Structural and Systemic Racism: Definitions and Constructs for the Field

Academic and policy-driven efforts to address racism have increasingly centered on structural and systemic racism (Hardeman et al., 2022). However, the absence of a unified theoretical framework due to varied definitions, constructs, and interpretations has hindered progress in both scholarly and applied contexts (Omi & Winant, 2014; Feagin, 2010). This paper proposes a framework that delineates the concepts of structural and systemic racism to advance theoretical clarity and empirical rigor in this field. Measurement challenges continue to hinder the study of structural and systemic racism. A systematic review by Groos et al. (2018) found that only 20 studies between 2007 and 2017 explicitly measured structural racism, while Krieger et al. (2021) noted that fewer than 10% of medical research articles incorporating discussions of racism included quantitative measures. However, recent methodological advancements offer promising directions. Index-based approaches and latent variable models facilitate multidimensional assessments of structural racism, aligning with frameworks that conceptualize it as an interlocking and mutually reinforcing system (Adkins-Jackson et al., 2022; Hardeman et al., 2022). That said, there is still more work necessary to bring the measurement of structural and systemic racism to scale in the field. This paper introduces a framework that distinguishes between structural and systemic racism, emphasizing their interrelated but distinct roles in perpetuating racial inequities. The framework proposed in this paper distinguishes between racism as a noun (Structural Racism and Systemic Racism) and racism as a verb (the actions these entities perform). This distinction clarifies that Structural Racism and Systemic Racism are nouns, and these terms represent structural entities/organizations or systems that “activate/do” racism. Structural Racism refers to entities/organizations, such as schools, businesses, or government agencies, that “activate/do” racism while Systemic Racism refers to interconnected networks of Structural Racism that collectively “activate/do” racism. Racism as a verb are the discriminatory actions or policies that Structural Racism and/or Systemic Racism enact—such as book bans, redlining, Jim Crow laws, mass incarceration, or school segregation. It is these actions that make real the existence of Structural Racism and/or Systemic Racism. Additionally, this proposed framework suggests that Structural Racism and Systemic Racism exist in a nested, bi-directional hierarchy. Structural Racism can be embedded within Systemic Racism, and Systemic Racism(s) can form/be a part of larger Structural Racism. This process can repeat, extending from the micro (proximal) to the macro (distal) levels of society. For example, within a healthcare system, individual hospitals or medical boards may be Structural Racism if they enforce discriminatory hiring or treatment practices. This healthcare system, which collectively includes these hospitals and boards (Structural Racisms), is Systemic Racism if it “activates/does” racial health disparities across its hospitals and boards (Structural Racisms). Simultaneously, the healthcare system is nested within larger structural entities (i.e. state governments, independent organizations, other agencies) that shape its policies and practices, potentially embedding it within broader Structural Racism at higher levels (i.e. state, large organizations/companies, national). This nested approach emphasizes that structural entities and systems are interconnected and may be mutually reinforcing. (1) By defining Structural Racism as an entity/organization and Systemic Racism as interconnected Structural Racisms, this framework allows researchers to identify specific actions and outcomes that reveal these structures as Structural Racism or Systemic Racism. This approach enables clearer and more consistent measurement criteria for analyzing racial inequities. (2) This nested model of Structural Racism and Systemic Racism highlights the need for policies that address both individual entities/organizations and broader networks of entities/organizations. For example, reforming healthcare to reduce racial disparities requires both institutional (Structural Racism) change within hospitals (structural level) and systemic reform across the healthcare system (Systemic Racism) to address inter-organizational practices and policies. (3) Recognizing the iterative nature of nested systems supports a multi-level analysis that can be applied across fields, from sociology and public health to economics and criminal justice. It acknowledges that Structural Racism and Systemic Racism operate across scales and systems, informing interdisciplinary approaches to studying and dismantling racism. Through these additions, we may deepen our understanding of Structural Racism and Systemic Racism by distinguishing between entities/organizations and actions and emphasizing the nested, interdependent nature of these entities/organizations. This conceptualization potentially lays the foundation for rigorous empirical research and targeted interventions that address the root causes of racism/racial disparity at multiple societal levels. REFERENCES: Adkins-Jackson, P. B., Chantarat, T., Bailey, Z. D., & Ponce, N. A. (2022). Measuring structural racism: A guide for epidemiologists and other health researchers. American Journal of Epidemiology. Feagin, J. R. (2010). Racist America: Roots, current realities, and future reparations (2nd ed.). Routledge. Groos, M., Wallace, M., Hardeman, R., & Theall, K. P. (2018). Measuring inequity: A systematic review of methods used to quantify structural racism. Journal of Health Disparities Research and Practice, 11(2), 13. Hardeman, R. R., Homan, P., & Jackson, B. A. (2022). Interlocking systems of oppression: A structural racism perspective. Social Science Research, 108, 102639. https://doi.org/10.1016/j.ssresearch.2021.102639 Krieger, N., Boyd, R. W., De Maio, F., & Maybank, A. (2021). Medicine’s privileged gatekeepers: Producing harmful ignorance about racism and health. Health Affairs Blog. Retrieved from https://www.healthaffairs.org Omi, M., & Winant, H. (2014). Racial formation in the United States (3rd ed.). Routledge.