Professor of Social Epidemiology
Director, Interdisciplinary Concentration on Women, Gender and Health, at the Harvard School of Public Health
Chair, Spirit of 1848 Caucus, American Public Health Association
Ph.D., 1989, University of California, Berkeley
M.S., 1985, University of Washington
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 April 2011, Dr. Krieger’s book, Epidemiology and the People’s Health: Theory and Context, was published by Oxford University Press. This book presents the argument for why epidemiologic theory matters. Tracing the history and contours of diverse epidemiologic theories of disease distribution from ancient societies on through the development of — and debates within — contemporary epidemiology worldwide, it considers their implications for improving population health and promoting health equity.
In her current empirical epidemiologic research, she is investigating:
Racial discrimination and risk of chronic disease
This study, based in several community health centers in Boston, is investigating different approaches to measuring exposure to racial discrimination (both explicit and implicit) and examining the association of these exposures with the occurrence of well-known behavioral, anthropometric and physiological risk factors for chronic disease, including cardiovascular disease, diabetes, and cancer.
Jim Crow & Health Disparities: Exploring Age-Period-Cohort Effects
This study is using long-term US mortality data to explore how best, conceptually and methodologically, to integrate use of age-period-cohort (APC) analysis to advance understanding of determinants of trends in the magnitude of health inequities. The focus is on Jim Crow: the impact of both its existence and abolition on mortality in the US, overall and in relation to race/ethnicity and socioeconomic position.
Exploring Trends in US Health Inequities in Context: NHES to NHANES, 1959-2006
This study seeks to examine the changing magnitude of US health inequities, in relation to socioeconomic position and race/ethnicity, using data on measured health characteristics obtained in the US National Health Examination Surveys and the National Health and Nutrition Examination Surveys, spanning from 1959-2006.
Recently completed studies include:
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 )
Measuring racial discrimination for health research
This is the validation study for 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 free access to the instrument and information on how it can be used, see register for access to EOD instrument
In 2010 we published new preliminary studies indicating the value of using both explicit measures of self-reported experiences of racial discrimination (such as the EOD) along with measures of exposure obtained using the methodology of the Implicit Association Test (IAT).
Physical and Social Hazards: Jobs, Race, Gender, and Health
This union-based study, led by Dr. Elizabeth Barbeau (PI), has examined 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.
Cancer and Changing Trends in US Mortality Inequities: 1960-2004
Building on her recent work which showed that in the period from the mid-1960s to 1980, inequities in premature mortality and infant death shrank in the US, but then increased or stagnated thereafter — a finding that empirically refutes the widespread view that as population health improves, it is inevitable that health inequities will rise (because the better off always benefit most from progress) — this study examined temporal trends in the magnitude of health inequities for cause-specific mortality for outcomes ranging from specific types of cancer to deaths preventable by medical intervention.
Breast cancer incidence after the Women’s Health Initiative Study
This study documented that, as hypothesized, incidence rates did not decline equally among all women, but instead declined only among white women who lived in affluent counties and who had estrogen receptor positive (ER+) tumors, meaning that the decline occurred chiefly among the women most likely to have used hormone therapy and who had the types of tumors most liked to exposure to hormone therapy.
Socioeconomic trends in breast cancer incidence
This study assessed whether the socioeconomic gradient in breast cancer is changing, using US cancer registry data from the past 30 years. Key findings are that the socioeconomic gradient has remained unchanged among US white and black women, but has increased among Hispanic and Asian and Pacific Island women, i.e., groups with a higher proportion of immigrants arriving from countries that exhibit the stronger class gradients evident among regions with lower breast cancer incidence rates.
Racial/ethnic disparities in breast cancer estrogen receptor status
This study assessed 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 demonstrated these problems lead to inflation of the estimates of racial/ethnic and socioeconomic disparities in ER status.
Selected recent original investigations (since 2005)
Long-term trends in health inequities
Krieger N, Chen JT, Waterman PD, Kosheleva A, Beckfield S. History, haldanes, & health inequities: exploring phenotypic changes in body size by generation and income level among the US-born white and black non-Hispanic populations, 1959-1962 to 2005-2008. Int J Epidemiol 2012 (Dec 4: epub ahead of print)
Krieger N, Chen JT, Kosheleva A, Waterman PD. Shrinking, widening, reversing, and stagnating trends in US socioeconomic inequities in cancer mortality: 1960-2006. Cancer Causes Control 2012; 23:297-319.
