With COVID-19 no longer considered a public health emergency of international concern, the federal government is engaging in efforts to improve pandemic preparedness both domestically and globally, recognizing the need to learn from COVID-19 and prepare for the next potential infectious disease crisis.

Among the many lessons learned from the pandemic is the need to better mitigate the health and social inequities exacerbated by, and created within, COVID-19 responses.

One way to prevent such inequities is to incorporate intersectionality into pandemic preparedness. Intersectionality refers to how multiple social identities – such as race, gender, sexual orientation, socioeconomic status and disability – intersect with structural conditions and can further disadvantage individuals in more than one of these categories.

While incorporating intersectionality into pandemic preparedness is a complex task, we suggest three key starting points: use pre-pandemic data to better identify such individuals; use this data to identify their unique needs and tailor future pandemic measures accordingly; and develop plans that look beyond social identities to consider how political and socioeconomic structures shape lived experiences.

Throughout the COVID-19 pandemic, we saw individuals of different social identities experience varying direct health effects and indirect socioeconomic effects stemming from the pandemic response.

Existing inequalities resulted in groups – such as women, ethnic minorities, individuals with disabilities, the elderly and those in front-line occupations – being disproportionately affected.

For example, people with disabilities and low socioeconomic status were more likely to have poorer health outcomes if diagnosed with COVID-19.

Immigrant mothers who worked in precarious jobs and who lacked access to public assistance and support systems faced compounding challenges due to gender roles, familial responsibilities and limited access to resources.

So, what exactly is intersectionality and how would it help in future pandemic preparedness plans?

Overlapping disadvantages

Intersectionality grew from Black feminists’ activism in the U.S. challenging a one-size-fits-all approach in feminist and antiracism movements. While the term was coined by Kimberlé Crenshaw in the late 1980s, it represents a movement with a long history in the U.S., Canada and globally.

In her 1851 speech, “Ain’t I A Woman,” Sojourner Truth highlighted the different realities of white women and Black women. Her speech brought attention to the intricate ways that sexism and racism interacted in the lives of Black women. Feminism could not speak for all women until it spoke for the most marginalized women.

Intersectionality has been defined by Lisa Bowleg as “a theoretical framework for understanding how multiple social identities such as race, gender, sexual orientation, SES (socioeconomic status), and disability, intersect at the micro level of individual experience to reflect interlocking systems of privilege and oppression (i.e., racism, sexism, heterosexism, classism) at the macro social-structural level.”

Intersectionality acknowledges that the experiences of individuals differ based on the various social identities they carry (or are perceived to carry) because of political, social and economic structures that distribute privilege and oppression in a way that corresponds to these identities.

Intersectionality therefore calls for a more wholesome understanding of social processes and consequences. For instance, the experiences of Black women can be understood by looking at structural and interpersonal racism and sexism, and not solely by examining their identities.

Applying intersectionality to pandemic preparedness

The widespread health and socioeconomic effects of COVID-19 effectively demonstrated that pandemics do not affect people equally. Rather, they have varied and intersecting effects.

While this makes understanding the true scope of the pandemic challenging, intersectional frameworks provide a starting point to engage with this complexity. Some examples of pandemic responses that demonstrate a consideration of intersectional inequities include:

  • The United Nations Relief and Works Agency (UNRWA) introduced a program to aid in the procurement of basic supplies for people with disabilities and their families experiencing poverty at a Palestinian refugee camp. Deferred payments also allowed these families to acquire their necessities amid COVID-19 restrictions.
  • UNDP Zimbabwe partnered with Leonard Cheshire Disability Zimbabwe to restructure its activities to promote an intersectional gender and disability-inclusive response.
  • In Canada, government agencies utilized the gender-based analysis plus (GBA+) in responding to the effects of the pandemic. While its application was more reactive than proactive, it offered direction to addressing the needs of those people most affected.

We suggest three key starting points for future Canadian pandemic preparedness plans:

First, use pre-pandemic data to identify different societal groups. For instance, data on who is more likely to experience poor health outcomes and limited health-care access could indicate who is more at risk during a pandemic.

Data on employment status and conditions could also shed light on who is more likely to experience more extreme economic effects associated with pandemic public health measures.

Those marginalized in society are likely to be even further marginalized during pandemics, so identifying such groups is the first step in working with them to address current risk factors and prepare to mitigate issues that might emerge during a pandemic.

Second, apply this data, in consultation with identified priority populations, to tailor pandemic preparedness to meet their needs. This must include critically engaging with the potential negative secondary effects of public health measures by asking: who is most likely to be affected?

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When considering gendered effects of pandemic-related child-care closures, for instance, it is important to acknowledge that not all parents are affected in the same way. Other identity factors such as gender, race, ability, employment status and immigration status all result in differing effects among parents.

Third, develop pandemic preparedness plans that look beyond social identities to consider how political and socioeconomic structures shape lived experiences.

Immigration policies, for instance, affect the employment opportunities and other conditions of newcomers, while child-care policies shape unpaid care, mostly affecting women. An immigrant woman’s experiences are therefore shaped by these and other structures in society.

Pandemic preparedness plans must consider such structural factors that contribute to disproportional risks during a pandemic. Further, they must interrogate who is likely to be most affected by such factors.

Incorporating intersectionality into pandemic preparedness will not only protect those most at risk of the health, social and economic costs of health crisis, it will also improve preparedness to the benefit of all.

As Crenshaw once wrote, “If [equity efforts] instead began with addressing the needs and problems of those who are most disadvantaged and with restructuring and remaking the world where necessary, then others who are singularly disadvantaged would also benefit.”

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Haaris Tiwana
Haaris Tiwana is a research fellow in the faculty of health sciences at Simon Fraser University, with a focus on equity-based research and policy analysis.
Julia Smith
Julia Smith is an assistant professor in the faculty of health sciences at Simon Fraser University. She co-leads the gender and COVID-19 project and is the health and social inequities theme lead at PIPPS.

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