Beyond Multiculturalism: The Need to Understand Intersectionality

On my Saturday afternoon walk across San Francisco, I ran into Abel, a young man in his mid-20s, who was panhandling at the corner of 19th Street and Dolores. As I walked past, he offered me a deal I found very peculiar, so peculiar in fact that I had to take it. For $1, I was given 10 minutes of his time to talk about a topic of my choosing. Having never paid before to converse, I wanted to make these 10 minutes count, yet I struggled to decide on what I wanted to talk about. Having just listened to a talk about identity formation that morning, I asked first how he identified.

 “I am a gay Latino,” he replied quickly. 

“And what does that mean to you?”

“It means being homeless.”

I was stunned by his response, partly because I had a preconceived notion of what being a gay Latino meant. In the conversation that ensued, he told me about being thrown out of his house at the age of 18 after he came out to his family. His church, which had previously provided his family with food, refused to feed him. He lived the first month of his post-coming out life on the streets. And in those months, his identity as a gay Latino man merged with that of being a homeless teen.

“I came to Castro to find a home,” he went on. “But everything and everyone here is white. Ain’t no point being gay, ‘cause colored folks like me don’t have a place in Castro.”

“Have you tried looking elsewhere for community?”

“Yeah, I be trying to hit up Mission, but they ain’t too friendly with the gays, when you get down to it. I go to them churches, and they make it clear that I ain’t welcome.”

I couldn’t help but wonder what would happen if Abel ever went to get medical help.  Would we, who are being trained in cultural competency and multicultural communication, really be equipped to understand where he is coming from?

To some degree, we will have the knowledge needed to begin providing care to him. Yet, by looking at him through the lens of multiculturalism, we would miss an important part of who he is as a human being.  Abel’s perception of himself constantly changes at different points in a given day.

Multiculturalism in health care has evolved as a way to educate about and take care of people of different backgrounds. For example, sexuality, gender, class and ability are taken apart individually to address how they might affect a person. Most schools have lectures that talk about each topic on its own.

But what may be more important is to understand the ways in which these identities interact with each other to produce the person before us. At the intersections of these identities, new realities often emerge. For example, a patient may self-identify as gay, but we cannot assume that this means the same thing to every such patient.

What it means to be a gay white man in the United States is often drastically different from what it means to be a gay man of color. Individuals might be united by their sexual identities, but their other forms of identification influence the significance associated with their sexuality.

It is not enough to presume that all identities are equal in the power scheme of our society. When two privileged identities intersect, the meaning created is often different from when two marginalized identities intersect. Moreover, if both privileged and marginalized identities intersect, it creates challenges associated with being at the boundaries of both power and powerlessness.  

Due to his skin color, Abel struggles to find a place within a largely white upper-middle-class gay community,. In his cultural community, he is not welcomed due to his sexuality. Moreover, his identity as a man puts him in a position of privilege within both the LGBT and Latin communities, but his homelessness marginalizes him within both communities.

Of course, it is impossible to learn what every interaction between identities can mean to different people. Yet, the growing literature on intersectionality suggests that for us as emerging health care professionals, intersectionality can be a useful framework to keep in mind. If we are to provide effective care, we can no longer afford to silo individual identities and address them one at a time.

As I walked away from our 10-minute conversation, I realized that Abel had chosen the corner of 19th Street and Dolores to panhandle. This point is midway between Castro Street and Mission Street, and at this intersection stands a church that is no longer a place of worship. At this corner, worlds are colliding in and out of existence. And amidst it all is a young man whose breath is his form of activism, an ever-present reminder that we are more than what we seem.