Header image with headshot of Nancy Krieger. Title reads "Talking With Nancy Krieger: Deconstructing Data for Health Equity."

The de Beaumont Foundation’s Speaker Series highlights leaders in public health practice, advocacy, policymaking, and other related fields.

In her more than 30 years of activism, blending social justice, science, and health, Nancy Krieger, PhD, of the Harvard T.H. Chan School of Public Health, has challenged public health to go deeper into data. The professor of social epidemiology and director of the school’s interdisciplinary concentration on women, gender, and health brings to her work the essential historical and socio-ecological context behind the numbers.

Krieger’s recent Speaker Series presentation to de Beaumont Foundation staff touched on relationships between structural racism and health inequities, relationships between political ideology and health outcomes, and ecosocial theory,[i] with a focus on unpacking the complexities of data and its uses.

“My premise is that another world is possible in which health justice exists, and aspects of knowing whether or not we are there requires data,” she said. However, Krieger explained that “invoking the notion of data requires reckoning with what data are and who wields the two-edged sword of data.”

In this metaphor, one edge represents how societies that have been impacted by structural racism often lack data on racialized groups,[ii] which erroneously suggests that no problems exist. In other words, “no data, no problem.” Krieger used the example of paltry data from early in the pandemic that failed to reflect COVID’s outsized impact on Black and brown communities.

The other edge represents the use of problematic data in harmful ways that further entrenches injustice against racialized groups due to how data are collected, analyzed, and used. Or as Krieger succinctly puts it: “problematic data, big problem.” On both sides of the sword, “these edges cut deep in relation to any and all forms of injustice,” Krieger said.

This metaphor has another real-world application in the Modernized Anti-Racist Data Ecosystems (MADE) for Health Justice initiative from the de Beaumont Foundation and Robert Wood Johnson Foundation. Recognizing the consequences of incomplete and decontextualized data, MADE for Health Justice was created to support communities across the U.S. in developing health-focused local data ecosystems that are centered on principles of anti-racism, equity, justice, and community power.

“To guide policy and action for health equity, it’s vital to identify the structural drivers past as well as present and these methods and metrics that show structural injustice and relationships between privilege and harm,” Krieger said. “When it comes to health justice, the point of the two-edged sword of data is to produce actionable data for health equity and accountability.”

She further spoke to the responsibility in collecting, analyzing, and implementing data, and acknowledging the power structures inherent in research. The fourth core construct in Krieger’s ecosocial theory, agency and accountability, is critical to fully understanding data and its purposes. “At issue is who benefits from injustice and from research which ignores injustice, versus who was harmed by injustice and by the overt suppression, lack of funding, and self-censorship that can limit research,” she said.

Krieger explained how historical context is necessary to identify biases in research. “It matters who was doing the science and with what intent,” Krieger said, pointing to scientific research that has advanced policies and political agendas that are in opposition to public health, including profiting from environmental destruction. Having such context can also help to address injustices against historically marginalized groups.

Two studies — Krieger’s research on the association between historical redlining and risk of preterm birth in New York City and research connecting historical redlining and contemporary pedestrian deaths by de Beaumont Foundation Chief of Staff Jamila M. Porter and colleagues — reveal the present-day repercussions of a racist, federally sponsored policy introduced in the 1930s. Communities that were “redlined” were colored red on maps of hundreds of U.S. cities. These communities, populated by Black people and other people of color, were systematically denied public and private loans and investments. Both studies light on the continued devastation of racist policies adopted nearly a century ago on public health outcomes today.

Krieger left de Beaumont staff with a call to action for engaging in more responsible, ethical research in public health: “Let us do this work informed by history and a vision premised on social justice, along with deep recognition of our interconnection…on a wondrous and threatened planet.”

[i] In Methods for the Scientific Study of Discrimination and Health: An Ecosocial Approach, Krieger explains that the ecosocial theory of disease distribution “concerns who and what drive social inequalities in health.” According to Krieger, “A central focus is on how we literally biologically embody exposures arising from our societal and ecological context, thereby producing population rates and distributions of health.”

[ii] A racialized group is one that has had the concept of “race” — and the related inequities and injustices of racism — forced on them as an identity for the purposes of subjugating, controlling, and excluding them.

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