Towards a Synthesis of Intersectionality and Life Course Analyses

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Article: Holman, D. orcid.org/0000-0003-4134-6238 and Walker, A. orcid.org/0000-0002-3169-2738 (2020) Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses. European Journal of Ageing. ISSN 1613-9372 https://doi.org/10.1007/s10433-020-00582-7

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ORIGINAL INVESTIGATION

Understanding unequal ageing: towards a synthesis of intersectionality and life course analyses

Daniel Holman1 · Alan Walker1

Accepted: 22 September 2020 © The Author(s) 2020

Abstract Intersectionality has received an increasing amount of attention in health inequalities research in recent years. It suggests that treating social characteristics separately—mainly age, gender, ethnicity, and socio-economic position—does not match the reality that people simultaneously embody multiple characteristics and are therefore potentially subject to multiple forms of discrimination. Yet the intersectionality literature has paid very little attention to the nature of ageing or the life course, and gerontology has rarely incorporated insights from intersectionality. In this paper, we aim to illustrate how intersectionality might be synthesised with a life course perspective to deliver novel insights into unequal ageing, especially with respect to health. First we provide an overview of how intersectionality can be used in research on inequality, focusing on intersectional subgroups, discrimination, categorisation, and individual heterogeneity. We cover two key approaches—the use of interaction terms in conventional models and multilevel models which are particularly focussed on granular subgroup diferences. In advancing a conceptual dialogue with the life course perspective, we discuss the concepts of roles, life stages, transitions, age/cohort, cumulative disadvantage/advantage, and trajectories. We conclude that the synergies between intersectionality and the life course hold exciting opportunities to bring new insights to unequal ageing and its attendant health inequalities.

Keywords Intersectionality · Life course · Cumulative disadvantage · Unequal ageing · Health inequalities

Introduction a brief account of the life course perspective before considering how its synthesis with intersectionality can help to The main aim of this paper is to illustrate how intersection- further understanding of unequal ageing. Our secondary aim ality might be synthesised with a life course perspective to is to encourage further analyses of unequal ageing from an deliver new insights into unequal ageing, especially with intersectional life course perspective. This paper focuses on respect to health. First we outline the background to inter- quantitative methods, but also draws on the wider literature sectionality and its potential for furthering knowledge on for illustrative purposes. health inequalities, noting the potential for mutual enrichment between intersectionality and gerontology. We then discuss the key concepts and debates in intersectionality Background before considering the approaches that are typically used and a recently developed multilevel method. Finally, we provide Intersectionality originated some thirty years ago in the USA and has subsequently attracted wide interest. Crenshaw (1989: 155) coined the term to describe how the experi- Responsible editor: Marja J.Aartsen. ences of Black women in the legal system were shaped by ‘crosscurrents of racism and sexism’. She used the exam- * Daniel Holman [email protected] ple of an employment discrimination lawsuit iled by ive Black women against General Motors to illustrate the idea. Alan Walker [email protected] The company hired both women and Black people, but had a poor record of hiring Black women in particular. The 1 Department of Sociological Studies, The University court rejected the discrimination case based on this ‘special of Sheield, Elmield, Northumberland Road, sub-category’, arguing that ‘Black woman’ is not a legally Sheield S10 2TU, UK

Vol.:(0123456789)1 3 European Journal of Ageing protected class under civil rights law and that ‘the prospect argues that instead of controlling for race, socio-economic of the creation of new classes of protected minorities, gov- position (SEP), and gender, as is typically done in life course erned only by the mathematical principles of permutation research, we should embrace a more complex systems and and combination, clearly raises the prospect of opening the holistic view of how they might interact. hackneyed Pandora’s box’ (Crenshaw 1989: 142). Cren- Bringing together intersectionality with ageing research shaw’s motivation for outlining intersectionality was that was proposed in an earlier paper by Dressel et al. (1997), without a way to frame such subgroup inequalities they can which from a gerontological perspective argued that ideas be rendered invisible; focussing on only one social charac- around intersectionality and interlocking oppressions can be teristic at a time is a ‘trickle down approach to social justice’ used to better understand how structural factors shape ageing. (Crenshaw 2016). Thus, the main value of intersectionality Ferrer et al. (2017) argued for combining concepts from inter- is that it directs attention towards subgroups that face disad- sectionality and life course from an ethnographic perspective. vantages which might otherwise go undetected. We discuss this existing work and provide empirical examples Recently, intersectionality has been suggested as a in more detail below. promising way to advance health inequalities research precisely because it is well-suited to addressing and elu- Intersectionality: key concepts and debates cidating diverse inequalities (Bowleg 2012) and how they are driven by multifaceted power structures and processes Intersectional subgroups (Kapilashrami and Hankivsky 2018)—especially systems of discrimination such as sexism and racism that characterise Intersectionality relects the fact that people embody mul- social hierarchies. Discrimination—the unjust, unfair treat- tiple social characteristics such as gender, ethnicity, age, ment on the basis of social categories—has been shown to socio-economic position (SEP) simultaneously. Combina- be an important determinant of health inequalities (Krieger tions of social characteristics constitute diferent poten- 2014). Given its focus on diverse inequalities and the pro- tial intersectional subgroups, for example a working-class cesses that drive them, intersectionality has also been seen 55-year-old Black woman. Intersectional subgroups repre- as a rich framework for equity-driven health policy analysis sent (1) (objective) positions in the social hierarchy and (2) (Hankivsky et al. 2014). It has been argued that the knowl- (subjective) social identities (Bauer 2014). They are also edge generated by intersectional analyses could provide evi- therefore associated with diferential power/resources, life dence for implementing ‘proportionate universalism’ (Merlo chances, and lived experiences. Further, and fundamentally et al. 2019), the idea that health services and actions should for intersectionality, because subgroups are (at least partly) be resourced and delivered with a scale and intensity pro- socially distinctive and relational (i.e. ‘female’ is deined in portionate to the level of disadvantage (Marmot et al. 2020). contrast to ‘male’), they make discrimination possible. For Highlighting particularly vulnerable subgroups might sug- example, a working-class 55-year-old Black woman typi- gest targeted policies (Lofters and O’Campo 2012), although cally has distinct power/resources, life chances, and lived categorisation and heterogeneity are essential to consider experiences to a 25-year-old White middle-class man and is in such an approach, as we explore below. A recent series more likely to be discriminated against. of papers in Social Science & Medicine have focussed on Despite intersectional patterning, it is important to avoid intersectionality (Bauer 2014; Bauer and Scheim 2019; deterministic understanding and instead acknowledge how Evans et al. 2018; Gkiouleka et al. 2018; Green et al. 2017; agency mediates intersectional efects (Nash 2008). For Lizotte et al. 2019; Merlo 2018; Warner and Brown 2011), example, alongside considering how discrimination impacts and a paper in The Lancet argued that it is important for on health, we should also consider ‘how people resist injus- global public health and the ‘leave no one behind’ agenda tice and its health-harming efects, individually and collec- (Kapilashrami and Hankivsky 2018). tively, and the resilience that enables them to do so’ (Krieger Yet the intersectionality literature has paid very little 2014: 656). Structural position and social identity are there- attention to the nature of ageing or the life course, and geron- fore not always in accordance with each other, as people tology has rarely incorporated insights from intersectionality can resist social categories or be empowered to engage with (Calasanti and King 2015; Koehn et al. 2013). As Corna them in diferent ways. Opportunities to do so are to some (2013: 154) notes for example with respect to gender, ‘cur- extent context dependent (e.g. with respect to place and rent scholarship may be overlooking how gender and social time) (Bauer 2014). Much work is yet to be done to under- policy contexts intersect to inluence socio-economic ine- stand how intersecting identities are experienced and in what qualities, and their relationship to health, diferently for men circumstances and contexts. Corlett and Mavin (2014) have and women over time’, despite gender being a fundamental usefully set out a future research agenda on this topic. axis of inequality in education, the labour market, the family, and later life pension wealth. Similarly, Dannefer (2018) 1 3 European Journal of Ageing

