How Education Shapes Women's Work and Family Lives Across Race and Ethnicity.

Drawing on life course and intersectional approaches, this study examines how education shapes the intertwined domains of work and family across race and ethnicity. By applying multichannel sequence analysis and cluster analysis to the National Longitudinal Survey of Youth 1979, we identify a typology of life course trajectories of work and family and test for the interactive associations of race and ethnicity with college education for different trajectory types. While our results show statistically significant and often sizable education effects across racial and ethnic groups for most of the work‒family clusters, they also suggest that the size and direction of the education effect vary widely across groups. Educational attainment plays an outsize role in shaping Black women's work‒family lives, increasing their access to steady work and partnerships, while educational attainment primarily works to increase White women's participation in part-time work. In contrast, Latina women's work‒family trajectories are less responsive to their educational attainment. In combination, the racialized role of education and persistent racial and ethnic gaps across the education distribution yield unequal patterns in work‒family strategies among Black, Latina, and White women.

Health occupations salary outcomes: intersections of student race, gender, and first-generation status.

Greater diversity in the healthcare workforce has been identified as a critical need in serving an increasingly diverse population. Higher education institutions have been tasked with increasing the number of underrepresented students in the health occupations pipeline to better align with the demographics of the general population and meet the need for a diverse health occupations workforce. This study used the National Science Foundation's National Survey of College Graduates dataset to capture data across time, examining the intersectionality of race, gender, and first-generation status on the salary outcomes of students who earn degrees related to health occupations. Results indicate that the intersecting identities of students who earn a bachelor's degree or higher in the health professions impact salary outcomes. Results of this study have implications for higher education policies that can impact increased diversity in the health occupations workforce pipeline.

Pandemic preparedness with 20/20 vision: Applying an intersectional equity lens to health workforce planning.

Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re-frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills-needs misalignment. We critique the supply-and-demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans.

Control of resources in the nursing workplace: Power and patronage relations.

Immigrant nurses make up a large percentage of the Australian nursing workforce. Since the support in the workplace is expected to be inclusive for all nurses, the aim of this article is to explore how support and opportunities for professional growth, learning and development are distributed across different categories of nurses working in a neonatal intensive care unit (NICU). An ethnographic approach has opened an examination of the everyday workplace practices in the NICU to gain insight into how nurses made sense of the social and power relations occurring between themselves and their senior colleagues and how they experienced the support and opportunities they received in their workplace. As today's workplaces such as the NICU are diverse in races, culture and experiences, the concepts of intersectionality and cultural safety assisted in identifying inequality and injustice related to such diversity. The results showed how patronage relations rendered nurses with immigrant status with major disadvantage and left them clinically and culturally vulnerable. Such inequity defeats the reasons for encouraging skilled migration of nurses and poses questions on the cultural competency of recruiting organisations. Considering how cultural safety might guide staff development offers opportunities for authentic support to culturally diverse nurses.

Healthcare Professionals' Conflicts When Treating Transgender Youth: Is It Necessary to Prioritize Protection Over Respect?

Increasingly, transgender minors are seeking medical care such as puberty-suppressing or gender-affirming hormone therapies. Yet, whether these interventions should be performed at all is highly controversial. Some healthcare practitioners oppose irreversible interventions, considering it their duty to protect children from harm. Others view minors, like adults, as transgender individuals who must be protected from discrimination. The underlying ethical question is presented as a problem of priority. Is it primarily relevant that minors are involved? Or should decision makers focus on the fact that they treat transgender individuals? The paper explores the relevance for medical practice. We provide results of an interview study with German healthcare professionals. We discuss the general question whether prioritization among different group memberships of the same person is ethically defensible. We conclude that priority conflicts between group memberships of the same person can be deceptive and should be addressed by an intersectional approach. Eventually, we discuss practical implications.

Intersectionality and global health leadership: parity is not enough.

