You may have heard the term ‘intersectionality’ bandied about recently in conversations around diversity and inclusion within health care, but you might have found the meaning or application to be unclear, confusing or inconsistent. This feature will delve into the history of intersectionality and its relevance to conversations about diversity and inclusion in allied health. Additionally, I’ll share insights into how I’m using intersectionality in allied health through my PhD which is exploring issues of representation and diversity in the Australian dietetics’ profession.

So what exactly is intersectionality?

The concept of intersectionality has been gaining traction in Australian discourse in recent years, especially as dialogue about diversity and inclusion across the health sector has become mainstream.

It’s a helpful way to conceptualise unequal distribution of privilege and resources associated with how personal identities are impacted by social structures of power and marginalisation, but intersectionality is far from new.

Intersectionality was first theorised by African American critical legal studies scholar Dr Kimberlé Crenshaw in the late 1980s as an analogy which could illustrate what is referred to as multiple-axis oppression. Crenshaw states;

Consider an analogy to traffic in an intersection, coming and going in all four directions. Discrimination, like traffic through an intersection, may flow in one direction and it may flow in another. If an accident happens in an intersection, it can be caused by cars travelling from any number of directions, and sometimes from all of them. Similarly, if a black woman is harmed because she is in the intersection, her injury could result from sex discrimination or race discrimination (Crenshaw, 1989, p. 149).

Rather than considering marginalisation experienced as a result of (for example) race and gender, intersectionality provides a framework to consider compounding and interconnected marginalisation that is unique ‘at the intersection’ of race and gender. Crenshaw’s initial work focused on how and why Black women were disadvantaged under the law, which neither adequately protected them from racism or sexism (Crenshaw 1989). Further, Crenshaw argues that existing feminism and antiracism movements, while claiming to be inclusive of all women and all Black people respectively, misses the unique and compounded marginalisation that Black women experience; that Black women’s experiences of sexism are intertwined with their Blackness and their experiences of racism are intertwined with their womanness (Crenshaw 1989; Delbridge 2022).

An intersectionality multiple-axis framework enables the analysis of how many forms of marginalisation are intertwined with each other through systems of power. Crenshaw argues that identities including sex and gender, race, class, sexuality, nation and (dis)ability can be associated with lived experiences of both privilege and marginalisation that cannot be considered separately because people live their lives as whole people, not as separate identities (Cho et al 2013; Crenshaw 1991).

Applications of intersectionality in allied health

Intersectionality as a term is often used as short-hand to indicate an understanding that people live within multiple axes of identity. However, intersectionality is more about how these identities are impacted by structures of power and marginalisation rather than just tick-box identity counting.

For example, within the dietetics profession, the vast majority of dietitians are white women, who are both privileged by their whiteness and marginalised by virtue of their sex through the impact of sexism (Delbridge, 2022). Meanwhile, dietitians who are: women and people of colour are navigating both sexism and racism; women living in larger bodies are experiencing both sexism and weight stigma; men of the LGBTQIA+ community are navigating both male privilege and LGBTQIA+ discrimination (Delbridge 2022; Lassemillante & Delbridge 2021; Bessey 2021; Joy 2018).

Through an intersectional lens, questions about diversity and inclusion in allied health workforces are not limited to single axis considerations of race or gender or Indigeneity (for example). Intersectionality enables a more complex, nuanced and closer-to-real-life consideration of who the people in our workforces are (and are not), how they experience their lives interacting with systems of power and marginalisation, and how this impacts the workforce.

Intersectionality also invites and challenges communities to ask courageous questions about who is and who is not at ‘home’ in our spaces (Crenshaw 1991 p.1299), and to see our personal and collective responsibility to ‘bring a courageous critique of the profession[s]’ (Delbridge 2022 p.9).

Critique in dietetics

From its inception, dietetics as a profession has been characterised by women, moving away from the perceived confines of traditionally feminised roles of food and care work in home economics, to seek legitimacy in the medical hierarchy through association with the traditionally male dominated medical and nutrition science (Brady, 2017; Rose, 1912).

