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Structural competency: Theorizing a new medical engagement with stigma and inequality

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  • Metzl, Jonathan M.
  • Hansen, Helena

Abstract

This paper describes a shift in medical education away from pedagogic approaches to stigma and inequalities that emphasize cross-cultural understandings of individual patients, toward attention to forces that influence health outcomes at levels above individual interactions. It reviews existing structural approaches to stigma and health inequalities developed outside of medicine, and proposes changes to U.S. medical education that will infuse clinical training with a structural focus. The approach, termed “structural competency,” consists of training in five core competencies: 1) recognizing the structures that shape clinical interactions; 2) developing an extra-clinical language of structure; 3) rearticulating “cultural” formulations in structural terms; 4) observing and imagining structural interventions; and 5) developing structural humility. Examples are provided of structural health scholarship that should be adopted into medical didactic curricula, and of structural interventions that can provide participant-observation opportunities for clinical trainees. The paper ultimately argues that increasing recognition of the ways in which social and economic forces produce symptoms or methylate genes then needs to be better coupled with medical models for structural change.

Suggested Citation

  • Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    • Handle: RePEc:eee:socmed:v:103:y:2014:i:c:p:126-133
    DOI: 10.1016/j.socscimed.2013.06.032
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    1. Anonymous, 2014. "Introduction to the Issue," Journal of Wine Economics, Cambridge University Press, vol. 9(1), pages 1-2, May.
    2. Benjamin Springgate & Ashley Wennerstrom & Cynthia Carriere, 2011. "Capacity Building for Post-Disaster Mental Health Since Katrina: The Role of Community Health Workers," The Review of Black Political Economy, Springer;National Economic Association, vol. 38(4), pages 363-368, December.
    3. Hopper, Kim, 2007. "Rethinking social recovery in schizophrenia: What a capabilities approach might offer," Social Science & Medicine, Elsevier, vol. 65(5), pages 868-879, September.
    4. Parker, Richard & Aggleton, Peter, 2003. "HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action," Social Science & Medicine, Elsevier, vol. 57(1), pages 13-24, July.
    5. Hatzenbuehler, Mark L. & Bellatorre, Anna & Lee, Yeonjin & Finch, Brian K. & Muennig, Peter & Fiscella, Kevin, 2014. "Structural stigma and all-cause mortality in sexual minority populations," Social Science & Medicine, Elsevier, vol. 103(C), pages 33-41.
    6. Anonymous, 2014. "Introduction to the Issue," Journal of Wine Economics, Cambridge University Press, vol. 9(2), pages 109-110, August.
    7. Paul E Farmer & Bruce Nizeye & Sara Stulac & Salmaan Keshavjee, 2006. "Structural Violence and Clinical Medicine," PLOS Medicine, Public Library of Science, vol. 3(10), pages 1-6, October.
    8. Feagin, Joe & Bennefield, Zinobia, 2014. "Systemic racism and U.S. health care," Social Science & Medicine, Elsevier, vol. 103(C), pages 7-14.
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