There has been a welcome emphasis on gender issues in global health in recent years in the discourse around human resources for health. Although it is estimated that up to 75% of health workers are female (World Health Organization, Global strategy on human resources for health: Workforce 2030, 2016), this gender ratio is not reflected in the top levels of leadership in international or national health systems and global health organizations (Global Health 50/50, The Global Health 50/50 report: how gender responsive are the world's leading global health organizations, 2018; Clark, Lancet, 391:918-20, 2018). This imbalance has led to a deeper exploration of the role of women in leadership and the barriers they face through initiatives such as the WHO Global Strategy on Human Resources for Health: Workforce 2030, the UN High Level Commission on Health Employment and Economic Growth, the Global Health 50/50 Reports, Women in Global Health, and #LancetWomen. These movements focus on advocating for increasing women's participation in leadership. While efforts to reduce gender imbalance in global health leadership are critical and gaining momentum, it is imperative that we look beyond parity and recognize that women are a heterogeneous group and that the privileges and disadvantages that hinder and enable women's career progression cannot be reduced to a shared universal experience, explained only by gender. Hence, we must take into account the ways in which gender intersects with other social identities and stratifiers to create unique experiences of marginalization and disadvantage.

Informal caregivers' judgements on sharing care with home care professionals from an intersectional perspective: the influence of personal and situational characteristics.

The European policy emphasis on providing informal care at home causes caregivers and home care professionals having more contact with each other, which makes it important for them to find satisfying ways to share care. Findings from the literature show that sharing care between caregivers and professionals can be improved. This study therefore examines to what degree and why caregivers' judgements on sharing care with home care professionals vary. To improve our understanding of social inequities in caregiving experiences, the study adopts an intersectional perspective. We investigate how personal and situational characteristics attached to care judgements are interwoven. Using data of the Netherlands Institute for Social Research, we conducted bivariate and multivariate linear regression analysis (N = 292). We combined four survey questions into a 1-4 scale on 'caregiver judgement' (α = 0.69) and used caregivers' personal (such as gender and health status) and situational characteristics (such as the care recipient's impairment and type of care) as determinants to discern whether these are related to the caregivers' judgement. Using a multiplicative approach, we also examined the relationship between mutually constituting factors of the caregivers' judgement. Adjusted for all characteristics, caregivers who provide care to a parent or child with a mental impairment and those aged between 45 and 64 years or with a paid job providing care to someone with a mental impairment are likely to judge sharing care more negatively. Also, men providing care with help from other caregivers and caregivers providing care because they like to do so who provide domestic help seem more likely to be less satisfied about sharing care. This knowledge is vital for professionals providing home care, because it clarifies differences in caregivers' experiences and hence induce knowledge how to pay special attention to those who may experience less satisfaction while sharing care.

"We just take care after each other": Relational health strategies of nurses and nursing aides working in residential long-term care as a mechanism of in- and exclusion in care teams.

BACKGROUND: The health of care workers in residential long-term care (LTC) is under pressure. Scholars emphasize the importance of gender-sensitive and intersectional approaches to occupational health. OBJECTIVE: To unravel how the health of nurses and nursing aides is shaped by gender, class, age, sexuality and race. METHODS: A qualitative participatory study. A participatory research team, consisting of academic scholars and nursing aides, conducted semi-structures interviews (N = 20) and one natural group discussion (N = 8 participants) to validate our findings. Thematic data-analysis was guided by gender and intersectionality theory. RESULTS: Empirical findings suggest that gendered norms limit possibilities for self-care for female nurses and nursing aides. Feeling uncared for by society and LTC organizations, paid care workers describe how they take care of each other. These relational health strategies require a feeling of sameness, limiting space for diversity and disability within care teams. Care workers seen as 'cultural other', or those who experienced (chronic) health issues, financial struggles or informal caregiving, risked being excluded from relational care within care teams, which negatively impacted their health. CONCLUSIONS: Care workers' relational health strategies are a gendered and care ethical response to the lack of societal and political care for LTC, but can become mechanisms of exclusion within care teams. This can be understood as a sign of exhaustion, shaped by adverse working conditions and leading to moral stress. The lack of societal appreciation needs to be addressed by occupational health physicians and LTC organizations, to counter mechanisms of exclusion among paid care workers.

The Legacy of Slavery and the Socialization of Black Female Health and Human Services Workforce Members in Addressing Social Determinants of Health.

