Intersections of inequality: Gender, rurality, and health in older women

Abstract

This essay examines the contribution of the intersectional approach to understanding inequalities in access to healthcare affecting older women in rural contexts, with particular emphasis on the Ñuble Region in Chile. Based on a critical review of traditional public policy frameworks, especially the Social Determinants of Health model, it argues that, although relevant, these approaches are insufficient to fully capture the complexity of the experiences of historically marginalized groups, as they tend to analyze inequalities in a fragmented and isolated manner. In contrast, intersectionality offers an analytical perspective that makes it possible to understand how the interplay of dimensions such as gender, age, rurality, and socioeconomic vulnerability shapes specific scenarios of exclusion and barriers to the exercise of social rights. The essay also problematizes the role of the State in the production and reproduction of these structural inequalities, highlighting the limitations of policies designed from homogeneous and decontextualized perspectives. Finally, it argues that incorporating an intersectional perspective into the design and implementation of health policies is not only a technical challenge in terms of management and targeting, but also an ethical and political imperative aimed at promoting greater equity and social justice in rural territories.