Contained within are notes taken during a stakeholder workshop and results of a stakeholder survey. The workshop was was held at The University of Sheffield in May 2019. Included is a report of the workshop which provides more details and a summary of the event. The notes relate to the presentations that were given and the subgroup discussions. The presentation slides can be found on the project website, http://intersectionalhealth.org. The stakeholder survey was open for four months prior to the workshop. There were two versions, one for those whose job mainly involved research and one for other stakeholders. More detail on the methodology is included in the methodology.txt file. The findings were written up in an article in BMC Health Research Policy and Systems: Holman, Daniel, et al. "Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders." Health research policy and systems 19.1 (2021): 1-15.Chronic diseases entail huge personal and societal costs and pose a significant challenge for public health. Furthermore, they are key drivers of inequalities in later life (50+) health. So far, health inequalities research has tended to focus on how health varies according to single categories of difference, such as gender or socioeconomic status. Yet in the real world we know that any given person is not just a man or woman, poor or rich, etc., but a combination of attributes, so that we might describe an older, poorer, ethnic minority man, for example (or any other combination that exists). This project takes up a theory which addresses this complexity called intersectionality. In particular, it focuses on how each of the combinations possible from the interaction of gender, age, socioeconomic status, and ethnicity (and in ageing research, also typically retirement and marital status), is associated with a particular location in the social structure, which brings with it particular (yet overlapping) resources, policy effects, processes, and types of discrimination. In turn, each position is associated with a particular (yet overlapping) set of social determinants of health, with differential consequences for chronic disease outcomes. Different intersectional positions might also entail different cultural and social identities. For example, there might be distinctive aspects to the identity of a younger unemployed man that cannot be reduced to age, employment status, or gender alone. In this project, we are particularly interested in the chronic diseases of type 2 diabetes, heart disease and obesity. These conditions are highly prevalent and have shared social determinants. We will analyse survey data from the English Longitudinal Study of Ageing, the Survey of Health, Ageing and Retirement in Europe, Understanding Society and the UK Biobank to identify which intersectional positions are at particular risk of these conditions. We will then investigate which factors might lead to this excess risk. We plan to focus on two types of factors. The first is events over the lifecourse, since we know that dis/advantage from womb to tomb is crucial to later life health outcomes. The second is health practices (i.e. health behaviours in social context) since there is strong evidence that these influence chronic disease outcomes. We will use a newly developed multilevel modelling technique and growth curve models; these methods allow for socially 'mapping out' health outcomes, and examining how they vary on time. In this work, we plan to analyse biomarker data which is increasingly collected in inter/national surveys. Biomarkers are objective measures of underlying pathology. Commonly-known biomarkers include blood pressure, BMI, and for diabetes, HbA1c. The advantage is that biomarkers are objective, valid measurements of health. Furthermore, by analysing biomarker outcomes at intersectional positions, we are advancing a highly novel biosocial approach, bringing together sociological theory with medical measurements. In effect, we will be able to see how social disadvantage 'gets under the skin' where factors such as gender, age and ethnicity interact with each other. What is the benefit of this research? It will highlight fine-grained inequalities that have previously escaped attention. It will suggest new ways to design, target and tailor public health policies and interventions. Academically, it takes up and runs with a theory which is currently seen as holding great promise to move health inequalities research forward. It will generate new conceptual, methodological and empirical knowledge which will be of substantial interest to the research community across multiple disciplines. Ultimately, the project offers a significant opportunity for a new approach to tackle the growing chronic disease burden negatively affecting the lives of many older people, but especially those in particularly deprived positions.

A research team comprising university researchers and policy and practice professionals designed and implemented an online survey and a stakeholder workshop. Survey The online survey was designed based on our understanding of the intersectionality literature, especially in relation to health inequalities research. We identified the key issues and debates in the literature, for example, in relation to topics around categorization, complexity, heterogeneity and targeting/tailoring policies. We designed the questions so that respondents were able to easily raise these themes but purposely asked questions in a balanced, neutral and easy to understand manner, following the principles of Dillman’s Tailored Design Method. We piloted the survey with a policy and practice respondent and academic colleagues, which resulted in numerous improvements mostly around simplifying the language. We designed two questionnaires, one tailored for researchers and one for policy and practice professionals. Shared topics included familiarity with the term and concept of “intersectionality”, general reactions to it, and practical issues and barriers to its uptake. Respondents were also asked their opinion on two aforementioned specific policy suggestions—intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. Sociodemographic information was collected. Policy and practice professionals were additionally asked how health inequalities are currently understood within their work arena and were asked questions about a vignette referencing gender, ethnicity, age and socioeconomic background. Researchers were asked about three specific research challenges—categorization, intersectional heterogeneity, and policy and practice relevance. The survey was advertised on academic mailing lists, Twitter, and policy and practice networks. These were wide ranging with both national and local (mostly in the North of England) coverage and included for example Age UK, NIHR (National Institute for Health Research) School for Public Health Research, the Centre for Ageing Better, various city councils and academic departments/centres/institutes as well as various relevant JiscMail mailing lists. Direct invitations were also sent via existing contacts and respondents were asked to suggest further potential respondents, who were also invited. The survey was advertised for four months prior to the workshop. Workshop The workshop created an opportunity for detailed dialogue around the idea of intersectionality. Specific aims were to explore the potential of intersectionality for understanding and/or tackling health inequalities; share examples of how intersectionality can be applied in health inequalities practice and research; address challenges; and identify potential ways to advance intersectional approaches. We invited people from a range of backgrounds via the survey and direct invitation. For the latter, we invited stakeholders who we established a relationship with as part of the project the work is based on, and also drew upon existing stakeholder relationships from previous projects. The workshop was held at the University of Sheffield in May 2019 and lasted for one day, with 23 people attending. It included presentations from practice and research, subgroup discussions, and a concluding plenary discussion. Three note-takers took detailed notes. For the subgroup discussions facilitators were given a topic guide, as well as practical tasks centred on engaging with illustrative survey responses. We aimed for a dialectical engagement at the workshop by feeding survey responses back to participants to expand them in the group setting, allowing for wider reflections.