Structural Competency: A Societal Necessity

By Davin Means

Various social determinants, biases, inequities and blind spots within daily living can affect the health of an individual, years upstream to the development of illness. Variables such as race, class, discriminatory housing, employment, education, income, criminal justice, and healthcare, all are important factors that impact future patients long before they enter the examination room. Structural Competency is a cross disciplinary mode of action that employs methods from sociology, economics, and urban planning in order to combat negative health outcomes imposed by poverty, inequality, racism, and discrimination. Structural competency identifies and analyzes ways that unequal social conditions create and perpetuate negative health outcomes and trains healthcare professions to recognize ways that neighborhood conditions, public policies, local consumer economy, food networks, transportation systems, and localized healthcare delivery systems impact a population’s susceptibility to diseases and negative symptoms. Structural competency analyzes the effects of how previous practices such as structural, institutional, political, and economic racisms affect minority healthcare, but it does so with the ultimate goal of developing new systems, practices, and action plans that address health disparities in the present day. 

There are a few possible ways that structural competency can influence modern health. Structural vulnerability analysis can be done to highlight inadequate infrastructures and policies such as medical bankruptcies or lack of personal protective equipment that contribute to devastating outcomes in vulnerable populations. Structural competency emphasizes the necessity of community communication and the expansion of the public voice within healthcare, in order to build structurally competent community health centers and hospitals that address both the medical and social issues of patients. Physicians and healthcare providers must be educated in the social, structural, and political basis for disease, and the field of medical care and public health must seamlessly integrate in order to effectively impact health outside of the clinical setting. Furthermore structurally competent health centers would provide aid within food and housing assistance, the delivery of resources such as PPE, and the creation of novel financial and legal partnerships.

Structural competency is crucial for the future advancement of cardiovascular health and disease research. Despite the continual advances within medicine, minority populations such as African Americans, Latin Americans, and American Indians, are continuously having higher negative cardiovascular health outcomes than their non minority counterparts. African Americans, for example, are almost 50% more likely to have hypertension and almost two times more likely to die of  heart disease than whites; nearly one in every three Latin American women develop heart disease or stroke; and American Indians ate 30% more likely to develop coronary artery disease than whites. Structural competency is necessary to counteract the health disparities that affect these minority populations. These disparities include but are not limited to the following minority realities.  Competent health centers are less likely to be built in lower economic areas, thus minorities lack access to clinics and healthcare specialists. Blacks and Hispanics are twice as likely to live in poverty than whites. Blacks are ten percent less likely, and American Indians and Latin Americans are twenty percent less likely to have healthcare insurance or coverage. Furthermore, over 51% of hispanic americans admit to having no doctor. These factors in conjunction with increased alcohol and tobacco accessibility in minority areas, as well as decreased accessibility to healthy foods within minority neighborhoods, all contribute to these disastrous cardiovascular consequences that affect minority populations. The implementation of structurally competent healthcare facilities and community intervention would reduce these negative cardiovascular outcomes. 

In our media project, Stress, Anxiety, and Depression Effects on Cardiovascular Health, we address structural competency throughout the entirety of our production. Within the stress and hypertension section, we address the various socioeconomic stressors that contribute to negative minority cardiovascular health outcomes. We view the connections between anxiety and cardiovascular disease through a lens of social factors such as class, economic factors such as income, psychological factors such as racism, and behavioral factors such as unhealthy habits. Within the depression and cardiovascular disease section, we touch on cultural mindsets about mental health and how that affects the method in which patients seek treatment. We conclude our media project by addressing methods with which individuals, communities, and healthcare systems can employ structural competencies within their own underserved populations. 

References and Additional Readings.

https://www.americanprogress.org/issues/healthcare/news/2010/12/16/8762/fact-sheet-health-disparities-by-race-and-ethnicity/

https://source.colostate.edu/native-american-tribes-pandemic-response-is-hamstrung-by-manyinequities/https://www.womenheart.org/

https://sistahvegan.com/2016/02/29/infographic-racial-disparities-in-health-care/

https://journalofethics.ama-assn.org/article/structural-competency-and-reproductive-health/201803

https://jamanetwork.com/journals/jama/fullarticle/2767027https://structuralcompetency.org/about-2/

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