Dr. Nancy Krieger's work focuses on social inequalities in health. She is a social epidemiologist, with a background in biochemistry, philosophy of science, history of public health, and involvement as an activist in issues involving social justice, science, and health. Her work involves: (a) etiologic studies of health inequities, (b) methods for improving monitoring of social inequalities in health, and (c) development of theoretical frameworks, including ecosocial theory, to guide work on understanding and addressing societal determinants of health.

In her current epidemiologic research, she is investigating:

Area-Based Socioeconomic Measures for Health Data

This epidemiologic investigation has demonstrated the utility of using US census tract poverty data for monitoring socioeconomic inequalities in health. It did so by evaluating which area-based measures of socioeconomic position, at which level of geography (census tract, census block group, or ZIP Code), are appropriate for US public health surveillance systems and health research. The goal is to improve capacity for monitoring socioeconomic inequalities in health in the United States. Health data for this project were obtained from public health surveilance systems in 2 states (Massachusetts and Rhode Island), and pertain to: mortality (all-cause and cause-specific), cancer incidence (all sites and site-specific), low birthweight, childhood lead poisoning, sexually transmitted infections, tuberculosis, and non-fatal weapons-related injury. Visit our Public Health Disparities Geocoding Project Monograph website (listed below) for a discussion of our project, plus free access to our publications and a sample data set (Geocoding Project )

Physical and Social Hazards: Jobs, Race, Gender, and Health

This union-based study, led by Dr. Elizabeth Barbeau (PI), will examine how workplace hazards, both physical (e.g., noise, ergonomics) and social (e.g., discrimination, sexual harassment), affect workers' health at work and at home. The study uses the newly validated "Experiences of Discrimination" (EOD) instrument developed by Krieger to measure self-reported experiences of racial discrimination.

Measuring racial discrimination for health research

This just-completed study, funded separately as a sub-study to the above grant on "Physical and Social Hazards," was designed to validate the "Experiences of Discrimination" (EOD) instrument designed to measure self-reported experiences of racial discrimination. The validation study was conducted in both English and Spanish among a random sample of African American and Latino/a low-wage workers showed the instrument has good psychometric properties. For access to the instrument and information on how it can be used, see register for access to EOD instrument

Socioeconomic trends in breast cancer incidence

This study is assessing whether the socioeconomic gradient in breast cancer is changing, using US cancer registry data from the past 30 years. Data to test the hypothesis that the incidence of breast cancer is increasing more quickly among less affluent and more working class women (and men), thereby leading to a reduction in the class gradient, will be obtained from 2 cancer registries in California and from the Massachusetts State Cancer Registry, which will be geocoded and analyzed using area-based socioeconomic measures derived from the US census (1970-2000).

Racial/ethnic disparities in breast cancer estrogen receptor status

This study is assessing whether conventional estimates of racial/ethnic disparities in breast cancer estrogen receptor (ER) status for breast tumors are biased by missing data on ER status, a lack of socioeconomic data, and inappropriate modeling assumptions. It employs data from from 2 cancer registries in California, geocoded and analyzed using area-based socioeconomic measures derived from the 2000 US census. 

Newly funded studies, just underway, pertain to racial discrimination and risk of chronic disease, and also to changes in socioeconomic gradients in breast cancer following release of the Women's Health Initiative results regarding hormone therapy.

Dr. Krieger's is also engaged in study and critique of theories that epidemiologists and others use to explain population patterns of health, disease, and well-being.

Ph.D., 1989, University of California, Berkeley
M.S., 1985, University of Washington

Recent original investigations (since 2000)

From the Public Health Disparities Geocoding Project (these studies may be obtained from our website, listed below)

Krieger N, Waterman PD, Chen JT, Rehkopf DH, Subramanian SV. Geocoding and monitoring US socioeconomic inequalities in health: an introduction to using area-based socioeconomic measures -- The Public Health Disparities Geocoding Project monograph. Boston, MA: Harvard School of Public Health. Available at: http://www.hsph.harvard.edu/thegeocodingproject/

Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health 2005; 95:312-323.

Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures--The Public Health Disparities Geocoding Project. Am J Public Health 2003; 93:1655-1671.

