Artigos

Conteúdo (article):

Reflexões sobre a abordagem intersetorial e a saúde da mulher
Reflexiones para el abordaje del enfoque interseccional y la salud de las mujeres
Reflections on the intersectional approach to women\'s health

Autores/Authors
Miguel Alejandro Saquimux Contreras
Correo / Email: asaquimux@yahoo.com
Institución / Institution: Departamento de Tocoginecologia. Faculdade de Ciências Médicas. Universidade Estadual de Campinas, São Paulo State, Brazil.
ORCID: 0000-0003-2916-5311

Odette del Risco Sánchez, PhD
Correo / Email: oderisco89@gmail.com
Institución / Institution: Departamento de Tocoginecologia. Faculdade de Ciências Médicas.
Universidade Estadual de Campinas, São Paulo State, Brazil.
ORCID: 0000-0002-7094-0378


Natividad Guerrero Borrego, PhD
Correo / Email: nguerrero5361@gmail.com
Institución / Institution: Centro de Estudios Sobre la Juventud, La Habana, Cuba.
ORCID: 0000-0001-5359-1420

Maria José Duarte Osis, PhD
Correo / Email: mjosis@yahoo.com
Institución / Institution: Faculdade de Medicina de Jundiaí, São Paulo State, Brazil.
ORCID: 0000-0003-3625-1525

Fernanda Garanhani De Castro Surita, PhD
Correo / Email: surita@unicamp.br
Institución / Institution: Departamento de Tocoginecologia. Faculdade de Ciências Médicas.

Universidade Estadual de Campinas, São Paulo State, Brazil.

ORCID: 0000-0003-4335-0337
 
Resumo
Esta análise baseia-se, mas não se limita, no que foi apresentado na Mesa 1 – “Interseccionalidade e saúde da mulher do Fórum Permanente: Determinantes sociais na saúde da mulher” ocorrido na Universidade Estadual de Campinas – UNICAMP, cujo objetivo foi promover a discussão sobre a interseccionalidade como categoria de análise para ampliar a compreensão dos determinantes sociais da saúde. Surge a necessidade de questionar o que se entende por interseccionalidade e como compreender os determinantes sociais da saúde da mulher nas pesquisas emanadas do campo das Ciências da Saúde. É fornecido um breve quadro histórico sobre os determinantes para ilustrar a evolução da análise ao longo do tempo, juntamente com a necessidade de adotar uma abordagem interseccional através da reflexão teórica latino-americana. As limitações e possibilidades associadas à combinação destas duas abordagens aumentam a urgência de pesquisas interdisciplinares com quadros epistemológicos definidos e contextualizados. É feita uma consideração final sobre a sinergia de abordagens que podem contribuir para uma compreensão mais profunda dos determinantes sociais da saúde.

Resumen
Este análisis está basado, pero no limitado, en lo expuesto en la Mesa 1 – “Interseccionalidad y salud de la mujer del Foro permanente: Determinantes sociales en la salud de la mujer” que tuvo lugar en la Universidad Estatal de Campinas – UNICAMP, cuyo objetivo fue promover la discusión sobre la interseccionalidad como categoría de análisis para ampliar la comprensión sobre los determinantes sociales de la salud. Se plantea la necesidad de cuestionar qué se está entendiendo por interseccionalidad y cómo entender los determinantes sociales de la salud de las mujeres en las investigaciones que emanan del campo de la Ciencias de la Salud. Se proporciona un marco histórico breve sobre los determinantes para ilustrar la evolución del análisis durante el tiempo junto con la necesidad de adoptar un enfoque interseccional mediante la reflexión teórica latinoamericana. Las limitaciones y posibilidades asociadas a la combinación de estos dos enfoques plantean la urgencia de investigaciones interdisciplinarias con marcos epistemológicos definidos y contextualizados. Se hace una consideración final sobre la sinergia de los enfoques que pueden contribuir a una comprensión más profunda de los determinantes sociales de la salud.

