Walking Beyond Privilege, Towards Equity

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An intersectional approach is essential for understanding health inequities because it highlights how people’s health is not shaped by a single factor or social identity, but instead by the interwoven effects of gender, ethnicity, socioeconomic status, disability, migration status, and other dimensions that interact to create unique patterns of advantage or disadvantage and that influence opportunities for health and wellbeing. An intersectional lens helps move beyond one-size-fits-all explanations, revealing how structural inequities compound and are experienced differently across populations. By embracing intersectionality, health policies and practices can become more responsive, equitable, and better equipped to address the real-world complexity of people’s lives.

The complexity of intersectionality emerged during the last meeting of the working group on Healthier Urban Environments held in Athens last October. To understand how social identities get embodied into people's lives and how they shape opportunities for health and wellbeing, the participants of the “Workshop on inequality and intersectionality” were asked to take part in the Walk of Privilege – a role-play activity designed to make visible the often-unseen layers of power, disadvantage, and structural inequity that shape health and wellbeing experiences.

Participants were randomly assigned a social identity, drawn from a diverse set of profiles ranging from the multiply privileged to those facing overlapping disadvantages, including refugees, undocumented workers, LGBTQ+ individuals, people with disabilities, and those from low income or unstable backgrounds. These roles ranged from a “middle class heterosexual white man with university educated parents” to a “refugee woman from Syria,” a “Latina single mother working multiple unstable jobs,” a “deaf white woman,” or a “gay man living with HIV.”

They then stepped forward or backward in response to statements reflecting real societal advantages or barriers—such as parental education, discrimination, financial instability, disability, healthcare access, and language background. However, at the start, the “deaf” participant indicated that she could not hear, and since there was no sign-language translator, she could not participate.

As the room stretched into a visible gradient of privilege, many participants expressed surprise at how quickly disparities emerged. Those left behind described discomfort and frustration – “I would need to take five steps to get closer!” – while those at the front reflected on how invisible their own advantages often feel.

After the role play, the facilitators led a short debrief, encouraging participants to consider how these dynamics mirror inequities within the pilots they are implementing and the communities they aim to serve.

• What did it feel like to move forward or backward?
• Were you surprised by your final position?
• How do these dynamics show up in the pilots we are developing?
• Which groups might risk being overlooked in our approaches?

Facilitators emphasized that the aim is not to rank hardships but to help us recognize “processes of vulnerabilisation”—the ways in which social identities and environments intersect to amplify inequities, especially in urban contexts where policies, services, and resources converge.

The activity served as a catalyst for discussions on how to better integrate equity considerations into pilot design—particularly around representation, community engagement, and identifying blind spots affecting vulnerabilised groups. Participants were encouraged to examine how power, privilege, and structural barriers might influence their approaches and decisions. It also has become a tool ready to apply in all the interventions on Healthy Urban Environment carried out by JA PreventNCD.

Embedding an intersectional approach into the planning, rolling out and evaluation of public health initiatives requires health and social care professionals to engage in a deeper understanding of the social processes that shape health and to respond to the challenge of the non-communicable diseases’ burden not only with technical tools and individual-level intervention but with structural, intersectoral, and participatory actions that re-address power relations, social determinants of health, and the root causes of inequity.

JA PreventNCD team on Healthy Living Environment

Nina Iszatt
Norwegian Institute of Public Health, Norway

Chiara Di Girolamo
University of Turin and Emilia-Romagna Region, Italy