Interlocking systems of discrimination: the ‘matrix had analysed interactions with other forms of discrimina- of domination’ tion, leading the authors to argue that intersectionality is an important area of future research on this topic (Chang Discrimination is rooted in the relationships of dominance et al. 2020). and oppression that characterise social hierarchies. Stereo- types are central to this, which can be either descriptive in Categorisation terms of what a social group are perceived to be like, e.g. older adults being stereotyped as being weak, sick, or senile Although intersectionality was originally concerned with (Palmore 2015) or prescriptive, e.g. older adults are expected the position/identity of Black women (and crosscurrents of to not consume too many resources or engage in activities racism and sexism), this focus ignores how Black women seen as traditionally for ‘younger’ people (Centre for Age- are diferentiated according to other axes of inequality, ing Better 2020). Discrimination can be either interpersonal such as social class or nationality (Nash 2008). Poor Black (perceived discrimination in face-to-face encounters), insti- women have diferent experiences in housing, education, tutional (policies or practices of state or non-state institu- and employment compared with wealthy Black women. tions), or societal (the totality of ways in which societies fos- This does not mean that studies on ‘Black women’—such ter discrimination, e.g. in housing, education, employment, the seminal contributions of Crenshaw (1989) and Collins earnings, social security) (Krieger 2014). Institutions are (2002)—lack value; the experience of being a Black woman important for understanding unequal ageing as they not only to some extent transcends socio-economic lines. Similarly, have stratifying efects on health, but also ‘open possibili- studies on single categories of diference and discrimination, ties for social connections and collective action’ (Gkiouleka including age/ageism or gender/sexism, have provided valu- et al. 2018). Typically, researchers have focussed on welfare able contributions on fundamental dimensions of diference states, but there is a need to consider the health efects of and inequality. Yet, if we do not consider how such funda- other types of institutions, such as education, employment, mental dimensions intersect, we assume that the experience and incarceration, and to consider how these efects interplay of all women or people of a certain age for example are the with individual positioning through multiple axes of power. same and will likely miss important subgroup inequalities. Corna (2013) provides a framework for how researchers can Given the wide availability of data on gender, ethnicity, examine the links between institutional policies and health age, and socio-economic position and that these are known which we describe in more detail further below. to be key dimensions of inequality, a sensible default posi- Systems of discrimination such as sexism, racism, age- tion for intersectionality research is to include them. Other ism, and classism are multiple and ‘interlocking’: the axes of inequality such as nationality, disability, and sexual- ‘matrix of domination’ according to Collins (2002: 228), ity should be included if relevant to the topic and the data ‘within which intersecting oppressions originate, develop, allow. Yet they typically receive far less attention—a relec- and are contained’. She elaborates that ‘In the USA, such tion of dominant groups often deciding which other groups domination has occurred through schools, housing, employ- will be the subject of study, and how they will be studied ment, government, and other social institutions that regulate (Dressel et al. 1997). The increasing availability of ‘big data’ the actual patterns of intersecting oppressions that Black in the form of linked administrative data and biobanks, for women encounter’. The ‘matrix of domination’ therefore example, suggests that there are new untapped opportunities describes a society’s interconnected coniguration of sexism, for intersectional life course research. However, the record- racism, ageism, classism, and other types of discrimination, ing of social variables is often sketchy in such data, and as rooted in its institutions, policies, practices, as well as ideally investment in rich large-scale prospective cohort in face-to-face encounters. An example of how systems of studies is needed to fully capture of the experience of mar- discrimination overlap is evident in intersectional stereo- ginalised groups, especially. A further decision for research- types. Against a prejudiced backdrop of Black Americans ers to take is how each axis of inequality is categorised. as lazy and unintelligent, Black women in particular are Intersectionality prompts us to question traditional catego- often viewed as welfare ‘mammies, matriarchs, and welfare risations. For example, measuring ethnicity using a White/ recipients’, while black men are stereotyped as criminals and Non-White indicator might be the only option given data rapists (Krieger 2014: 651). Gerontologists have considered availability constraints but nonetheless misses important the interplay between ageism and other forms of discrimi- variations in the population (Gkiouleka et al. 2018). Gender nation, most notably with respect to sexism (e.g. Krekula is often taken-for-granted as binary, though to properly cap- 2007). Yet empirical studies are rare. A recent systematic ture diversity a non-binary category might also be included. review of individual and structural ageism including over 7 Socio-economic position has many potential measures such million people and 422 studies around the world conirmed as income, occupation, and wealth, which are more or less its pernicious health efects yet noted that only 18 studies 1 3 European Journal of Ageing relevant at diferent points in the life cycle. We discuss these subgroups for study are justiied for the reasons stated. It life course dynamics further below. is also important to note that not all inequalities research Once axes of inequality have been included and catego- or policy should be intersectional: focussing only on for rised, researchers need to decide which intersectional posi- example gender or age inequality can be a type of ‘strate- tions/locations resulting from combinations of these cat- gic essentialism’—a way to stress commonality over dif- egories they should focus on. As noted by Bauer (2014), ference to help mobilise action (Smith 2016). few people are disadvantaged according to all axes of inequality; rather, people typically experience of a mixture Individual heterogeneity of advantage and disadvantage (though some much more than others). From a health inequalities perspective, all Even within tightly deined intersectional positions substan- intersectional positions/identities are potentially of inter- tial individual heterogeneity will always remain; in other est (Aisenbrey and Fasang 2018; McCall 2005), including words, not all those who are, e.g. a working-class 55-year- more powerful and privileged ones in order to understand old Black woman are the same, in terms of health, or other- advantage, and marginalised and oppressed ones to under- wise. This ecological fallacy can risk stereotyping and stig- stand disadvantage, and identify both protective and risk matising particular subgroups (Merlo 2018) and amounts factors—highly relevant for social equity policies. This to essentialism in regarding social categories as immutable suggests an exploratory approach in the sense of which properties of individuals rather than socially constructed particular intersections to focus on can be justiied. Repli- (Dressel et al. 1997). Suggestions to target policies based cation in such an approach is of course crucial. on intersectional diferences need to take this into account, Supposing complete population data are available (e.g. which might not only lead to stigma, but might also be as with register data) with rich measures, researchers ineicient. Indeed, recent empirical indings suggest that, might be tempted to include a range of axes of inequality in fact, intersectional subgroups exhibit a high degree of and categories within each to capture the ‘true’ complexity overlap in terms of their distribution with respect to a range of intersectional patterning in the population. It is impor- of health outcomes (Evans and Erickson 2019; Fisk et al. tant to note however that it is not the purpose of inter- 2018; Hernández-Yumar et al. 2018; Persmark et al. 2019), sectionality to deine ever more risky granular subgroups which might also be expected with regard to other subgroup (Green et al. 2017). Further, it soon becomes apparent that characteristics. Thus, intersectional patterning illustrates adding enough granular detail according to how intersec- the diversity of population inequalities, but belonging to an tions are deined will lead to conclusion that ‘everyone intersectional subgroup does not deine individual experi- is diferent’—a unique combination of social character- ence, not least because of the role of human agency. None- istics. As more and more granularity is added, categori- theless, average intersectional diferences might be useful sation would eventually result in each intersection con- from a policy perspective because they might suggest that taining only one person, and the commonalities between societal (and therefore modiiable) factors underlie the popu- people are lost. This is the ‘ininite regress’ of sub-cat- lation distribution of individual risk (Merlo 2018). egorisation (Davis 2008) and was a key reason why the court rejected the discrimination case Crenshaw referred to. Further, complexity can lead to ‘deicit thinking’, by Intersectional approaches and methods focussing on particularly disadvantaged intersections, for health inequalities research and not on their assets and resilience. This can mean that ‘power relations and material inequalities that constitute Inter‑ and intracategorical approaches oppression remain obfuscated’ (Dressel et al. 1997: 581). to intersectionality In contrast to a broad approach mapping disadvantage/ advantage across multiple axes and categories of inequal- Once categories have been deined, two main approaches to ity, a more theoretically informed approach might focus on intersectionality relevant to inequalities research can be dis- speciic intersectional positions/identities (Bauer 2014). tinguished: inter- and intracategorical (McCall 2005). The As noted, intersectionality theory itself has now moved irst is concerned with diferences between intersections, the away from an exclusive focus on Black women and has second with focussing within particular intersections with- instead incorporated multiple axes of inequality and their out necessarily comparing them with others. Qualitative resulting intersections. Beyond intersectionality, particu- methods are especially suited to this approach since they are lar theories when considered together, such as feminism able to explore the complexities and diversity of the social and Marxism, might suggest prioritising a focus on, for lives of those who occupy diferent intersections (McCall example, working-class women. In our view, both explora- 2005) (a fundamental aspect of which is time and timing). In tory and deductive approaches to selecting intersectional a recent guide to how researchers can apply intersectionality

