Looking Back to Leap Forward: A Framework for Operationalizing the Structural Racism Construct in Minority Health Research

Abstract

Racism is now widely recognized as a fundamental cause of health inequalities in the United States. As such, health scholars have rightly turned their attention toward examining the role of structural racism in fostering morbidity and mortality. However, to date, much of the empirical structural racism-health disparities literature limits the operationalization of structural racism to a single domain or orients the construct around a White/Black racial frame. This operationalization approach is incomprehensive and overlooks the heterogeneity of historical and lived experiences among other racial and ethnic groups. To address this gap, we present a theoretically grounded framework that illuminates core mutually reinforcing domains of structural racism that have stratified opportunities for health in the United States. We catalog instances of structural discrimination that were particularly constraining (or advantageous) to the health of racial and ethnic groups from the late 1400s to present. We then illustrate the utility of this framework by applying it to American Indians or Alaska Natives and discuss the framework's broader implications for empirical health research. This framework should help future scholars across disciplines as they identify and interrogate important laws, policies, and norms that have differentially constrained opportunities for health among racial and ethnic groups.

Keywords: Health; Operationalization; Racial/Ethnic; Structural Discrimination; Structural Racism.

Figure 1.. Framework for operationalizing structural racism for health research in the United States

a. Enactment or enforcement of racist policy, laws, events, or norms regarding: C, Civil / Political Rights; L, Land / Housing / Neighborhoods; E, Education; W, Jobs / Benefits / Wealth; J, Justice System; H, Health; M, Migration and Movement; and R, Racial Climate. b. See Figure 2 for additional details for American Indians / Alaskan Natives and Whites. c. Importantly, the domains listed for Whites primarily represent a structural advantage. Although several European ethnic immigrant groups (eg, Irish, Polish, Jewish, German, etc.) experienced discrimination and unfair treatment upon arrival to the United States, their eventual racialization into the White racial group enabled them to access benefits associated with whiteness earlier than non-White groups. d. Domains of structural racism differentially affected various ethnic subgroups within and across these eras.

Figure 2.. Operationalization of structural racism for health of American Indians / Alaska Natives (vs Whites)