In this seminal article, Kimberlé Crenshaw (1991) sets out her theory of intersectionality through discussion of the tensions in identity politics encountered by racially minoritised women as situated within both feminist and anti-racist identity politics. As a starting point, Crenshaw highlights that identity politics can provide strength and community development through recognition of systemic level issues faced by identity groups. However, identity politics are also limited by ignoring differences within groups, thus flattening the many axes of identity that shape individual experience.
Crenshaw sets out this argument through discussion of the unique challenges encountered by racially minoritised women who face domestic and sexual violence, highlighting their marginalisation within both the mainstream feminist and anti-racist movements. Mainstream feminist discourses on domestic and sexual violence highlight universality and the systemic level of violence against women as a product of the patriarchy. The normative experience of domestic and sexual violence within this discourse is based on White women, and thus support services, interventions, and legal protections best cater to white women’s needs. As a result, racially minoritised women facing domestic and sexual violence are not only excluded from discourse, but also face greater challenges in accessing services, protection, and justice. Concurrently, narratives of domestic and sexual violence have been used as racist attacks against Black men, as highlighted by anti-racist movements. Crenshaw argues that the normative experience within anti-racist discourse is that of Black men, and that Black women and racially minoritised women more broadly are thus excluded from these movements and their experiences of violence ignored.
Through this discussion, Crenshaw sets out three types of intersectionality experienced by racially minoritised women. Structural intersectionality refers to the interplay of legal, social, and economic structures in shaping their experiences. Political intersectionality highlights that racially minoritised women are situated within at least two marginalised groups that frequently pursue conflicting political agendas. Representational intersectionality refers to how racially minoritised women are represented and to what end. Overarchingly, intersectionality demonstrates that the lived experience of multiple forms of intersecting discrimination and subordination is greater than and distinct from the sum of its parts.
Crenshaw concludes by arguing that intersectionality can serve to form coalitions and organise for change in a way that provides recognition and challenges subordination more comprehensively. “Through an awareness of intersectionality, we can better acknowledge and ground the differences among us and negotiate the means by which these differences will find expression in constructing group politics” (p. 60).
The 2022 Lancet Series Paper 3, on ‘intersectional insights into racism and health’, emphasises the necessity of an intersectional approach to respond to health inequities. Although not officially named in Baba et al.’s primary study, dimensions of an intersectional approach appear present in its contextual examination of Indigenous health disparity. In their study, Baba et al explored how Aboriginal medical services (AMS) address the health impacts of discrimination in Brisbane communities through the lay perspectives of Indigenous Australians. Qualitative work with 21 clients frequenting a government-controlled AMS and an Aboriginal community-controlled health service, identified historical and persisting racism as a primary influence in compromised healthcare seeking behaviour, essential health awareness, and mental health. The role of AMS in alleviating Indigenous health and associated racial discrimination was stressed by participants.
In-depth participant discussion revealed that discomfort experienced in mainstream health services is instrumental in the manifestation of delayed healthcare seeking, culminating in delayed diagnosis and increased fatality. Discomfort mainly results from mainstream services’ denial of Indigenous concepts of health, Indigenous fear of medical services, and discrimination by professionals and patients. Participants expressed an overall preference for Indigenous medical services.
While the participant sample was Brisbane-based, the phenomenon of racism and discrimination is a nation-wide multi-sectoral reality, subjugating Indigenous Australians to poor health across the age range. The authors further highlight Australia’s diffused domestic neglect of Indigenous health compared to most of its Western counterparts, where Indigenous health has made notable progress.
The authors make clear that contemporary marginalisation of Indigenous health in Australia sprouts from the roots of former British colonisation, which relegated Indigenous people to mass eradication, land dispossession, restricted reproduction, and systematic assimilation. Survivors were ‘…forced to squat and beg on the outskirts of British settlements…’. Similarly, the contemporary status of Indigenous health and wellbeing appears relegated to the periphery of mainstream Australian healthcare.
Against a backdrop of perpetuating neglect, the authors advise on the unique remedial capacity of the over one hundred Aboriginal community-controlled health services nationally. Compared to government-controlled AMS, they are independently designed and governed by Indigenous Australians, specifically providing community-led, culturally sensitive primary care aligned with Indigenous concepts of holistic health understood as ‘spiritual, emotional…physical…deeply connected to the land of their ancestors, and to their past, present and future simultaneously’.
Through centring their quality of care on Indigenous concepts of holistic health, an intersectional approach appears at work as Indigenous-led services recognise the inseparable relationship between Indigenous patients’ current state of health and their ‘…social, economic and historical state of colonisation…and continuing marginalisation’. Indeed, as the authors maintain, the AMS are fundamental to addressing adverse effects of persistent discrimination on Indigenous health and must be prioritised by the domestic health agenda. They also conclude that the services are an incomplete response to the institutionalised marginalisation of Indigenous Australians, requiring at the core, as put forth in the Lancet Series Paper 3, ‘a structural approach…to make lasting change’.
Nonetheless, the transformative effect of Indigenous-led services appears evident. Whilst they continue to operate within the contemporary parameters of colonial legacy, they appear concurrently to be restructuring, individually and collectively, the patient experience and engagement of Indigenous Australians within the Australian healthcare system, improving Indigenous healthcare seeking rates and health outcomes. Given that Indigenous-led services are directly in charge of their own people’s health, they appear to facilitate, in the face of extensive historical Indigenous dispossession, a reclaiming of ‘the body as the locus of political control and colonisation…’ and a potential decolonial space, through community empowerment, to holistically deconstruct embodied social constructs of difference.