Intersectionality in health policy analysis: A scoping review

Introduction: Intersectionality is increasingly applied in health policy analysis, but its operationalisation has not been systematically examined. Methods: Following JBI guidance, this scoping review aimed to map the application of intersectionality in health policy analysis. Six bibliographic databases were systematically searched, supplemented by Google Scholar and backward citation searching. Two reviewers independently screened the retrieved records. Data were extracted using a bespoke theory-informed framework, examining six dimensions: conceptual clarity, analytical modality, categorical complexity, epistemic diversity, positionality and reflexivity, and transformative potential. Results: Of 131 included records, 78.6% were published from 2020 onwards. Among classifiable records, 81.4% of first authors were coded as women (105/129), and 78.7% were affiliated with institutions in high-income economies (100/127). Analyses were overwhelmingly retrospective (96.9%) and only 9.2% drew on theories of policy processes, governance, or political economy. Although 89.3% cited intersectionality scholarship, only 71.8% explicitly defined intersectionality and 20.6% applied a named intersectionality-informed policy analysis approach. Most records examined intersectional disadvantage without considering relative privilege (62.6%). Gender/sex was the axis most frequently selected a priori (80.0%) and most often given primacy. Reporting of participatory engagement (23.7%), positionality (33.6%), and deliberate reflexivity practices (8.4%) were uncommon. Most proposed policy or practice recommendations (88.5%), but only 29.3% of these explicitly called for liberation from oppression. Few reported challenges in applying intersectionality (9.2%) or proposed methodological improvements (6.9%). Conclusion: Overall, the adoption of intersectionality in health policy analysis has not been matched by consistent theoretical and methodological integration. Guidance is provided to support methodological application that is more theoretically grounded and oriented towards the redistribution of power and privilege.