1 3 European Journal of Ageing theory to qualitative health research, Abrams et al. (2020) Bauer and Scheim (2019), some scholars have erroneously suggest that it should be deployed from a critical perspec- assumed that intersectionality only refers to multiplicative tive, but do not go on to prioritise a particular theoretical efects, and their absence falsiies it. Rather than a falsi- framework, arguing instead that the approach to be taken iable hypothesis, however, intersectionality is above all a depends on the aim of the research. Scholars in the intracat- framework for understanding heterogeneity and social power egorical tradition tend to focus on marginalised intersections (Bauer and Scheim 2019; Bowleg 2008). Emerging research rather than dominant ones (McCall 2005). However, not all suggests that there are typically large diferences in health intersectionality scholars advocate for categorisation. Anti- between intersectional subgroups, e.g. the health of a work- categorical scholars reject categories outright, arguing that ing-class 55-year-old Black woman is typically worse than they are false social constructions and unhelpful simpliica- that of a 25-year-old White middle-class man, and these are tions of the complexity of the social. Yet for quantitative mostly driven by additive rather than multiplicative efects research it is necessary to accept categories to some extent, (Holman et al. 2020). In other words, they are the result of even if acknowledged as socially constructed, somewhat adding up the average health diferences between 25 and imperfect, and always in lux (McCall 2005). 55 year olds, men and women, and so on. Nonetheless, it is important to test for multiplicative intersectional efects Analysing intercategorical intersectionality using by including an interaction term in case any are present; interaction terms otherwise, erroneous conclusions can result (Bowleg and Bauer 2016). Does a multiplicative interaction tell us about Quantitative analyses have typically used interaction terms any important policy-relevant diferences? Arguably, mul- to analyse intercategorical intersectionality. Not specifying tiplicative efects suggest that remedial policies that only interaction terms can lead to false conclusions in examin- focus on one type of discrimination at a time will not be fully ing subgroup diferences. Bowleg and Bauer (2016) give efective for those who experience multiple types. (Although an example by Schulman et al. (1999) who in their study of whether such a conclusion is warranted also depends on gender and race bias in cardiac catheterisation speciied only whether causality has been carefully considered to rule out main efects and did not include an interaction. They con- alternative explanations, as discussed below.) cluded that men and Whites were more likely to be referred for catheterisation than women and Blacks. In fact, correctly Multilevel analysis of individual heterogeneity including the interaction term, Black women in particular and discriminatory accuracy (MAIHDA) were the only group with lower odds of referral. Interaction terms can be speciied in nearly all types of analysis, includ- One key limitation with using interaction terms is that it is ing in longitudinal approaches, though caution must be exer- not feasible to specify two-, three-, or four-way terms to take cised because their interpretation depends on whether the account of all possible interactions between multiple social model is linear (e.g. linear regression) or not (e.g. logistic characteristics, due to problems with ‘scalability, model par- regression). Alternatives to specifying interaction terms to simony, reduced sample size in some intersectional identity study intersectionality are also sometimes used—see Bauer groups, and interpretability’ (Green et al. 2017). A poten- (2014) for an excellent review of this topic. tial salve to the issue of analysing multiway intersectional efects is the introduction of MAIHDA (Multilevel Analysis Additive versus multiplicative efects of Individual Heterogeneity and Discriminatory Accuracy), which arguably represented a new turn in the quantitative Analysing interaction terms tests for multiplicative interac- intersectionality literature (Evans et al. 2018; Green et al. tion (in linear models). Yet two types of statistical efect 2017; Jones et al. 2016). MAIHDA has been labelled as drive intersectional subgroup diferences: additive or mul- the new ‘gold standard’ for investigating health dispari- tiplicative (or some combination thereof). Additive efects ties (Merlo 2018). It is not without criticism however, and represent the layering of disadvantage/advantage, whilst interested readers might like to consult the recent exchange multiplicative efects might suggest that the efect of one between Lizotte et al. (2019), who dispute the interpretation social characteristic is attenuated or ampliied by another. of MAIHDA models with regard to what they tell us about For example, with only additive efects, the efect of ethnic intersectional disadvantage/advantage, and the reply by minority status on health is the same regardless of gender, Evans et al. (2019) who argue these concerns are unfounded. and with multiplicative efects, the efect of ethnic minor- We agree that MAIHDA models require careful interpreta- ity status on health might be particularly pronounced for tion, but also that they have a number of clear advantages, women. This begs the question of whether the absence of an which we now summarise. interaction efect, i.e. where no statistical multiplicativity is The innovation with MAIHDA was to use multi- present, somehow disproves intersectionality. As noted by level models to nest individuals (level one) within their

