Dear AJPM Reader,
Almost 30 years ago, Dr. Nancy Krieger, now a Harvard professor, and colleagues published in AJPM a careful and detailed exploration of the intersectional impacts of racism, sexism, and social class on studies of health, disease, and well-being. As part of our From the Archive feature, we are pleased to reprint this article, which was remarkably prescient given its enduring contemporary relevance, in our June issue. Accompanying the reprint are invited commentaries by Dr. Krieger and Dr. Ana Diez Roux, dean of Drexel’s Dornsife School of Public Health, who reflect on the origins of the article and its impact on the development of social epidemiology.
In her commentary, Dr. Krieger traces the history of her 1993 article, which emerged from a CDC symposium on preterm delivery among Black women organized by African American women researchers led by Krieger's coauthor Dr. Diane Rowley. Dr. Krieger notes that at the time, they were pushing the envelope by even mentioning racism, along with sexism and social class, as a key factor in determining health outcomes. In contrast, the CDC declared racism to be a public health crisis in 2021—evidence of progress that has been made in recognizing the harms of structural racism and other social injustices in the context of public health.
Dr. Diez Roux, in her commentary, describes her excitement upon reading Dr. Krieger's article in 1993 as a PhD student exploring, and advocating for the importance of, connections between neighborhood disadvantage and health. She explores the article's key themes, including the influence of historical contexts on studies on race, sex, and social class; the need for clear conceptual frameworks and definitions; the necessity of examining racism, sexism, and social class as intersecting processes; and the importance of using research to develop comprehensive explanations of pervasive gaps in health outcomes.
In wrapping up her commentary, Dr. Diez Roux declares that the message in Dr. Krieger's 1993 article remains as compelling now as it was when first published. Indeed, as Dr. Krieger notes, advances in understanding and addressing the connections between structural inequities in race, sex, and social class have sparked backlash at both official and grassroots levels. In concluding her commentary, Dr. Krieger writes that in 2018, the Black–White disparity in infant mortality was as bad as or worse than in 1993, just one example of the work still to be done in the journey toward health justice.
We hope you find this feature, as well as the rest of our June 2022 articles, to be timely, topical, and informative.
Yours in prevention and health,