Minority Health and Health Equity Archive
Permanent URI for this collectionhttp://hdl.handle.net/1903/21769
Welcome to the Minority Health and Health Equity Archive (MHHEA), an electronic archive for digital resource materials in the fields of minority health and health disparities research and policy. It is offered as a no-charge resource to the public, academic scholars and health science researchers interested in the elimination of racial and ethnic health disparities.
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Item The Fall and Rise of US Inequities in Premature Mortality: 1960–2002(2008) Krieger, Nancy; Rehkopf, David H.; Chen, Jarvis T.; Waterman, Pamela D.; Marcelli, Enrico; Kennedy, MalindaAbstract available at publisher's website.Item Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective.(2003) Krieger, NancyResearch on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the "battered child syndrome" dramatically increased attention to-and prompted new research on-the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.Item Epi + demos + cracy: linking political systems and priorities to the magnitude of health inequities--evidence, gaps, and a research agenda.(2009) Beckfield, Jason; Krieger, NancyA new focus within both social epidemiology and political sociology investigates how political systems and priorities shape health inequities. To advance-and better integrate-research on political determinants of health inequities, the authors conducted a systematic search of the ISI Web of Knowledge and PubMed databases and identified 45 studies, commencing in 1992, that explicitly and empirically tested, in relation to an a priori political hypothesis, for either 1) changes in the magnitude of health inequities or 2) significant cross-national differences in the magnitude of health inequities. Overall, 84% of the studies focused on the global North, and all clustered around 4 political factors: 1) the transition to a capitalist economy; 2) neoliberal restructuring; 3) welfare states; and 4) political incorporation of subordinated racial/ethnic, indigenous, and gender groups. The evidence suggested that the first 2 factors probably increase health inequities, the third is inconsistently related, and the fourth helps reduce them. In this review, the authors critically summarize these studies' findings, consider methodological limitations, and propose a research agenda-with careful attention to spatiotemporal scale, level, time frame (e.g., life course, historical generation), choice of health outcomes, inclusion of polities, and specification of political mechanisms-to address the enormous gaps in knowledge that were identified.Item The ostrich, the albatross, and public health: an ecosocial perspective--or why an explicit focus on health consequences of discrimination and deprivation is vital for good science and public health practice.(2001) Krieger, NancyConcern for social inequalities in health in the United States is increasingly becoming part of the mainstream public health and health research agenda. Responding to organized efforts within and outside the health sector, the Department of Health and Human Services (DHHS) is supporting programs dedicated to eliminating social disparities in health, and within DHHS, the National Institutes of Health (NIH) are supporting research into health disparities. The NIH Office of Research on Women’s Health (founded in 1990) and the new National Center on Minority Health and Health Disparities (including socioeconomic disparities) are, for example, focusing attention on multiple health outcomes in relation to specified social determinants, rather than parsing out ailments solely by body parts. At issue are ways in which population patterns of health, disease, and well-being, from conception to death, reflect societal conditions, including social inequality, across the lifecourse.Item Changing to the 2000 Standard Million: Are Declining Racial/Ethnic and Socioeconomic Inequalities in Health Real Progress or Statistical Illusion?(2001) Krieger, Nancy; Williams, David R.Objectives. This study determined the effects of changing from the 1940 to the 2000 standard million on monitoring socioeconomic and racial/ethnic inequalities in health. Methods. Using the 1940, 1970, and 2000 standard million, we calculated and compared ageadjusted rates for selected health outcomes stratified by socioeconomic level. Results. Changing from the 1940 to the 2000 standard million markedly reduced the age-adjusted relative risks for self-reported fair or poor health status of poor Americans compared with high-income Americans. Conclusions. Public health researchers and practitioners should give serious consideration to the implications of the change to the 2000 standard million for monitoring social inequalities in health.Item Mapping a Course for Community Action and Research to Eliminate