Using intersectionality to understand structural inequality in Scotland: evidence synthesis

5. Spotlight examples of how the concept of intersectionality has been used to identify and understand structural inequality in Scotland

An intersectional approach can cast light on the lived experiences of people with intersecting identities, and help to develop policies and services that tackle structural inequality. This section of the report summarises four examples of where an intersectional approach has been used to identify and understand structural inequality. Examples have been selected to showcase the use of an intersectional approach in a range of policy areas relevant to the Scottish and wider UK context. It is important to note that while these examples provide a showcase of intersectional approaches already being undertaken, they do not necessarily represent best practice.

Spotlight Example One: Understanding experiences of poverty

IPPR Scotland were commissioned by Scotland's Poverty and Inequality Commission^[56] to review existing research on intersecting inequalities in theory and practice; review existing policy and practice relevant to intersectionality; collect qualitative data from five individuals with lived experience of intersecting protected characteristics; and gather data from policy experts and academics. ^[57]

A varied range of difficulties faced by those with lived experience of poverty and intersecting protected characteristics, including:

• Barriers to accessing public services, such as housing and health and care, and language barriers creating additional barriers as they tried to access services.
  
  For example, at the time of the research, Sequoia^[58] was seeking asylum, lived alone and had chronic health conditions. Sequoia described how when she arrived in Scotland she was in temporary accommodation for a number of weeks, but when her money ran out she became destitute. She felt this would have been entirely preventable if she had known what support she was entitled to as someone seeking asylum.

• Digital poverty, including difficulties accessing computers and tablets. This was a persistent challenge for people living on low incomes.
  
  For example, at the time of the research, Rowan was a young woman seeking asylum. She was studying at college part-time, and lived with her mother and younger siblings. A lack of reliable internet access or a computer or tablet device at home meant she was unable to continue with her college studies during lockdown. For her, the closure of colleges and libraries had cut off her ability to pursue her education almost entirely, and she worried about falling behind her classmates.

• The social security system presented barriers to financial security, such as due to administrative errors disrupting payments and a lack of information about how the process would work and how assessments would be carried out.
  
  For example, at the time of the research, Fern worked part time and was a lone parent. She had lived in Scotland for around a decade and lived with her young son. Fern's experience was that the social security system had presented more barriers to financial security, where it should have provided a safety net to fall back on. Fern used to receive tax benefits, and had more recently applied for Universal Credit, but had her application affected by a payroll error that saw her pay counted twice in a single assessment period, and her benefit reduced to 10% of her normal payment as a result.

• Additional challenges arising among those with 'No Recourse to Public Funds' (NRPF) due to unresolved immigration status, including barriers to paid employment due to unresolved asylum claims.
  
  Sequoia described the sense of powerlessness generated by the system. She talked about not being signposted to help that she had later learned that she was entitled to, and information was often not available in any language other than English.

• Difficulties affording food and other essentials. Food insecurity was a persistent challenge for participants which, for some, was exacerbated during lockdown. This was related to being on very low incomes, but also interacted with other barriers in how participants could spend the limited funds they had, and difficulties in accessing appropriate food.
  
  For Rowan, the challenge of finding food that her family were familiar with and could afford was intensified during lockdown. She and her family rely on an ASPEN card^[59] provided by the Home Office, but that card can only be spent in shops and does not allow them to make purchases online. This caused particular challenges during lockdown as the family were not able to shop online, and Rowan or her mother would have to travel by bus during the peak of the pandemic to buy food, often having to visit multiple supermarkets. This pushed Rowan and her family into greater food insecurity, presenting additional risks to their health.^[60]

Spotlight Example Two: Understanding racial inequalities during COVID-19

Research looking at the impact of COVID-19 has found that minority ethnic people are more likely to contract and experience serious outcomes from COVID-19. During the first six months of the pandemic, people from minority ethnic groups in England were almost three times as likely to contract COVID-19 and five times more likely to experience serious health outcomes.^[61] In Scotland, National Records of Scotland (NRS) found that between 12th March 2020 and 30th September 2021 deaths amongst people with Pakistani ethnicity were 3.7 times as likely to involve COVID-19 as people with White Scottish ethnicity. Deaths amongst people with Chinese ethnicity (1.7 times as likely), Indian ethnicity (1.7 times as likely) and Other Asian^[62] ethnicity (3.0 times as likely) were more likely to involve COVID-19 than people with White Scottish ethnicity.^[63]

Taking account of a range of factors demonstrates that the link between being a member of a minority ethnic group and a heightened risk of contracting and experiencing serious outcomes from COVID-19 is not direct. Looking across evidence from Scotland, England and across the UK, a number of mediating factors were identified, including:

• Socio-economic circumstance – Minority ethnic people remain more likely to be in poverty than the majority White Scottish population^[64],[65]. Data from the ONS and the PHE analysis confirmed the strong association between economic disadvantage and COVID-19 diagnoses, incidence and severe disease.^[66]
• Research suggests that individuals from minority ethnic groups are more likely to have had to work outside of their home during the national lockdown, and are more likely to work in occupations with a higher risk of COVID-19 exposure, such as health and social care.^{[67],[68],[69]}
• COVID-19 disparities between different minority ethnic groups may be due to reduced access to healthcare. Analyses by the Institute for Public Policy Research indicate that in England the ten most deprived authorities have experienced 15% of all public health budget cuts in the past 5 years. According to Census data, many of these areas are more ethnically diverse than the population average.^[70]
• Effects of lockdown - according to The Runnymede Trust, people from Bangladeshi (43%) and Black African^[71] groups (38%) were most likely to report loss of income since COVID-19, compared with 22% of White people. Those from Black and minority ethnic groups were also more likely to have used savings for day-to-day spending (14%) compared with those from White British backgrounds (8%).^[72],[73]

