The Science and Epidemiology of Racism and Health in the United States: an Ecosocial Perspective

by Nancy Krieger, M.S., Ph.D.

Abstract

Racism harms health. It also creates the very categories of “race.” Racial/ethnic health inequities are a biological expression of racism; their origins lie in injustice, not biology. This is not an ideological argument: it is a scientific statement that rests on rigorous tests of scientific hypotheses about how racial/ethnic inequities in health status and health care arise from unfair and unjust societal conditions. As delineated by ecosocial theory, at issue are the myriad ways racial inequality becomes biologically embodied, over the lifecourse and across generations, thereby creating racial/ethnic health inequities. Relevant pathways include adverse exposure to: economic and social deprivation; toxic substances, pathogens, and hazardous conditions; social trauma; targeted marketing of harmful commodities; and inadequate and degrading medical care. In this presentation I will discuss conceptual and methodological issues involved in analyzing how racial and economic injustice produce health inequities, coupled with empirical examples drawn from research I have done, as a social epidemiologist, on these issues.