Measuring Structural Intersectionality Through State Policy Contexts: Development of a Policy-Based State Discrimination (PBSD) Measure

Few existing measures of structural discrimination consider the synergistic effects of racism, sexism, and classism on health inequities. Using intersectionality as an analytical tool, we developed a policy-based state discrimination measure. From an initial pool of 235 policies, we selected 87 thematically relevant policies across various domains as potential indicators of intersectional structural discrimination. We conducted a series of confirmatory factor analyses (CFA) to evaluate the relationship between our policy domains and the underlying latent constructs of racism, sexism, and classism. We identified two models to quantify intersectional state-level discrimination. A 3-factor model for racism, sexism, and classism included 9 policy domains and showed good fit (RMSEA: 0.026; CFI: 0.989; TLI: 0.983). A unidimensional model for intersectional discrimination also included 9 policy domains and showed good fit (RMSEA: 0.014; CFI: 0.996; TLI: 0.995). Top policy drivers of intersectional structural discrimination were domains related to the social safety net, criminal justice, and sexual and reproductive health. This measure of state-level structural discrimination advances our understanding of the intersecting effects of structural racism, sexism, and classism on health inequities by quantifying the combined effects of multiple policies and can be used to account for the policy context of each state.