Looking Back to Leap Forward: A Framework for Operationalizing the Structural Racism Construct in Minority and Immigrant 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.Ethn Dis. 2021;31(Suppl 1):301-310; doi:10.18865/ed.31.S1.301

Racism and health care: Experiences of Latinx immigrant women in NYC during COVID-19

“…There are increasing calls for research that centers immigrant health care experiences and health outcomes as products of structural racism and resulting social inequalities ( Dennis et al, 2021 ). This study shows how multi-level forms of racism and subsequent inequities shaped foreign-born Latinx women's health care interactions and experiences during the COVID-19 pandemic.…”

“…While it is asserted that immigrants enter the U.S. with better health compared to U.S. natives, research has shown that their health often deteriorates the longer they reside in the U.S. ( Acevedo-Garcia & Bates, 2008 ; Castañeda et al, 2015 ; Crimmins et al, 2007 ; Franzini et al, 2001 ) . Such a decline in immigrant health outcomes has been attributed to several multilevel factors, including health systems, interpersonal dynamics, access to resources, and individual behaviors, but xenophobia, or exclusion and discrimination of others based on national origin, which includes structural racism as well as perceived discrimination is often overlooked in the U.S. immigrant experience ( Dennis et al, 2021 ; Samari et al, 2021 ; Viruell-Fuentes et al, 2012 ). Racism has long been linked to greater health disparities ( Gee & Ford, 2011 ; Williams et al, 1997 ), only to be exacerbated by COVID-19 ( Zalla et al, 2021 ).…”

Institutional procedural discrimination, institutional racism, and other institutional discrimination: A nursing research example

“…Institutional racism, within organizations in the United States, involves policies, practices, and procedures which privilege majority White racial groups (Carmichael & Hamilton, 1967 ; Dennis et al, 2021 ; Gee & Hicken, 2021 ). Thus, institutional racism is defined as the existence of systematic policies, laws, and practices that provide differential access to goods, services, and opportunities because of socially constructed racial identity.…”

Conceptualization, operationalization, and utilization of race and ethnicity in major medical journals 1995-2018: a systematic review

“…As a settler-colonial state which achieved global financial power through slave labor and imperialism, the structures which continue to support the political, financial, judiciary, and educational systems maintain a hierarchical status quo based on established racial groups. 19 Racism may be globally pervasive, but the structure of the system and the experience of living within it is different in the U.S. than it is in Mexico, Brazil, South Africa, India, or any other country.…”