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P R A I S E F O R E C O S O C I A L T H E O RY,
EMBODIED TRUTHS, AND
T H E P E O P L E ’ S H E A LT H
“This book provides a clear, accessible entry into one of the author’s
main contributions to public health literature—the ecosocial
theory of disease distribution—with helpful examples for the ap-
plication and importance of this theory for a general audience.
Many communities of color will resonate with her explanation of
the interdependence of societal and environmental situations on
unequal and disparate health outcomes.”
—RANDALL AKEE,
Department of Public Policy and American Indian Studies,
University of California, Los Angeles
Nancy Krieger
PROFESSOR OF SOCIAL EPIDEMIOLOGY
AND AMERICAN CANCER SOCIET Y
CLINICAL RESEARCH PROFESSOR
AT T H E H A R VA R D T. H . C H A N S C H O O L
O F P U B L I C H E A LT H
1
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2021
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: Krieger, Nancy, author.
Title: Ecosocial theory, embodied truths, and the people’s health / by Nancy Krieger.
Other titles: Small books with big ideas ; 4.
Description: New York, NY : Oxford University Press, [2021] | Series: Small
books, big ideas in population health ; 4 | Includes bibliographical references and index.
Identifiers: LCCN 2021024150 (print) | LCCN 2021024151 (ebook) |
ISBN 9780197510728 (hardback) | ISBN 9780197510742 (epub) |
ISBN 9780197510759 (ebook)
Subjects: MESH: Health Status Disparities | Socioeconomic Factors | Social Justice |
Health Equity | Social Medicine | Epidemiologic Methods
Classification: LCC RA563.M 56 (print) | LCC RA563.M 56 (ebook) |
NLM WA 300.1 | DDC 362.1089—dc23
LC record available at https://lccn.loc.gov/2021024150
LC ebook record available at https://lccn.loc.gov/2021024151
DOI: 10.1093/oso/9780197510728.001.0001
This material is not intended to be, and should not be considered, a substitute for medical or other
professional advice. Treatment for the conditions described in this material is highly dependent on the
individual circumstances. And, while this material is designed to offer accurate information with re-
spect to the subject matter covered and to be current as of the time it was written, research and knowl-
edge about medical and health issues is constantly evolving and dose schedules for medications are
being revised continually, with new side effects recognized and accounted for regularly. Readers must
therefore always check the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers and the most recent
codes of conduct and safety regulation. The publisher and the authors make no representations or
warranties to readers, express or implied, as to the accuracy or completeness of this material. Without
limiting the foregoing, the publisher and the authors make no representations or warranties as to the
accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do
not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed
or incurred as a consequence of the use and/or application of any of the contents of this material.
9 8 7 6 5 4 3 2 1
Printed by Integrated Books International, United States of America
I dedicate this book to my parents, Dr. Dorothy T. Krieger (1927–
1985) and Dr. Howard P. Krieger (1918–1992), who taught me to
value knowledge for the good we can do with it in the world, and to
Mrs. Montez Davis (1913–1997), who helped raise me and further
opened my eyes to injustice and to living a loving life.
EPIGRAPHS
. . . true stories are worth telling, and worth getting right, and
we have to behave honestly towards them and to the process of
doing science in the first place. It’s only through honesty and
courage that science can work at all. . . . The more we discover,
the more wondrous the universe seems to be, and if we are
here to observe it and wonder at it, then we are very much part
of what it is. . . . The story continues, and the rest is up to us.
P h i li p P u llm an (2017) 2
Preface xi
Acknowledgments xvii
Notes 177
Index 327
ix
P R E FAC E
for good and for ill, especially when deployed and contested in
systems of governance, economics, and politics that set the terms
by which people and this planet can either thrive or be treated as
entities to be exploited for the private gains of a few. Using con-
crete examples to illustrate critical concepts, the goal of this book
is to use the ecosocial theory of disease distribution to promote clear
thinking about the distinct but connected realities of embodying
(in)justice and embodied truths. The intent is to inform critical and
practical research, actions, and alliances to advance health equity
in a deeply troubled world on a threatened planet.
