Chapter 8 216 Implications for future research An intersectional gender approach While it is already a challenging endeavour to capture the full range of gender-related variables that may be relevant to health outcomes and illness experiences of people with PD, gender dimensions are additionally informed by other intersecting social identities, such as ethnicity, sexual orientation, and socio-economic status. From this perspective, social categories of ‘women’ and ‘men’ are not considered homogeneous, mutually exclusive, and collectively exhaustive groups and there can be large withingroup variations, depending on the research context. This intersectional nature of social identities can further complicate efforts to operationalize gender in (bio)medical research because intersectionality can create unique health risks and disparities that may not be apparent if gender dimensions are analysed in isolation. However complex, an intersectional gender approach in (bio)medicine can help to better understand how different social identities and associated normative practices intersect to create unique personal experiences of health and disease. An intersectional gender approach takes gender identity as an entry point for a more complex analysis that recognizes the interconnectedness of these multiple social identities and includes a critical lens towards the ways how power hierarchies operate at the individual, institutional and societal levels. The recognition of power dynamics in this approach is essential to understand how health disparities develop and affect different populations and to avoid the treatment of social identities themselves as being inherently ‘risky’ rather than as proxies for social positions and experiences. For example, a recent study across US Parkinson’s Disease Centres of Excellence found that African American and Hispanic patients with PD seem to be at increased risk of cognitive impairment, reported a lower quality of life and were less likely to be prescribed anti-depressant medications compared to White non-Hispanic patients.19 This study emphasized the need for additional research to better understand reasons for treatment and outcome differences in underrepresented populations. An intersectional gender approach could further investigate how the intersection of ethnicity with gender affect access to healthcare, disease management and quality of life between and within different populations of people with PD. West and Fenstermaker (1995) extended their methodological perspective from ‘doing gender’ to ‘doing difference’ to expand their understanding of how gender, ethnicity and class operate simultaneously with one another.20 They defined this process as “relations between people and institutional practices that create and maintain social hierarchies and power relations”. By using a critical lens towards gender, ethnicity and
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