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Cited by 314Racial and Ethnic Identity ResearchHealth disparities and outcomesGender, Health, and Social Inequality

Improving The Measurement Of Structural Racism To Achieve Antiracist Health Policy: Study examines measurement of structural racism to achieve antiracist health policy

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Hardeman, Rachel R., Homan, Patricia A., Chantarat, Tongtan, Davis, Brigette A., Brown, Tyson H.·2022·Health Affairs
DOI 10.1377/hlthaff.2021.01489PMC PMC9680533
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Abstract

Antiracist health policy research requires methodological innovation that creates equity-centered and antiracist solutions to health inequities by centering the complexities and insidiousness of structural racism. The development of effective health policy and health equity interventions requires sound empirical characterization of the nature of structural racism and its impact on public health. However, there is a disconnect between the conceptualization and measurement of structural racism in the public health literature. Given that structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy, how can anyone accurately measure its insidiousness? This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity. We identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.

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  • Structural racism erodes the health of Black individuals by exposing them to economic injustice, poor living conditions, and political exclusion, which pose health risks and limit access to resources.

    “According to ecosocial theory, structural racism erodes the health of Black individuals by exposing them to economic injustice, poor living conditions, and political exclusion [10], all of which pose health risks and limit their access to resources [11,12].”

    From Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents (2025) · cites this paper as [12]

    The Abstract (page unavailable) links structural racism to harms to Black health and describes discrimination across housing, employment, earnings, and other systems. The section on multifaceted measurement (page unavailable) describes restricted economic and sociopolitical resources, and the state-level section reports associations with worse health among Black people. The paper does not identify this account as ecosocial theory, and its reported health findings are associations rather than a demonstrated causal pathway through all three conditions named in the claim. (LLM, conf=0.79)

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  • State-level racism is associated with racial health inequities in the United States due to the power of states to govern their own social, political, and economic policies beyond those already constrained by federal authority.

    “In support of this proposition, statelevel has been evidenced as an important geospatial unit in prior research, because state-level racism is associated with racial health inequities in the United States due to the power of states to govern their own social, political, and economic policies beyond those already constrained by federal authority [12].”

    From Intersections of Structural State-Level Racism and Neighborhood Deprivation on Nutrition and Obesity for Black Adolescents (2025) · cites this paper as [12]

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Research works printed but not linked: 52

