The Importance of Structural Competencies

Structural competencies are fundamental ideals that health professionals should hold surrounding the social determinants of health that affect disease. It is important to keep disparities involving education, income, housing, and various other environmental factors in mind when treating patients because these factors disproportionately affect minorities and make them more susceptible to certain illnesses. This is seen especially with cardiovascular disease which is a leading cause of death world-wide, however, being a minority and living in areas that don’t provide adequate access to grocery stores or a safe environment to exercise drastically increases your chance of developing this illness and not recovering from it. Therefore, training to recognize these risk factors and their vast impact on certain populations can improve the treatment of the illnesses that these inequalities give rise to.  

Before, medical training was focused on recognizing and addressing cultural differences, but the need for structural competency has become increasingly apparent in recent years. The pandemic we are currently experiencing has further marginalized those that were already disadvantaged to begin with, such as Blacks, Hispanics, and Native Americans (Metzl 2020). To some, the data on mortality rates amongst these populations was shocking, but these disparities have existed far longer than COVID-19 has. This is largely due to the socioeconomic disadvantages present in these populations. Often, the employment opportunities available to these individuals are particularly vulnerable to virus exposure, and the low-incomes earned through these jobs are insufficient to access proper disease treatment. Therefore, it is not surprising that these groups are suffering the most during this time, but this explanation is only the first part of what needs to occur in addressing these disparities.  

The entire infrastructure of the U.S HealthCare System needs to be modified to best meet the needs of vulnerable populations. This has been an objective in many areas of the nation for a long time, often through community health centers that provide resources to underserved populations. However, we have still not reached a level of systemic change that will better the health outcomes of everyone regardless of their race or place of residence. 

The project I am working on this summer is focused on cost-sharing for cardiac rehabilitation services among different medicare advantage plans. Cardiac rehabilitation services are intended for those with cardiovascular disease who either have already suffered a myocardial infarction or are at a very elevated risk of one. These programs provide exercise training, nutritional counseling, mental health services, and a plethora of resources that increase an individual’s functioning in society after a cardiovascular event and prevent another one from occurring. However, these services are often expensive and underutilized in particularly vulnerable populations, further contributing to disparities in health outcomes among these individuals. Therefore, analyzing the cost-sharing requirements that may pose barriers to low-income individuals is the first step in addressing these disparities and increasing treatment access. 

https://jamanetwork.com/journals/jama/fullarticle/2767027

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