrich population health research? Soc Sci Med. 2017;178:214-216. doi:10.1016/j.socscimed.2017.02.029.
Hankivsky O. Women’s health, men’s health, and gender and health: Implications of intersectionality. Soc Sci Med. 2012;74(11):1712-1720. doi:10.1016/j.socscimed.2011.11.029.
Viruell-Fuentes EA, Miranda PY, Abdulrahim S. More than culture: Structural racism, intersectionality theory, and immigrant health. Soc Sci Med. 2012;75(12):2099-2106. doi:10.1016/j.socscimed.2011.12.037.
Kapilashrami A, Marsden S. Examining intersectional inequalities in access to health (enabling) resources in disadvantaged communities in Scotland: advancing the participatory paradigm. Int J Equity Health. 2018;17(1):83. doi:10.1186/s12939-018-0797-x.
Hulko W. The Time- and Context-Contingent Nature of Intersectionality and Interlocking Oppressions. Affilia. 2009;24(1):44-55. doi:10.1177/0886109908326814.
Elaine Muirhead V, Milner A, Freeman R, Doughty J, Macdonald ME. What is intersectionality and why is it important in oral health research? Community Dent Oral Epidemiol. 2020;48(6):464-470. doi:10.1111/cdoe.12573.
Else-Quest NM, Hyde JS. Intersectionality in Quantitative Psychological Research: I. Theoretical and Epistemological Issues. Psychology of Women Quarterly. 2016;40(2):155-170. doi:10.1177/0361684316629797.
Evans CR, Williams DR, Onnela JP, Subramanian SV. A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Social Science & Medicine. 2018;203:64-73. doi:10.1016/j.socscimed.2017.11.011.
Hankivsky O, Grace D, Hunting G, Giesbrecht M, Fridkin A, Rudrum S, Ferlatte O, Clark N. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity. Int J Equity Health. 2014 Dec 10;13:119. doi: 10.1186/s12939-014-0119-x. PMID: 25492385; PMCID: PMC4271465.
Bauer GR. Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science & Medicine. 2014;110:10-17. doi:10.1016/j.socscimed.2014.03.022.
Homan P, Brown TH, King B. Structural Intersectionality as a New Direction for Health Disparities Research. J Health Soc Behav. 2021;62(3):350-370. doi:10.1177/00221465211032947.
McCall L. The Complexity of Intersectionality. Signs: Journal of Women in Culture and Society. 2005;30(3):1771-1800. doi:10.1086/426800.
Collins PH, Da Silva ECG, Ergun E, Furseth I, Bond KD, Martínez-Palacios J. Intersectionality as Critical Social Theory: Intersectionality as Critical Social Theory, Patricia Hill Collins, Duke University Press, 2019. Contemp Polit Theory. 2021;20(3):690-725. doi:10.1057/s41296-021-00490-0.
Patricia Hill Collins, Sirma Bilge segunda. Interseccionalidade. 1st ed. Boitempo; 2020.
Bowleg L. When Black + Lesbian + Woman ≠ Black Lesbian Woman: The Methodological Challenges of Qualitative and Quantitative Intersectionality Research. Sex Roles. 2008;59(5-6):312-325. doi:10.1007/s11199-008-9400-z.
Johnson BT, Hennessy EA. Systematic reviews and meta-analyses in the health sciences: Best practice methods for research syntheses. Soc Sci Med. 2019;233:237-251. doi:10.1016/j.socscimed.2019.05.035.
Harari L, Lee C. Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies. Soc Sci Med. 2021;277:113876. doi:10.1016/j.socscimed.2021.113876.
Trinh MH, Agénor M, Austin SB, Jackson CL. Health and healthcare disparities among U.S. women and men at the intersection of sexual orientation and race/ethnicity: a nationally representative cross-sectional study. BMC Public Health. 2017;17(1):964. doi:10.1186/s12889-017-4937-9.
Bastos JL, Constante HM, Schuch HS, Haag DG, Jamieson LM. The Mouth as a Site of Compound Injustices: A Structural Intersectionality Approach to the Oral Health of Working-Age US Adults. Am J Epidemiol. 2023 Apr 6;192(4):560-572. doi: 10.1093/aje/kwac205. PMID: 36453443.
Assari S, Nikahd A, Malekahmadi MR, Lankarani MM, Zamanian H. Race by Gender Group Differences in the Protective Effects of Socioeconomic Factors Against Sustained Health Problems Across Five Domains. J Racial and Ethnic Health Disparities. 2017;4(5):884-894. doi:10.1007/s40615-016-0291-3.
