Grand Rounds- Dr. Nancy Krieger, PhDShow details
Inheritance & Health: What Really Matters for Health Equity? – Considering History, Jim Crow, and Racialized Economic Segregation
Nancy Krieger, PhD
Professor of Social Epidemiology
Harvard T.H. Chan School of Public Health
What type of inheritance truly matters for the people’s health? This question gains new urgency as genomics and precision medicine take center stage in US biomedicine, taxes for corporations and the wealthy are slashed, regulations and programs to protect the environment and public health are undermined, and racism and coddling of white supremacy are evident at the highest levels of the US government. Guidance is perhaps surprisingly offered by the work of Wilhelm Johannsen, who in 1909 coined the terms “gene,” “genotype,” and “phenotype.” He was worried that biologists’ uncritical use of the term “inheritance” would become conflated with what he termed its “every day” meaning, i.e., “the `transmission’ of money or things, rights or duties – or even ideas and knowledge – from one person to another or to some others: the `heirs’ or `inheritors.’” Johannsen was right to worry. For public health, the decidedly non-biological type of inheritance is key – and is getting short shrift. As history shows, societal regulation and restriction of massive concentrations of private inheritance, along with promotion of public inheritance and support for shared and inclusive knowledge, is what best enables societies to improve population health and promote health equity. To underscore this point, empirical examples will be provided regarding: (1) the health impacts of spatial social and economic polarization on health, as quantified using the Index of Concentration at the Extremes, and (2) the beneficial impact of the abolition of Jim Crow, its embodied legacy in contemporary health inequities, and new initiatives tackling structural racism to promote equity, including health equity.
Nancy Krieger is Professor of Social Epidemiology and American Cancer Society Clinical Research Professor at the Harvard T.H. Chan School of Public Health (HSPH) and Director of the HSPH Interdisciplinary Concentration on Women, Gender, and Health. She is an internationally recognized social epidemiologist (PhD, Epidemiology, UC Berkeley, 1989), with a background in biochemistry, philosophy of science, and history of public health, plus 30+ years of activism involving social justice, science, and health. She is an ISI highly cited scientist (since 2004; reaffirmed: 2015), a group comprising “less than one-half of one percent of all publishing researchers.” Dr. Krieger’s work addresses: (1) conceptual frameworks to understand, analyze, and improve the people’s health, including the ecosocial theory of disease distribution she first proposed in 1994, concerned with embodiment and equity; (2) etiologic research on societal determinants of population health and health inequities; and (3) methodologic research on improving monitoring of health inequities.