Health Disparities
Structural Intersectionality: Development of a policy-based measure of state-level discrimination Sara Daniel* Sara Daniel Daniel Daniel University of Maryland Baltimore School of Pharmacy
Background: Identifying methods to measure structural determinants of health is key to advancing health disparities research. However, few structural measures of discrimination consider the synergistic effects of racism, sexism, and classism on health inequities. Using intersectionality as an analytical tool to account for multiple axes of oppression, this study addresses key gaps in measurement of structural intersectionality by developing a novel policy-driven measure of state-level discrimination.
Methods: From an initial pool of 235 state-level policies from six databases, we coded and selected 88 thematically relevant policies across 10 domains as potential indicators of intersectional discrimination. We conducted a series of confirmatory factor analyses (CFA), including unidimensional, 3-factor, and second-order models, to evaluate the relationship between our policy domains and the underlying latent constructs of racism, sexism, and classism.
Results: We identified 2 models to quantify intersectional state-level discrimination (Figure 1). A 3-factor model for racism, sexism, and classism included 9 policy domain indicators and showed good fit (RMSEA: 0.026; CFI: 0.989; TLI: 0.983). A unidimensional model for intersectional discrimination also included 9 policy domains and showed good fit (RMSEA: 0.014; CFI: 0.996; TLI: 0.995). Top policy-drivers of intersectional structural discrimination were domains related to social safety net, criminal justice, and sexual and reproductive health.
Conclusions: This measure of state-level structural discrimination advances our understanding of the intersecting effects of structural racism, sexism, and classism to address health inequities by quantifying the combined effects of multiple policies and can be used to account for the policy environment in each state. Further development of this measure can include longitudinal trends and other forms of structural discrimination.