Abstract
This analysis is based on, but not limited to, what was presented in Table 1 - "Intersectionality and women\'s health of the Permanent Forum: Social Determinants in Women\'s Health" that took place at the State University of Campinas - UNICAMP, whose objective was to promote discussion on intersectionality as a category of analysis to broaden understanding on the social determinants of health. It raises the need to question what is currently understood by intersectionality, and how to understand the social determinants of women\'s health in research emanating from the field of Health Sciences. A brief historical framework on determinants is provided to illustrate the evolution of the analysis over time, along with the need to adopt an intersectional approach through Latin American theoretical reflection. The limitations and possibilities associated with combining these two approaches raise the urgency of interdisciplinary research with defined, contextualised, epistemological frameworks. A final consideration is made on the synergy of approaches that can contribute to a deeper understanding of the social determinants of health.

Palavras-chave: Saúde da Mulher, Interseccionalidade, Determinantes sociais da saúde.
Palabras claves: Salud de las Mujeres, Interseccionalidad, Determinantes sociales de la salud.
Keywords: Women\'s health; Intersectionality; Social determinants of health.

Introduction
Social determinants are cultural, economic and political factors that can affect health. Based on the premise that it is necessary to consider racism, forced migration, ableism, sexism, ageism, among others as conditions that increase the vulnerability of women and people with uteruses in access to and their permanence in health care, indeed exercise of the right to health. It emphasizes that vulnerabilities are linked to living conditions. Therefore, addressing these issues from an intersectional perspective is essential to recognize oppressive matrixes1, 2 with the intentionality of dimensioning inequalities and promoting egalitarian health.

Therefore, understanding the conditions women experience throughout their lives in specific territories, such as Latin America, requires articulation of theoretical-methodological tools that cover the complexity of social, political, cultural, economic and ecological processes.

For example, as proposed by international agendas that model a path toward the defence of human rights and gender equality3, in particular the 2030 Agenda through the Sustainable Development Objectives (SDGs), together with the provisions of international agreements and instruments, such as the Convention on the Elimination of all forms of Discrimination against Women (CEDAW), both of which highlight the need to intensify efforts to address the various problems women contend with daily; in this case specifically, health inequalities still persistent in Latin America.

Likewise, sexual and reproductive rights, the health of girls, adolescent and adult women; gender-based violence, among others, are phenomena that this agenda and this agreement are understood as commitments that have to be assumed and addressed intensely and systematically, because women constitute a diverse group formed by the integration of multiple realities, identities and social categories. In addition, it should be noted that this multiplicity of social interrelations is asymmetric causing its intensity, albeit true that all women still occupy subordinate positions with respect to men, not to be the same for all in the various spaces. This which has generated profound inequalities.

It is important to remember that women allocate three times more hours to domestic and care work than men. They remain a minority in managerial or leadership positions in the labour market (38%)4, and occupy only 33.6% of the Latin American parliamentary seats5. Furthermore, one in three women has been a victim of physical and/or sexual violence committed by their partner or ex-partner6. In 2020, more than 4,000 females were victims of femicide, of whom 4.1% were girls aged 0 - 4 years7. Also, one in four girls and female adolescents are living in an early, forced marriage or union8.

In this sense, it is urgent to discuss paradigms that allow complex analysis of inequalities and their effects on women\'s health, as well as the potential to translate their results into public policies. Thus, drawing on the Health Sciences, it becomes necessary to address the intertwining of micro and macrosocial factors that place women in vulnerable situations, especially from the analysis of problems that compromise their health, well-being and full development.

It is for these reasons that we propose to seek understanding of these phenomena from an intersectional approach. However, aware of the current debate on the utilization of this category in various areas9-11, we propose that it is necessary to begin by discussing how we understand it in the field of Latin American health.

How can one understand the category intersectionality in the health field?

In order to understand social phenomena and their effects on women\'s health in a holistic, comprehensive way, it is necessary, in the area of health, to utilize an intersectional approach to the understanding of health inequalities and their complexities in specific contexts, such as Latin America12-15. For this reason, this article joins the existing debate about the need to theorize intersectionality in the health area11, 13-16, but beyond identification of the epidemiological profiles of women in health spaces.

