Health Disparities and Structural Competency

By Dimitri Johnson

In the United States, cardiovascular disease is the leading cause of death.  Disparities in medical care across minority groups.  The way medical professionals are trained can have a negative impact on the health outcomes in patients of low socioeconomic status. Another area to explore in resolving health disparities is new clinical politics in order to understand the relationships among class, race, and how symptoms are expressed. This exploration is termed structural competency.  But in a clinical setting this is called “cultural competency.”  A culturally competent approach highlights  the sociocultural backgrounds of patients and their illnesses and the doctors involved.

A strong way to implement structural competency would be to start at the educational level of the healthcare providers. In order to help these systems we must recognize how decision making of health care providers is influenced by economic, physical, and socio-political forces.  We must also pay attention to the infrastructure of the healthcare environment and the infrastructure of public health. Researchers are beginning to understand that environments poor in resources do lead to physiological responses that eventually lead to chronic disease. Another part of this is using literature from multiple disciplines to help define cultural clinical presentation without taking away from the individual cultures.  We need specific language to better able the teaching of healthcare providers.  One of the biggest areas of change needed is in the legislation.  It must be recognized at the national level that structural intervention.  Once we identify structures that impact minority populations, we must then find out how to change them.  The last component of structural competency is structural humility.  We must recognize the limitations of structural competency.  In terms of applying this to healthcare education, students must realize that the system will not always work and has its limits. 

For my group’s summer media topic we are focusing on pregnancy and hypertension.  We are looking at this issue specifically in the Black population so we can include structural and cultural competency in this discussion.  We will talk about methods to prevent hypertension before pregnancy specifically in the minority populations.  Metrics that could be used in a rubric to evaluate these efforts could include making sure there is discussion about how to affect the healthcare or legislative system in terms of structural competency.  Also, there should be discussion about the particular media project and how it addresses health disparities. 

AMA J Ethics. 2018;20(3):211-223. doi: 10.1001/journalofethics.2018.20.3.peer1-1803.

Metzl, J. M., & Hansen, H. (2014). Structural competency: theorizing a new medical engagement with stigma and inequality. Social science & medicine (1982), 103, 126–133.

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