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Reprint - The
Epidemiology Monitor - March 2008
Nancy Krieger
Gives UNC Keynote Lecture On Racism And Health
Nancy Krieger,
Harvard University social epidemiologist, gave the 10th annual William
Small Keynote Address in late February at the University of North
Carolina's annual minority health conference. The first part of her
talk, entitled "The Science and Epidemiology of Racism and Health in
the United States: An Eco-social Perspective ", was devoted to
debunking the often heard concept that race is genetic or that race is
about gene frequency differences. According to Krieger, what matters
is gene expression and not gene frequency, and as she called
race/ethnicity "a historically contingent social category with
biological consequences." In other words, race/ethnicity is a social
and not a biological construct, and the fact that disparities in
health exist says more about society than it does about biology,
according to Krieger.
However, she argued
for the usefulness of race/ethnicity as a social category because it
can provide evidence of discrimination that can then be used to argue
for counter measures. "No data" could be interpreted to mean "no
problem", according to Krieger, and that would be misleading.
Premature mortality
She used part of her
time to present information from a recent paper published in PLoS
Medicine on "The Fall and Rise of US Inequities in Premature
Mortality: 1960-2002". The main purpose of this work was to examine
what happens to the gap in income and health disparities between
populations when the overall population health improves as it did in
the 42 year period indicated in the title of the paper. The work was
prompted in part by speculations that health disparities are
inevitable because efforts to improve the health of the less well-off
would also be taken advantage of by those better-off and therefore
disparities would remain.
Krieger found that
actually the gap narrowed during the period 1966-80 and later widened
after 1980. If the entire US population had done as well as those most
well-off during this 42 year period, an estimated 14% of the deaths
among whites and 30% among persons of color would have been prevented.
These figures equate to 4.9 million lives cut short, according to
Krieger. The major point from the work is not the uniqueness of the
findings but the implication that inequities in health are not
immutable. As Krieger told the audience, "death is inevitable.
Premature mortality is not. If we make reducing disparities a
priority, progress is possible".
[Editor’s Note:
Following
her presentation, Krieger fielded several questions from the
listeners, many of whom were interested in knowing how to can see
convince others about the validity of these findings and how to
translate them into public health action. To read the article
including the questions and answers,
click here.
Dr Krieger’s
perspective on this talk more than a decade after it was written and
her views today about the current focus on racism in the US and around
the world continues
here.]
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