LDI Research Seminar featuring: Nancy Krieger, PhD

Nancy Krieger, PhD
Associate Professor of Public Health in the Department of Society, Human Development, and Health at the Harvard School of Public Health; Associate Director of the Harvard Center for Society and Health, Harvard University

The Public Health Disparities Geocoding Project: Monitoring US Social Inequalities in Health

April 29, 2005
12:00 - 1:30 PM
Colonial Penn Center Auditorium

Abstract

Biosketch:
Nancy Krieger is Associate Professor of Public Health in the Department of Society, Human Development, and Health at the Harvard School of Public Health and Associate Director of the Harvard Center for Society and Health. She received her PhD in Epidemiology from the University of California at Berkeley in 1989. Dr. Krieger is a social epidemiologist, with a background in biochemistry, philosophy of science, and the history of public health, combined with 20 years of experience as an activist in issues involving social justice, science, and health. Her work focuses on three aspects of social inequalities in health: (a) etiologic studies, (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 social determinants of health. Examples of her empirical work include studies of: appropriate measures of social class (individual, household, and neighborhood), especially for population-based monitoring of social inequalities in health and also for studying women, gender, and health; socioeconomic and racial/ethnic disparities in breast cancer; and associations between elevated blood pressure and discrimination based on race/ethnicity, gender, and sexual orientation. Other work concerns history and politics of epidemiology and public health, including study and critique of theories that epidemiologists and others use to explain population patterns of health, disease, and well-being. She is editor of "Embodying Inequality: Epidemiologic Perspectives" (Baywood Press, 2004) and co-editor, with Glen Margo, of "AIDS: The Politics of Survival" (Baywood Publishers, 1994), and, with Elizabeth Fee, of "Women's Health, Politics, and Power: Essays on Sex/Gender, Medicine, and Public Health" (Baywood Publishers, 1994). In 1994 she co-founded, and still chairs, the Spirit of 1848 Caucus of the American Public Health Association.

Abstract:
Background: Despite longstanding evidence on intimate links between neighborhood poverty and neighborhood health, most US public health surveillance system lack socioeconomic data, thus precluding routine monitoring of socioeconomic disparities in health and their contribution to US urban health inequities.

Methods: To address this problem, The Public Health Disparities Geocoding Project geocoded and linked public health surveillance data from Massachusetts and Rhode Island to 1990 census-derived area-based socioeconomic measures (ABSMs) to determine which ABSMs, at which geographic level (census block group, census tract, ZIP Code) could validly be used to monitor socioeconomic inequalities in health. Outcomes comprised: birth, childhood lead poisoning, sexually transmitted infections, tuberculosis, non-fatal weapons-related injuries, cancer incidence, and mortality.

Results: In both the total population and diverse racial/ethnic-gender groups, measures of economic deprivation proved most sensitive to expected socioeconomic gradients in health, with census tract (CT) ABSMs yielding the most consistent results and maximal geocoding across outcomes, and the CT poverty measure performing as well as more complex composite measures.

Implications: Geocoding and use of the CT poverty measure permits routine monitoring and mapping of US socioeconomic inequalities in health, using a common and accessible metric.