Warner DF, Brown TH. Understanding how race/ethnicity and gender define age-trajectories of disability: An intersectionality approach. Soc Sci Med. 2011;72(8):1236-1248. doi:10.1016/j.socscimed.2011.02.034.
Etherington C. Race, Gender, and the Resources That Matter: An Investigation of Intersectionality and Health. Women & Health. 2015;55(7):754-777. doi:10.1080/03630242.2015.1050544.
Nixon SA. The coin model of privilege and critical allyship: implications for health. BMC Public Health. 2019;19(1):1637. doi:10.1186/s12889-019-7884-9.
Levine-Rasky C. Intersectionality theory applied to whiteness and middle-classness. Social Identities. 2011;17(2):239-253. doi:10.1080/13504630.2011.558377.
Brown TH. Racial Stratification, Immigration, and Health Inequality: A Life Course-Intersectional Approach. Social Forces. 2018;96(4):1507-1540. doi:10.1093/sf/soy013.
Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003 Oct;57(10):778-83. doi: 10.1136/jech.57.10.778. Erratum in: J Epidemiol Community Health. 2003 Nov;57(11):914. PMID: 14573579; PMCID: PMC1732305.
Evans CR, Erickson N. Intersectionality and depression in adolescence and early adulthood: A MAIHDA analysis of the national longitudinal study of adolescent to adult health, 1995–2008. Soc Sci Med. 2019;220:1-11. doi:10.1016/j.socscimed.2018.10.019.
Ellaway A, Macintyre S, Kearns A. Perceptions of Place and Health in Socially Contrasting Neighbourhoods. Urban Studies. 2001;38(12):2299-2316. doi:10.1080/00420980120087171.
Chaix B. Geographic Life Environments and Coronary Heart Disease: A Literature Review, Theoretical Contributions, Methodological Updates, and a Research Agenda. Annu Rev Public Health. 2009;30(1):81-105. doi:10.1146/annurev.publhealth.031308.100158.
Cummins S, Curtis S, Diez-Roux AV, Macintyre S. Understanding and representing ‘place’ in health research: A relational approach. Soc Sci Med. 2007;65(9):1825-1838. doi:10.1016/j.socscimed.2007.05.036.
Bastos JL, Fleming E, Haag DG, Schuch HS, Jamieson LM, Constante HM. The Relations between Systems of Oppression and Oral Care Access in the United States. J Dent Res. 2023;102(10):1080-1087. doi:10.1177/00220345231184181.
Schuch HS, Haag DG, Bastos JL, Paradies Y, Jamieson LM. Intersectionality, racial discrimination and oral health in Australia. Comm Dent Oral Epid. 2021;49(1):87-94. doi:10.1111/cdoe.12581.
Jamieson L, Ju X, Haag D, Ribeiro P, Soares G, Hedges J. An intersectionality approach to Indigenous oral health inequities; the super-additive impacts of racism and negative life events. Lim S, ed. PLoS ONE. 2023;18(1):e0279614. doi:10.1371/journal.pone.0279614.
Freeman R, Doughty J, Macdonald ME, Muirhead V. Inclusion oral health: Advancing a theoretical framework for policy, research and practice. Comm Dent Oral Epid. 2020;48(1):1-6. doi:10.1111/cdoe.12500.
Brown TH, Richardson LJ, Hargrove TW, Thomas CS. Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age. J Health Soc Behav. 2016;57(2):200-222. doi:10.1177/0022146516645165.
Brown TH. Racial Stratification, Immigration, and Health Inequality: A Life Course-Intersectional Approach. Social Forces. 2018;96(4):1507-1540. doi:10.1093/sf/soy013.
Cummings JL, Braboy Jackson P. Race, Gender, and SES Disparities in Self-Assessed Health, 1974-2004. Res Aging. 2008;30(2):137-167. doi:10.1177/0164027507311835.
Stepanikova I, Oates GR. Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race. Am J Prev Med. 2017 Jan;52(1S1):S86-S94. doi: 10.1016/j.amepre.2016.09.024. PMID: 27989297; PMCID: PMC5172593.
Guan A, Thomas M, Vittinghoff E, Bowleg L, Mangurian C, Wesson P. An investigation of quantitative methods for assessing intersectionality in health research: A systematic review. SSM Popul Health. 2021 Nov 20;16:100977. doi: 10.1016/j.ssmph.2021.100977. PMID: 34869821; PMCID: PMC8626832.
Turner CM, Arayasirikul S, Wilson EC. Disparities in HIV-related risk and socio-economic outcomes among trans women in the sex trade and effects of a targeted, anti-sex-trafficking policy. Soc Sci Med. 2021;270:113664. doi:10.1016/j.socscimed.2020.113664.
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