However, before delving deeper, it must be established that it is based on the premise that health is a universal human right, which has evolved to the extent that the person and the surrounding environment assumes greater relevance in understanding states of health. This evolution has caused disease to cease to be the centre of analysis so as to focus on the people, active and participant, in the achievement of their well-being, reflected in their health, in the social environment of which they are part.

Intersectionality, as a concept, was coined by the Afro-American, Crenshaw, who, even though he had embarked on a career in the legal field, expanded his range to the most diverse academic spaces17. However, according to Deepeka Sarma, cited by Hill and Bilge1, intersectional analysis has been carried out for several decades. An example of this is the analyses carried out by Savitribai Phule in 19th century India. Phule\'s work addressed the different forms of oppression in existence at that time, and how they affected women’s lives. These were also perceived by Goes18 in Brazil, and Santos in the rest of Latin America19. It is from these works that it has become established that the analysis of social realities cannot focus on a single area of life due to oppressive matrixes. This is something that feminist and social movements in mainly black and indigenous communities have evidenced. So the intersectional approach is linked to various resistance positions against the dominant discourse17.

The contributions around this concept, their interpellations and criticisms have aided visualization and distinguishing of social categories, roles that intersect and converge in the oppressive systems, revealing the need for more complex analysis compared to policies aimed at reducing inequality gaps. It is for this reason we support the Hill and Bilge1 proposal about understanding intersectionality as “an analytical tool that examines how power relations are intertwined and mutually constructed”1. In this sense, we must emphasize that investigating health, women and intersectionality demands should be made with a decolonial gender approach19-22 that considers the course of life and the Latin American territories.

Thus, it is proposed that the condition of women and gender intersect with the oppression that is present and influences their health. Therefore, in this article it is understood that women are a diverse group without losing sight of the fact that this multiplicity of social interrelations is immersed within asymmetric power relations, and where they occupy positions subordinate to men, and what is considered masculine.

It is due to the above that, in this article, intersections are not considered identities, but are understood as forms of domination23 that oppress, condition and determine the lives of women, and specifically in this case, their health.

In Latin America it has become necessary to utilize theoretical-analytical tools that allow discussion of the various inequalities operating interwoven in this context, generating various experiences of oppression, marked not only by gender or skin colour, but also by belonging to historically marginalized groups. However, the expanded utilization of this category has been pointing out the need for a decolonial view of it, recognizing that, over the years, several researchers and feminists in the region have promoted debates about the multiple forms of oppression and their interrelations, So this is not a novel concept for the field of feminist theories23, but for that of health, as evidenced by Santos19.

In Brazil, since the 60s, Brazilian activists and intellectuals. such as Thereza Santos, Lelia González, Maria Beatriz do Nascimento, Luiza Bairros, Jurema Werneck and Sueli Carneiro, among others, have promoted debates regarding the oppression triad, “Race-Class-Gender”23, which must also be considered together with sexuality, disability, ethnicity, nationality, religion, body dimension and age as analytical categories, but without disregarding that these are also categories that have distinct significances within the power relations of racism, sexism and class exploitation1.

Currently, several disciplines utilize the intersectional approach to achieve more comprehensive analyses, because women live in different contexts in which they have roles that identify and place them into different groups, in particular socio-economic and cultural contexts. This accounts for the feelings about and the interpretations of a category that, originated in social movements, has been rooted in the academic environment as the theoretical referential to address health inequality.

Thus, intersectionality emerges, not only as a political perspective, but also as a theoretical one, which passes through recognition of the complexity of human beings and the multidimensionality of their existence to reveal and attract attention to the intersectionalities that generate inequalities, with potential to find possible solutions from a social justice perspective23. Therefore, the intersectional paradigm in the health field allows understanding of the experiences of women within oppressive matrixes, and how these are structured in dimensions of inequality. As a consequence, it is understand that the answers and solutions to their claims have to be heterogeneous and holistic in order to adjust to the realities.