In addition, Keys and colleagues highlighted that, when considering health inequalities and potential ethnicity-related vulnerabilities to COVID-19 in the UK, it is important to understand the historical context.^[74] This is a key tenet of intersectionality. Previous global influenza pandemics and infectious diseases epidemics have clearly shown a clear association between poverty and increased transmission of infectious diseases.^[75],[76]

The context of racism and discrimination experienced by minority ethnic communities, particularly minority ethnic key workers, is vital to understanding health risks, exposure risk and disease progression risk. Issues of stigma with COVID-19 were identified as negatively impacting health seeking behaviours. Fear of diagnosis and death from COVID-19 was identified as negatively impacting how minority ethnic groups took up opportunities to get tested and their likelihood of presenting early for treatment and care. For many minority ethnic groups, lack of trust in NHS services and health care treatment resulted in their reluctance to seek care on a timely basis, and late presentation with disease.^[77]

The Scottish Government established an Expert Reference Group on COVID-19 and Ethnicity (ERG) in response to reports that some minority ethnic groups are at risk of experiencing disproportionate effects of COVID-19. In September 2020, the ERG published advice and recommendations to the Scottish Government in relation to data, evidence, risk and systemic issues.^[78] This highlighted that "vulnerabilities to COVID-19 are consistent with an established pattern in which 'intersections between socioeconomic status, ethnicity and racism intensify inequalities in health for ethnic groups"^[79], and suggested a range of institutional and systemic factors that could be driving this increased vulnerability among minority ethnic groups including:

• Differential exposures to COVID-19, due to occupation exposure, income and housing issues faced by those seeking asylum, living conditions, poverty, racism and discrimination, and a lack of understanding of Scotland's ethnic diversity.
• Differential vulnerabilities due to health inequalities.
• Differential access to treatment and other forms of support, including a greater risk to adverse outcomes even after hospitalisation, barriers to accessing NHS services among migrants, and experiences of discrimination when accessing health services.^[80]

Spotlight Example Three: Understanding the experiences of women in STEM

In 2019, Equate Scotland commissioned research using an intersectional approach to understand the experiences of women who have worked or were working in science, technology, engineering and maths (STEM) and the built environment, as well as women who are currently studying these subjects in further or higher education.^[81] The research was carried out by Talat Yaqoob and Sayana Duenas. The aim of the research was to find out more about women's experiences of multiple discriminations, and to provide disaggregated data on these experiences based on other characteristics to understand differences between women.

The research comprised of a national survey with 461 women and focus groups with 13 women who were from minority ethnic backgrounds, had caring responsibilities and/or were disabled. The women were involved in the research design by running a test survey with 50 women and redesigning the survey based on that feedback. In addition, online focus groups were used were used to increase accessibility for women in remote areas of Scotland, disabled women and those with caring responsibilities.

The research found that women with intersecting protected characteristics, including disabled women, LGBT women, minority ethnic women, women with caring responsibilities and women aged over 35, face a number of barriers in STEM. These included:

• Discrimination and harassment. 60% of respondents had experienced sexism in the workplace or in their place of education. 1 in 3 has also experienced ageism, and 1 in 6 had experienced discrimination related to caring responsibilities or maternity.
• 1 in 3 women did not feel confident in reporting experiences of exclusion or discrimination to their employers. Within this 50% of disabled women, 50% of minority ethnic women and 50% of LGBT women stated that they did not feel confident reporting these experiences to their employer.
• 64% of women did not feel enough was being done to create inclusive workplaces or education institutions. Within these over 80% of minority ethnic, 70% of women aged over 35, 74% of women with caring responsibilities, 90% of disabled women and over 80% of LGBT women who participated in the survey did not believe that enough was being done to create inclusive workplaces or education institutions.
• Over half of women stated that efforts to support women in STEM were not fully inclusive of women who experienced multiple discriminations. Within this almost 60% of women aged over 35, over 60% of women with caring responsibilities, 77% of disabled women, over 60% of minority ethnic women, and over 60% of LGBT women felt that efforts to support women in STEM were not fully inclusive of women who experienced multiple discriminations.

Spotlight Example Four: Understanding the experiences of disabled people when accessing services

Inclusion Scotland^[82], one of Scotland's leading disabled people's organisations, carried out research to explore the experiences of disabled people with intersectional protected characteristics when accessing services. The research was co-produced in partnership with disabled people, and was led by a group of disabled people with lived experience of intersectional discrimination. It is worth noting that this is small-scale piece or research which is not representative of all equality groups, or indeed of all disabled people.

A mixed methods approach was taken, comprising:

• A literature review.
• A survey on experiences of accessing leisure services, public services and housing services. The survey was distributed via Inclusion Scotland's network and received 96 responses.
• Interviews with 13 disabled people carried out in locations across Scotland.
• An online focus group for members of the co-production group to contribute their ideas on the recommendations that should be included in the report.

The research found that:

• Disabled people with other characteristics experienced distinct barriers when accessing services, and attributed unfair treatment experienced when accessing services to their intersectional identity, including a denial of choice, control and person-centred services.
• Negative attitudes were the main reason why disabled people with intersectional identities experienced forms of unfair treatment, including negative assumptions, lack of knowledge and understanding on the part of service providers.
• Service providers understand the need for person-centred services but are not always able to deliver these. Whilst the term intersectionality was not as familiar, discussions around person-centeredness included an awareness of the need to consider the whole person including their different characteristics, relationships and life circumstances.