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Measuring Community Power as a Structural Determinant of Health for Latino Communities
Journal article   Open access   Peer reviewed

Measuring Community Power as a Structural Determinant of Health for Latino Communities

Julianna Pacheco, Nicole Novak, Samantha Deragon and Stephanie Schmitt
The Milbank quarterly
02/17/2026
DOI: 10.1111/1468-0009.70072
PMCID: PMC13042544
PMID: 41700454
url
https://doi.org/10.1111/1468-0009.70072View
Published (Version of record) Open Access

Abstract

Policy Points Voting rights are the most common measure of power when studying structural determinants of health. Voting is a narrow conceptualization of community power and irrelevant for noncitizen populations who are vitally affected by health policymaking despite not being able to vote. We measure six factors related to community power, including laws, policies, and practices/norms at the county level that are applicable to counties with significant populations who identify as Latino. These measures act to either overcome or exacerbate historical power imbalances based on race, ethnicity, and citizenship status. These findings contribute to our understanding of the structural determinants of health and highlight the important ways that community power can be conceptualized and measured for specific racial or ethnic groups. We broaden our understanding of community power by going beyond traditional measures of voting and voting rights. Our objectives are to (1) create county-level measures of community power that are more expansive than voting and (2) explore the descriptive and geographic patterns of community power. Six novel measures of community power were developed at the county level. Three were indicators of power-building activities that overcome historic power imbalances faced by Latino populations. These include measures on political representation, immigrant incorporation, and language accessibility for elections. We also measured three indicators related to immigration enforcement that act to exacerbate historical power disparities. Correlational and spatial analyses were conducted to better understand descriptive and geographic patterns. We found little evidence that our measures are correlated; spatial analyses largely confirmed this. There was evidence of regional spatial autocorrelation, but inferences depended largely on the measure used. We generally found that counties with more than 10% of residents who identify as Latino have higher values on our power-building measures, suggesting that these areas are especially primed to amplify the voices of Latino residents. Interestingly, our measures related to immigration enforcement were largely unrelated to recent Latino population growth (e.g., "new destination counties"). Power is a fundamental driver of the conditions that produce or mitigate health disparities, but the process by which communities influence decision making may be difficult to measure. This work provides a blueprint for future scholars studying the link between community power and health equity across different races, ethnicities, and citizenship statuses.
 county health structural determinants of health health disparities power Latino health

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