INTERSECTIONALITY
Evolving Intersectionality
January 2021, Vol 111, No. 1
AJPH
88
Within Public Health:
From Analysis to Action
Lisa Bowleg, PhD, MA
ABOUT THE AUTHOR
Lisa Bowleg is an AJPH associate editor and is with the Department of Psychological and Brain
Sciences, Intersectionality Training Institute, The George Washington University, Washington, DC.
See also the Intersectionality section, pp. 88–109.
I ntersectionality, an indispensable
critical theoretical framework for
public health,1,2 is ideally suited to ad-
dress the current “deadly confluence
of health, economic, and racial crises”
(Poteat, p. 91). Aligned with my invoca-
tion of intersectionality to lambaste the
“We’re all in this together” tropes of the
COVID-19 era,3 this special section af-
firms an essential need for “an inter-
sectional public health lens that . . .
embrace[s] rather than obscure[s] the
heterogeneity of people’s lived experi-
ence” (Elnaiem, p. 93; quote p. 94) with
new public health crises such as COVID-
19, and ongoing ones such as police
brutality and HIV/AIDS (Aguayo-Romero,
p. 101; Elnaiem; Poteat). The section also
ventures into uncharted terrains such as
epigenetics (Zota and VanNoy, p. 104)
and artificial intelligence (Bauer and
Lizotte, p. 98), and highlights the con-
ceptual and methodological challenges
of intersectionality research from the
perspective of a group of National Insti-
tutes of Health (NIH) extramural research
administrators (Alvidrez et al., p. 95).
Informed by Collins’s conceptualiza-
tion of intersectionality as a “broad-
based knowledge project”—a field of
study, an analytical strategy, and critical
Editorial Bowleg
praxis4(p3)—I characterize intersection-
ality’s inroads into public health and its
potential for addressing public health
crises as a series of overlapping waves.
Wave 1 was and is definitional, focused
on intersectionality’s history, core
tenets, and relevance to public health.
Wave 2 reflects the mainstreaming and
flattening of intersectionality as it travels
through traditional research organiza-
tions such as the National Academy of
Sciences (NAS) and NIH. Wave 3 is an-
alytical, reflecting the theoretical appli-
cation of intersectionality to current
public health crises. In this editorial, I
highlight how this special section spans
these waves and preview a fourth wave
essential to addressing and resolving
the current spate of multiple and
interlocking public health crises.
WAVE 1: ON DEFINITIONS
AND HISTORY
If the initial phase of intersectionality’s
first wave was definitional, then the
current phase is definitively about what
intersectionality is not and the need to
remoor intersectionality back to its his-
toric Black feminist vision to effectively
address current crises. To this end,
Aguayo-Romero, Elnaiem, and Poteat all
stress that intersectionality is not simply
about “multiple identities” and urge
greater fidelity to intersectionality’s his-
toric focus on power and interlocking
structural inequality. This emphasis un-
derscores that, despite its growing
popularity, intersectionality is still na-
scent within public health and also flat-
tening as it travels. Intersectionality
scholars typically use the term “flatten-
ing” to describe how intersectionality as
it becomes mainstream is being depo-
liticized and stripped of its attention to
power, social justice, and praxis.5,6
Consider, for example, the NAS (for-
merly the Institute of Medicine), one of
the first national research organizations
to embrace intersectionality as a cross-
cutting perspective for lesbian, gay, bi-
sexual, and transgender (LGBT) health
research in 2011.7 The NAS report’s
glossary defined intersectionality as “a
theory used to analyze how social and
cultural categories intertwine”7(p318) and
attributed the definition to a White
Swedish professor’s conference pre-
sentation. The issue is not simply pe-
dantic. Work that seeks to flatten
intersectionality or ignore its Black
feminist activist history not only erases
Black women’s foundational epistemic
contributions to intersectionality5,8 but
also fundamentally undermines the
framework’s transformative potential to
address the structural inequities that
undergird the contemporary public
health crises.
WAVE 2: MAINSTREAM
RESEARCH TRAVELS
In “Intersectionality as Buzzword,” an
insightful article about intersectionality’s
success and longevity as a feminist
theory, Davis9 draws on the sociol-
ogy of science to discuss the four