1 3 European Journal of Ageing intersectional positions/identities (level two). Unlike con- Discrimination and intersectional health ventional approaches involving interaction terms, the multilevel method can handle small intersectional subgroups due Given its social justice origins, intersectionality most natu- to statistical shrinkage inherent in the model, which causes rally aligns with explanations of health inequalities based smaller, more unreliable intersections to be ‘shrunk’ closer on discrimination. Intersectional diferences are associated to the grand mean, and so is crucial when working with with unequal ageing because the power, resources, and life a high number of granular subgroups (Bell et al. 2019). It chances associated with intersectional positions/identities also partly corrects for the issue of multiple testing (Bell are important social determinants of health (Marmot et al. et al. 2019). Conceptually, the model takes intersectional 2020). As Krieger (2014) notes, studies on the relationship subgroups as its unit of analysis and thus allows for socio- between institutional/societal levels of discrimination and demographically ‘mapping out’ granular inequality. Further, health are scant compared with those focussing on interper- it allows for estimating the extent to which the variance in an sonal discrimination, which are limited by under-reporting outcome is explained by diferences between intersections and inherent subjectivity. Studies on this relationship incor- versus diferences within them via the variance partition porating an intersectionality framework are rarer still, sug- coeicient (VPC). A high VPC (in a null model, without gesting a series of urgent research questions around ‘how main efects included) suggests that intersections vary sub- institutions shape individuals’ positioning and experience stantially with respect to a given outcome and that within of health’ (Gkiouleka et al. 2018). each intersection, individuals are similar, whereas a low We summarise initial guidelines in Table 1 on how to use VPC suggests high intersectional overlap: low mean inter- intersectionality to research inequality. sectional diferences and high individual variance (Merlo 2018). It thus allows an understanding of the extent to which intersectionality matters overall, as well as the efects of spe- The life course ciﬁc intersections. With regard to inding speciic intersectional efects, MAIHDA is inherently exploratory; however, It is now axiomatic that the life course is central to the study it can be extended to test for speciic hypotheses, for instance of old age. If we want to fully understand later life, we must testing for the signiicance of a single, speciic interaction situate it within the socially constructed nature of the life that is hypothesised prior to modelling. course, in which social risks and socio-economic resources MAIHDA is also able to estimate the extent to which are highly unevenly distributed and where these structural intersectional efects—both for each intersection and for inequalities play important roles in shaping the lived experi- intersectional inequality across the whole sample—are mul- ence of old age, for example in terms of health status and tiplicative (synergistic) or additive (layered) in their statisti- income (Walker 2009). This is not to argue that the life cal constitution. This approach might ind for example that course predetermines later life but that it undeniably exerts a there are multiplicative efects in the level of health for a powerful inluence. This perspective contradicts the view of particular intersection such as a working-class 55-year-old old age as a distinct phase of life and, especially, one that is Black woman but not for the equivalent male intersection. ‘disengaged’ from the preceding life course (Cumming and The VPC given by MAIHDA models when the main efects Henry 1961). Not surprisingly early life course analyses bore are included in the ixed part of the model is a measure of the imprint of such functionalism in, for example, emphasis- overall multiplicative intersectional variation. This might be ing the role of social norms in shaping behaviour and over- informative in showing how some outcomes are driven by emphasising the power of individual choice (Clausen 1986; multiplicative efects more than others. One potential reason Elder 1975; Neugarten et al. 1965). While not underesti- for this might be that some health conditions are more vis- mating the pioneering nature of these early developmental ible (e.g. obesity) and therefore more subject to stigma and approaches, especially Elder’s, their primary purpose was discrimination according to multiple social characteristics. not to attempt theoretical insight but, rather, the life course Multiplicativity might also be context dependent, depend- was utilised as a conceptual framework for conducting ing on the nature of discrimination in a particular society research and interpreting data concerning adult role transi- or historical period. For example, Warren (2018) observes tions. Focus on the institutionalisation of the life course by shifts in the visual stereotypes of older women over time. As sociologists like Dannefer (1987) and Kohli (1986) went with the interaction term approach, multiplicative intersec- hand in hand with the political economy perspective in ger- tionality might imply that particular policy interventions are ontology, which brought the life course to centre stage in needed to tackle inequality and its determinants. the study of old age. Social gerontologists working within this structural perspective analysed life course inequalities deriving from the work course and SEP (Guillemard 1986; Walker 1981), gender (Arber and Ginn 1991; Estes 2006) 1 3 European Journal of Ageing dimensions of inequality and should be considered as a minimum. and should be considered dimensions of inequality Eforts include further should be made to as national- dimensions such these to in relation inequali- in knowledge gaps given ity and sexuality ties of their exclusion potential given should be questioned non-White people marginalised speciic intersections, on more and (ii) focussing of inequality axes depending on justiied are Both knowledge/theory. existing by informed the topic/aims action collective the basis for weaken may tion level patterns; an intersectional position does not belonging to tion level intersectional pat- deine or determine Rather, individual experience. for evidence can generate which terning societal factors, is shaped by policy inequity acting on theirof oppression intersectional position/identity in mind kept is not if heterogeneity the exploring suited to richness within of individual experience intersectional subgroups sectionality; otherwise,sectionality; erroneous subgroup comparisons can result understand to heteroge- all a framework as it is above intersectionality, rather than a hypothesis neity and social power nonlinear models linear versus for varies pretation Guidelines and key issues Guidelines and key fundamental are socio-economic position, and age ethnicity, Gender, and White/ categorisations as male/female such Taken-for-granted multiple across (i) mapping advantage/disadvantage are approaches Two people and loses sight of commonalities between complexity much Too It is important to distinguish between individual prediction and popula- individual prediction It is important between distinguish to and sources structural resist to power and resilience agency have People stereotyping lead to can itself inadvertently An intersectional perspective well- are methods e.g. using qualitative Intracategorical approaches, Interaction terms should be speciied to account for multiplicative inter- multiplicative termsInteraction account for should be speciied to the term absence of a signiicant interaction falsify does not However, termsInteraction of models, but their inter- can be speciied in a range categories within each axis will be deined, and which resulting inter- resulting categories axis will be deined, and which within each on sectional subgroups focus to geneity will remain, in terms outcomes or will remain, ageing/health geneity of unequal otherwise analysed intercategorical intersectionality analysed Initial guidelines for using intersectionality in research on inequality using intersectionality in research Initial guidelines for Table 1 Table Topic Description Deining intersections included, how are of inequality axes decide which need to Researchers Individual heterogeneity deined intersections, substantial individual hetero- within tightly Even Use of interaction termsUse of interaction so far have researchers in which terms Interaction the are main way

