Nancy Krieger
Biographic Data
| ID | 217912 |
|---|---|
| NAME | Nancy Krieger |
| GIVEN NAMES | Nancy |
| FAMILY NAME | Krieger |
| SIGNATURE | KRIEGER N |
| AFFILIATIONS | Harvard University |
| ORCID | 0000-0002-4815-5947 |
| VERIFIED | Yes |
| TOTAL WORKS | 145 |
| TOTAL CITATIONS | 4077 |
| AUTHOR COUNT | 144 |
| EDITOR COUNT | 1 |
| FIRST PUBLICATION YEAR | 1986 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 32 |
Analyzing multiple types of discrimination using implicit and explicit measures, comparing target vs. Dominant groups, in a study of smoking/vaping among community health center members in Boston, Mas…
What would Len say
Buyer’s Remorse, Betrayal, and Blame
A latent measure of cultural racism and its association with US mortality and life expectancy
The US social context is characterized by systemic racism, a key driver of racial disparities. While structural and interpersonal racism are well-established components of systemic racism, cultural racism—a system of beliefs (ideology) and societal way of life (culture)—has been less robustly described and currently lacks a validated measure. We conducted confirmatory factor analysis on nine key indicators to define a cultural racism latent measu…
US Voting Rights Act Impact on Black and Black Versus White Infant Death Rates in Jim Crow States, 1959–1980 and 2017–2021
Objectives. To investigate the impact of the US Voting Rights Act (VRA) of 1965 on Black and Black versus White infant deaths in Jim Crow states. Methods. Using data from 1959 to 1980 and 2017 to 2021, we applied difference-in-differences methods to quantify differential pre–post VRA changes in infant deaths in VRA-exposed versus unexposed counties, controlling for population size and social, economic, and health system characteristics. VRA-expos…
Public Health Monitoring
Advancing gender transformative intersectional science for health justice
At a time when health-oriented institutions both globally and nationally are increasingly recognizing the need to support research, interventions and training that engage with analysis of how gendered social systems shape population health, independent of and in conjunction with sex-linked biology, it is essential that this work reject biological essentialism and instead embrace embodied integration. In this essay, guided by the ecosocial theory …
Using Implicit Measures of Discrimination
Recent studies showed that implicit measures are valuable instruments for assessing exposure to discrimination and predicting negative physical conditions. Between March 10, 2020, and April 1, 2020, we conducted three experiments (577 participants) in the USA to evaluate the use of group-specific vs. general race/ethnicity categories in implicit measures of discrimination. We measured implicit discrimination and attitudes towards the general race…
The impact of county-level fees & fines as exploitative revenue generation on US birth outcomes 2011–2015
Decreasing Survey Response Rates in the Time of Covid-19
Objectives. To examine whether, and if so how, US national and state survey response rates changed after the onset of the COVID-19 pandemic. Methods. We compared the change in response rates between 2020 and 2019 of 6 (3 social and economic, 3 health focused) major US national surveys (2 with state response rates). Results. All the ongoing surveys except 1 reported relative decreases (∼29%) in response rates. For example, the household response r…
The evolving roles of US political partisanship and social vulnerability in the Covid-19 pandemic from February 2020–February 2021
The COVID-19 pandemic has had intense, heterogeneous impacts on different communities and geographies in the United States. We explore county-level associations between COVID-19 attributed deaths and social, demographic, vulnerability, and political variables to develop a better understanding of the evolving roles these variables have played in relation to mortality. We focus on the role of political variables, as captured by support for either t…
Revealing the Unequal Burden of Covid-19 by Income, Race/Ethnicity, and Household Crowding
OBJECTIVE: To overcome the absence of national, state, and local public health data on the unequal economic and social burden of COVID-19 in the United States. DESIGN: We analyze US county COVID-19 deaths and confirmed COVID-19 cases and positive COVID-19 tests in Illinois and New York City zip codes by area percent poverty, percent crowding, percent population of color, and the Index of Concentration at the Extremes. SETTING: US counties and zip…
Comparing denominator sources for real-time disease incidence modeling
Across the United States public health community in 2020, in the midst of a pandemic and increased concern regarding racial/ethnic health disparities, there is widespread concern about our ability to accurately estimate small-area disease incidence rates due to the absence of a recent census to obtain reliable population denominators. 2010 decennial census data are likely outdated, and intercensal population estimates from the Census Bureau, whic…
Frequent police stops, parental incarceration and mental health
