Author An Intersectionality-Based Policy Analysis Framework Edited by Olena Hankivsky SUGGESTED CITATION: Hankivsky, O. (Ed.). (2012). An Intersectionality-Based Policy Analysis Framework. Vancouver, BC: Institute for Intersectionality Research and Policy, Simon Fraser University. This publication is also available online at www.sfu.ca/iirp/ibpa.html CONTACT INFORMATION: Institute for Intersectionality Research and Policy Simon Fraser University, Harbour Centre Campus Room 3274, 515 West Hastings Street Vancouver, B.C. Canada V6B 5K3 Tel: (778) 782-7641 An Intersectionality-Based Email: [email protected] Library and Archives Canada Cataloguing in Publication Hankivsky, Olena, 1969- Edited by Olena Hankivsky An Intersectionality-Based Policy Analysis Framework / Olena Hankivsky (Ed.). Includes bibliographical references. ISBN 978-0-86491-340-1 Copyright © 2012 by Institute for Intersectionality Research and Policy. All rights reserved. No part of this framework may be reproduced by any means without the written permis- sion of the publisher, except by a reviewer, who may use brief excerpts in a review. The Institute for Intersectionality Research and Policy (IIRP) enables and supports innovative groupings of scholars including interdisciplinary, intersectoral collaborations which foster the generation, application, and policy translation of intersectionality informed research. Please go to www.sfu.ca/iirp for more information. An Intersectionality-Based Policy Analysis Framework Edited by Olena Hankivsky Acknowledgements The authors would like to thank the anonymous reviewers for their thoughtful and insightful comments on this collection. We would also like to acknowledge and thank participants of the Spring 2011 hosted by the Institute for Intersectionality Research and Policy in Mission, BC for their initial feedback on the IBPA framework. The development and production of this collection was made possible by funding provided through Olena Hankivsky’s Michael Smith Foundation for Health Research Senior Scholar Award and CIHR IGH Mid-Career Research Chair in New Perspectives on Sex/Gender, Diversity and Health Reform in Canada. We would also like to acknowledge funding from the CIHR IGH dissemination grant program. Table of Contents Introduction: Why Intersectionality Matters for Health Equity and Policy Analysis ..........................7 Olena Hankivsky, Daniel Grace, Gemma Hunting, and Olivier Ferlatte Intersectionality-Based Policy Analysis ..........................................................................33 Olena Hankivsky, Daniel Grace, Gemma Hunting, Olivier Ferlatte, Natalie Clark, Alycia Fridkin, Melissa Giesbrecht, Sarah Rudrum, and Tarya Laviolette Policy Case Studies An Intersectional Critical Discourse Analysis of Maternity Care Policy Recommendations in British Columbia ..........................................................................47 Sarah Rudrum Intersectionality and the ‘Place’ of Palliative Care Policy in British Columbia, Canada .............................................................................................................69 Melissa Giesbrecht A Call for a Policy Paradigm Shift: An Intersectionality-Based Analysis of FASD Policy ......................................................93 Gemma Hunting Decolonizing Policy Processes: An Intersectionality-Based Policy Analysis of Policy Processes Surrounding the Kelowna Accord ...................................................115 Alycia Fridkin Perseverance, Determination and Resistance: An Indigenous Intersectional-Based Policy Analysis of Violence in the Lives of Indigenous Girls ......133 Natalie Clark Reconceiving the ‘Problem’ in HIV Prevention: HIV Testing Technologies and the Criminalization of HIV Non-Disclosure ............................................................161 Daniel Grace Are There Enough Gay Dollars? An Intersectionality-Based Policy Analysis of HIV Prevention Funding for Gay Men in British Columbia, Canada .........................189 Olivier Ferlatte Introduction: Why Intersectionality Matters for Health Equity and Policy Analysis Olena Hankivsky, Daniel Grace, Gemma Hunting, and Olivier Ferlatte As has been recognized elsewhere, the public policy world is in a constant state of flux (Orsini & Smith, 2007). Political, economic, environmental and health crises and events are creating new kinds of policy problems and challenges at international and national levels. Moreover, there is growing awareness that although policy alone cannot trans- form society, it does have an important but not yet fully understood role in the cre- ation of more just and equitable societies (Bryant, Raphael, Schrecker, & Labonte, 2011; Hankivsky & Cormier, 2011; Ingram & Schneider, 2006; Stone, 2001). In