Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden

Abstract

BackgroundIntersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage.ObjectiveThis article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression.DesignParticipants (N=25,585) came from the cross-sectional ‘Health on Equal Terms’ survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used.ResultsSignificant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison).ConclusionsThe study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups.

Self-rated health inequalities in the intersection of gender, social class and regional development in Spain: exploring contributions of material and psychosocial factors

“…The perspective of intersectionality, which takes into account such complexity, has therefore been advocated in public health research 11 . Diverse quantitative examples in population health research 11,12 demonstrate how intersectional approaches are taking combinations of disadvantages into account -a 'multiplicative approach'-as promising for providing more precise evidence for designing interventions and strategies towards equity in health 9 . Following these recommendations, intersectional approaches have recently begun to be applied more broadly in quantitative equity in health research.…”

Intersectional equity in health care: Assessing complex inequities in primary and secondary care utilization by gender and education in Northern Sweden

“…non additivity (31). Intersectionality-informed approaches therefore focus how multiple simultaneous inequities interact to produce complex inequities in for example population health (19,20,32), and intersectional, or complex, inequities thus refers to inequities arising in the combination of multiple inequities, e.g. socioeconomic and gender inequities.…”

Self-rated health inequalities in the intersection of gender and social class in Spain: exploring contributions of material and psychosocial factors

“…The perspective of intersectionality, which takes into account such complexity, has therefore been advocated in public health research 11 . Diverse quantitative examples in population health research 11,12 demonstrate how intersectional approaches taking combinations of disadvantages into account -a 'multiplicative approach'-as promising for providing more precise evidence for designing interventions and strategies towards equity in health 9 . Following these recommendations, intersectional approaches have recently begun to be applied more broadly in quantitative equity in health research 13,14,15,16 .…”