BACKGROUND: National monitoring of police-public contact does not extend below age 16 and few studies have examined associations with adolescent mental health. METHODS: We describe the distribution of police stops in a nationally representative cross-sectional sample of adolescents ages 12 to 18 years in the Panel Study of Income Dynamics Child Development Supplement 2002 and 2007 (n=2557). We used survey-weighted race/ethnicity-stratified and ge…
Impact of Differential Privacy and Census Tract Data Source (Decennial Census Versus American Community Survey) for Monitoring Health Inequities
Objectives. To investigate how census tract (CT) estimates of mortality rates and inequities are affected by (1) differential privacy (DP), whereby the public decennial census (DC) data are injected with statistical “noise” to protect individual privacy, and (2) uncertainty arising from the small number of different persons surveyed each year in a given CT for the American Community Survey (ACS). Methods. We compared estimates of the 2008–2012 av…
Counting for Accountability in a Time of Catastrophe
Structural Racism, Health Inequities, and the Two-Edged Sword of Data
Analyzing the myriad ways in which structural racism systemically generates health inequities requires engaging with the profound challenges of conceptualizing, operationalizing, and analyzing the very data deployed-i. e., racialized categories-to document racialized health inequities. This essay, written in the aftermath of the January 6, 2021 vigilante anti-democratic white supremacist assault on the US Capitol, calls attention to the two-edged…
The target/perpetrator brief-implicit association test (B-IAT)
Women’s Health, Politics, and Power: Essays on Sex/Gender, Medicine, and Public Health
Variation in racial/ethnic disparities in Covid-19 mortality by age in the United States
BACKGROUND: In the United States, non-Hispanic Black (NHB), Hispanic, and non-Hispanic American Indian/Alaska Native (NHAIAN) populations experience excess COVID-19 mortality, compared to the non-Hispanic White (NHW) population, but racial/ethnic differences in age at death are not known. The release of national COVID-19 death data by racial/ethnic group now permits analysis of age-specific mortality rates for these groups and the non-Hispanic As…
A Structural Model of Social Determinants of the Metabolic Syndrome
Neither race nor self-reported racial discrimination had direct effects on MetS level in our structural model. The large effects of socioeconomic position and male gender were not mediated by the other variables in the model
Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013–2017
Objectives. To assess if historical redlining, the US government’s 1930s racially discriminatory grading of neighborhoods’ mortgage credit-worthiness, implemented via the federally sponsored Home Owners’ Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth ( Methods. We analyzed 2013–2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time o…
Enough
Covid-19 and Overall Mortality Inequities in the Surge in Death Rates by Zip Code Characteristics
Objectives. To address evidence gaps in COVID-19 mortality inequities resulting from inadequate race/ethnicity data and no socioeconomic data. Methods. We analyzed age-standardized death rates in Massachusetts by weekly time intervals, comparing rates for January 1 to May 19, 2020, with the corresponding historical average for 2015 to 2019 stratified by zip code social metrics. Results. At the surge peak (week 16, April 15–21), mortality rate rat…
County-level jail incarceration and preterm birth among non-Hispanic Black and white U.S. women, 1999–2015
Experiences of discrimination
Racial and gender discrimination
Epidemiology and the web of causation
Discrimination and Health Inequities
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, s…
Methods for the Scientific Study of Discrimination and Health
The scientific study of how discrimination harms health requires theoretically grounded methods. At issue is how discrimination, as one form of societal injustice, becomes embodied inequality and is manifested as health inequities. As clarified by ecosocial theory, methods must address the lived realities of discrimination as an exploitative and oppressive societal phenomenon operating at multiple levels and involving myriad pathways across both …
Racial discrimination and blood pressure
OBJECTIVES: This study examined associations between blood pressure and self reported experiences of racial discrimination and responses to unfair treatment. METHODS: Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years ol…
Overcoming the absence of socioeconomic data in medical records
BACKGROUND. Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. METHODS. Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million),…
Embodiment
Embodiment. This construct and process are central to ecosocial theory and epidemiological inquiry. Recognising that we, as humans, are simultaneously social beings and biological organisms, the notion of “embodiment” advances three critical claims: (1) bodies tell stories about—and cannot be studied divorced from—the conditions of our existence; (2) bodies tell stories that often—but not always—match people’s stated accounts; and (3) bodies tell…
