Measuring Structural Racism to Advance Health Equity: A Scoping Review of Quantitative Approaches.

BACKGROUND

Structural racism, the interconnected policies, institutions, and norms that systematically disadvantage communities of color, remains a core determinant of health inequities in the United States. Despite growing recognition of its impact, public health lacks standardized, validated measurement tools across contexts, limiting intervention effectiveness and policy change.

METHODS

Following PRISMA guidelines, we systematically reviewed peer-reviewed studies published between January 2000 and March 2025 that quantified structural racism in relation to health outcomes in the U.S. We searched PubMed and Scopus databases and selected twenty-eight studies which met the inclusion criteria.

RESULTS

Studies operationalized structural racism across seven domains: education, socioeconomic status, judicial treatment, residential segregation, political participation, healthcare access, and historical legacies. Metrics included disparities in degree attainment, incarceration, unemployment, poverty, voter turnout, and multidimensional indices. These measures are consistently associated with poor health outcomes, including infant mortality, cardiovascular disease, and delayed cancer treatment. Recent methodological trends show movement toward composite, spatial, and longitudinal approaches.

CONCLUSION

Quantifying structural racism is vital to dismantling systemic inequities. While progress has been made, greater methodological consistency and cross-sectoral frameworks are needed. Standardized, multidimensional measures can enable practitioners and policymakers to identify inequities, allocate resources, and develop targeted strategies that promote racial health equity, thereby making the public's health a true national priority.