Following this line of analysis, Marcela Lagarde24 postulates that to understand the situation of women in Latin America, both similar elements and those that differentiate them in favour of a common claim discourse, must be taken into account. It highlights the need to understand multi-ethnic and multi-lingual diversity that characterizes Latin American women marked by “national, ethnic, racial, class, age, health, religious, political, ideological and cultural particularities”24. The foregoing part of the premise that health lies within such a multi-causal determining process, and as stated by Lalonde25, who proposed understanding health from four determinants that affect health: human biology, environment, lifestyles and health care system.

The Lalonde report, presented in 197425, showed that each factor has a potential contribution to the mortality of society. Also, from the epidemiological aspect, it is highlighted that the main causes of disease, death and disability are avoidable. This report postulated that life decisions and styles are the result of learned behaviour, and so can be addressed via prevention and education25. Therefore, this report25 affirms that the health of a population is classified according to different factors that, like the general organization of a country, establishes that health is physical, mental and social well-being. Consequently, health systems’ capacity to function, provide access and services where populations live is of vital importance26.

However, in the Lalonde Report, more importance was given to lifestyles than other factors, although these have to be understood within the environment, the demographic situation, biological and genetic elements, distribution of wealth, family relationships, social inequalities; educational system, information, values, access to health systems, among other social determinants. As a consequence, not all people are in the same conditions of social and health development. Therefore, health cannot continue to be addressed from an individual and standardized approach, because health is dependent on the living conditions that exist in each territory and society27, it being necessary to recognize that the health-disease processes are not exclusively mediated by so-called lifestyles.

Thus, in this line of approach, it is the reason why over time other approaches have been added that have also sought to understand and explain how the environment determines or conditions people’s health. For example, the Sick Individuals and Sick Populations27 publication, also considered classical in the field of epidemiology and public health, explains how, despite the same disease existing in a specific population, the prevalence or incidence of this varies depending on the living conditions of the people who comprise that population. This is something that, years later, Whitehead and Dahlgren28, 29 exemplified through a model, which was the interrelation between health determinants and the various levels that exist between the conditions and factors that generate inequalities. This publication was the one in which the “rainbow or Dahlgren and Whitehead model”30 approach was proposed.

This model proposes28 that health is made up of a complex social network, and there is evidence that the inevitability of most inequalities causes diseases, which, depending on living conditions, occur with varying intensity, morbidity and mortality. In the celebration of the 30 years of the model, Dahlgren and Whitehead30 wrote a review of the article in which they mention that the proposed model has endured over time thanks to the fact that it was an innovative proposal within the health field. Likewise, both emphasize that the most important aim was to “encourage people to think beyond health services and the health sector, and take into account the social determinants of health in local surroundings and society in this setting”30. The authors consider that the success was also due to the fact that a new way of understanding the interaction among the social health determinants was presented. Furthermore, the approach focused on risk factors was modified, and attention was transferred to a holistic vision of health and disease.

However, Dahlgren and Whitehead are aware that the model is not sufficient to “fully understand the determinants (root causes) of the inequalities within a country”30. Above all, because Lalonde’s25 statements about lifestyles have no support in reality, and, as they promote a moralistic, individualistic and biased discourse on living conditions31-33 that are ultimately those that determine or condition the possibilities of people\'s lives, it is necessary to change the conceptual approach.

In this sense, intersectionality as a theoretical-analytical tool1 is regarded as necessary to understand the social realities in which women live and their immersion in a series of forms of oppression that result in discrimination of various kinds. Thus, it is postulated that forms of oppression, when intersecting, condition or determine women’s health2.

Considering the intersectionality category as a theoretical-analytical tool for the field of health, studies carried out in Brazil contribute to the debate on the need to produce evidence based on this perspective. For example, based on the works mentioned by the participants of "Table 1 - Intersectionality and Health of Women", it is established that the discussion can be divided into three groups (Fig. 1)

Figure 1. Themes addressed in studies on intersectionality carried out in Brazil

In general, research in this context contributes to the debate on how inequalities are the result of existing oppressive systems in each territory and specific populations. However, they often lack comprehensive approaches to achieve an in-depth understanding of why certain groups are in a state of greater vulnerability, suffer exclusion, unequal conditions of health, discrimination, and a lower quality of life. In this field it is urgent to encourage the production of evidence on how racism, sexism, classism, binarism, among others, operate as systems of oppression that generate discrimination and inequality, and affect social actions, cultural practices and policies that act and contribute to the oppression of various groups of women leading to negative health consequences for them34.