Self-Reported Experiences of Racial Discrimination and Black–White Differences in Preterm and Low-Birthweight Deliveries
Self-reported experiences of racial discrimination were associated with preterm and low-birthweight deliveries, and such experiences may contribute to Black-White disparities in perinatal outcomes
Racial Discrimination, Psychological Distress, and Self-Rated Health Among US-Born and Foreign-Born Black Americans
Our results attest to the salience of racial discrimination, nativity, and socioeconomic position in understanding the experiences and psychological health of Black Americans
Unfair Treatment, Racial/Ethnic Discrimination, Ethnic Identification, and Smoking Among Asian Americans in the National Latino and Asian American Study
Our findings suggest that experiences of unfair treatment and racial/ethnic discrimination are risk factors for smoking among Asian Americans. Efforts to promote ethnic identification may be effective in mitigating the influence of racial/ethnic discrimination on smoking in this population
Working Class Matters
Objectives. We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures. Methods. We analyzed data from the 2000 National Health Interview Survey. Results. Overall, the prevalence of current smoking was greatest among persons in—and independently associated with—working class jobs, low educational level, and low income. Attempts to quit showed no socioeconomic gradient, while success in quitting was grea…
Race/Ethnicity, Gender, and Monitoring Socioeconomic Gradients in Health
Use of multilevel frameworks and area-based socioeconomic measures (ABSMs) for public health monitoring can potentially overcome the absence of socioeconomic data in most US public health surveillance systems. To assess whether ABSMs can meaningfully be used for diverse race/ethnicity–gender groups, we geocoded and linked public health surveillance data from Massachusetts and Rhode Island to 1990 block group, tract, and zip code ABSMs. Outcomes c…
A glossary for social epidemiology
Why “social epidemiology”? Is not all epidemiology, after all, “social” epidemiology? In so far as people are simultaneously social and biological organisms, is any biological process ever expressed devoid of social context?—or any social process ever unmediated by the corporal reality of our profoundly generative and mortal bodies?1 2 Yet, despite the seeming truism that social as well as biological processes inherently shape population health—a…
Painting a Truer Picture of US Socioeconomic and Racial/Ethnic Health Inequalities
Objectives. We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States. Methods. We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island. Results. For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were…
Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning
Study objectives: To determine which area based socioeconomic measures can meaningfully be used, at which level of geography, to monitor socioeconomic inequalities in childhood health in the US. Design: Cross sectional analysis of birth certificate and childhood lead poisoning registry data, geocoded and linked to diverse area based socioeconomic measures that were generated at three geographical levels: census tract, block group, and ZIP code. S…
Measuring Everyday Racial/Ethnic Discrimination in Health Surveys
While it is clear that self-reported racial/ethnic discrimination is related to illness, there are challenges in measuring self-reported discrimination or unfair treatment. In the present study, we evaluate the psychometric properties of a self-reported instrument across racial/ethnic groups in a population-based sample, and we test and interpret findings from applying two different widely-used approaches to asking about discrimination and unfair…
The impact of a police drug crackdown on drug injectors' ability to practice harm reduction
Proximal, Distal, and the Politics of Causation
Causal thinking in public health, and especially in the growing literature on social determinants of health, routinely employs the terminology of proximal (or downstream) and distal (or upstream). I argue that the use of these terms is problematic and adversely affects public health research, practice, and causal accountability. At issue are distortions created by conflating measures of space, time, level, and causal strength. To make this case, …
Combining Explicit and Implicit Measures of Racial Discrimination in Health Research
Our results suggest that the scientific rigor of research on racism and health will be improved by investigating how both unconscious and conscious mental awareness of having experienced discrimination matter for somatic and mental health
Shades of Difference
The resonance between scientific theory and ideology is starkly revealed by the medical debate on slavery, alleged black inferiority, and racial differences in disease: opposing doctors invoked the same science, but relied on contrary assumptions, to reach antagonistic conclusions. Reductionist, biological determinist, and ahistorical premises underlay the dominant belief that innate racial differences led to black bondage and racial disparities …