Throughout, the focus on embodying (in)justice and health
equity is central—albeit with no claims that health is the sole or
most important consideration, since there are so many facets and
features of social justice that warrant deep analysis and concerned
and concerted action. To me, however, concerns about health are
compelling, complex, and multifaceted. So too is the critical work
of critical science, done by real people in real societies, in ways that
can contribute publicly testable and tested ideas and evidence.
I offer this brief book to share insights I have gained through my
35+ years of professional work as a social epidemiologist and as
an advocate and activist linking issues of social justice and public
health. The intent is to provide an invitation and opportunity to
reflect on ideas that can lead to deeper, more rigorous, and action-
able analysis, not a comprehensive review of the literature.
This book is one of several volumes for a series I initiated with
Oxford University Press, on Small Books, Big Ideas in Population
Health.2 I conceived of this series because in my view the practice
and science of the intermingled fields of public health and popu-
lation health sciences could benefit from strengthening the critical
P reface xiii
The Nut-tree.
Corylus, Sativa, fructu anguloso. C. B. 418.
L. 1. Ch. 1.
XIV. Cl. 3. S. A. 14.
T H E S P O T T E D R E D and W H I T E U N D E R W I N G M O T H .
I found and fed the Caterpillar on Black Thorn: It made a Spinning,
and changed to Chrysalis in the Middle of April, and the Moth came
abroad about the Middle of May. The Caterpillar lives all Winter, and
the Moth is rarely to be met with.
See Rosel, Cl. 2. Tab. 43.
L. 1. Ch. 1.
XV. Cl. 3. S. A. 15.
L. 1. Ch. 1.
XVI. Cl. 3. S. A. 16.
The Cherry-Plumb.
Prunus, fructu majori, rotundo, rubro. Tourn.
L. 1. Ch. 1.
XVII. Cl. 3. S. A. 17.
The May-cherry.
Cerasus, majalis, fructu duro subdulci. Tourn.
L. 1. Ch. 1.
XVIII. Cl. 3. S. A. 18.
L. 1. Ch. 1.
XIX. Cl. 3. S. A. 19.
S e c t . 2 A.
L. 1. Ch. 1.
I. Cl. 3. S. 2 A. 1.
S e c t . 3 A.
l. i. ch. i. Cl. 3. S. 3. A. 1.
S e c t . b.
L. 1. Ch. 1.
I. Cl. 3. S. b. 1.
L. 1. Ch. 1.
II. Cl. 3. S. b. 2.
l. i. ch. i. Cl. 3. S. b. 2.
Figure 1. The Yellow Vetchling. 2. Bistort. 3. The
White Darnel Grass. 4. The Wood-Pease.
1. Lathyrus sylvestris, dumetorum, flore luteo. C. B. 2. Bistorta
major. I. B. 3. Gramen loliaceum spica longiori. C. B. 4. Astragalus
sylvaticus. Ger. Emac.
L. 1. Ch. 1.
III. Cl. 3. S. b. 3.
The Alder-Tree.
Alnus, rotundifolia, glutinosa, viridis. C. B.
L. 1. Ch. 1.
IV. Cl. 3. S. b. 4.
l. i. ch. i. Cl. 3. S. b. 4.
L. 1. Ch. 1.
V. Cl. 3. S. b. 5.
L. 1. Ch. 1.
I. Cl. 3. S. c. 1.
L. 1. Ch. 1.
II. Cl. 3. S. c. 2.
L. I. Ch. I. Cl. 3. S. c. 2.
L. 1. Ch. 1.
IV. Cl. 3. S. c. 4.
T H E O R A N G E T U S S O C K - M O T H . The Food of its Caterpillar
is Hasle, St. John’s Wort, Oak, &c. About the Middle of May it made
a Spinning, and changed to a Chrysalis, and the Moth came forth
three Weeks after. It is very scarce, and the Female has no Wings. I
took one of these Caterpillars, feeding on Oak Leaves, on the 25th of
September 1748; two Days after, it spun up in order to its Chrysalis
State, and, on the 8th of October, the Moth was bred: From whence
I conclude, this Moth breeds twice in a Year.
See Rosel, Cl. 2. Tab. 40. Albin, P. 90.
l. i. ch. i. Cl. 3. S. c. 4.
The elegant upright St. John’s Wort.
Hypericum pulchrum Tragi. I. B. III. 383.
L. 1. Ch. 1.
V. Cl. 3. S. c. 5.