The previous assertion is made considering the results of the Latin American study by Arias-Uriona et al.13, in which it is noteworthy that, in contexts of extreme inequality, both women and men of specific ethnic or indigenous groups perceive the affectation in their health with the same intensity. Here lies the reason why it is proposed to debate what is being understood by intersectionality, because, in most of the aforementioned articles, there are no theoretical sections that support the utilization of race concepts, racism, ethnic group, gender, socio-economic status, which do not establish what is understood by them. Perhaps the cause of what, in the state-of-the-art, is being established as intersectional health analysis is epidemiologically profiled men and women according to race/ethnicity, socio-economic status, schooling level, and assumed gender identity. However, only these data do not communicate beyond the health status of the group of interest to the research teams. Therefore, it is important to stop considering epidemiological profiles as social characterizations, and cease utilization of distributions and frequencies of morbidity and mortality to attempt to provide some explanation of the social phenomena manifested in women’s body dimensions and their health19.

For example, in Brazil the race and racism categories have their own singularity for historical and contemporary reasons. Additionally, they manifest themselves differently depending on the space in which they take place2. So it is necessary to discuss and, above all, establish what is being understood by these categories to be able to identify who the women being affected by the different kinds of oppression are. Otherwise, simplifications that hinder analysis and understanding of the health status of specific social groups by utilizing race/skin colour/ethnicity, occur indistinctly. The same applies to utilization of social class and socio-economic status categories, which, in many cases, are utilized without distinction, and likewise the women and gender concepts as if they were equivalent. The oppressive acts women undergo due to the discrimination they face and become crystallized in their health status cannot be condensed into a single dimension of oppression. Pursuing this logic would be to reduce the discussions to which form of oppression is the gravest in women’s daily lives, and would neglect the understanding of oppression and power relations as a whole that determine health.

In line with the above, Almeida et al.12 suggest problematization of the oppressive systems in the training processes for health professionals so as to expand the notions of oppression, bodies silenced and oppressed by the structural inequalities of society. Reflection that follows in accordance with what is raised by Mello and Gonçalves16 regarding the low capacity and knowledge of health professionals about the oppression of various social groups, suffered with differences in intensity. Ribeiro35 endorsed the latters’ evidence, and elaborated by highlighting the difficulties of implementing public policies when health centres practiced some types of broader approach, due to ignorance or denial of the oppression and discrimination that create inequalities, in addition to existing prejudices against specific social groups.

Likewise, as far as we know, there is limited evidence of promotion of intersectional analysis of the oppression women with some or multiple disabilities suffer, whether with large or small bodies, aged beyond that established as the reproductive phase, and with refugee or displaced status.

Therefore, it is essential to give priority to interdisciplinary theoretical and methodological approaches for the generation and collection of data that contribute meaning to the epidemiological characterization of women for the purpose of understanding the multiple forms of oppression women face, and exposing the social determinants that are part of their daily lives. This implies unravelling the complex social fabric in which they live without neglecting the social determinants of health that limit women\'s health and reflect the levels of inequality in which they interact, depending on the asymmetries the power relations impose.

Final considerations

Women\'s health is multi-dimensional, multi-causal and, consequently, requires diversity of approaches to understand the living conditions that limit full exercise of their rights. From an intersectional perspective, analyses of women\'s health can reveal the multiple forms of oppression to which they are subjected, as well as expose and explain the social determinants with which they live and are reflected in their health status. Thus, the complex social network that forms the realities of women in the region reveals the unquestionable need to transform the dynamics that oppress and limit their full development. However, this action requires, in addition to interdisciplinary approaches, questioning biomedicine because of its cishetereo-patriarchal and colonial logic, as well as thinking, analysing and proposing consistent strategies compatible with our territories and realities. What ultimately is required is establishment of new theoretical and methodological frameworks aimed at proper interpretation of women\'s health.

