What inspired you to propose the concept of “polysectionality,” and what problem in global health were you trying to solve?
Health is the most pressing human need with massive scientific developments taking place in the field of medicine and disease, globally. Yet the Covid 19 pandemic jolted the world badly. Most countries were unprepared to cope up with the emergency situation arising due to the contagion spreading at a fast speed and mutating at every stage. The large-scale casualties of pandemic brought back the debate on policy failures inspiring leading scholars to debate on the entanglement of ‘polycrisis’.
The loss of precious lives and state’s helplessness impacted me deeply and made me think what could be done which led me conceptualize the framework of ‘polysectionality’. It is an innovative policy approach to public health providing a multidimensional policy framework which can be applied in diverse contexts.
Many readers may be familiar with “intersectionality.” In simple terms, what is polysectionality, and how is it different?
Intersectionality, as coined by Kimberley Crenshaw and further developed by Patricia Hill Collins, is a theoretical lens and social theory locating where power interlocks and intersects and its impact on Blacks and women. Polysectionality is a step towards understanding and accepting the complex, multilayered matrix of global health (or any issue) dependent on an array of factors that are viewed mainly as non-health related yet affects health deeply. Intersectionality has been interpreted in diverse ways across the world as critical theory, a method, paradigm etc. which remains significant given the stubbornness of structural inequalities yet its applicability in welfare policy remains fuzzy. Polysectionality is a conceptual policy framework addressing the issues and gaps which often leads to health policy failures. Given the genesis of intersectionality, it is rooted on a ‘matrix of oppression’. On the other hand, Polysectionality is aimed towards building global solidarities among groups, communities and countries to face health crises collectively, based on a ‘matrix of opportunities.’
Polysectionality takes intersectionality forward in health policy research. Polysectionality is an advancement to the intersectional theories as it involves intra-sectional, inter-sectional and multi-sectional dimensions to various concerns such as health and climate change. Whereas intersectionality connotes the relatedness to two or more identities, polysectionality brings out the heterogeneities within the variables, focusing on intragroup/ community differences, inter-group and multisectoral diversities unravelling the often-hidden prejudices and biases missed by policymakers.
Why do you believe many global health policies fail to meet the needs of different communities, especially in the Global South?
Often global health policies take the Western framework as a blueprint and apply it by simply tweaking it to Global South countries without in-depth analysis of the issues affecting health. This is the first major cause of policy failure. Yet even a very good policy may not succeed due to piecemeal approach focusing solely on disease-management rather than a holistic understanding of factors affecting health. Given the pressure of multiple health crisis on policymakers, they focus on immediate management rather than long-term resolution. Many a times, community engagement is kept peripheral as the communities are not treated as equals by the policy experts. A nuanced understanding of ground realities which the community’s face and are much better aware of, is often forgotten once the crisis is over.
Your framework highlights factors such as location, culture, economy, politics, and identity. Why is it important to consider all of these together when designing health policies?
Health is polycentric meaning there are multiple factors affecting it. My framework of polysectionality considers factors like location, culture, economy, identity and political will all together to fill the gaps in policy-design. Health is affected by climate-change leading to disasters like forest fires, avalanches, cloud bursts which are aggravated due to one’s location and lead to differential health risks. Political will is paramount as health is a political-economy issue not merely medical. Individuals belonging to different communities and identities face health crisis differently. During my fieldwork with migrant workers during the Covid-19 pandemic, I found out how language used to disseminate health information played a decisive role in understanding the intensity of the contagion.
Can you share a real-world example where a polysectional approach could have improved healthcare outcomes or reduced health inequalities?
There are numerous examples, but I will give you two- women and young girls suffer greater risk of communicable diseases due to socio-cultural taboos related to menstruation. They are kept outside their homes with no or limited sanitation as some communities follow practices of chhaupadi and even though the Supreme Court of Nepal made it a violation of human rights, it is still practiced. The application of political will and cultural practices as emphasized in polysectional approach, may help change mindsets. Second, vaccine hesitancy among the indigenous and tribal communities became a major issue during the pandemic. Adopting the polysectionality approach could have saved many precious lives.
Looking ahead, how do you hope the concept of polysectionality will influence future global health research and policymaking?
I am working towards greater dissemination of polysectionality and making it more empirically evident through collaborative research and seeking global funding. As I have begun working on polysectionality only recently, I hope to develop it through rigorous comparative studies among diverse communities investigating how this approach can deliver better healthcare policy designing, implementation and training to personnels. This may attract policymakers and political leaders to take cognizance of polysectionality and adopt it in health governance.
The underlining objective of polysectionality is respecting diversities cultures and knowledge systems without compromising scientific findings affecting health. Towards this, polysectionality is to keep an open mind trying to limit our biases. It rests on the six prerequisites-acceptance by global health scholars and institutional projects worldwide that ‘decolonial’ is not only about reiterating the Global South as a field of study and experiments; Inclusion of communities as equals not mere involvement they do not have any say; respecting indigenous/local knowledge and not just to hold Eurocentric-Western know-how as scientific and superior; multidirectional knowledge exchange for open conversations, changing the mindset that knowledge emanates in Global North and flows to Global South; differential yardsticks of measurement; and contextualising health as a whole.