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and race and ethnicity (Blakemore and Boneham 1994; Nazroo 2003). Recently, the combination of biogeronto- logical and sociological analyses, for example in the New Dynamics of Ageing Programme (https://www.newdy namic s.group .shef.ac.uk/), has led to the introduction of a radical public health perspective, which places a particularly strong emphasis on the life course inluences on unequal ageing— for example in tracing associations between childhood deprivation and late life functioning (Foster and Walker 2015; Kuh et al. 2014; Walker 2018). Thus, a life course lens forces us to take a dynamic view of ageing rather than a static one of old age (Arber and Evandrou 1993). This dynamism has yielded some fruitful research avenues, including the notion of cumulative advantage/disadvantage—the systematic ten- dency towards divergence in socio-economic resources and status over time (Dannefer 2003).

extent to which intersections discriminate between individuals intersections discriminate which to between extent on granular subgroupinstead diferences termswhen using interaction the interpretation Careful sections and across whole sample. of these efects is required is crucialefects. Replication Mutual synergies between intersectionality Guidelines and key issues Guidelines and key MAIHDA distinguishes individual versus intersectional variation, i.e. the intersectional variation, individual versus distinguishes MAIHDA terms, specifying interaction to focussing approach It is an alternative categories uses age analyses; cross-sectional limited to It is so far problematic are intersectional cells, which It can handle small or empty individual inter- for efects both additive/multiplicative It can distinguish popular software most for syntax examples provide studies Existing inding speciic intersectional to with exploratory regard Inherently and the life course

Dressel et al. (1997) provided an early outline for how intersectionality could help frame a more inclusive and critical gerontology, to better understand ‘the dynamic interplay of race, class, gender, and ageing’ (1997: 579). They argued that systems of discrimination based on age, gender, ethnicity, and social class intersect across the life course to lead to varied older age outcomes, causing us to rethink taken-for-granted concepts such as retirement, adjustment to old age, and healthy ageing. For example, a study of African American grandmothers suggested that age was not seen as a prominent social identity in the face of lifelong experiences of poverty, racism, and sexism (Dressel and Barnhill 1994). Similarly, among low-income African Americans where redundancy and unemployment are common, the concept of voluntary retirement may have little meaning. Caregiving is a further area where an intersectional framework is illuminating (Dressel et al. 1997).

subgroup inequalities and heterogeneity subgroup inequalities Government policies commonly devalue both paid and An approach to analysing intersectionality speciically focussed on focussed intersectionality speciically analysing to An approach unpaid caregiving—as illustrated starkly by the Covid-19 pandemic. Furthermore, ethnic minority women are con- centrated in the lowest paid jobs and are particularly disadvantaged in terms of older age income if they are forced to leave work to care for someone. Finally, Dressel et al. (1997) also discussed intersectional efects in patterns of inequality over the life course, now well-known in gerontology: age as leveller, persistent inequality, and inally cumulative disadvantage/advantage. More recently, from an ethnographic perspective, Ferrer et al. (2017) outline

(continued) four elements of an ‘intersectional life course perspective’: life events, timing and structural forces, local and glob- erogeneity and discriminatoryerogeneity accuracy (MAIHDA) Table 1 Table Topic Description Multilevel analysis of individual het- analysis Multilevel ally linked lives, identities and categories of diference,

1 3 European Journal of Ageing and agency, domination, and resistance. They argue for intersectional diferences in work and family life courses examining the interconnections between life events, tran- and career outcomes, inding for example that ‘for Black sitions, trajectories, and systems of domination over the men high prestige careers are only accessible if they are life course. in stable relationships with maximum one child’. This These existing attempts at combining intersectionality example compellingly shows how social ties to signii- and life course perspectives provide the point of departure cant others ‘establish forms of socialization and control in for the present analysis, incorporating recent methodologi- channelling individual actions and decisions’ (Elder and cal developments, and focussing on unequal ageing with a Giele 2009: 10). It also demonstrates how people move particular emphasis on health. between SEPs over the life course, which is also the case with other positions/identities typically used in intersec- The life course, intersectionality, and categorisation tionality research, e.g. based on disability, migrant status, or neighbourhood. An understanding of transitions, both From a life course perspective which emphasises the in terms of social categories and how these are tied into dynamic and temporal nature of social categories, gender, social roles transitions, ofers a much-needed rich and ethnicity, and SEP and their disparities are both causes dynamic view of intersectional subgroups. and consequences of social stratiication (Richardson and The existence of social categories also depends on his- Brown 2016). At the same time, the overarching point of torical time. For example, contemporary societies exhibit intersectionality, that axes of social inequality are diferenti- substantial ethnic diversity (Salway et al. 2020), and tra- ated according to others, can help to strengthen a focus on ditional patterns of retirement have become increasingly diversity in gerontology. fragmented in contemporary society, now characterised Seldom acknowledged in the intersectionality literature, by bridge jobs, lexible retirement, and unretirement (De yet fundamental to life course dynamics, is the view of Tavernier et al. 2019). The meaning of social categories the individual life cycle as comprised of various socially such as ‘Black’ depends on context. For example, it means constructed life stages and role transitions: ‘Lives change something diferent to be Black in America compared with as relationships and social roles change’ (Elder and Giele the UK and in 2020 compared with 1920. The dynamic 2009: 9). The ‘traditional’ life cycle describes how people nature of categorisation means that exposure to the inter- transition from childhood to independence, marriage, child- sectional ‘matrix of domination’ is not monolithic but, bearing, and ‘growing old’, and with respect to productive rather, people belong to multiple social categories over roles, from education to employment and then retirement. the life course and the meaning of this belonging depends The ‘age-graded normative organization of society’ governs on historical time (Ferrer et al. 2017). This insight allows when key transitions such as marriage or retirement are con- for conceptual separation of age and cohort efects. For sidered normal—the so-called ‘institutionalisation of the life example, Elder (1974) showed how the Great Depression course’ (Kohli 1986). Norms dictate the ‘appropriate’ time was a formative experience that shaped particular views for life transitions and people can be early, late, or on time of and orientations towards the world for the cohorts that and are generally aware of their timing (Elder 1975). experienced it (Gubrium and Holstein 2006). Often, in From an intersectionality perspective, role transitions cross-sectional intersectionality research age is split are a fundamental part of development and social identity into 5- or 10-year bands, yet this treatment sidesteps the (Vespa 2009) and also entail moving through diferent importance of life course dynamics. So far the distinction structural positions in the social hierarchy, with difer- between age and cohort has received little acknowledge- ential access to power and resources. Norms around tim- ment in intersectionality research (with some exceptions ing are intersectionally patterned, as with Dressel et al.’s such as Warner and Brown 2011). Importantly, the same (1997) example of deprived ethnic groups and retirement. age can have a diferent meaning for those in diferent With respect to intersectional categories and time, people intersections given intersectional variation in role transi- usually belong to a certain gender and ethnic group over tions. However, to properly unpack these dynamics, longi- the lifespan, such as the category of ‘Black woman’. As tudinal approaches are needed, as we explore below. Black women (or any other gender/ethnic group) age, they Alongside a concern with historical time, both intersec- transition through diferent social and re/productive roles tionality and life course researchers also often emphasise and occupy diferent structural positions. Social identity the importance of spatial context (Elder and Giele 2009; and lived experience therefore constantly evolve over the Scott and Siltanen 2016). Recently, geographers have begun lifespan (Ferrer et al. 2017). Intersectional patterning to consider the crossover with intersectionality (Hopkins in how people move through life transitions can help to 2019), though methods for how to investigate spatial inter- explain intersectional outcomes. For example, Aisenbrey sectionality are still being established. Spatial context by and Fasang (2018: 1) use sequence analysis to examine contrast has been well-examined in gerontology in how it

