Carl J. Martinson lecture: The Elephants in the Room: Social Justice, Public Health, and Health Inequities
Nancy Krieger, PhD, Eleventh Annual Martinson Lecture, September 28, 2007. Division of Epidemiology and Community Health, University of Minnesota School of Public Health.
Abstract:
Rigorous scientific research on understanding and reducing health disparities is essential, as is federal support for this work. The problems of unjust suffering that we confront are huge, both within the United States and globally. To rectify these wrongs, we need a clear understanding of their causes. The research we need to do necessarily draws on insights from many disciplines and must be concerned with multiple levels of determinants and outcomes and their embodiment across the lifecourse, in different historical generations and different geographic locales. While the specifics of how we approach these issues may vary by research topic, we nevertheless all confront the same three fundamental questions. These are: what are health disparities?; what are their causes?; and who is responsible for health inequities? In my presentation, I will contend that while there may be many partial correct answers to these questions, not all answers are equal and some are out right wrong. To make this case, I will first offer a brief historical reminder that we are not the first to debate these issues. Second, I will argue for why we need an analytic, rather than descriptive, definition of health disparities. Third, I will present several case examples, including some of our new work on current and changing inequities in US premature mortality, to clarify why the science of health disparities is about correct science, not “politically correct� science. And throughout, I will draw attention to some salient elephants, including several in the room whom we need to name if our work is to make a dent in eliminating health inequities.