BACKGROUND: One legacy of slavery and colonialist structures is that minority populations, particularly the Black populations, experience higher rates of poverty, disease, job insecurity, and housing instability today - all indicators of poor health or negative social determinants of health (SDOH). While the historical legacy of slavery may explain why certain populations currently experience social determinants, they may also embody Post Traumatic Slave Syndrome (PTSS) through manifestations of negative health outcomes. MATERIAL AND METHODS: Black female health and human services (HHS) workforce members, who have taken SDOH trainings through a medical-legal partnership (MLP), were recruited for an ethnographic study to determine how historical context, specifically PTSS, can help Black female HHS workforce members understand and advocate for their patients as well as challenge the medial and legal institutions. RESULTS: Themes emerged around how Black women in HHS have persisted and resisted, struggled, and strived to protect and raise a resistant community that is perpetually threatened. Black women constantly exist in the past, present, and future, negotiating their identities and reproducing the modeled behavior of the parents, particularly their Black mothers, who taught them how to exist in the world as Black women. CONCLUSIONS: As sufferers of negative social determinants, Black women, especially those working in HHS, use their lived experiences and historical trauma to challenge the systems within which they work. They use their intersectional identities and their reimagined definitions of SDOH to rethink how the HHS workforce can move forward in working in the best interests of their patients. Future SDOH trainings may consider integrating historical legacies to challenge medical-legal institutions.

Intersectionality and Its Impact on Microaggression in Female Physicians in Academic Medicine: A Cross-Sectional Study.

Introduction: The burden of microaggressions in the workplace is an ongoing stressor for female physicians in academic medicine. For female physicians of Color or of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual community, this burden is even heavier due to the concept of intersectionality. The goal of this study is to assess frequency of microaggressions experienced by participants. In addition, to explore the associations between microaggression and individual outcomes, patient care practices and attitudes, and perception of pay/promotion equity. Methods: This was a cross-sectional analysis of female residents, fellows and attendings conducted from December 2020-January 2021 at Northwell Health across all specialties. One hundred seventeen participants replied to the study in REDCap. They completed questionnaires related to the topics of imposter phenomenon, microaggressions, gender identity salience, patient safety, patient care, counterproductive work behavior and pay and promotion equity. Results: A majority of the respondents were white (49.6%) and 15+ years out of medical school (43.6%). Around 84.6% of female physicians endorsed experiencing microaggressions. There were positive associations between microaggressions and imposter phenomenon as well as microaggressions and counterproductive work behavior. There was a negative association between microaggressions and pay equity or promotion. The small sample size did not allow for us to examine differences by race. Discussion: Although the number of female physicians continues to rise due to an uptick in female medical school enrollees, female physicians still must deal with the burden of microaggressions in the workplace. Conclusions: As a result, academic medical institutions must seek to create more supportive workplace for female physicians.

Is the disability wage gap a gendered inequality? Evidence from a 13-year full population study from Norway.

Recent research has confirmed the employment disadvantages of disabled people, but disability wage gaps in interaction with gender have not been sufficiently explored. This article asks how the disability wage gap can be accounted for, how the unexplained disability wage gap has evolved over time and how the intersections of disability and gender relate to wage penalties. Norwegian nation-wide annual registry data from the period 2005-2017 (N = 8.5 million) are used to estimate longitudinal pay gaps of disabled men and women in relation to nondisabled workers. The analyses arrive at a persistent residual wage gap for disabled employees. Results confirm that gender is a defining predictor for income, and that disabled women are especially disadvantaged. Implications for intersectional theory are discussed. The current study is a reminder that antidiscrimination legislation and implementation of regulations has not been successful in levelling out injustices experienced by disabled people in the labour market.

From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens.

In the United States, nursing is the largest healthcare profession, with over 3.2 million registered nurses (RNs) nationwide and comprised of mostly women. Foreign-trained RNs make up 15 percent of the RN workforce. For over half a century, the U.S. healthcare industry has recruited these RNs in response to nurse shortages in hospitals and nursing homes. Philippines-trained RNs make up 1 out of 20 RNs in this country and continue to be the largest group of foreign-trained nurses today. Recently, the news media has publicized the many deaths of Filipino RNs as a result of the COVID-19 pandemic in the United States. Given the imperial historical ties between these two countries in the context of the nursing profession and the enduring labor inequities that persist, this nationally representative study is one of the few to our knowledge to not only quantitatively examine the current work differences in characteristics and experiences of Philippines-trained RNs and U.S.-trained white RNs practicing in the United States today, but to also do so from an intersectionality lens. The overall aim of this paper is to illuminate how these differences may serve as potential factors contributing to the disproportionate number of Filipino nurses' COVID-19 related vulnerability and deaths in the workplace.

