Background: Research is essential to understand not only how systems of oppression influence health inequities, but how multiple systems of oppression interact to cause these health inequities. State policy offers a way to investigate a changeable and actionable aspect of structural racism and discrimination.

Methods: This paper examines independent and joint associations between structural racism, structural cisheterosexism (i.e., LGBTQ+ discrimination), and race and sexual orientation and gender identity (SOGI) subgroups on outcomes of health-related quality of life, cost barriers to seeking healthcare, and insurance status. Data sources include 2020-2023 Behavioral Risk Factor Surveillance System data, as well as indices of structural racism (Agénor et al.’s database of Structural Racism-related State Laws for Health Equity Research and Practice) and structural cisheterosexism (Movement Advancement Project LGBTQ Policy Tally) in state policy.

Results: This study found that state policy environments—and the systems of oppression they reflect—are significantly associated with health and healthcare access across a number of race and SOGI subgroups. Living in more harmful states for (1) structural racism, (2) structural cisheterosexism, and (3) both was generally associated with significantly worse outcomes for not only BIPOC and LGBTQ+ populations, but also for White and non-LGBTQ+ people. Our results suggest a broad impact of systems of oppression; however, the most marginalized still bear a disproportionate burden of poor health and barriers to healthcare.

Impact: These findings should be used to advocate for state policy change and galvanize changemakers in academic, policy, and community. Through these results, stakeholders can explore which demographic groups are most impacted in terms of health and healthcare access. This can help partners target their policy advocacy, as well as community-based interventions.