Public Health Monitoring of Privilege and Deprivation With the Index of Concentration at the Extremes
Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. Results. Point estimates for rate ratios we…
Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013–2017
Objectives. To assess if historical redlining, the US government’s 1930s racially discriminatory grading of neighborhoods’ mortgage credit-worthiness, implemented via the federally sponsored Home Owners’ Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth ( Methods. We analyzed 2013–2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time o…
Alcohol disorders among Asian Americans
Social hazards such as unfair treatment and racial/ethnic discrimination should be considered in the development of programmes addressing alcohol disorders among Asian Americans. Interventions that promote ethnic identification in this population may be particularly relevant in mitigating the negative influence of racial/ethnic discrimination on alcohol disorders
Racial discrimination and skin color in the Cardia study
OBJECTIVES: This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research. METHODS: Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined. RESULTS: Skin…
Social class and black-white differences in breast cancer survival
In the United States, Blacks have poorer survival rates than Whites for breast cancer. The root of this difference--social or genetic--is unclear. Utilizing the Western Washington Cancer Surveillance System and 1980 Census block group data, we examined social class and race as predictors of breast cancer survival in 1,506 women during their first 11 years following diagnosis (251 Blacks, 1,255 Whites). In a Cox regression model, after adjustment …
The Health of Black Folk
Since the first crude tabulations of vital statistics in colonial America, one stark fact has stood out: black Americans are sicker and die younger than whites. As the epidemic infectious diseases of the nineteenth century were vanquished, the black burden of ill health shifted to the modern killers: heart disease, stroke, and cancer. Today black men under age 45 are ten times more likely to die from the effects of high blood pressure than white …
Shades of Difference
The resonance between scientific theory and ideology is starkly revealed by the medical debate on slavery, alleged black inferiority, and racial differences in disease: opposing doctors invoked the same science, but relied on contrary assumptions, to reach antagonistic conclusions. Reductionist, biological determinist, and ahistorical premises underlay the dominant belief that innate racial differences led to black bondage and racial disparities …
Aids, policy analysis, and the electorate
Current debates concerning appropriate policy to combat the epidemic of acquired immunodeficiency syndrome (AIDS) have raised critical questions regarding the role that schools of public health and individual public health professionals should play, if any, in AIDS-related policy analysis and social advocacy. In the summer of 1986, the School of Public Health at the University of California at Berkeley initiated a telegram sent by the Deans of al…
Racial and gender discrimination
Women and social class
STUDY OBJECTIVE--The aim was to compare four different measures of women's social class (interview and census based) as predictors of well known social gradients in reproductive outcomes. The intent was to address two obstacles that confront research in the United States regarding social gradients in women's health: how women's social class should be measured, and the absence of socioeconomic data in most health records. STUDY DESIGN--The study w…
Overcoming the absence of socioeconomic data in medical records
BACKGROUND. Most US medical records lack socioeconomic data, hindering studies of social gradients in health and ascertainment of whether study samples are representative of the general population. This study assessed the validity of a census-based approach in addressing these problems. METHODS. Socioeconomic data from 1980 census tracts and block groups were matched to the 1985 membership records of a large prepaid health plan (n = 1.9 million),…
Racism, Sexism, and Social Class
Understanding Aids
The popular and scientific understanding of acquired immunodeficiency syndrome (AIDS) in the United States has been shaped by successive historical constructions or paradigms of disease. In the first paradigm, AIDS was conceived of as a "gay plague," by analogy with the sudden, devastating epidemics of the past. In the second, AIDS was normalized as a chronic disease to be managed medically over the long term. By examining and extending critiques…
The politics of 'race' and health
Social Class
National vital statistics in the United States are unique among those of advanced capitalist countries in reporting data only by race, sex, and age—not by class and income. This article reviews the limited U.S. data resources that may be used to document social class inequalities in health. Summarizing the strengths and weaknesses of the British approach to gathering data on social class and health, the authors discuss possible approaches to coll…
Epidemiology and the web of causation