1 3 European Journal of Ageing shapes social roles and identities including in diferent socie- (Bauer 2014). People may forefront diferent identities in ties, regions, and localities, or as with early life course anal- diferent social contexts or at diferent points in their life ysis of childhood development, schools, neighbourhoods, course (Kapilashrami et al. 2015). and communities (Elder and Giele 2009). For example, in Dannefer and Miklowski (2006) argue that the concept of deprived neighbourhoods, the role of age may be less salient, social risk helps us to understand the role of agency in late and in certain countries disability is more common than in modern societies. Key risks once stemmed from a lack of others. Dressel et al. (1997: 593) elaborate, asking: information to inform action, whereas now there is a risk of too much information, placing more responsibility for action in declining neighbourhoods where work is disap- on the individual. One example is the UK pension system. pearing, what is the role of elders in terms of their Not only is it seen as one of the most complex in the world contribution to the socialization of children and ado- (Pensions Commission 2004), but it has also been shifted lescents into normative work roles? Do such roles towards individual responsibility with the introduction of a vary by ethnicity, gender, or other factors? self-managed deined contribution system. From an inter- They note that answers to these questions have the potential sectionality perspective, social risk is not only shifted to to ‘link issues of individual, group, and community well- individuals, but to intersecting deprivations because these being in ways that could shape more efective social policies structure inancial acumen (Holman et al. 2018). As well and community development activities’. Similarly Ferrer as language, knowledge, and other dispositional structures, et al. (2017) suggest that people formulate their identities and the ways in which they can act as vehicles of discrimina- based on relationships with multiple family members and tion, intersectional diferences may also structure the ways multiple generations, and these relationships taken place in which people are enabled or constrained in expressing across transnational spaces. The recent turn to localism in agency as they shape access to power and resources. public health in the UK, which devolved responsibility to city councils (Phillips and Green 2015), suggests a role for The life course, intersectionality, and patterns a local intersectional approach to generate knowledge useful of inequality for informing locally relevant inequity policy. Population level life course analysis examines patterns of inequality over the life course, focussing on birth cohorts or The life course, intersectionality, and agency other subpopulations (Dannefer and Kelley-Moore 2009). Observed patterns suggest that population processes or char- As noted, intersectionality scholars are keen to stress the acteristics are inluenced by social, political, or economic strengths and assets of those who experience oppression and structures and policies (Dannefer and Kelley-Moore 2009). how they can resist it, how social identities are luid and Such factors explain both diferences between cohorts and multifaceted, and how the expression of agency is depend- stratiication within them. Methodologically, trajectories are ent on time and place. Similarly, in the life course perspec- used to understand how outcomes such as health or income tive, it is generally accepted that people have a degree of change as people age individually, and whether this change control over their roles and situations, constructing ‘their is associated with a characteristic or experience that var- own life course within given constraints’ (Elder and Giele ies between people. George (2009) points out that social 2009; Walker 2006). However, agency remains the subject scientists are used to thinking in terms of between person of active debates in the ield, for example concerning choice, diferences, such as how those in SEP are associated with constraints, action, and resilience (Gilleard and Higgs diferences in health. Trajectory analysis extends this by 2010; Marshall and Clarke 2010). Clausen’s (1991) notion allowing for a consideration of how changes in SEP over of ‘planful competence’—a putatively stable personality the life course inluence health. In this, a number of potential characteristic or individual strategy formed by adolescence dynamics emerge, such as time spent in certain SEPs (dura- and a predictor of life course success (Dannefer 2018) high- tion) and at what age (timing/critical periods), how the order lights the interplay with social structure over the lifespan. As of SEP statuses might inluence health (sequential efects), noted by Dannefer and Miklowski (2006), agency can only or how certain SEP transitions might constitute a big life be expressed within institutional structures, language being change (turning points). the most fundamental example. The way in which particu- The extension to multiple social characteristics and their lar uses of language exclude certain groups and limit life intersections is a natural progression of such analyses. chances is well-documented, classically in relation to social Rather than examining only SEP, trajectory analysis might class and education (Bernstein 1964). These dynamics may consider timing, order, and turning points with respect to help to explain the ways in which intersectional position intersectional subgroups, constituting an ‘intersectional tra- and identity become separated under certain social contexts jectory’ approach. Dressel et al. (1997) discuss the potential

