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1. there is a top of the line definition when it comes to public health which is a particular framing so much what other people have said. There is a shoehorning to fit into this one particular definition.

2. How intersectionality critiques and questions as far as who set up these systems and structures of power to make these disparities and what is their approach to it?

3. intersectionality allows us to critique these things, to question who is doing this? How is it upholding the systems and structures of power of whiteness, of maleness, the patriarchy, the heterosexism, everything.

we need to reckon with this history. And to remember our history and not to whitewash it in any type of way.

4. as a reflective piece with intersectionality, how do we deal with it ourselves? How do we be agents of change? How do we instead of perpetuating these systems, how do we take a step back  and question them and critique them, not only while it's happening but what are we doing and what is our part that we're playing as well?

5. our conversation took a reflective piece where we had to ask ourselves how we have internalized some of these things that society has told us about ourselves. how do we confront that? How do we have these open conversations and talk about how we can break out of those different cycles

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Dr. Peek: What about the impact of COVID?

Serious impact on rural and native communities in Canada, simultaneous with difficulties in guaranteeing funding, overall institutional resources, review boards. Lack of similar initiatives with NIH in the U.S.

Everhart: How to fight these battles institutionally? What about getting participatory ethics review from indigenous groups rather than privileging institutional reviews? Often labels can be used by research authorities to bar funding for intersectionality rather than sponsor it, so researchers involved in this praxis have to navigate institutions strategically.

Everhart: Often trans research includes samples that are disproportionally white given the community connections of the academic institutions involved, which ends up not taking into account the actual diversity of trans experiences. One way for intersectional research to have leverage over uncooperative academic and funding institutions is on the ground support and connections with intersectional communities.

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Integrate into public health:
- think about time costs & access to things that are necessary for health
- geography & space - housing, segregation, where there is housing available, allocation of resources, etc.
- rural healthcare access
- whiteness & rurality -- subvert by focusing on Indigenous, latinx and Black youth in research and physical access to care through commute times, income, insurance
- intentionality / methods / design / researchers
- spatial & temporal understanding of healthcare
- who gets to ask questions, what are good questions, and who is centred
- always remember what is the center and how are we pointing to solutions
- move away from myopic methodology and think through how methodology can match the problems we are trying to solve
- PEOPLE aren't intersectional, SYSTEMS are
- robustness of our work, data is not a monolith

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Health research funding for indigenous populations : the research needs to meet certain criteria requirements  that delays processes for acceptance
-Research and framing of process do not accommodating intersectionalities.

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- Theme:
Which counties in the U.S. have the greatest co-occurrence of HIV and COVID-19?
- Issue:

POC-communities have disproportional geographic impact of COVID-19 and HIV. Additionally, COVID-19 and related social distancing measures could disrupt prevention measures like routine testing, ongoing HIV treatment and funding streams.

This is the first national study quantifying the intersection between COVID-19 and HIV with statistically robust spatial models.

- Method:

Various data sources were combined and aggregated at county level, including Census data, ACS 5-year estimate, CDC data on Chlamydia infection rates, BRFSS data on binge drinking etc.

In terms of statistical modeling, a Bayesian multivariate spatial model was used.

- Research Results:

There was evidence of strong spatial clustering between COVID-19 and HIV infections, some correlation between HIV and COVID-19 infections, and a group of counties was identified as co-hotspots.

Most of those counties considered co-hotspots of both infections were in the South, with the exception of a New York state county.

- Policy Interventions:
Increased resources focused on counties most vulnerable simultaneously to both COVID-19 and HIV infections, in terms of vaccines, testing etc.
- Limitations:

HIV incidence data is slightly outdated, coming from 2018.

The total number of HIV and COVID-19 infections are not age-adjusted.

- Q&A:

What about urban-rural divide? Urban areas, though with higher population density, have overall less COVID-19 incidence but higher HIV incidence.

What about the foregrounding/backgrounding happening in terms of control vs. predictor variable choices? Should race be an additional predictor variable rather than control variable as a way to account for intersectionality? Are there robust enough occupational data to account for essential workers in the models? Choices for model simplicity, teasing out the spatial relation between these two infection rates, while avoiding to assume that HIV is a risk factor for COVID-19 which is yet not backed up by evidence.

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Resources informing intersectionality work : 

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Resources informing intersectionality work : 

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Q What are some texts and resources that you all use to understand intersectionality and apply it to your work?
-Beta : I try to find different books that discuss environmental justice from the perspectives of those on the ground - Theres something in the water by Ingrid Waldron / A Terrible thing to waste by Harriet Washington / Black faces, white spaces - Finney — some of my favorite!

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Question: What message or key learning would you want to pass along to someone earlier in their professional journey in your field?
M : Oppressive systems have sustained for really long and social justice has to be at the core of our everyday business and not a side project
Align the work that we do to social justice.
Alicia Boyd : Maintaining mental piece and alignment with core values
Avery Everhart : Do not be a conduit to oppressive systems in professional networks.

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Theme: addressing children's environmental justice

Issue: disparities in children's rights around environmental impacts and conditions.