Applying intersectionality theory to understand female Arab art-therapists' experiences with child maltreatment mandatory reporting.

This study moved away from the usual empirical and moral discussion about all-encompassing child maltreatment mandatory reporting outcomes toward a much more detailed and nuanced investigation of its implementation in a minority group. We focused on female Arab art-therapists in Israel working in their community. Twelve female Arab art-therapists participated in semi-structured interviews. Data were analysed using grounded theory. Participants' extreme vulnerability was an emergent quality of analysis and facilitated intersectional framing to account for the findings. The convergence of gender, ethno-culture and occupational status constituted unique obstacles to reporting. Participants described an array of systemic barriers to reporting, some of which could jeopardise their safety and that of their family and job. They raised doubts about the benefits of reporting outweighing the harm. Creating a climate in which reporting is possible and acceptable is the responsibility of the society, rather than that of individuals.

Nurse-Family Partnership and Geography: An Intersectional Perspective.

Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. In the context of a process evaluation, we posed the question: "In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?" The qualitative methodology of interpretive description guided study decisions and data were collected through 10 focus groups with 50 nurses conducted over 2 years. We applied an intersectionality lens to explore the influence of all types of geography on the delivery of Nurse-Family Partnership. The findings from our analysis suggest that the nature of clients' place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. Geography had a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage.

Sem heróis, sem heroínas: reflexões sobre o discurso heroico utilizado pela mídia sobre os profissionais de enfermagem na pandemia de COVID-19 / No heroes, no heroines: reflectinguponthe heroic discourse used by the media about nursing professionals in the COVID-19 pandemic / Sin héroes, sin heroínas: reflexiones sobre el discurso heroico utilizado por los medios de comunicación sobre los profesionales de enfermería en la pandemia de la COVID-19

Objetivo: discutir a utilização do discurso heroico, amplamente disseminado pela mídia durante a pandemia de COVID-19, como referência aos profissionais de enfermagem atuantes na crise sanitária. Metodologia: partiu-se da análise temática qualitativa de matérias jornalísticas publicadas em um portal online de notícias com abrangência nacional, entre março e julho de 2020, e da utilização do conceito de interseccionalidade como categoria analítica, com perspectiva decolonial. Resultados: constatou-se que, articuladas à linguagem militar e à política de morte do atual governo brasileiro, essas construções colaboram para o enfraquecimento e invisibilidade da categoria profissional. Conclusão: existem graves problemas associados a essa construção narrativa, uma vez que, além de contribuir para a desvalorização e silenciamento da profissão e de seus profissionais, desvirtua discussões críticas sobre questões estruturais enfrentadas por esses últimos. Argumenta-se, ainda, a importância da politização dos profissionais de enfermagem, visto sua frágil formação política, a fim de construírem outras narrativas que consolidem o cuidado de enfermagem como um cuidado político, democrático e consciente de sua inserção no atual contexto da crescente precarização do trabalho no país.

Objective: this article aims to discuss the use of heroic discourse, widely disseminated by the media during the COVID-19 pandemic, as a reference for nursing professionals working in the health crisis. Methods: we started with the qualitative thematic analysis of journalistic articles published in an online news portal with national coverage, between March and July 2020, and the use of the concept of intersectionality as an analytical category, with a decolonial perspective. Results: it appears that, articulated to the military language and the death policy of the current Brazilian government, these constructions collaborate for the weakening and invisibility of the professional category. Conclusion: there are serious problems associated with this narrativeconstruction, since in addition to contributing to the devaluation and silencing of the profession and its professionals, it distorts critical discussions on structural issues faced by the latter. It is also arguedthe importance of politicization of nursing professionals, given their fragile political training, tobuild other narratives that consolidate nursing care as a political, democratic care that is aware of its insertion in the current context of increasing precariousness of work in the country.

