What Structural Racism Is (or Is Not) and How to Measure It: Clarity for Public Health and Medical Researchers

Introduction

Recent incidents of police brutality against Black Americans sparked heightened awareness of systemic racism in the United States, leading to discussions about racism’s pervasive presence in society, including within public health structures. This awareness has also translated to increased attention and funding for research on structural racism’s effect on health. However, there is inconsistency in defining and measuring the concept of structural racism, potentially hindering efforts to address health inequities effectively. This article by Lorraine T. Dean and Roland J. Thorpe, Jr. aims to precisely define the concept of structural racism in American society. The authors argue that clear definitions of structural racism are crucial for conducting quality research and devising effective strategies to dismantle it.

Lorriane T. Dean is an Associate Professor at the Johns Hopkins Bloomberg School of Public Health. Dr. Dean is a social epidemiologist whose research focuses on how individual- and neighborhood-level social and economic factors contribute to health disparities and health outcomes for those managing chronic disease. Roland J. Thorpe, Jr. is also affiliated with the Johns Hopkins Bloomberg School of Public Health; he is a Professor and Co-Director of several programs, including the Health Equity and Social Justice Concentration of the DrPH Program. Dr. Thorpe is a gerontologist and social epidemiologist whose research focuses on minority aging, men’s health, and place-based disparities.

Methods and Findings

In this article, Dean and Thorpe illustrate the meaning of structural racism, and they contextualize its use (or lack thereof) within the field of public health research. 

What Structural Racism Is Not

The concept of structural racism has been absent from public health research, primarily because it has been conflated with institutional racism. These two concepts are not the same. Institutional racism is racism that is embedded in its institutions, such as bodies that make up and oversee government, economy, and culture.

In the next section of the article, the authors distinguish structural racism from institutional racism.

What Structural Racism Is

Dean and Thorpe conclude that,“structural racism represents the totality of ways in which multiple systems and institutions interact to assert racist policies, practices, and beliefs about people in a racialized group.”

Structural racism includes all of the following concepts of racism:

• Institutional Racism (Defined in “What Structural Racism is Not”): Racism within a particular type of institution.
• Systemic Racism: A term used to describe the existence of racialized systems of power within society.
• Racial Discrimination: Action that stems from racist beliefs.
• Cultural Racism: Reflects the ideologies and societal norms about a particular racial/ethnic group.

The authors explain that all of these concepts interact to influence peoples’ health.

Measurement of Structural Racism

In research, when considering the impact of structural racism, it is imperative to know how to measure it. Thus far in the field of public health research, measurement of structural racism has varied widely, and again, has often been misconstrued with institutionalized racism.

In order to accurately represent structural racism, researchers must assess the interactive effects across multiple institutions and domains such as education, employment, housing, criminal justice, and healthcare. The authors recommend using index measures to capture these interactive effects. Then, researchers can identify associations between a given index measure and health outcomes like infant mortality and cardiovascular health. 

Effective considerations for measuring structural racism also include examining measures over time and in different geographical contexts.

Conclusions

Dean and Thorpe emphasize that researchers should state in their work the levels and type of racism being assessed, and whether or not they are being measured. If researchers assess structural racism, they should adopt a multidimensional measure in order to capture the multidimensional nature of structural racism in American society. These frameworks will enable researchers to conduct more accurate and impactful, antiracist work.