Krieger N, Chen JT, Waterman PD, Soobader M-J, Subramanian SV, Carson R. Choosing area-based socioeconomic measures to monitor social inequalities in low birthweight and childhood lead poisoning-The Public Health Disparities Geocoding Project (US). J Epidemiol Community Health 2003; 57:186-199.

Krieger N, Waterman PD, Chen JT, Soobader M-J, Subramanian SV. Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures--The Public Health Disparities Geocoding Project (US). Public Health Reports 2003; 118;240-260.

Krieger N, Chen JT, Waterman PD, Soobader M-J, Subramanian SV, Carson R. Geocoding and monitoring US socioeconomic inequalities in mortality and cancer incidence: does choice of area-based measure and geographic level matter?-the Public Health Disparities Geocoding Project. Am J Epidemiol 2002; 156:471-482.

Krieger N, Waterman P, Chen JT, Soobader M-J, Subramanian SV, Carson R. ZIP Code caveat: bias due to spatiotemporal mismatches between ZIP Codes and US census-defined areas -the Public Health Disparities Geocoding Project. Am J Public Health 2002; 92:1100-1102.

Krieger N, Waterman P, Lemieux K, Zierler S, Hogan JW. On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research. Am J Public Health 2001; 91:1114-1116.

Subramanian SV, Chen JT, Rehkopf DH, Waterman PD, Krieger N. Neighborhood disparities in context: multilevel analysis of census tract variations in black excess mortality and poverty. Am J Public Health 2005 95: 260-265.

Krieger N. A century of census tracts: health and the body politic (1906-2006). J Urban Health 2006; 83:355-361.

Subramanian S V, Chen JT, Rehkopf DR, Waterman PD, Krieger N. Comparing individual and area-based socioeconomic measures for the surveillance of health disparities: a multilevel analysis of Massachusetts births, 1988-92. Am J Epidemiol 2006; 164:823-834.

Rehkopf DH, Haughton L, Chen JT, Waterman PD, Subramanian SV, Krieger N. Monitoring socioeconomic disparities in death: comparing individual-level education and area-based socioeconomic measures. Am J Public Health 2006; 96:2135-2138.

Chen JT, Rehkopf DH, Waterman PD, Subramanian SV, Coull BA, Cohen B, Ostrem M, Krieger N. Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999-2001. J Urban Health 2006; 83:1063-1085; doi: 10.1007/s11524-006-9089-7.

Additional selected original investigations

Krieger N, Rehkopf DH, Chen JT, Waterman PD, Marcelli E, Kennedy M. The fall and rise of inequities in US premature mortality: 1960-2002. PLoS Med (in press).

Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM. Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med 2005; 61:1576-1596.

Krieger N, Waterman PD, Hartman C, Bates LM, Stoddard AM, Quinn MM, Sorensen G, Barbeau EM. Social hazards on the job: workplace abuse, sexual harassment, and racial discrimination -- a study of black, Latino, and white low-income women and men workers (US). Int J Health Services 2006; 36:51-85.

Krieger N, Chen JT, Waterman PD, Rehkopf DH, Yin R, Coull BA. Race/ethnicity and changing US socioeconomic gradients in breast cancer incidence: California and Massachusetts, 1978-2002. Cancer Causes Control 2006; 17:217-226.

Krieger N, Chen JT, Coull BA, Selby JV. Lifetime socioeconomic position and twins’ health: an analysis of 308 pairs of United States women twins. PLoS Med 2005; 2(7): e162. DOI:10.1371/journal.pmed.0020162

Mustillo S, Krieger N, Gunderson EP, Sidney S, McCreath H, Kiefe CI. Self-reported experiences of racial discrimination and black-white differences in preterm and low-birthweight deliveries: The CARDIA Study. Am J Public Health 2004; 94:2125-2131.

Barbeau, E, Krieger N, Soobader M-J. Working class matters: Socioeconomic disadvantage, race/ethnicity, gender and smoking in the National Health Interview Survey, 2000. Am J Public Health 2004; 94:269-278.

Krieger N, Strong EF, Makoksy C, Weuve J. Breast cancer, birth cohorts & Epstein-Barr virus: methodological issues in exploring the "hygiene hypothesis" in relation to breast cancer, Hodgkin's disease, and stomach cancer. Cancer Epidemiol Biomarkers Prevention 2003; 12:405-411.