With the emergence of dietetics in North America in the early 1900s, women were gaining access to science education, paid employment and professional recognition in both hospitals and military as part of the broader promotion of women’s rights (Brady, 2017; Scott, 2009). However, this was not available to all women, with early dietitians characterised as ‘white, native-born, Protestant, middle-class women’ (Scott, 2009), or ‘typically middle-class and white…women’ (Brady, 2017). Therefore, the emancipatory potential of a dietetics career for women was exclusively for white middle-class women, which was reinforced by the broader social context (Delbridge et al., 2022).

In our intersectionality informed critique of the dietetics profession (Delbridge et al 2022), we outline three tenants of intersectionality—structural, political and representational intersectionality—and we invite the profession as a whole, and dietitians as individuals, to commit to life-long self-reflection and commit to act within their sphere of influence to address power imbalances existing in our profession (Lassemillante & Delbridge, 2021; Ng & Wai, 2021).

To support this process/invitation, these recommendations offer first steps of an agenda for increasing diversity and representation in Australian dietetics (Delbridge 2022):

1. Adopt a ‘lens’ in practice and research which can ‘see’ systems of oppression, and embrace the political nature of transforming health and social systems towards social justice;
2. Challenge structures of accepted universalisation of western normative expectations through meaningful contributions of non-Western epistemologies, non-Western food-ways and non-slim bodies to the dietetics landscape;
3. Challenge the stereotypes of dietitians which perpetuate homogeneity and conformity in the profession through privileging discourses (in text, image and audio) which honours diversity and representation of peoples in dietetics.

Closing remarks

Allied health professions are not immune to influences of power and oppression which unequally distribute power and resources to some people over others.

I extend an invitation to my AHP peers  to critique your own profession through an intersectional lens. Who are the most privileged groups and why? What can you do within your sphere of influence, to privilege the voices and experiences of marginalised peoples and act to make allied health professions ‘home’ for those who want to belong (Crenshaw 1991 p.1299).

References

Bessey, M., Brady, J., Lordly, D., & Leighteizer, V. (2020). “This is what you’re supposed to do”: weight stigma in dietetics education. Fat Studies, 1-13.

Brady, J. (2017). Trading the Apron for the White Lab Coat: a contemporary history of dietetics in Canada, 1954-2016 [Doctoral dissertation, Queen’s University]. Kingston, Ontario, Canada.

Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of women in culture and society, 38(4), 785-810.

Crenshaw, K. W. (1989). Demarginalizing the intersection of race and sex: A Black Feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 139-168.

Crenshaw, K. W. (1991). Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanford Law Review, 43, 1241-1300.

Delbridge, R., Jovanovski, N., Skues, J., & Belski, R. (2022). Exploring the relevance of intersectionality in Australian dietetics: Issues of diversity and representation. Sociology of Health & Illness, 44(6). 919-935.

Joy, P., & Numer, M. (2018). Queering educational practices in dietetics training: A critical review of LGBTQ inclusion strategies. Canadian Journal of Dietetic Practice and Research, 79(2), 80-85.

Lassemillante, A.-C. M., & Delbridge, R. (2021). Do we dare ask if this is racism? Nutrition & Dietetics, 78, 458-460.

Ng, E., & Wai, C. (2021). Towards a definition of anti-oppressive dietetic practice in Canada. Journal of Critical Dietetics, 5(2), 10-14.

Rose, M. S. (1912). The Training of the School Dietitian. The Psychological Clinic, 6(2), 52.

Scott, K. M. (2009). Recipe for citizenship: Professionalization and power in World War I dietetics (Publication Number 1539634551) [Doctoral Dissertation The College of William and Mary]. Virginia.

 

Robyn Delbridge (She/Her) is an Advanced Accredited Practising Dietitian, PhD Scholar, and Senior Lecturer Dietetics and Human Nutrition at Latrobe University. Her research interests span Aboriginal and Torres Strait Islander health, critical dietetics and the scholarship of teaching and learning. Robyn’s PhD is engaging with critical and qualitative approaches exploring how social power and privilege influences the diversity and representation in the dietetics profession. Connect with Robyn on LinkedIn

Intersectionality as it relates to allied health is a pivotal topic, and we’d like to hear your thoughts. Please leave a comment below.

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