1 3 European Journal of Ageing for intersectional efects in three patterns of inequality over conditions. Further, these studies use interaction terms to the life course, now well-known in gerontology: age as lev- examine intersectional efects in trajectories, which is a eller, whereby gender, ethnicity, or class inequalities are valid, though as noted a somewhat limited approach. There gradually washed away by the strength of age efects in later is therefore a methodological and conceptual gap between life; persistent inequality, whereby inequalities persist over recent advances in intersectionality using the MAIHDA the lifespan; and inally cumulative disadvantage/advantage, approach (Merlo 2018) and trajectory analysis. An exten- the notion that early disadvantages/advantages amplify and sion to the MAIHDA method would potentially allow for widen over the lifespan (Dannefer 2003). partitioning variance between individuals and intersec- The cumulative disadvantage/advantage hypothesis sug- tional groups, adding a third level to model change. Such an gests that early life inequalities in disadvantage/advantage approach would speak to current gaps in understanding in set the scene for (though do not determine) further dis- both life course and intersectionality scholarship, but would advantage/advantages and therefore that childhood cir- push the limits of typical sample sizes at least in longitudinal cumstances and experiences have particularly formative surveys. and cumulative efects (O’Rand 2009). With respect to health Ferraro and Kelley-Moore (2003) found that obesity The life course, intersectionality and discrimination during adulthood, but not childhood, follows this pattern. They argue for a focus on compensatory mechanisms, both Intersectionality focuses on discrimination in explaining ine- in terms of exiting the risk state of being obese, but also quality as it is concerned with social diferences which entail countervailing mechanisms including exercise, which have relationships of power, privilege, and oppression. However diferential efects. From an intersectionality perspective, subgroup inequalities not only result from discrimination, researchers might examine the extent to which intersec- but also other social, psychological, or even physiological tional position/identity at a particular stage of the life or genetic diferences. One challenge with intersectionality course is contingent upon previous stages (as with the research is therefore to attribute intersectional diferences to aforementioned research by Aisenbrey and Fasang (2018)) wider systems of discrimination and their interconnections and the role of compensatory mechanisms in breaking (the ‘matrix of domination’ Collins 2002). chains of disadvantage/advantage. For example, the rela- Research in this area might proceed by showing that inter- tionship between childhood intersectional position and sectional discrimination has a life course dimension. People markers of disadvantage related to early conditions and are simultaneously afected in diferent ways by multiple experiences, such as child abuse, changes in family com- overlapping policies depending on their intersectional posi- position including parental death or divorce, and health tion, which Beckield et al. (2015) describe as ‘institutional during childhood or adolescence might be considered. imbrication’. For example, age, cohort, and gender inlu- Ferraro et al. (2016) argue that researchers have so far ence who is afected by rising state pension ages, and we mostly considered these factors in isolation, and instead might expect that the ability to respond to these changes we need to think about how such domains of disadvantage is further diferentiated by ethnicity and SEP. Policies and are related to each other, e.g. in having simultaneous, over- institutions are therefore a key way in which the ‘matrix lapping, or sequential efects, echoing the same underlying of domination’ inluences intersectional position. In addi- logic of intersectionality. Similarly, as with an intersection, successfully navigating institutions is often associated tionality perspective, advantages are in theory as pertinent with key life transitions, such as entry into certain schools, as disadvantages, such as positive childhood experiences universities, professions or countries, and institutional dis- of parental warmth, household security, or the availability crimination therefore potentially leads to further exclusion of books in the household (Brunello et al. 2017). and marginalisation. In this way, institutions mediate one’s Doren and Yin (2019) examine intersectional life course intersectional trajectory. For example, organisational narra- trajectories in the gender gap in earnings and ind that the tives help to construct identities of students, employees, or gap increases most with age for whites and those with col- care home residents as having potential and being worthy lege education, such that male advantage is most pronounced of investment, or as hopeless and ‘dead wood’ (Dannefer for those who also have racial and ethnic advantages. Some 2018). On the social psychological level, Bengtson’s (1973) analyses with health as an outcome have been carried out concept of ‘induced incompetence’ explains how vulner- (Ailshire and House 2011; Brown et al. 2016; Richardson able individuals—originally on the basis of age but also on and Brown 2016; Warner and Brown 2011). For example, other axes of inequality—are susceptible to being labelled Richardson and Brown (2016) found a multiplicative efect as incompetent. of ethnicity and gender on hypertension risk trajectories. We might expect that duration, timing/critical periods, However, these analyses have so far focussed on the later and sequential efects associated with intersectional posi- life course and there is need to also consider earlier life tions/identities will have particular consequences for ageing

1 3 European Journal of Ageing ) 1997 ) ind a multiplicative efect of ) ind a multiplicative ) ind that high prestige careers careers ) ind that high prestige ) showed the in political variations ) showed 2016 2018 1999 ) suggest women disadvantaged according according disadvantaged women ) suggest ) highlight how retirement might have little might have retirement ) highlight how 2018 1997 intersectional variation in diferent historical in diferent intersectional variation times and spatial of intersectional understand power locations to explanatory patterning people with intellectual disabilities age, this by varies and how health inequalities, in explaining of inequality axes and other gender, age with in neighbourhoods deprivation a high average place-speciic evidence generate et al. (Dressel hoods with high unemployment meaning among low income African Americansmeaning among low are mainly only accessible for Black men if they are in stable are men if they Black accessible for only mainly are withrelationships a maximum of one child participation between diferent groups diferent of older people, based participation between EU countries in diferent on SEP, to SEP and ethnicity were less able to mitigate the damaging mitigate less able to were SEP and ethnicity to because state pension age the to efects of increases women’s and less likely of the change be aware to less likely were they pensions complex make to the inancial knowledge have to decisions ethnicity and gender on hypertension risk and gender ethnicity trajectories patterning in this spent in certain (timing/critical at what age SEPs (duration) theperiods), of SEP statuses might inluence health order how certain efects), or how might SEP transitions (sequential (turning points) change a big life constitute Examine time/place diferences in intersectional diversity time/place diferences Examine within and between examine to analysis Conduct MAIHDA cohorts of diferent the ageing Examine of disabled people and individual SEP versus deprivation of area relevance Compare or neighbourhoods in deprived of age the relevance Examine scale to on a local or regional Conduct intersectional analyses in neighbour- change of older adults may role care Informal Richardson and Brown ( and Brown Richardson Dressel et al. ( et al. Dressel Holman et al. ( Holman et al. Walker and Naegele ( and Naegele Walker Examine how people navigate role transitions and intersectional transitions role people navigate how Examine outcomes depending on time gender by ethnicity Analyse ( and Fasang Aisenbrey Examples and potential approaches and potential Examples diferent intersectional diversity, which changes over time over changes which intersectional diversity, diferent minority ethnic numbers of professional (e.g. changing women) be a working- to diferent It means something ent contexts. 2020, and in in 1920 versus woman Black class 55-year-old the USA the UK versus in certain ageing with unequal to respect historical times and than in others spatial contexts inter- why for explanations key are policies, and institutions (see below) context sectional outcomes vary by sibilities for agency sibilities for patterned be intersectionally may theto pension system characteris- class, and other ethnicity, gender, on their age, tics over the life cycle the life over social stratiication cycle the life over SEP changes disadvantage/ or cumulative inequality, persistent leveller, patterns ageing of unequal advantage intertwined are as personal relationships, with intersectional trajectory decisions patterned be intersectionally may Diferent schools, neighbourhoods, regions, or countries have or countries regions, neighbourhoods, have schools, Diferent meanings in difer- Intersectional subgroups on diferent take power explanatory more have Intersectional patterning may discriminatory an intersectionality perspective, From norms, Resource constraints and institutional structures and institutional limit the constraints pos- Resource e.g. in relation and information, Risks knowledge to in relation time based shape their positions/identities over actively People Description People occupy a series occupy of structuralPeople positions/social identities of causes and consequences both are of inequality Social axes while stable characteristics, relatively are Gender and ethnicity as withIntersectional trajectories might be consistent age as well and production, reproduction to in relation Social roles individual actions and channel and relationships Social roles and transitions roles The norms key and meanings regarding Synthesising intersectionality and life course analyses to understand unequal ageing understand unequal to course analyses Synthesising intersectionality and life ing varies by historical time and spatial context by ing varies own identities across the life cycle, within given constraints within given cycle, the identities across life own could therefore be said to follow an ‘intersectional trajec- follow be said to could therefore tory’ Table 2 Table of synergy Areas Intersectional patterning and its signiicance for unequal age- unequal Intersectional patterning and its signiicance for People employ agency to resist discrimination resist to and shape their agency employ People People change intersectional subgroups over the life cycle and cycle the life intersectional subgroups over change People

