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This paper applies an intersectional lens to health in informal urban settlements in Freetown, Sierra Leone. We explored how intersecting social characteristics including gender, age, wealth, occupation, and tenant status influence health and well-being outcomes. We found that hazardous environmental conditions, poor waste disposal, and waste burning contribute to health problems at a neighbourhood level. Health-care access was also generally poor in informal settlements. However, beyond this, there were differences in people’s experiences of coping with health burdens and accessing care. Against a backdrop of limited state support, coping and access strategies were found to be heavily mediated by people’s social positions and status, especially their ability to draw on support from social networks. There are particular challenges around the management of prolonged health problems. For population groups such as the old and the chronically ill, this creates further vulnerabilities including social isolation, stigma, and cycles of poverty. Although intersecting power dynamics apply to men too, women are particularly disadvantaged by coalescing social inequalities: they are both expected to perform caring roles but are less likely to be cared for. Young and old women were especially vulnerable and reliant on external support or self-sacrifice. This paper contributes to knowledge gaps in intersectional dynamics in urban settings and provides evidence that suggests policy shifts are needed to address the multiple social and health inequalities faced by women in informal settlements in Freetown, Sierra Leone.

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