Identifying High-Priority Ecological-Level Indicators of Structural Racism in Black and Hispanic/Latino Communities

Structural racism manifests as a multifaceted phenomenon in which various social and structural drivers of health can carry different levels of significance and impact. This study used a theory-driven approach to identify high-priority key ecological-level manifestations of structural racism to inform the development of a novel, multilevel, and multidimensional structural racism measure for Black and Hispanic/Latino communities. Based on the National Institute on Minority Health and Health Disparities framework, a content development team of four social epidemiologists pre-selected 68 ecological indicators of structural racism from the previous literature. The panel comprised five health equity researchers, two social stratification researchers, and three community organization leaders, all of whom engaged in a modified Delphi process. In the final phase, eight out of ten panel members evaluated the relevance of each ecological-level indicator for assessing structural racism, using a 5-point scale ranging from 1 (extremely relevant) to 5 (not at all relevant). The average relevance score for each indicator was visualized using Python Matplotlib and Seaborn for data visualization. Overall, economic-related indicators were ranked as highly relevant, suggesting that financial stability measures are priority metrics for measuring structural racism among Black and Hispanic/ Latino communities. This study offers empirical evidence for prioritizing key ecological-level indicators of structural racism and for developing a weighted measure of structural racism for Black and Hispanic/Latino communities.