Objetivo: este artículo tiene como objetivo discutir el uso del discurso heroico, ampliamente difundido por los medios de comunicación durante la pandemia de COVID-19, como referencia para los profesionales de enfermería que trabajan en la crisis de salud. Metodología: partimos del análisis temático cualitativo de artículos periodísticos publicados en un portal de noticias en línea con cobertura nacional, entre marzo y julio de 2020, y el uso del concepto de interseccionalidad como categoría analítica, con perspectiva descolonial. Resultados: se constató que, articuladas al lenguaje militar y a la política de muerte del actual gobierno brasileño, estas construcciones colaboran para el debilitamiento y la invisibilización de la categoría profesional. Conclusión: existen serios problemas asociados a esta construcción narrativa, ya que además de contribuir a la devaluación y silenciamiento de la profesión y sus profesionales, distorsiona discusiones críticas sobre temas estructurales que enfrentan estos últimos. También se argumenta la importancia de la politización de los profesionales de enfermería, dada su frágil formación política, para construir otras narrativas que consoliden el cuidado de enfermería como un cuidado político, democrático y consciente de su inserción en elcontexto actual de creciente precariedad del trabajo en el país.

Diversidade e diferença: desafios para a formação dos profissionais de saúde / Diversity and difference: health professional training challenges

Resumo O artigo tem como objetivo discutir a questão da diversidade a partir da sua incorporação na formação dos profissionais de saúde por meio da análise das Diretrizes Curriculares Nacionais (DCN) de dois cursos de graduação na área da saúde no Brasil: medicina e psicologia. Para isso, problematiza a questão da diversidade a partir da contribuição das ciências sociais, ao considerar as múltiplas noções presentes na natureza das diferenças sociais e culturais, rompendo com conceitos essencialistas de diferença. Reflete-se sobre como a diversidade está presente nas diretrizes curriculares desses cursos e, a partir de trabalhos recentes, analisa-se como a diversidade tem sido contemplada na formação, bem como os principais desafios colocados. A interseccionalidade é considerada um referencial teórico político importante para apreender a articulação de múltiplas diferenças e desigualdades que atuam de forma dinâmica, fluida e flexível a partir de contextos históricos particulares, sendo nesse sentido sensível para abordar a questão da diversidade na formação dos profissionais de saúde. Destaca-se a importância de realizar uma análise das diferenças, sugerindo um quadro analítico que articule discursos e práticas, formas de subjetivação e relações sociais.

Abstract This paper aims to discuss the issue of diversity from its incorporation into the training of health professionals through the analysis of the National Curriculum Guidelines (DCN) of two Brazilian undergraduate health courses: medicine and psychology. Thus, it debates the concept of diversity from the contribution of the social sciences, considering the multiple concepts in the nature of social and cultural differences, breaking with essentialist concepts of difference. Reflecting on how diversity appears in the curricular guidelines of these courses, it analyzes from recent studies how this has been considered in training and the main challenges. Intersectionality is an essential political theoretical framework to apprehend the articulation of multiple differences and inequalities acting in a dynamic, fluid, and flexible way from particular historical contexts. Thus, it is sensitive to address the issue of diversity in the training of health professionals. We highlight the importance of studying differences, suggesting an analytical framework that articulates discourses, practice, subjectivation, and social relationships.

Intersectionality and underrepresentation among health care workforce: the case of Arab physicians in Israel.

BACKGROUND: An intersectionality approach that addresses the non-additive influences of social categories and power structures, such as gender and ethnicity, is used as a research paradigm to further understanding the complexity of health inequities. While most researchers adopt an intersectionality approach to study patients' health status, in this article we exemplify its usefulness and importance for studying underrepresentation in the health care workforce. Our research objectives were to examine gender patterns of underrepresentation in the medical profession among the Arab minority in Israel. METHODS: We used both quantitative and qualitative methodologies. The quantitative data were obtained from the 2011 Labor Force Survey conducted by the Israeli Central Bureau of Statistics, which encompassed some 24,000 households. The qualitative data were obtained through ten semi-structured, in-depth interviews conducted during 2013 with Arab physicians and with six nurses working in Israeli hospitals. RESULTS: The findings indicate that with respect to physicians, the Arab minority in Israel is underrepresented in the medical field, and that this is due to Arab women's underrepresentation. Arab women's employment and educational patterns impact their underrepresentation in medicine. Women are expected to enter traditional gender roles and conform to patriarchal and collectivist values, which makes it difficult for them to study medicine. CONCLUSIONS: Using an intersectionality approach to study underrepresentation in medicine provides a foundation for action aimed at improving public health and reducing health disparities.