In this paper, Krieger explains how discrimination based on racial/ethnic origins affects health of the racial/ethnic minorities. She uses a bio-cultural approach to understand the interactions between social aspects (social structure, economic and social derivation, individual’s life-long experience of racism, and individuals’ cognitive aspects) and biological aspects of race (physical traits and exposures to toxins, hazards, and pathogens). This approach incorporates the temporal (life-cycles starting in utero to the end of life) and spatial (from individual to global level) aspects that affect minority health. While incorporating the wide variety of aspects of minority individuals and societies into her theoretical framework, she focuses on the causal relationship between discrimination and health, so she sees health inequality is manifestation of social inequality.
But we really need to look at these tables from her paper to understand the social context.
There are more African Americans living at poverty level, unemployed, and without health insurance compared to European Americans. Infant mortality rate is much higher among African Americans, and more African American self-report having poor health status. Minority groups are underrepresented in the congress and state legislature.
However, so many white Americans and Tea Party and Republicans agree that “Today discrimination against Whites has become as big a problem as discrimination against Blacks and other minorities.”
The core concept in her approach is embodiment of social inequality. I believe the concept of embodiment came from habitus, idea developed by Pierre Bourdieu, a French social theorist who also talked about social capital. Embodiment is one of the core aspects of habitus, and I believe it means that people’s e experience, material word, and social structure are incorporated deep into one’s cognition. Krieger develops this concept further to reflect biological aspects related to health inequality. Because of discrimination, racial minorities are more likely to be exposed toxins, hazards, and pathogens and surfer from economic and social deprivation and inadequate medical care, so racial minorities are more likely to have worse health condition.
I believe embodiment is the concept that we should explore in our research and could be very useful to analyze social determinants of health. For example, we can use this idea to analyze the relationship between fast food culture and health. In the U.S. fast food restaurants are fun place for kids and provide quick and inexpensive food for teenagers and adults. It is culturally acceptable to go to fast food restaurant regularly, if you do not have time and money. The food tastes good for kids and fills adults’ stomach for a long time. Over time, we develop the taste for fast food, and going to fast food restaurant became an integrated part of people’s life and cognition. People who grow up with fast food restaurants now have children and take them there regularly. It is not surprising if these children prefer French fries over vegetables. Because of targeted marketing and economic condition, low-income individuals, and many of them are racial/ethnic minorities, are more likely to be exposed to these high fat high calories diet.
While she focuses on racial discrimination as one of the causes of health inequality, her ecosocial approach seems to be a holistic framework for analysis of social determinants of health. Human and our societies are very complex, we need a framework as holistic as possible to capture multidimensional aspects of human societies (social determinants of health, racism, etc.) and human biology (health).
Because her focus in this paper was explaining the causal relationship between discrimination and health, she did not explain how this framework can be used to reduce health inequality. If we can identify the social issue related to racism and health that we hope to fix, how can we use this approach to develop a strategies for intervention?