Method:
-environmental epidemiology: looking at various environmental exposures and their impact on health and development and environmental benefits (e.g. proximity to plants, gardens, parks, etc.), both of which involve looking at family/school/neighborhood demographics. The most important demographic to consider is race (environmental racism).
-how are children treated at schools (e.g. discipline is harsher for Black children, stereotype threats associated with success on tests).
-school funding, household income levels.
-because of all of these factors, uses spatiotemporal modeling to create a more holistic picture across all explanatory variables. How do they collectively create conditions?

Research Results:
-children needing increased levels of protection against environmental factors. Environmental injustice to children is heavily based in issues from multiple sectors. A holistic analysis is required.

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Theme : Behavioral outcomes for sexual and gender (SGM) youth, exploring their emotions, identity and well-being especially in non-metropolitan communities.

Issue : Non metropolitan areas have limited resources for SGM youth ranging from reproductive health care support to mental health and well being. These limited resources and stigmas associated make it difficult for SGM youth to manage their emotions towards positive  health outcomes and future workforce opportunities.

Methodology : Data- Qualitative information from stakeholder interviews
-Modeling the legal social and physical infrastructure of SGM youth using the minority capacity framework
- How do SGM youth navigate through emotions of shame and pride which impacts their health outcomes.

Findings:
-Pride buffers the impact of stigma and  leads to positive experiences contributing to enhanced economic/future outcomes.
- Engaging community can help bring awareness, widen educational opportunities and improve advocacy for LGBTQ needs.
-because there are no SGM specific resources for SGM youth in non-metropolitan areas, they are found to be migrating to more urban environments to receive care.
-Advocacy for (i) Political Education is important to make SGM youth aware of their rights in work place settings,
(ii) Proper implementation of SGM specific inclusive policies and making sure that there's not just awareness but proper implementation of these policies.

KEY INSIGHTS : Funding institution are less focussed on political education and awareness but more on direct impact/application which needs to be changed.
Latin America inform most about how grass-root level work needs to be done in this context and have taught more about political education in disconnected and isolated areas.
Global work : Worth checking out Asia-Pacific Transgender Network, Iranti, Gender Dynamix, ILGA world, TGEU and Global Action for Trans Equality (GATE) for more on global movements and transnational solidarity work on mostly trans-specific initiatives

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How can you measure intersectionality which methodologies will you use when looking at health inequalities among the migrant population, speacially undocumented migrant groups?

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How can you measure intersectionality which methodologies will you use when looking at health inequalities among the migrant population, speacially undocumented migrant groups?

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Readings discussed from keynote address: 

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Readings discussed from keynote address: 

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"In addition to this excellent history Director Mia Keeys is breaking down, the Equal Justice Initiative researched and found that there were more than 4,400 lynchings of African Americans between 1870-1950. Source: https://eji.org/reports/lynching-in-america/.

Scholar Liam Hogan and others have identified 290 instances where Black areas, neighborhoods, or economic districts were destroyed or attacked by white supremacists.

So overall, Black people AND Black spaces have experienced a tremendous amount of white supremecist violence.

Source for scholar Liam Hogan’s work: https://limerick1914.medium.com/collective-punishment-mob-violence-riots-and-pogroms-against-african-american-communities-e1a801c41aa4

Also see: https://www.jetmag.com/news/history-of-violence-an-interactive-map/

He used to have a map of these on Google. It would be great to have these mapped again."
-Contributed by Lawrence Brown

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1. Could you comment on the rise of policy and political actions against the teaching of "critical race theory" and how it might affect health equity efforts?

2. Great discussion on "Equality" and "Equity". Could you also share your view on "equal opportunities" and "equal outcomes" in the context of "Equity"? Thanks!

3. Great discussion on "Equality" and "Equity". Could you also share your view on "equal opportunities" and "equal outcomes" in the context of "Equity"? Thanks!

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What about barriers to access of mental health resources for Latina women?
- Not primary care, but key component of health.
- Especially difficult in terms of linguistic access.
- Book recommendation:

"The Spirit Catches You and You Fall Down", Anne Fadiman

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In the chat: Canada's public health authorities and immigration organizers are facing similar issues about health access to different immigration communities.

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- Specific national backgrounds were not in focus for this survey, which was not specific to Mexican-American families.
- This was due to the fact that the research broadened the scope to immigrant-related and immigrant-identified Latina women in addition to first-generation immigrants.

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Given the mixed methods approach taking into account both open-ended answers and GIS, how to deal with confidentiality?
- Answers were de-identified, no personal names or specific healthcare locations.

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- Factors like immigration policies and immigration status lead to invisibility, given issues with medical deportations and legal vulnerability.

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- Latina women are often responsible for procuring social services for their families.
- Documented linguistic mismatch and difficulties of access to various immigrant communities (bias, lack of insurance, financial barriers) (Wang 2007, Wang et al 2011).
- Lack of research focusing on Latina women, which brings specific challenges.

