4. Using an intersectional risk environment approach to understand health and drug outcomes: Looking across social locations

There are more than two decades of research highlighting the relationship between individuals and environmental influences on the production or mitigation of health- and drug-related risks. Of this work, multi-dimensional conceptualizations of health, such as the ‘risk environment’ framework, have been prominent within substance use research. Such framings draw attention to how social, structural, and physical environments shape population distribution of health. While conceptual models like the risk environment framework have advanced understandings of health and drug outcomes for people who use drugs (PWUD), they have seldom been mobilized to more fully account for the ways environmental factors interact with each other to produce differential risks and harms across populations who use drugs.

Building on the risk environment framework and complementary social-ecological approaches, we articulate the ‘intersectional risk environment’ to understand the interconnected ways that social location is simultaneously shaped by and structures the risk environment to produce or mitigate drug-related harms and discuss implications for public health interventions.

The intersectional risk environment framework draws attention to the distinct ways that social and structural forces intersect to produce unique health outcomes and experiences within and between groups. This is particularly important for looking at the intersections of multiple social locations (e.g., gender, ability, race) to understand the heterogeneous needs of PWUD.

In doing so, the intersectional risk environment framework provides a social justice-oriented approach that can inform drug and health policies, as well as public health interventions, to better meet the diverse needs of PWUD.