The development, evolution, and maintenance of structural racism for the study of health inequities: An expanded framework for Asian, Black, Hispanic, Indigenous, and White Americans

Evaluating the relationship between structural racism and health inequity is conceptually and empirically complex. This critical review of policies and events extends a previously published framework for understanding structural racism in health research across ethnoracial groups from 1400 to present. We apply this framework for Asian, Black or African American, Hispanic/Latinx, Native Hawaiian/Pacific Islander, and White groups and reflect on, compare, and contrast the overarching patterns within and across groups. Our findings illustrate the utility of our framework as a tool for conceptualizing and operationalizing structural racism in future health research. We suggest that health scholars can advance the field by: (1) recognizing multiple, reinforcing domains of structural racism; (2) expanding research beyond a Black-White binary to include other ethnoracial groups; (3) emphasizing the role of time and its different manifestations as exposure across the life course and cohorts; (4) highlighting the implications of collective resistance and agency as alternatives to deficit models; and (5) disaggregating data, whenever possible, to avoid rendering smaller ethnoracial groups invisible.