1 3 European Journal of Ageing ) 2006 ) ) found that for African American that for ) found ) found that accumulated interpersonal) found 2013 1994 2018 ) 2018 grandmothers age was not seen as a prominent social identity seen as a prominent not was grandmothers age and racism, of poverty, experiences of lifelong in the face sexism to cosmetic appearance, with a particularly severe impact on impact with appearance, severe a particularly cosmetic to (Twigg older women single and multiple axes of inequality at a time, e.g. ageism at a time, e.g. ageism of inequality and multiple axes single women of older men versus and stereotypes of the early ageing’ century thetwentieth to ‘productive century (Macnicol twenty-irst discrimination has a negative impact on the impact mental healthdiscrimination of has a negative minorityolder ethnic women tancy according to age, cohort, gender, race, and ethnicity race, cohort,tancy age, to according gender, time and place across in one policy and e.g. ageism contexts, diferent ination across of discrimination, forms and multiplicative in another, sexism and ageist sexist both e.g. some policies are individual data, to or cross-national linked can be directly of perspective a comparative panel data can be used for time over policy contexts changing ren ren The cultural turn in ageist stereotypes from physical limitations physical from stereotypes turnThe cultural in ageist Dressel and BarnhillDressel ( Analyse inequalities in life expectancy and healthy life expec- life and healthy expectancy in life inequalities Analyse in reported diferences Examine interpersonal discrimination of discrim- multiple forms individuals experience how Examine interpret can be used to individual outcomes, contexts Policy and Zhang ( Bécares Policy analysis of how policies discriminate based on both of how analysis Policy of the early older workers out’ ‘worn from The transformation Examples and potential approaches and potential Examples Shifts in the visual stereotypes of older women over time (War- over Shifts of older women in the visual stereotypes state, education, immigration, social care, and retirement are are state, education, immigration, and retirement social care, or less discriminatorymore depending on historical time and spatial context or multiple social characteristics single alism shapes discrimination and oppression life course dynamics, e.g. duration, timing/critical course dynamics, e.g. duration, periods,life efects sequential age later life inluences how other thancharacteristics age discrimination is experienced dynamics and the social-psychological individual potential, the over of internalised inequalities reproduce incompetence cycle life not multiple policies/institutions/stereotypes to i.e. exposure but on based on their intersectional position/identity, only and cohort age, their country, (see ‘matrix of domination’ depending on the prevalent below) Social policies and institutional practices, such as the welfare as the welfare such practices, Social policies and institutional can discriminate policies and practices Such on the basis of e.g. austerity and neoliber- The wider socio-political context, time over changes of stereotypes and prevalence The nature Description The impact of discrimination on unequal ageing depends on of discriminationThe impact ageing on unequal on the basis of cycle the life Sustained discrimination over discriminatory e.g. labelling of mechanisms, Meso-level imbrication’, ‘institutional diferential Individuals experience Experiences time and place of discrimination by varies (continued) and their interconnections (the ‘matrix of domination’) vary and their (the interconnections ‘matrix of domination’) historical time and spatial context by the life cycle and according to historical to and according time and spatial cycle the life context Ageism, sexism, racism, and other forms of discrimination forms and other racism, sexism, Ageism, Table 2 Table of synergy Areas People are afected by multiple forms of discrimination over of discrimination multiple forms over afected by are People

1 3 European Journal of Ageing outcomes. For example, a study by Bécares and Zhang factors. To extend Corna’s list, methods for causal inference (2018) found that accumulated interpersonal discrimination might also be used, such as natural experiments or the use has a negative impact on the mental health of older ethnic of instrumental variables, to show that social policies have minority women. Timing of discrimination also matters, for diferential intersectional efects. example, the younger the age of irst arrest the greater the Empirically, MAIHDA may provide a tool to investigate risk of subsequent incarceration (Elder and Giele 2009), and the role of the wider context in shaping the total amount of racial bias in arrest is well known. From a health develop- intersectional variation in health, whether this is multiplica- ment perspective, stress and social adversity are embedded tively driven, and how this plays out within individual inter- into the biology of human development during sensitive and sections (Merlo 2018). Diferent conigurations of social critical periods, when ‘biological and behavioural regulatory and political determinants of health, or diferent matrices systems are being initialized’ (Halfon et al. 2014). Margin- of domination, should be seen as central to the wider con- alisation, exclusion, and discrimination, as causes of social text. Yet given their socio-historical contingency, a historical stress (Masters et al. 2012), are therefore important mecha- perspective is needed to correctly position the inluence of nisms through which the matrix of domination becomes bio- sociological factors on population health. logically embedded in intersectional identities. Table 2 summarises areas of synthesis between intersec- A further factor to consider in a life course perspective tionality and life course analyses and how they can be used is that the ‘matrix of domination’ changes over historical to understand unequal ageing. time, and people therefore experience sexism, age, racism, etc., diferently in diferent historical periods. Examination of trends in ageism in particular has been identiied as a research gap (Palmore 2015). One notable exception is the Conclusion work of Twigg (2013) who observes a shift in ageist stereotypes from physical limitations to cosmetic appearance, This paper has argued for a conceptual dialogue between the with a particularly severe impact on older women. Health or frameworks of intersectionality and the life course. These social policy can help mitigate the health efects of discrimi- analyses are preliminary owing to the many unanswered nation in diferent historical periods. For example, as Halfon questions that arise from beginning this endeavour. It is now et al. (2014: 348) note ‘the experiences of low socio-eco- widely accepted that a life course perspective is essential nomic status, discrimination, and racial segregation could to understanding unequal ageing, with health being a fun- have diferent efects on health for diferent cohorts based on damental dimension, at both individual and societal levels. compensatory and mediating factors such as the availability Equally, it is essential for gerontological students to under- of healthcare, or the impact of diferent social policies’. stand that ageing is unequal with respect to a number of Corna (2013) suggests how policy contexts including intersecting axes of inequality which operate simultaneously work and family experiences, pension structure, and tax poli- and often in combination. There is a strong case, therefore, cies can be incorporated in empirical work. First, when it is for moving towards the integration of both perspectives, not possible to link contextual information with microlevel based on a dialogue with mutual beneits. We have dem- data, the former can be used to interpret indings on the lat- onstrated that there are clear synergies and great scope for ter. For example, this might be an examination of national mutual enrichment between intersectional and life course policies on social care, pensions, and retirement and how perspectives, particularly regarding categorisation, agency, they might discriminate diferent groups. More widely, pol- patterns of inequality and discrimination. These synergies icy contexts such as austerity (Greer Murphy 2017), neolib- hold exciting opportunities to bring new insights to unequal eralism (Bell and Green 2016), and corporate/commercial ageing and its attendant health inequalities. interests (McKee and Stuckler 2018) shape intersectional inequalities. Second, contextual information can indeed Funding This work was supported by the Economic and Social often be linked to micro data, e.g. survey or census data, to Research Council [Grant No. ES/R00921X/1]. facilitate a cross-national perspective (or indeed other area- level analyses). Such comparisons are illuminating in that Open Access This article is licensed under a Creative Commons Attri- racism, sexism, ageism, and so on are historically and con- bution 4.0 International License, which permits use, sharing, adapta- textually speciic (Veenstra 2011). Thirdly, cross-national tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, panel data would also allow for incorporating a dynamic provide a link to the Creative Commons licence, and indicate if changes understanding of how different social policy contexts were made. The images or other third party material in this article are inluence intersectional outcomes. Multilevel longitudinal included in the article’s Creative Commons licence, unless indicated analysis is well suited to such an approach as it is able to otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not incorporate multiple levels representing diferent contextual

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