Despite the centrality of structural explanations for understanding racialized inequality, less than one percent of studies on the link between race and health have focused on structural racism. Moreover, the disconnect between the conceptualization and measurement of structural racism has hindered our understanding of the relationship between structural racism and health. This study advances the field by 1) distilling central tenets of theories of structural racism into concrete measures of structural racism, 2) conceptualizing U.S. states as racializing institutional actors shaping health, 3) developing a novel latent measure of structural racism in states across multiple domains, including education, economics, politics, housing, and the judicial system, and 4) quantifying the association between of structural racism and six health outcomes among Black and white adults. We use administrative data measuring state-level racial stratification linked to geocoded individual-level demographic and health data from the HRS (N=9,126) and the BRFSS (N=308,029). Results show that, whereas structural racism is consistently associated with worse health for Black people, it is either unrelated to health or predictive of better health among whites. Findings highlight the utility of rigorously conceptualizing and measuring structural racism and its impact on population health.