Structural Racism and Inequality in Canadian Population Health and Wellbeing: a Scoping Review.

Little is known about the prevalence of structural racism in Canada or the extent to which it contributes to racial/ethnic inequality in population health and wellbeing. This scoping review examines which racial/ethnic groups are represented in Canadian population research, how structural racism is quantitatively measured and operationalized in the Canadian context, and which health indicators are associated with exposure to structural racism. Key gaps and opportunities to advance the study of racial/ethnic health inequality in Canada are identified. We searched Web of Science, SocIndex, Medline, and Canada Business & Canadian Affairs databases to identify original, peer-reviewed research that analyzed Canadian samples, included at least one quantitative structural racism measure, and estimated at least one health-, wellbeing- or healthcare-related outcome. After removing duplicates, remaining articles were screened and assessed using predefined eligibility criteria. Twenty-eight studies met the inclusion criteria. The majority of studies focused on the health impacts of structural racism among Indigenous populations, with comparatively few examining visible minority racial/ethnic groups. The majority of studies relied on self-reported measures of perceived discrimination across social institutions, including healthcare and housing, or self-reported cultural and historical loss. Across studies, exposure to structural racism was consistently associated with adverse physical and mental health outcomes. Advancing this field will require: (1) improved collection and dissemination of racial/ethnic demographic data; (2) increased data disaggregation for visible minority populations, (3) the development of theoretically grounded, Canada-specific measures of structural racism and (4) greater attention to the behavioral- and healthcare-related mechanisms linking structural racism to health.