Intersectional approaches in epidemiology: 6 essential articles on epistemology and praxis

This is part 3 of a 3 part series examining intersectional approaches in epidemiological research. See past articles on 6 essential articles on theory and 8 essential articles on methods.

Epidemiologists and other population health researchers have made considerable developments in bridging intersectionality theory with epidemiological methods over the past decade. The following list attempts to reflect the dynamic and non-linear nature of this endeavor and is organized as follows. The first set of articles are conceptual, reviewing the why and how of incorporating an intersectional lens into epidemiological research. The second set of articles are methodological, presenting new or novel applications of existing analytic approaches to studying the distribution and determinants of health and disease. When possible, I mention published commentaries and responses to these articles to highlight the ongoing challenges involved in “quantifying” intersectionality and to emphasize the fact that no single method is inherently intersectional. Finally, because intersectionality theory is first and foremost a critical theory with the goal of enacting transformative social change, the third set of articles are focused on examining the process of epidemiological knowledge production itself as a means of reinforcing or challenging systems of power, as well as how epidemiological knowledge can be used to promote intersectional health equity. Of course, this list is nowhere near exhaustive, and is influenced by both extant interpretations of intersectionality theory in the field of epidemiology and my own social location, academic training, and worldview… read more »

Praxis Articles


Shim JK. Understanding the routinised inclusion of race, socioeconomic status and sex in epidemiology: The utility of concepts from technoscience studies. Sociol Heal Illn. 2002;24(2):129 – 150. 

In this sociological article, Shim reviews the use and conceptualization of social identities within epidemiological research and argues that the conflation of social identity with individual-level biology and/or behavior in mainstream epidemiology (re)produces hegemonic (and problematic) notions regarding differences between social groups. She offers a critique of the multifactorial model of disease causation, positing that the model ignores both the intersectional nature of social identities and the social and historical contexts in which disease occurs, and raises important questions about the process of epidemiological knowledge production (e.g., “To what extent are epidemiologists deliberately conscious of and concerned about the meanings that specific measures of race, class and sex/gender embody?” (p. 143)). Overall, Shim’s article is an important read as it encourages epidemiologists to view our work as both a scientific and social product. 

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Wemrell M, Merlo J, Mulinari S, Hornborg AC. Contemporary epidemiology: A review of critical discussions within the discipline and a call for further dialogue with social theory. Sociol Compass. 2016;10(2):153–171. 

Wemrell and colleagues offer a critical review of historical debates within epidemiology, with a focus on critiquing the hegemony of “risk factor epidemiology”. In particular, risk factor epidemiology is argued to erase within-group heterogeneity, ignore social and historical contexts, and prioritize scientific objectivity and neutrality over public health-promoting social change. They conclude by arguing for a greater incorporation of social theory (including intersectionality theory) into epidemiological research, particularly with respect to studying the social determinants of health and health disparities, in order to produce epidemiological knowledge that better promotes health equity. 

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Breilh J. Latin American critical (‘Social’) epidemiology: New settings for an old dream. Int J Epidemiol. 2008;37:745–750. 

Breilh’s article provides an important critique of the “scientific discrimination” in mainstream epidemiological and public health research, whereby the scientific contributions from Latin America are under-appreciated and under-acknowledged relative to contributions from Western countries. As a means of challenging this form of structural academic bias, he outlines the objectives and major contributions of “Latin American critical epidemiology”, illustrating how the field has “constructed a sound institutional and academic platform from which to exercise a democratic projection of science and mold an alternative public health movement” (p. 749). Breilh’s article is an essential read for epidemiologists looking to engage in intersectional scholarship as it encourages us to ask who is “at the table” of epidemiological knowledge production (and why), and what the implications are with respect to producing knowledge to promote intersectional health equity.

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Ng E, Muntaner C. A critical approach to macrosocial determinants of population health: Engaging scientific realism and incorporating social conflict. Curr Epidemiol Reports. 2014;1:27–37. 

Ng and Muntaner argue for the advancement of macrosocial epidemiology, defined as the study of macro-level factors, processes, and institutions (e.g., globalization, macroeconomics) on the population patterning and determinants of health and disease. Although they do not explicitly discuss intersectionality theory, macrosocial epidemiology’s emphasis on structural power and social justice is directly in-line with the theory’s core tenets and critical bent, making this read helpful for thinking about how intersectionality and social epidemiological theories can inform and build upon one another. 

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Inhorn MC, Whittle KL. Feminism meets the “new” epidemiologies: toward an appraisal of antifeminist biases in epidemiological research on women’s health. Soc Sci Med. 2001;53(5):553–67. 

Similar to Ng and Muntaner’s argument for macrosocial epidemiology, Inhorn and Whittle put forth their vision of a “feminist epidemiology”, characterized by a strong engagement with critical social theory (including intersectionality theory), an examination of the researcher’s positionality, a focus on structural power, and a grass-roots, participatory approach. 

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Cho S, Crenshaw KW, McCall L. Toward a field of intersectionality studies: Theory, applications, and praxis. Signs (Chic). 2013;38(4):785–810. 

Last but certainly not least, this article from Cho and colleagues provides a comprehensive overview of extant intersectional scholarship in an effort to define and distinguish a field of “intersectionality studies”. Although not specific to epidemiology, the authors “Template for a Collaborative Intersectionality” can provide epidemiologists with important guidelines for incorporating intersectionality into their work and foster a more critical, interdisciplinary, and social justice-oriented epidemiology.

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Ariel Beccia (she/her/hers) (@arielbeccia) is a PhD candidate in the Clinical and Population Health Research program at the University of Massachusetts Medical School. Her research interests include a) the social epidemiology of eating disorders, and b) bridging quantitative epidemiological methods with social and feminist theories. Straddling both of these interests, her dissertation research is examining the population patterning and social determinants of eating disorders at the intersection of sexual orientation, gender identity/expression, and weight status.

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