light of such developments, existing policy tool kits need to be re-examined to evaluate the adequacy of information currently being generated to inform policy and, importantly, to more fully explore and determine what policy analysis is supposed to achieve (Orsini & Smith, 2007). In the field of health, calls have been made for ‘policy acumen’ (Jones & Salmon, 2001) to deal with increasingly complex environments that shape and influence health. Although there is no shortage of approaches to health policy analysis (e.g., Collins, 2005; Dunn, 1981; Portney, 1986) there is little attention to ‘meaty dialogue’ around the kinds of theoretical frameworks that can improve policy analyses (Abelson et al., 2008) so that a broader and more accurate base of information about what makes people healthy or alternatively unhealthy can be generated. The purpose of this introductory chapter is to advance this dialogue by critically examin- ing existing approaches to health policy analysis, including their theoretical and practical utility, and, in the process, highlighting what important issues they fail to adequately confront in relation to health inequities. We then move on to make the case for why the theory of intersectionality holds so much promise in constructing an improved method for policy analysis that can generate knowledge necessary for achieving more inclusive, just, effective and efficient health policies. Arguably, intersectionality can significantly advance the operationalization of equity in public policy. 7 Introduction: Why Intersectionality Matters for Health Equity and Policy Analysis The chapter begins with a brief overview of public policy, health policy and a number of select approaches to health policy analysis, including sex and gender based analysis and health equity impact assessment tools, which, to date, represent the most promis- ing ‘state of the art’ tools for determining the distributional effects of health policy. Our investigation reveals that despite progress made to date, there is still much work to be done to better understand how policy affects the diversity of populations, including precisely identifying who is benefiting and who is excluded from health policy goals, priorities and related resource allocation. In this collection, we follow Waldegrave (2009) in arguing that: We need to deconstruct the industries of . policy making from the perspec- tives of culture, gender, and socioeconomic status and enquire as to the reasons for their hegemony and practice. Are they . achieving equity? Do they enable the goals of social inclusion and well-being to be reached? Do they respect the breadth of citizenship in a country, and do they enhance or hinder the inspira- tions of all citizens? (p. 97) Our central argument is that in drawing on the theory of intersectionality we can build on and improve existing equity focused tools, and specifically, health equity impact assessment tools. Our aim is lay the groundwork for an Intersectionality-Based Policy Analysis (IBPA) Framework that we present in detail in the next chapter (Hankivsky et al., 2012). The IBPA Framework facilitates the asking of questions that can capture the most important and relevant information about decision-making priorities, processes and policy outcomes. In advancing a case for intersectionality in policy analysis our goal is to bring about a paradigm shift that foregrounds the complex contexts and root causes of health and social problems. Extending beyond gender-specific and social determinants frameworks, intersectionality focuses attention on a variety of multi-level interacting social locations, forces, factors and power structures that shape and influence human life. In the con- text of health – broadly conceived – the lens of intersectionality can better illuminate how policy constructs citizens’ relative power and privileges vis-à-vis their status, health and well-being. As Bacchi and Eveline (2010) put it, “policies do not simply ‘impact’ on people; they ‘create’ people” (p. 52), including their social locations, and access to power and resources. 8 Olena Hankivsky, Daniel Grace, Gemma Hunting, and Olivier Ferlatte What is Public Policy? What is Health Policy? Public policy can be understood as “a guide to action, a plan, a framework, [or] a course of action or inaction designed to deal with problems” (Pal, 2001, p. 5). In general, public policy is seen as an output from governments, namely “what public officials, within gov- ernment, and by extension the citizens they represent, choose to do or not to do about public problems” (Kraft & Furlong, 2009, p. 5). But public policy is not only an observed phenomenon of what governments do or choose not to do. It also has a normative com- ponent because it raises