Despite the centrality of structural explanations for understanding racialized inequality, less than one percent of studies on the link between race and health have focused on structural racism. Moreover, the conceptualization of structural racism in the race theory literature has often differed from the measurement strategies used in population health research. This study advances the field by 1) distilling central tenets of theories of structural racism into concrete measures of structural racism, 2) conceptualizing U.S. states as racialized institutional actors shaping health, 3) developing a novel latent measure of structural racism in states across multiple domains, including political participation, education, economics, housing, and the judicial system, 4) mapping structural racism across states, and 5) quantifying the effects of structural racism on six individual-level health outcomes and state-level COVID-19 mortality among Black and white adults. We use administrative data measuring state-level racial stratification linked to geocoded individual-level demographic and health data from the HRS (N=9,126) and the BRFSS (N=308,029), and state-level Black-white disparities in COVID-19 mortality. Results show that, whereas structural racism is consistently associated with worse health for Black people, it is either unrelated to health or predictive of better health among Whites; ecological analyses also show that higher levels of structural racism are predictive of larger Black-white inequality in COVID-19 mortality . Findings highlight the utility of rigorously conceptualizing and measuring structural racism and its impact on population health.
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