References
1. Hill Collins, P. and S. Bilge, Intersectionality. Cambridge: Polity Press. 2016.
2. Hogan VK, de Araujo EM, Caldwell KL, Gonzalez-Nahm SN, Black KZ. "We black women have to kill a lion everyday": An intersectional analysis of racism and social determinants of health in Brazil. Soc Sci Med 2018; 199: 96-105.
3. Comisión Económica para América Latina y el Caribe (CEPAL). Adaptar sistemas de información de género, como eje de implementación de la Agenda Regional de género, in XIII Conferencia “Estrategia de monitoreo para la implementación de la Agenda Regional de Género en el Marco del Desarrollo Sostenible hacia 2030: Santiago, Chile¸ 2017.
4. Comisión Económica para América Latina y el Caribe (CEPAL). Oportunidades y desafíos para la autonomía de las mujeres en el futuro escenario del trabajo. Asuntos de Género: Santiago, Chile; 2019.
5. Comisión Económica para América Latina y el Caribe (CEPAL). La sociedad del cuidado: horizonte para una recuperación sostenible con igualdad de género: Santiago, Chile; 2022.
6. World Health Organization (WHO), Violence against women prevalence estimates, 2018: global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women: Geneva; 2021.
7. Comisión Económica para América Latina y el Caribe (CEPAL). La pandemia en la sombra: femicidios o feminicidios ocurridos en 2020 en América Latina y el Caribe. Asuntos de Género: Santiago, Chile; 2021.
8. Comisión Económica para América Latina y el Caribe (CEPAL), Los matrimonios y uniones infantiles, tempranos y forzados: prácticas nocivas profundizadoras de la desigualdad de género en América Latina y el Caribe: Santiago, Chile; 2021.
9. Davis K. Intersectionality as buzzword. Feminist Theory 2008; 9(1): 67-85.
10. Dhamoon RK. Considerations on Mainstreaming Intersectionality. Political Research Quarterly 2011; 64(1): 230-243.
11. Bauer GR. Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med 2014; 110: p. 10-7.
12. Almeida AMB, França LC, Melo AKS. Diversidade humana e interseccionalidade: problematização na formação de profissionais da saúde. Interface (Botucatu) 2021; 25: e200551 DOI: https://doi.org/10.1590/interface.200551
13. Arias-Uriona AM, Losantos M, Bedoya P. La interseccionalidad como herramienta teóricoanalíticapara estudiar las desigualdades en salud en las Américas. Rev Panam Salud Publica 2023; 47: e133.
14. De Jesus MAC, Acioli S, Silva MFB, Dos Santos RG. A interseccionalidade como categoria analítica na saúde com foco na enfermagem na Atenção Primária em Saúde: uma revisão integrativa de literatura. Contribuciones a Las Ciencias Sociales 2023; 16(10): p. 18773-18793.
15. Oliveira de Paula M. Interseccionalidade de classe, raça e gênero nos estudos sobre saúde, in 9º Encontro Internacional de Política Social 16 º Encontro Nacional de Política Social; 2023; Vitória, ES.
16. Mello L, Gonçalves E. Diferença e interseccionalidade. Notas para pensar práticas em saúde. Revista do Programa de Pós-graduação em Ciências da URFN 2010; 11(2).
17. Roth J. Interseccionalidades más allá del occidentalismo. In: Zabala Argüelles MC, Fundora Nevot GE, organizadores. Interseccionalidad, Equidad y Políticas Sociales. La Habana: Ediciones Acuario, Centro Félix Varela; 2022. p. 10-20.
18. Goes E. Interseccionalidade no Brasil, revisitando as que vieram antes. Observatório de Análise Política em Saúde, OAPS/ISC/UFBA 2019; Pensamentos e debates.
19. Santos Madrigal O. Hacia los feminismos descoloniales, negros y comunitarios para descolonizar los estudios de género y salud 2024; Cuadernos del pensamiento crítico latinoamericano, Programa de Estudios Africanos, CLACSO, Buenos Aires.
