Beyond the Binary: A Critical Synthesis of Colorism, Racism, and Health Disparities in Puerto Rico

Although Puerto Rican society has long been shaped by the heritage of Spanish and United States (U.S.) colonization, current research has started to examine how racism and colorism interact to create and maintain health inequalities throughout the archipelago. However, this body of work remains theoretically fragmented and methodologically inconsistent, limiting its ability to inform public health practices. To address this gap, this article presents a systematic review of peer-reviewed studies examining colorism, racism, and health outcomes among Puerto Ricans residing in the archipelago. The publications were identified through searches in three different databases (i.e., CINAHL, MEDLINE, and PubMed) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The findings highlight the underutilization of decolonial and community-based frameworks and the need for more nuanced, culturally grounded measures of racial classification and skin tone. In this article we present arguments for a shift toward intersectional, participatory, and longitudinal research designs that center the experiences of the population of African descent and challenge U.S.-centric racial paradigms. By mapping the current landscape and its limitations, this work contributes to a more equitable and contextually relevant research agenda on racialization, color, and health in Puerto Rico. The conclusion calls for a paradigm shift in public health research and practice—one that centers the experiences of the population of African descent, community-based knowledge, and structural transformation.