Socioeconomic differences in sexually transmitted disease rates among black and white adolescents, San Francisco, 1990 to 1992
This paper examines the effect of socioeconomic position on the differences in the 3-year rates (1990 to 1992) of reported cases of gonorrhea and chlamydia between Black and White adolescents, aged 12 to 20 years, residing in San Francisco. The crude relative risks for Blacks were 23.4 (95% confidence interval [CI] = 20.4, 27.8) for gonorrhea and 9.3 (95% CI = 8.3, 10.3) for chlamydia. Adjusting for poverty and occupational status, the relative r…
Racial discrimination and blood pressure
OBJECTIVES: This study examined associations between blood pressure and self reported experiences of racial discrimination and responses to unfair treatment. METHODS: Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years ol…
Reframing Women's Risk
Social inequalities lie at the heart of risk of HIV infection among women in the United States. As of December, 1995, 71,818 US women had developed AIDS-defining diagnoses. These women have been disproportionately poor, African-American, and Latina. Their neighborhoods have been burdened by poverty, racism, crack cocaine, heroin, and violence. To explain which women are at risk and why, this article reviews the epidemiology of HIV and AIDS among …
Measuring Social Class in US Public Health Research
Increasing social inequalities in health in the United States and elsewhere, coupled with growing inequalities in income and wealth, have refocused attention on social class as a key determinant of population health. Routine analysis using conceptually coherent and consistent measures of socioeconomic position in US public health research and surveillance, however, remains rare. This review discusses concepts and methodologies concerning, and gui…
Accounting for health of women
This article was originally published in ‘Current Issues in Public Health’ 1995, 1: 251-6. This version is reproduced with the permission of the publishers Rapid Science Publishers
Adult Female Twins' Recall of Childhood Social Class and Father's Education
To assess recall of childhood socioeconomic position for public health research, the authors conducted a cross-sectional study of 352 adult women twin pairs enrolled in Examination II of the Kaiser Permanente Women Twins Study carried out in 1989-1990 in Oakland, California. Among twin pairs, 91% (95% confidence interval (CI) 89-94%) agreed on their father's educational level and 81% (95% CI 77-85%) on their childhood social class. Recall did not…
HIV infection in women
Social inequalities lie at the heart of risk of HIV infection among women living in poor countries and among poor women living in wealthy countries. As of December 1996, UNAIDS estimated that 12.1 million women have developed AIDS-defining diagnoses. These women have been disproportionately poor, and in the US, African-American and Latina. Their neighborhoods and villages have been burdened by poverty, civil unrest, structural adjustment, racism,…
A vision of social justice as the foundation of public health
A vision of social justice as the foundation of public health: commemorating 150 years of the spirit of 1848. N Krieger, and A E BirnCopyRight https://doi.org/10.2105/AJPH.88.11.1603 Published Online: August 30, 2011
Racial discrimination and skin color in the Cardia study
OBJECTIVES: This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research. METHODS: Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined. RESULTS: Skin…
Embodying Inequality
Investigating effects of discrimination upon health requires clear concepts, methods, and measures. At issue are both economic consequences of discrimination and accumulated insults arising from everyday and at times violent experiences of being treated as a second-class citizen, at each and every economic level. Guidelines for epidemiologic investigations and other public health research on ways people embody racism, sexism, and other forms of s…
Comparing individual-based and household-based measures of social class to assess class inequalities in women's health
STUDY OBJECTIVE: To describe and compare magnitude of class inequalities in women's health detected with four occupation-based class measures: individual, conventional household (male dominant), gender neutral household, and combined household. DESIGN: Cross sectional study, using health data obtained by physical examination, laboratory analysis, and self report. SETTING: A large pre-paid health maintenance organisation in Oakland, CA (US). PARTI…
Sticky webs, hungry spiders, buzzing flies, and fractal metaphors
"Whiting out" white privilege will not advance the study of how racism harms health
"Whiting out" white privilege will not advance the study of how racism harms health. N Krieger, D Williams, and S Zierler Raj S. Bhopal, and Liam J. Donaldson CopyRight https://doi.org/10.2105/AJPH.89.5.782 Published Online: October 07, 2011
Medicine (120 works) · Sociology (86 works) · Demography (70 works) · Public health (67 works) · Population (66 works) · Environmental health (63 works) · Political science (57 works) · Health disparities and outcomes (56 works) · Gerontology (49 works) · Psychology (44 works)