Importance of Structural competencies in Cardiovascular Health

By: Logan Long

Disparities in the U.S. health-care system has become a consistent issue in America. Currently, the U.S. spends more on health-care per capita compared to any other country in the world. Yet, we rank below most developed countries in health-care outcomes due to inequalities in health-care. Research shows that health-care disparities in socioeconomic status, ethnicity, and race are key agents of poor health outcomes. Therefore, structural competency has emerged as a way to conceptualize and address health-related social injustice issues. 

  Structural competency builds on the social determinants of health, cultural sensitivity, cultural humility, and cultural competency. This is an approach that conveys the idea that race, social class, education, political beliefs, sexual orientation, and other individual factors determine interactions between patients and doctors. Cultural competency emerged as a method to remedy the U.S. health-care system’s blatant Eurocentrism. However, it backfired, and overtime, it limited culture to a list of traits and stereotypes that mask the effects of social inequalities on health outcomes. It also ran the risks of homogenizing, perpetuating stereotypes, and promoting victim-blaming explanations. While cultural competency focuses mainly on improving patient-physician communication, structural competency shifts attention beyond factors that influence health outcomes at individual interactions. It emphasizes the recognition of political and economic structures that created and sustained racial inequalities in health-care. Structural competency consists of social and economic policies, laws regulating the distribution of health and social resources, and social stratification based on race, ethnicity, religious affiliation, immigration status, ability, gender identity, sexual orientation,etc..

           Structural competency highlights how unjust social structures lead to suffering in health among vulnerable individuals and communities. This is especially demonstrated amidst the COVID 19 pandemic where there are significant sociodemographic and racial differences in COVID 19 morbidity and mortality rates. Many of the adverse health outcomes can be traced to zip codes, where some individuals have increased risk of exposure due to housing, employment, or income. These structural factors can also be applied to other health outcomes such as Cardiovascular health. Some cardiovascular diseases can be attributed to an unhealthy lifestyle. In the past, medical doctors have referred to those that didn’t follow medical advice as non-compliant and refused due to cultural or individual reasons. Although personal choice can play a part, the role of structural and social factors have become more apparent. For instance, a healthy diet and exercise can be difficult for those that live in low income or underserved areas due to lack of services like grocery stores, sidewalks, public transportation, and community gyms or parks. Safety could also be a concern. Meanwhile, those communities only have access to fast food, tobacco products, and other unhealthy items, all of which contribute to poor cardiovascular health. Some areas also lack health-care facilities, which can increase adverse outcomes in those areas as well. Overall, disease research should take into account how institutions, markets, resource availability, and health-care delivery shape presentations of symptoms in individuals. It also examines the impact of structural inequity, structural racism, and structural stigma on heart health and illness.

           For our media project, my group examines the impact of tobacco use during pregnancy and the risk of congenital heart defects. We used structural competency when regarding our audience, which are minority women in low-income areas. This is mainly because cigarette companies typically market aggressively in these areas, which makes it very difficult for some women to quit as well as escape secondhand smoke. These areas also lack cessation resources and our goal by the end of the presentation is to present solutions that are accessible to our audience. A metric that can be used to test the effectiveness of the media project in addressing structural competency and science communication is pre and post surveys to see if the learning objective was achieved. Also possibly incentivizing the polls to encourage completion.


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