Krieger N. Breast cancer: a disease of affluence, poverty, or both?-the case of African American women. Am J Public Health 2002; 92:611-613.

Wise LA, Krieger N, Zierler S, Harlow BL. Lifetime socioeconomic position in relation to onset of perimenopause: a prospective cohort study. J Epidemiol Community Health 2002; 56:851-860.

Krieger N, Chen JT, Selby JV. Class inequalities in women's health: combined impact of childhood and adult social class-a study of 630 US women. Public Health 2001; 115: 175-185.

Kuzbansky LD, Krieger N, Kawachi I, Rockhill B, Steel GK, Berkman LF. United States: Social inequality and the burden of poor health. In: Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M (eds). Challenging Inequities in Health: From Ethics to Action. Oxford, UK: Oxford University Press, 2001; 104-121

Krieger N, Williams DR. Changing to the 2000 Standard Million: are declining racial/ethnic and socioeconomic inequalities in health real progress or statistical illusion? Am J Public Health 2001; 91:1209-1213.

Selected recent essays and review articles

Krieger N. Proximal, distal, and the politics of causation: what’s level got to do with it? Am J Public Health 2008; 98:221-230.

Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol 2001; 30:668-677.

Krieger N. A glossary for social epidemiology. J Epidemiol Community Health 2001; 55:693-700.

Krieger N. Embodiment: a conceptual glossary for epidemiology. J Epidemiol Community Health 2005;59:350-355.

Krieger N. Epidemiology and social sciences: towards a critical reengagement in the 21st century. Epidemiologic Reviews 2000; 11:155-163.

Krieger N, Davey Smith G. Bodies count & body counts: social epidemiology & embodying inequality. Epidemiol Review 2004; 26:92-103.

Krieger N. Why epidemiologists cannot afford to ignore poverty. Epidemiology 2007; 18:658-663.

Krieger N. Ways of asking and ways of living: reflections on the 50th anniversary of  Morris’ ever-useful Uses of Epidemiology. Int J Epidemiol 2007; 36:1173-1180.

Krieger N. Researching critical questions on social justice and public health: an ecosocial perspective. In: Levy BS, Sidel VW (eds). Social Injustice and Public Health. New York: Oxford University Press 2006; 460-479.

Krieger N. Stormy weather: “race,” gene expression, and the science of health disparities. Am J Public Health 2005; 95:2155-2160.

Krieger N. Does racism harm health? did child abuse exist before 1962?-on explicit questions, critical science, and current controversies: an ecosocial perspective. Am J Public Health 2003; 93:194-199.

Krieger N. Genders, sexes, and health: what are the connections--and why does it matter? Int J Epidemiol 2003; 32:652-657.

Krieger N. Hormone therapy and the rise and perhaps fall of US breast cancer incidence rates: critical reflections. Int J Epidemiol (in press).

Krieger N, Löwy I, and the “Women, Hormones, and Cancer” group (Aronowitz R, Bigby J, Dickersin K, Garner E, Gaudillière J-P, Hinestrosa C, Hubbard R, Johnson PA,  Missmer SA, Norsigian J, Pearson C, Rosenberg CE, Rosenberg L, Rosenkrantz BG, Seaman B, Sonnenschein C, Soto AM, Thorton J, Weisz G). Hormone replacement therapy, cancer, controversies & women’s health: historical, epidemiological, biological, clinical and advocacy perspectives. J Epidemiol Community Health 2005; 59:740-748.

Krieger N. Defining and investigating social disparities in cancer: critical issues. Cancer Causes Control 2005; 16:5-14.

Krieger N, Gruskin S. Frameworks matter: ecosocial and health & human rights perspectives on women and health-the case of tuberculosis. J Am Women's Med Assoc 2001; 56:137-142.

Krieger N, Northridge M, Gruskin S, Quinn M, Kriebel D, Davey Smith G, Bassett MT, Rehkopf DH, Miller C and the HIA “promise and pitfalls” conference group. Assessing health impact assessment: multidisciplinary & international perspectives. J Epidemiol Community Health 2003; 57:659-662.

Krieger N. Refiguring "race": epidemiology, racialized biology, and biological expressions of race relations. Int J Health Services 2000; 30:211-216.

