This study examines the relationship between structural racism and health outcomes, focusing on the U.S. states as key institutional actors shaping population health. It develops a novel latent measure of structural racism across five domains: economy, education, politics, criminal-legal system, and residential segregation. Using multilevel models, the study quantifies the association between structural racism and five health outcomes among Black and White adults, drawing from the Health and Retirement Study (N=9,020) and the Behavioral Risk Factor Surveillance System (N=308,029). Results show that structural racism is consistently associated with worse health for Black people but not White people. The study contributes to the field by advancing theoretical understanding of structural racism, developing a new measurement approach, and making the measure publicly available to support further research. It highlights the importance of considering structural racism as a multifaceted, interconnected, and institutionalized system that shapes racial health disparities. The findings underscore the need for further research on the health consequences of structural racism, particularly its impact on Black populations.This study examines the relationship between structural racism and health outcomes, focusing on the U.S. states as key institutional actors shaping population health. It develops a novel latent measure of structural racism across five domains: economy, education, politics, criminal-legal system, and residential segregation. Using multilevel models, the study quantifies the association between structural racism and five health outcomes among Black and White adults, drawing from the Health and Retirement Study (N=9,020) and the Behavioral Risk Factor Surveillance System (N=308,029). Results show that structural racism is consistently associated with worse health for Black people but not White people. The study contributes to the field by advancing theoretical understanding of structural racism, developing a new measurement approach, and making the measure publicly available to support further research. It highlights the importance of considering structural racism as a multifaceted, interconnected, and institutionalized system that shapes racial health disparities. The findings underscore the need for further research on the health consequences of structural racism, particularly its impact on Black populations.