  1. [5]Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017; 389(10077): 1453– 63. 28402827
  2. [7]Dyer L, Hardeman R, Vilda D, Theall K, Wallace M. Mass incarceration and public health: the association between black jail incarceration and adverse birth outcomes among black women in Louisiana. BMC Pregnancy Childbirth. 2019; 19(1): 525. 31881857 PMC6935062
  3. [9]Boyd RW, Lindo EG, Weeks LD, McLemore MR. On racism: a new standard for publishing on racial health inequities. Health Affairs Blog [ blog on the Internet]. 2020 Jul 2 [ cited 2021 Dec 13]. Available from: https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/ · DOI
  4. [10]Groos M, Wallace M, Hardeman R, Theall KP. Measuring inequity: a systematic review of methods used to quantify structural racism. J Health Dispar Res Pract. 2018; 11(2): 13.
  5. [11]Williams DR, Sternthal M. Understanding racial-ethnic disparities in health: sociological contributions. J Health Soc Behav. 2010; 51(Suppl): S15– 27. 20943580 PMC3468327
  6. [12]DuBois WEB. The Philadelphia Negro: a social study. Philadelphia (PA): University of Pennsylvania Press; 2010. (Original work published in 1899).
  7. [13]Thomas SB. The color line: race matters in the elimination of health disparities. Am J Public Health. 2001; 91(7): 1046– 8. 11441728 PMC1446717
  8. [14]Krieger N. Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv. 1999; 29(2): 295– 352. 10379455
  9. [15]Krieger N, Boyd RW, De Maio F, Maybank A. Medicine’s privileged gatekeepers: producing harmful ignorance about racism and health. Health Affairs Blog [ blog on the Internet]. 2021 Apr 20 [ cited 2021 Dec13]. Available from: https://www.healthaffairs.org/do/10.1377/hblog20210415.305480/full/ · DOI
  10. [16]Feagin JR. Racist America: roots, current realities, and future reparations. Second edition. New York (NY): Routledge; 2010.
  11. [17]Bonilla-Silva E. Rethinking racism: toward a structural interpretation. Am Sociol Rev. 1997; 62(3): 465– 80.
  12. [18]Omi M, Winant H. Racial formation in the United States. New York (NY): Routledge; 2014.
  13. [19]Pager D, Shepherd H. The sociology of discrimination: racial discrimination in employment, housing, credit, and consumer markets. Annu Rev Sociol. 2008; 34: 181– 209. 20689680 PMC2915460
  14. [20]Seamster L, Ray V. Against teleology in the study of race: toward the abolition of the progress paradigm. Sociol Theory. 2018; 36(4): 315– 42.
  15. [21]Desmond M, Emirbayer M. What is racial domination? Du Bois Rev. 2009; 6(2): 335– 55.
  16. [22]Krieger N, Chen JT, Coull B, Waterman PD, Beckfield J. The unique impact of abolition of Jim Crow laws on reducing inequities in infant death rates and implications for choice of comparison groups in analyzing societal determinants of health. Am J Public Health. 2013; 103(12): 2234– 44. 24134378 PMC3828968
  17. [23]Alexander M. The new Jim Crow: mass incarceration in the age of colorblindness. New York (NY): New Press; 2012.
  18. [24]Feagin J, Bennefield Z. Systemic racism and U.S. health care. Soc Sci Med. 2014; 103: 7– 14. 24507906
  19. [25]Payne BK, Vuletich HA, Brown-Iannuzzi JL. Historical roots of implicit bias in slavery. Proc Natl Acad Sci U S A. 2019; 116(24): 11693– 8. 31138682 PMC6575576
  20. [26]Kramer MR, Black NC, Matthews SA, James SA. The legacy of slavery and contemporary declines in heart disease mortality in the U.S. South. SSM Popul Health. 2017; 3: 609– 17. 29226214 PMC5718368
  21. [27]Oliver M, Shapiro T. Black wealth/White wealth: a new perspective on racial inequality. Second edition. New York (NY): Routledge; 2006.
  22. [28]Faber JW. We built this: consequences of New Deal era intervention in America’s racial geography. Am Sociol Rev. 2020; 85(5): 739– 75.
  23. [29]Krieger N, Van Wye G, Huynh M, Waterman PD, Maduro G, Li W, Structural racism, historical redlining, and risk of preterm birth in New York City, 2013–2017. Am J Public Health. 2020; 110(7): 1046– 53. 32437270 PMC7287548
  24. [31]Goosby BJ, Heidbrink C. The transgenerational consequences of discrimination on African-American health outcomes. Sociol Compass. 2013; 7(8): 630– 43. 24855488 PMC4026365
  25. [32]Lewis TT, Cogburn CD, Williams DR. Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol. 2015; 11(1): 407– 40. 25581238 PMC5555118
  26. [33]Montez JK. Deregulation, devolution, and state preemption laws’ impact on US mortality trends. Am J Public Health. 2017; 107(11): 1749– 50. 29019768 PMC5637688
  27. [34]Farina MP, Zajacova A, Montez JK, Hayward MD. US state disparities in life expectancy, disability-free life expectancy, and disabled life expectancy among adults aged 25 to 89 years. Am J Public Health. 2021; 111(4): 708– 17. 33600246 PMC7958042
  28. [36]Anderson C. One person, no vote: how voter suppression is destroying our democracy. New York (NY): Bloomsbury Publishing; 2018.
  29. [39]Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Soc Sci Med. 2014; 103: 42– 50. 24507909 PMC4133127
  30. [40]Davis B, Arcaya M, Williams DR, Krieger N. The impact of county-level fees & fines as exploitative revenue generation on US birth outcomes 2011–2015. Health Place (under review). 36842240
  31. [42]Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001; 116(5): 404– 16. 12042604 PMC1497358