Krieger N, Chen JT, Kosheleva A, Waterman PD. Not just smoking and high-tech medicine: socioeconomic inequities in US mortality rates, overall and by race/ethnicity, 1960-2006. Int J Health Services 2012; 42:293-322.
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 2008; 5(2):e46. doi:10.1371/journal/pmed.0050046
Racial discrimination & health
Krieger N, Waterman PD, Kosheleva A, Chen JT, Carney DR, Smith KW, Bennett GG, Williams DR, Freeman E, Russell B, Thornhill G, Mikolowsky K, Rifkin R, Samuel L. Exposing racial discrimination: implicit & explicit measures—the My Body, My Story study of 1005 US-born black & white community health center members. PLoS ONE 2011; 6(11):e27636.doi:10.1371/journal.pone.0027636
Krieger N, Kosheleva A, Waterman PD, Chen JT, Koenen K. Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born black Americans. Am J Public Health 2011; 101:1704-1713.
Krieger N, Carney D, Lancaster K, Waterman PD, Kosheleva A, Banaji J. Combining implicit and explicit measures of racial discrimination in health research. Am J Public Health 2010; 100:1485-1492.
Krieger N, Kaddour A, Koenen K, Kosheleva A, Chen JT, Waterman PD, Barbeau EM. Occupational, social, and relationship hazards and psychological distress among low-income workers: implications of the “inverse hazard law.” J Epidemiol Community Health 2011; 65:260-272.
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.
Breast cancer epidemiology: health inequities in societal & historical context
Krieger N, Chen JT, Waterman PD. Temporal trends in the black/white breast cancer case ratio for estrogen receptor status: disparities are historically contingent, not innate Cancer Causes Control 2011; 22:511-514.
Krieger N, Chen JT, Waterman PD. Decline in US breast cancer rates after the Women’s Health Initiative: socioeconomic and racial/ethnic differentials. Am J Public Health 2010; 200:1485-1492.
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
Selected recent essays and review articles (since 2000)
Krieger N. Who and what is a “population”? Historical debates, current controversies, and implications for understanding “population health” and rectifying health inequities. Milbank Q 2012; 90:634-681.
Krieger N. History, biology, and health inequities: emergent embodied phenotypes & the illustrative case of the breast cancer estrogen receptor. Am J Public Health 2013; 103:22-27.
Krieger N. Methods for the scientific study of discrimination and health: from societal injustice to embodied inequality – an ecosocial approach. Am J Public Health 2012; 102:936-945.
Krieger N, Alegria M, Almeida-Filho N, Barbosa da Silva J Jr, Barreto ML, Beckfeld J, Berkman L, Birn A-E, Duncan BB, Franco S, Garcia DA, Gruskin S, James SA, Laurell AC, Schmidt MI, Walters KL. Who, and what, causes health inequities? — reflections on emerging debates from an exploratory Latin American/North American workshop. J Epidemiol Community Health 2010; 64:747-749. doi: 10.1136/jech.2009.1060906
Krieger N. Social inequalities in health. In: Olsen J, Saracci R, Trichopolous D (eds). Teaching Epidemiology: A Guide for Teachers in Epidemiology, Public Health, and Clinical Medicine. 3rd ed. Oxford: Oxford University Press, 2010; 215-239.
Beckfield J, Krieger N. Epi + demos + cracy: linking political systems and priorities to the magnitude of health inequties. Epidemiol Rev 2009; 31:152-177.
Krieger N. Ladders, pyramids, and champagne: the iconography of health inequities. J Epidemiol Community Health 2008; 62:1098-1104.
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 2008; 37:627-637.
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. Discrimination and health. In: Berkman L, Kawachi I (eds). Social Epidemiology. Oxford: Oxford University Press, 2000; 36-75.
Krieger N. Epidemiology and The People’s Health: Theory and Context. New York: Oxford University Press, 2011.
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.
Publications 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 articles of note (prior to 2005):
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.
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.