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- Background: Research focused on Latina women living in the Chicagoland suburbs, given recent transition from immigrants to those areas.
- Finding: Proximity is not the only factor determining healthcare access, but also cost reduction, including transportation difficulties.
- Although suburban locations led to widespread access to cars, that was not always straightforward, given time constraints for instance.

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Were you successful at integrating intersectionality into your quantitative methods? How would you change your work?

- Neighborhoods in Chicago are constituted in ways that relate to race. Matching characteristics of interest and that matter are hard to get at in a quantitative way. Trouble with census data!

- Think too (with regard to travel) about who uses what type of transit and how can we measure it. With transit, this can be viable!

- Missing the link between individual and aggregate. Trouble getting individual-level data, blocking some components of implementing intersectional methods.

Policy implications?

- Shape healthcare policy by gathering that data!

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Need to Identify Spatial & Temporal Barriers 

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Need to Identify Spatial & Temporal Barriers 

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As shown by the OUD Stigma presentation, linking qualitative data (and asking new types of questions) with quantitative approaches & environment representations give new insights to the multiple dimensions of stigma.

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Theme : Capturing Latina women  health care experiences

Issue : Latina women who have poor access to linguistic concordant services, unavailability of Spanish translators for doctor visits. There is no linguistic concordance in health care services.

Method :
-Data collected from online survey respondents (Income < 75,000$/year)
-Incorporating qualitative information for Latina women and linking it to their spatial  distribution for a given geography

Research Results :
- Barries to health care for Latina women range from transportation costs, financial costs and communication(unavailability of translators/physicians)
-The lack of Spanish speaking health care service is widespread in Chicago along with financial constraints that Latina women face.
- These results help to advocate better for access to information that minority communities lack.
-Scope for future work : Dearth of mental health practitioners who speak Spanish essentially when effective communication is essential for mental health wellness.

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Theme: intersectional nature of stigma towards people with OUD (opioid use disorder) and access to MOUD

Issue: How does social stigma vary across groups, and how does it impact access to MOUD?

Method:
-nationally representative samples of U.S. households
-Omnibus surveys
-brief stigma surveys (4) across several months
-independent variables: age, ethnicity, education, personal history with OUD, access to MOUD, population of zip code area, area of zip code

Research Results:
- older respondents show stronger stigma across the board
- black respondents show weaker stigma
- personal experience with OUD tends to show weaker stigma
- people with more education are less willing to have people with current OUD marry into their family
- better access to medication is associated with lower stigma in neighborhoods
- people from areas with more resources show lower stigma
- no causal conclusions can be drawn, but these associations are very importance
- stigma can impact people's ability to get MOUD

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Theme: neighborhood-level disparities in travel cost in Chicago; a focus on mobility inequity

Issue: there is a well-documented, systematic "spatial mismatch" between jobs and segregated housing, which causes an issue because upward economic mobility relies on access to the right kinds of job opportunities and other assets (e.g. healthcare, education, etc.)

Method:
-dynamic mode choice profiles -- asking: to what extent is there heterogeneity in cost:distance for transit, what features are related to socioeconomic status?
-open trip planner was used to get travel times for transit, biking, and walking in Chicago AND individual trips by each uber, lyft, etc. which is collected by Chicago
-take travel times and convert into travel cost

Research results:
-some flows (i.e. trips) have significantly lower cost:distance ratios than others
-non-auto modes are consistently slower to and from predominantly Black/Hispanic neighborhoods, and walking/biking/transit better in Jacob's neighborhoods (which supports a walking-based hypothesis)
-Black population a key predictor of high cost:distance ratio

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Theme: leveraging urban residents' satisfaction on perceived health; focus on China

Issue: health perception can help predict quality of life, but is influenced by various components of identities. However, there isn't much research on the topic.

Method: survey collection among different demographics in China, with almost 900 valid responses.

Research results:
- health perception is strongly correlated to gender and age, air-quality and environments
- Income and Marital Status impact only women, especially psychological health due to social stigma
- Men often had stronger correlation between health and work conditions
- Low-income individuals experience worse perceived health
- Should consider ways to improve health for women, elderly, low-income and migrant workers

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In terms of intersections, which patients living with HIV are experiencing higher stigma and which providers are demonstrating bias against HIV patients?

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How has innovation helped or hurt vulnerable populations during the pandemic? For example ,in Miami the ADAP pharmacy is now dispensing 3 month supplies of antiretrovirals ( helps African Americans since the pharmacy moved away from African American neighborhoods years ago. But during surges Physicians that restricted visits to telehealth alienated poor minorities who had precarious or no access to wifi.

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Even after decades of SOME subject matter public health experts , SOME public officials, and SOME community health advocates

have been working collaboratively to develop and deploy S.M.A.R.T., innovative, - functional frameworks,
best practices, policies, action plans, etc., b- Why are most within the public health, academic, government, public, private sector, non-profit, faith-based / community- based, etc. sectors  still functioning as the Most resistant to change?

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How do we better measure racism as an experience & structure versus as single variables that can miss the picture? Limitations of isolation or segregation indices?

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What methods can we use with existing data (and its limitations) to study intersectionality?

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What type of data do we need to better address intersectionality?