  32. [43]Sewell AA. The racism-race reification process: a mesolevel political economic framework for understanding racial health disparities. Sociol Race Ethn (Thousand Oaks). 2016; 2(4): 402– 32.
  33. [44]Riley AR. Neighborhood disadvantage, residential segregation, and beyond—lessons for studying structural racism and health. J Racial Ethn Health Disparities. 2018; 5(2): 357– 65. 28573643
  34. [45]Wong DWS. The modifiable areal unit problem (MAUP). In: Janelle DG, Warf B, Hansen K, editors. WorldMinds: geographical perspectives on 100 problems. New York (NY): Springer; 2004. p. 571– 5.
  35. [46]Mendez DD, Hogan VK, Culhane JF. Institutional racism, neighborhood factors, stress, and preterm birth. Ethn Health. 2014; 19(5): 479– 99. 24134165 PMC11219028
  36. [47]Zhou Y, Bemanian A, Beyer KMM. Housing discrimination, residential racial segregation, and colorectal cancer survival in Southeastern Wisconsin. Cancer Epidemiol Bio-markers Prev. 2017; 26(4): 561– 8. 28196847
  37. [48]Homan P, Brown TH, King B. Structural intersectionality as a new direction for health disparities research. J Health Soc Behav. 2021; 62(3): 350– 70. 34355603 PMC8628816
  38. [49]Chantarat T, Mentzer KM, Van Riper DC, Hardeman RR. Where are the labor markets?: Examining the association between structural racism in labor markets and infant birth weight. Health Place. Forthcoming 2022. PMC8923951 35091167
  39. [50]Chantarat T, Van Riper DC, Hardeman RR. The intricacy of structural racism measurement: a pilot development of a latent-class multidimensional measure. EClinicalMedicine. 2021; 40: 101092. 34746713 PMC8548924
  40. [51]Massey DS. The age of extremes: concentrated affluence and poverty in the twenty-first century. Demography. 1996; 33(4): 395– 412, discussion 413–6. 8939412
  41. [52]Adkins-Jackson PB, Chantarat T, Bailey ZD, Ponce NA. Measuring structural racism: a guide for epidemiologists and other health researchers. Am J Epidemiol. 2021; kwab239. [ Epub ahead of print]. PMC9077112 34564723
  42. [53]Sances MW, You HY. Who pays for government? Descriptive representation and exploitative revenue sources. J Polit. 2017; 79(3): 1090– 4.
  43. [54]Gee GC, Hicken MT. Structural racism: the rules and relations of inequity. Ethn Dis. 2021; 31(Suppl 1): 293– 300. 34045831 PMC8143846
  44. [56]Bollen K, Lennox R. Conventional wisdom on measurement: a structural equation perspective. Psychol Bull. 1991; 110(2): 305– 14.
  45. [57]Cené CW, Akers AY, Lloyd SW, Albritton T, Powell Hammond W, Corbie-Smith G. Understanding social capital and HIV risk in rural African American communities. J Gen Intern Med. 2011; 26(7): 737– 44. 21311999 PMC3138603
  46. [58]Lykes MB, Scheib H. Visual methodologies and participatory action research: performing women’s community-based health promotion in post-Katrina New Orleans. Glob Public Health. 2016; 11(5–6): 742– 61. 27080253
  47. [60]Wallerstein N, Duran B, Oetzel JG, Minkler M. Community-based participatory research for health: advancing social and health equity. Hoboken (NJ): John Wiley &Sons; 2017.
  48. [63]Chambers BD, Arega HA, Arabia SE, Taylor B, Barron RG, Gates B, Black women’s perspectives on structural racism across the reproductive lifespan: a conceptual framework for measurement development. Matern Child Health J. 2021; 25(3): 402– 13. 33398713
  49. [64]Chambers BD, Arabia SE, Arega HA, Altman MR, Berkowitz R, Feuer SK, Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health. 2020; 36(2): 213– 9. 31919987 PMC7269549
  50. [65]Hardeman RR, Karbeah J. Examining racism in health services research: a disciplinary self-critique. Health Serv Res. 2020; 55(Suppl 2): 777– 80. 32976632 PMC7518806
  51. [67]Samari G, Nagle A, Coleman-Minahan K. Measuring structural xenophobia: US state immigration policy climates over ten years. SSM Popul Health. 2021; 16: 100938. 34660879 PMC8503659
  52. [68]Griffiths K, Coleman C, Lee V, Madden R. How colonisation determines social justice and Indigenous health—a review of the literature. J Popul Res (Canberra). 2016; 33(1): 9– 30.

Cited by

Sorted by citations

Authors
Hardeman, R. R., Homan, P. A., Chantarat, T., Davis, B. A., & Brown, T. H.
Affiliations
  • University of Minnesota (US)
  • Florida State University (US)
  • University of California, San Francisco (US)
  • Duke University (US)
ORCID
Venue
Health Affairs
Publisher
Health Affairs Publishing, LLC
Published
2022-02-01
Volume
41
Issue
2
Pages
179-186
ISSN
  • 0278-2715 (ISSN-L)
  • 1544-5208
DOI
10.1377/hlthaff.2021.01489
PMC
PMC9680533
OpenAlex
W4210857417
Cited by
314
References
7
Citations by year
2026: 41 · 2025: 53 · 2024: 81 · 2023: 86 · 2022: 53
FWCI
98.21
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Health Affairs (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion, cc-by)
Funders
  • National Institute on Aging (P30AG034424)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD065563, T32HD098057, R24HD041023, P2CHD041023)
Topics
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
Keywords
structural racism, health equity, health disparities, white supremacy, systemic oppression, historical context, geographic context
MeSH terms
Health Equity, Systemic Racism, Mental Disorders, Health Policy, Humans, Racism

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