Krieger N. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. Oxford: Oxford University Press, 2000; 36-75.

Braveman P, Krieger N, Lynch J. Health inequalities and social inequalities in health. Bull World Health Org 2000; 78:232-234.

Krieger N. Counting accountably: public health implications of new approaches to classifying race/ethnicity in the United States 2000 census-US and global perspectives. Am J Public Health 2000; 90:1687-1689.

Krieger N. Commentary: society, biology, and the logic of social epidemiology. Int J Epidemiol 2001; 30:44-46.

Krieger N. Latin American Social Medicine: the quest for social justice & public health. Am J Public Health 2003; 93:1989-1991.

Krieger N. Place, space, and health: GIS and epidemiology. Epidemiology 2003; 15:384-385.

Additional articles of note (prior to 2000):

Epidemiologic theories of disease distribution and critical analyses of public health

Krieger N. Epidemiology and the web of causation: has anyone seen the spider? Soc Sci Med, 1994, 39:887-903.

Krieger N. Questioning epidemiology: objectivity, advocacy, and socially responsible science. Am J Public Health, 1999; 89:1151-1153.

Krieger N. Embodying inequality: a review of concepts, measures and methods for studying health consequences of discrimination. Int J Health Services, 1999; 29:295-352.

Krieger N, Birn AE. A vision of social justice as the foundation of public health: commemorating 150 years of the Spirit of 1848. Am J Public Health 1998; 88:1603-1606.

Krieger N, Williams D, and Moss N. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annual Review Public Health, 1997, 18: 341:378.

Krieger N, Fee E. Measuring social inequalities in health in the United States: an historical review, 190-1950. Int J Health Services, 1996, 26:391-418.

Epidemiologic investigations of social inequalities in health

Krieger N and Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health, 1996, 86: 1370-1378.

Krieger N, Sidney S, and Coakley E. Racial discrimination and skin color in CARDIA: implications for public health research. Am J Public Health, 1998; 88:1308-1313.

Krieger N, Sidney S. Prevalence and health implications of anti-gay discrimination: a study of black and white women and men in the CARDIA cohort. Int J Health Services, 1997, 27:157-176.

Krieger N, Chen JT, and Selby JV. Comparing individual-based and household-based measures of social class to assess class inequalities in women's health: a methodologic study of 684 US women. J Epidemiol Community Health, 1999, 53:612-623.

Krieger N, Okamoto A, and Selby JV. Adult female twins' recall of childhood social class and father's education: A validation study for public health research. Am J Epidemiol, 1998, 147:704-708.

Krieger N, Chen JT, Ebel G. Can we monitor socioeconomic inequalities in health? A survey of U.S. Health Departments¹ data collection and reporting practices. Public Health Reports 1997; 112:481-491.

Krieger N, Wolff MS, Hiatt RA, Rivera M, Vogelman J, and Orentreich N. Breast cancer and serum organochlorines: A prospective study among white, black, and Asian women. J Natl Cancer Inst, 1994, 86:589-599.

Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 1992; 82:703-710.

Books

Krieger N, ed. Embodying Inequality: Epidemiologic Perspectives. Amityville, NY: Baywood Publications, Inc., 2004.

Krieger N and Margo G, eds. AIDS: The Politics of Survival. Amityville, NY: Baywood Publications, Inc., 1994.

Fee E, and Krieger N, eds. Women's Health, Politics, and Power: Essays on Sex/Gender, Medicine, and Public Health. Amityville, NY: Baywood Publications, Inc., 1994.

Public Health Disparities Geocoding Project - Making visible the invisible: A new tool for US health departments to monitor – and boost efforts to address – socioeconomic inequalities in health

The Working Group of the Interdisciplinary Concentration on Women, Gender and Health - The Working Group on Women, Gender, and Health was organized by Harvard School of Public Health faculty members, post-doctoral fellows and students who are interested in advancing the study of women, gender, and health at the School. The common goal of the Working Group members is to improve the health of women and girls, and population health overall, though curriculum development, scientific research, and community outreach.

Experiences of Discrimination (EOD) - an instrument designed to measure self-reported experiences of racial discrimination

Spirit of 1848 - A caucus affiliated with the American Public Health Association, co-founded by Krieger in 1994, that links issues of social justice and public health.