20. Dimenstein M. Silva G, Dantas C, Macedo J, Leite J, Alves A. Gênero na perspectiva decolonial: revisão integrativa no cenário latino-americano. Revista Estudos Feministas 2020; 28(3).
21. Gomes C. Gênero como categoria de análise decolonial. Civitas: Revista De Ciências Sociais 2018; 18(1): 65-82.
22. Mendes G. Fonseca A. A questão de gênero numa perspectiva decolonial. Rev. Ed. Popular 2020; 19(1): 82-101.
23. Vigoya V. La interseccionalidad: una aproximación situada a la dominación. Debate Feminista 2016; (52).
24. Lagarde M. De la igualdad formal a la diversidad: una perspectiva étnica latinoamericana. Anales de la Cátedra Francisco Suárez 2003; (37): 57-79.
25. Lalonde M. A New Perspective on the Health of Canadians. A Working Document. Ottawa: Ministry of National Health and Welfare; 1981.
26. Palomino Moral PA, Grande Gascón ML, Linares Abad M. La salud y sus determinantes sociales. Desigualdades y exclusión en la sociedad del siglo XXI. Rev Internacional de Sociología 2014; 72: p. 45-70.
27. Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14(1): 32-38.
28. Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe. Sweden: Institute for Future Studies; 1991.
29. Whitehead M, Dahlgren G. Concepts and principles for tackling social inequities in health: Levelling up Part 1. Denmark: World Health Organization Regional Office for Europe; 2007.
30. Dahlgren G, Whitehead M. The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health 2021; 199: 20-24.
31. Campos G. Saúde pública e saúde coletiva: campo e núcleo de saberes e práticas. Cien Saude Colet 2000; 5(2): 219-230.
32. Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol 2006; 35(1): 55-60.
33. Kronenfeld JJ. Changing conceptions of health and life course concepts. Health 2006; 10(4): 501-17.
34. Saquimux Contreras, Miguel Alejandro. Replication Data for: Reflexiones para el abordaje del enfoque interseccional y la salud de las mujeres. https://doi.org/10.48331/scielodata.D75UWA, 2024; SciELO Data.
35. Ribeiro Oliveira J. A intersetorialidade e a interseccionalidade nas políticas públicas de saúde da mulher negra. In Escola Nacional de Administração Pública, organizador. Coordenação-Geral de Especialização. Brasilia; 2018. p. 36.
36. de Oliveira EM, Couto M, Separavich L, Olinda do Carmo. Contribuição da interseccionalidade na compreensão da saúde-doença-cuidado de homens jovens em contextos de pobreza urbana. Interface (Botucatu) 2020; 24.
37. de Sousa Nogueira F. de Freitas Leitão E, Santos da Silva E. Interseccionalidades na experiência de pessoas trans nos serviços de saúde. Rev Psicologia e Saúde. 2021; 13(3): 35-49.
38. Oliveira F, Bastos J, Moretti-Pires R. Interseccionalidade, discriminação e qualidade de vida na população adulta de Florianópolis, Sul do Brasil. Cad Saude Publica 2021; 37(11): e00042320.
39. Silva R, Santos S, Afonso T, Moreira K, Fonseca S, Silva P, Ferreira PLA, Silva HKFD, Sabino CS, Rodrigues JS, Costa RCM, Ferreira HB, Alves WDC, Brito YF. Síndromes Hipertensivas Gestacional e o manejo da Enfermagem no âmbito da Atenção Primaria. Research, Society and Development 2021; 10(15).
40. Goes E, Guimaraes J, Almeida M, Gabrielli L, Katikireddi S, Campos A, Matos SMA, Patrao AL, Oliveira Costas AC, Quaresma M, Leyland AH, Barreto ML, Dos Santos Silva I, Aquino EML. The intersection of race/ethnicity and socio-economic status: inequalities in breast and cervical cancer mortality in 20,665,005 adult women from the 100 Million Brazilian Cohort. Ethn Health 2024; 29(1): 46-61.
41. Rodrigues L, Miranda N, Cabrini D. Obesidade e interseccionalidade: análise crítica de narrativas no âmbito das políticas públicas de saúde no Brasil (2004-2021). Cad Saude Publica 2023; 39(7): e00240322.