Applying Intersectionality to Health Professions Education

by Caitlin Leach, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy

Health professions are comprised of a distinct group of people with specific domains of inquiry possessing language, methods, and skills within a focused framework.  While health professions education encourage the acquisition of an impressive depth of knowledge, they limit the scope of practitioners’ expertise.  A common solution to this issue involves promoting interprofessional education. Theoretically, this exposes learners to other areas of specialization in order to provide a more holistic approach to the task at hand.

I argue that this is not an adequate solution.

Interprofessional approaches involve temporary overlap of profession-specific frameworks to provide insight and new knowledge regarding a particular task. Unfortunately, this categorizes information outside the practitioner’s framework as the responsibility of other professions. This approach is appropriate when complex tasks have access to an interprofessional perspective. However, often in pharmacy practice, particularly in settings where patients face barriers-to-care and lack-of-access, complex cases must be solved independently of additional practitioners’ perspectives. To address this gap, pharmacy students need more exposure — not to interprofessional education, but to intersectional education.

“Intersectionality” is a sociological theory coined by Kimberlé Crenshaw in 1989.¹ The theory postulates that multiple axes of identity contribute simultaneously to a person’s experience of oppression and discrimination.  The typical manifestations of oppression - sexism, racism, classism, biphobia, homophobia, transphobia, and belief/cultural-based prejudice – cannot be examined independently because they contribute to inequality in a way that is interconnected and interrelated. Instead, intersectionality offers a holistic framework to evaluate the impact of multiple identities contributing to a person’s experience of inequality.¹ Borrowing the concept of intersectionality, it can be applied in health professional education and used to help students see the multiple determinants contributing simultaneously to a patient’s experience of health.

This figure illustrates various axes of human identity converging to a point of intersection

Image from: http://www.clydefitchreport.com/2015/01/intersectionality-going-forward/

Similar to identity, the origin of poor health is multifactorial and cannot be examined through a singular lens. Pathophysiologic and psycho-social determinants of health are interconnected and interrelated. While interprofessional approaches provide a different perspectives, from ability (physical therapy), family and income status (social work), to mental health (psychology, psychiatry), and others, it is imperative for pharmacists to be able to incorporate these health determinants when making therapeutic decisions in the absence of consulting other professions. In healthcare education, intersectionality can be applied to patient cases with the realization that health is not determined by any one thing. Through addressing psycho-social health determinants and discussing their impact on pharmacotherapeutic decision-making, intersectionality can provide students with a more complex understanding of health in order to address the needs of diverse patient populations.²

Intersectional case studies could explore a variety of questions including:

• What does lifestyle modification look like in a patient with diabetes on a fixed-income, with limited access to reliable electricity and heat, and sporadic medication adherence due to transportation issues to the pharmacy?
• In a patient with metabolic syndrome, depression, and anxiety that loses insurance coverage and can only afford half of her medications, which 5 of 10 medications are the most important in maintaining her health?
• What preventative care and screening recommendations do you make for male, female or transgender patients lacking primary care providers?

Adding layers of complexity regarding the human experience to patient cases can aid students in making the transition from the classroom to practice. Using intersectionality to address health disparities and improve health outcomes will also lead to more encompassing, holistic healthcare.³ Intersectionality provides a framework for pharmacy education that takes into account the complexity of health and human experience rather than reinforcing barriers-to-care as the responsibility of other health professionals and, in effect, perpetuates health disparities.

References:

1. Sumi C, Crenshaw K, McCall L. Toward a Field of Intersectionality Studies: Theory,Applications, and Praxis. Signs: Journal of Women in Culture & Society. Summer 2013;38(4):785-810.
2. McGibbon E, Rochester C. Applying Intersectionality & Complexity Theory to Address the Social Determinants of Women’s Health. Women's Health & Urban Life. May 2011;10(1):59-86.
3. Hankivsky O. Women’s health, men’s health, and gender and health: Implications of intersectionality. Social Science & Medicine. June 2012;74:1712-1720.