characteristics of a successful theory. As
for intersectionality’s successful inroads
into public health, I would add a fifth:
research funding. In May 2018, the Di-
vision of AIDS Research at NIH’s National
Institute of Mental Health concretized its
interest in the topic of intersectional
stigma (https://bit.ly/31IKzTr), prompting
requests for proposals (https://bit.ly/
34uU36D) that applied intersectionality
to HIV prevention and LGBT health re-
search. As the article by Alvidrez et al.
affirms, NIH has had an uptick in
intersectionality-focused grant pro-
posals. Yet, many proposals lack clarity
about what makes the research ques-
tions, designs, or data analysis inter-
sectional. In illustrating these gaps,
Alvidrez et al. pinpoint the fundamental
challenge that researchers face in
attempting to apply a framework initially
developed for critical analysis, activism,
and praxis—not research—to research.
WAVE 3:
INTERSECTIONALITY AS
ANALYTICAL TOOL
In line with advocacy from inter-
sectionality scholars and activists to
demonstrate what intersectionality can
do, not just what it is,6 Elnaiem and
Poteat highlight how an intersectional
lens could improve the collection of
public health surveillance COVID-19
data at multiple intersections (e.g., race
and gender) instead of solely by a single
axis (i.e., race or gender). An intersec-
tional perspective, as Poteat notes, is
also vital to “conceptualize, document,
and explicitly articulate” (p. 92) the
structures that explain the racialized
and economic inequality of COVID-19.
Bauer and Lizotte, and Zota and
VanNoy, show that intersectionality is
also a suitable analytic tool for newer
domains such as epigenetics and
artificial intelligence. Bauer and Lizotte
use an intersectional lens to show how
the growing use of artificial intelligence
algorithms, such as recidivism systems
in criminal justice, and screening tools
for risks, such as suicide, reproduce and
intensify biases against intersectionally
marginalized groups. Zota and VanNoy
lay the groundwork for integrating
intersectionality within environmental
health’s emphasis on the exposome, a
paradigm focused on the totality of
people’s exposure to environmental
factors that increase chronic disease risk
across the life span. Using their work on
racial inequities in uterine fibroids as a
case study, Zota and VanNoy highlight
how greater attention to intersectional
inequalities such as racism and sexism
determine environmental exposures for
Black women, a group disproportion-
ately affected by fibroids.
TOWARD WAVE 4:
INTERSECTIONALITY
PRAXIS
Intersectionality praxis, the practical appli-
cation of intersectionality to facilitate eq-
uitable health policy and practice for
intersectionally marginalized groups, is the
fourth and arguably most essential wave to
address the public health crises of our
time. Several articles provide glimpses of
what an intersectional praxis response
to COVID-19 would look like. Elnaiem,
recounting his experiences doing COVID-
19 contact tracing in one of the poorest
counties in Massachusetts, highlights the
need to prioritize and build upon health
promotion initiatives led by grassroots and
community-based organizations. Poteat
argues that it has been community-based
organizations and policy think tanks, not
traditional public health agencies or public
health surveillance systems, that have
provided the most “sophisticated
INTERSECTIONALITY
intersectional analyses” (p. 91) about the
disproportionate and structural toll of
COVID-19 on US racial/ethnic minority
communities. This time of crisis would also
benefit from intersectionality equity met-
rics to assess the extent to which health
equity goals for practice (e.g., coronavirus
testing, contact tracing, vaccine distribu-
tion), policy (e.g., allocation of personal
protective equipment), and research
(e.g., COVID-19 surveillance) have been
achieved for the groups at the most vul-
nerable or marginalized intersections.
A concluding word about inter-
sectionality research is warranted here.
You likely noticed the absence of re-
search articles in this special section,
a reflection that the quantitative inter-
sectionality research field is inchoate.
AJPH
Nonetheless, it bears noting that although
intersectionality research is an important
January 2021, Vol 111, No. 1
step on the journey to health equity in this
time of crisis, it is not the destination.
Intersectionality is fundamentally a resis-
tance project. It does not assume that
“knowledge for knowledge’s sake”10(p118)
will resolve our current public health cri-
ses, but instead demands a “radical
reimagin[ing] of intersectional praxis”
(Elnaiem, p. 94) to solve them.
CORRESPONDENCE
Correspondence should be sent to Professor
Lisa Bowleg, Department of Psychological and
Brain Sciences, The George Washington Univer-
sity, 2125 G St NW, Washington, DC 20052
(e-mail: lbowleg@gwu.edu). Reprints can be
ordered at http://www.ajph.org by clicking the
“Reprints” link.
PUBLICATION INFORMATION
Full Citation: Bowleg L. Evolving intersectionality
within public health: from analysis to action. Am J
Public Health. 2021;111(1):88–90.
Acceptance Date: October 16, 2020.
DOI: https://doi.org/10.2105/AJPH.2020.306031
CONFLICTS OF INTEREST
The author has no conflicts of interest to declare.
Editorial Bowleg 89
 INTERSECTIONALITY

REFERENCES
1. Bowleg L. The problem with the phrase “women
and minorities”: intersectionality, an important
theoretical framework for public health. Am J Public
Health. 2012;102(7):1267–1273. https://doi.org/10.
2105/AJPH.2012.300750
2. Bowleg L. Perspectives from the social sciences:
critically engage public health. Am J Public Health.
2019;109(1):15–16. https://doi.org/10.2105/AJPH.
2018.304825
3. Bowleg L. We’re not all in this together: on COVID-
19, intersectionality, and structural inequality. Am J
Public Health. 2020;110(7):917. https://doi.org/10.
2105/AJPH.2020.305766
4. Collins PH. Intersectionality’s definitional dilemmas.
Annu Rev Sociol. 2015;41(1):1–20. https://doi.org/
10.1146/annurev-soc-073014-112142
5. May VM. Pursuing Intersectionality, Unsettling
Dominant Imaginaries. New York, NY: Routledge;
2015. https://doi.org/10.4324/9780203141991
6. Cho S, Crenshaw KW, McCall L. Toward a field of
intersectionality studies: theory, applications, and
praxis. Signs (Chic Ill). 2013;38(4):785–810. https://
doi.org/10.1086/669608
7. Institute of Medicine. The Health of Lesbian, Gay,
Bisexual and Transgender People: Building a
Foundation for Better Understanding. Washington,
DC: The National Academies Press; 2011.
January 2021, Vol 111, No. 1

8. Edmonds BM. The professional is political: on

citational practice and the persistent problem of
academic plunder. J Fem Scholarsh. 2019;16:74–77.
https://doi.org/10.23860/jfs.2019.16.08
9. Davis K. Intersectionality as buzzword: a sociology
of science perspective on what makes a feminist
theory successful. Fem Theory. 2008;9(1):67–85.
https://doi.org/10.1177/1464700108086364
10. Collins PH. Intersectionality as Critical Social Theory.
Durham, NC: Duke University; 2019. https://doi.
AJPH

org/10.1215/9781478007098

90 Editorial Bowleg