Disparities Embodying Racial Inequality: Race, Class, Gender and Health Assessing the Impact of Discrimination, an Ecosocial Perspective(2001) Krieger, NancyMP3 audio files recorded by the Pennsylvania and Ohio Public Health Training Center at the First Annual Minority Health Leadership SummitItem Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health(2005) Krieger, Nancy; Smith, Kevin; Naishadham, Deepa; Hartman, Cathy; Barbeau, Elizabeth M.Population health research on racial discrimination is hampered bya paucity of psychometrically validated instruments that can be feasiblyused in large-scale studies. We therefore sought to investigate the validityand reliability of a short self-report instrument, the ‘‘Experiences of Discrimination’’ (EOD) measure, based on a prior instrument used in the CoronaryArtery Risk Development in Young Adults (CARDIA) study. Studypar ticipants were drawn from a cohort of working class adults, age 25–64, based in the Greater Boston area, Massachusetts (USA). The main studya nalytic sample included 159 black, 249 Latino, and 208 white participants; the validation studyin cluded 98 African American and 110 Latino participants who completed a re-test survey two to four weeks after the initial survey. The main and validation survey instruments included the EOD and several single-item discrimination questions; the validation surveyal so included theWilliamsMajor and Everyday discrimination measures. Key findings indicated the EOD can be validlyand reliablyemploy ed. Scale reliabilitywas high, as demonstrated by confirmatory factor analysis, Cronbach’s alpha (0.74 or greater), and test–re-test reliabilitycoefficients (0.70). Structural equation modeling demonstrated the EOD had the highest correlation (r ¼ 0:79) with an underlying discrimination construct compared to other self-report discrimination measures employed. It was significantly associated with psychological distress and tended to be associated with cigarette smoking among blacks and Latinos, and it was not associated with social desirabilityin either group. By contrast, single-item measures were notablyless reliable and had low correlations with the multi-item measures. These results underscore the need for using validated, multi-item measures of experiences of racial discrimination and suggest the EOD maybe one such measure that can be validlyemploy ed with working class African Americans and Latino Americans.Item Historical Roots of Social Epidemiology:Socioeconomic gradients in health and contextual analysis(2001) Krieger, Nancyhttp://aje.oxfordjournals.org/cgi/reprint/154/4/299Item “Bodies Count,” and Body Counts: Social Epidemiology and Embodying Inequality(2004) Krieger, Nancy; Smith, GeorgeINTRODUCTION Bodies count. In epidemiology, this statement would appear to be a core proposition, for it is by counting people—in varying states of health, disease, and disability, the alive and the dead—that we derive our estimates of population rates and risks of morbidity and mortality. But bodies count for more than this, for, in their manifest form—in height, weight, physique, and overall appearance (including posture and disfigurement)—they provide vivid evidence of how we literally embody the world in which we live, thereby producing population patterns of health, disease, disability, and death (1–5). Readily identifiable to the naked eye, these aspects of our being not only are predictive of future health outcomes but also tell of our conjoined social and biologic origins and trajectories.Item Theories for social epidemiology in the 21st century: An ecosocial perspective(2001) Krieger, NancyIn social epidemiology, to speak of theory is simultaneously to speak of society and biology. It is, I will argue, to speak of embodiment. At issue is how we literally incorporate, biologically, the world around us, a world in which we simultaneously are but one biological species among many—and one whose labour and ideas literally have transformed the face of this earth. To conceptualize and elucidate the myriad social and biological processes resulting in embodiment and its manifestation in populations' epidemiological profiles, we need theory. This is because theory helps us structure our ideas, so as to explain causal connections between specified phenomena within and across specified domains by using interrelated sets of ideas whose plausibility can be tested by human action and thought.1–3 Grappling with notions of causation, in turn, raises not only complex philosophical issues but also, in the case of social epidemiology, issues of accountability and agency: simply invoking abstract notions of ‘society’ and disembodied ‘genes’ will not suffice. Instead, the central question becomes: who and what is responsible for population patterns of health, disease, and well-being, as manifested in present, past and changing social inequalities in health?