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Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice

  • Symposium: Structural Competency
  • Published:
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Abstract

This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine.

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References

  • Angoff, N., L. Duncan, N. Roxas, and H. Hansen. 2016. Power day: Addressing the use and abuse of power in medical training. Journal of Bioethical Inquiry 13(2). doi:10.1007/s11673-016-9714-4.

  • Berkman, A., J. Garcia, M. Munoz-Laboy, V. Paiva, and R. Parker. 2005. A critical analysis of the Brazilian response to HIV/AIDS: Lessons learned for controlling and mitigating the epidemic in developing countries. American Journal of Public Health 95(7): 1162–1172.

    Article  PubMed  PubMed Central  Google Scholar 

  • Campion, E.W., and S. Morrissey. 2013. A different model—medical care in Cuba. The New England Journal of Medicine 368(4): 297–299.

    Article  CAS  PubMed  Google Scholar 

  • Carpenter-Song, E.A., M. Nordquest Shwallie, and J. Longhofer. 2007. Cultural competence reexamined: Critique and directions for the future. Psychiatric Services 58(10): 1362–1365.

    Article  PubMed  Google Scholar 

  • Case, A., and A. Deaton. 2015. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences 112(49): 15078–15083.

    Article  CAS  Google Scholar 

  • Celermajer, D.D., and J. Saul. 2016. Preventing torture in Nepal: A public health and human rights intervention. Journal of Bioethical Inquiry 13(2). doi:10.1007/s11673-016-9712-6.

  • Chatterjee, S., V. Patel, A. Chatterjee, and H.A. Weiss. 2003. Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India. British Journal of Psychiatry 182(1): 57–62.

    Article  PubMed  Google Scholar 

  • Conley, D., and D. Malaspina. 2016. Socio-genomics and structural competency. Journal of Bioethical Inquiry 13(2). doi:10.1007/s11673-016-9716-2.

  • Doulgeris, J. 2012. New survey validates that US physicians are ailing. Physicians Practice, September 27. http://www.physicianspractice.com/new-survey-validates-us-physicians-are-ailing.

  • Drucker, E., K. Anderson, R. Haemmig, et al. 2016. Treating addictions: Harm reduction in clinical care and prevention. Journal of Bioethical Inquiry 13(2). doi:10.1007/s11673-016-9720-6.

  • Dyrbye, L.N., and S.D. Tait. 2011. Physician burnout: A potential threat to successful health care reform. The Journal of the American Medical Association 305(19): 2009–2010.

    Article  CAS  PubMed  Google Scholar 

  • Foege, W. 2010. Social determinants of health and health-care solutions. Public Health Reports 125(Suppl 4): 8–10.

    PubMed  PubMed Central  Google Scholar 

  • Fullilove, M.T., and M. Cantal-Dupart, 2016. Medicine for the city: Perspective and solidarity as tools for making urban health. Journal of Bioethical Inquiry 13(2). doi:10.1007/s11673-016-9713-5.

  • Hardcastle, L.E., K.L. Record, P.D. Jacobson, and L.O. Gostin. 2011. Improving the population’s health: The Affordable Care Act and the importance of integration. The Journal of Law, Medicine & Ethics 39(3): 317–327.

    Article  Google Scholar 

  • Harris Interactive. 2011. 2011 Physicians’ daily life report. http://www.rwjf.org/vulnerablepopulations/product.jsp?id=73646&cid=XEM_2809280. Accessed August 17, 2012.

  • Institute of Medicine and National Research Council. 2013. U.S. health in international perspective: Shorter lives, poorer health. Washington, DC: The National Academies Press.

    Google Scholar 

  • Kane, J. 2012. Health costs: How the U.S. compares with other countries. PBS Newshour, October 22. http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html.

  • Keck, W., and G. Reed. 2012. The curious case of Cuba. American Journal of Public Health 102(8): e13–e22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kleinman, A., and P. Benson. 2006. Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Medicine 3(10): e294. doi:10.1371/journal/pmed.0030294.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krupka, C. 2012. Nearly half of physicians struggle with burnout. AMA News, September 3 http://www.amednews.com/article/20120903/profession/309039952/2/.

  • Landon, B.E., J.D. Reschovsky, H.H. Pham, and D. Blumenthal. 2006. Leaving medicine: The consequences of physician dissatisfaction. Medical Care 44(3): 234–242.

    Article  PubMed  Google Scholar 

  • Link, B.G., and J. Phelan. 1995. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior 35(Extra Issue): 80–94.

    Article  Google Scholar 

  • Maki, A. 2012. Survey: 34 pct. of physicians to leave medical practice. Memphis Daily News, August 8. https://www.memphisdailynews.com/news/2012/aug/8/survey-34-pct-of-physicians-to-leave-practice/.

  • McCord, C., and H.P. Freeman. 1990. Excess mortality in Harlem. The New England Journal of Medicine 322(3): 173–177.

    Article  CAS  PubMed  Google Scholar 

  • Metzl, J.M. 2010. The protest psychosis. Boston: Beacon Press.

    Google Scholar 

  • Metzl, J.M., and H. Hansen. 2014. Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine 103: 126–133. http://www.sciencedirect.com/science/article/pii/S0277953613003778.

    Article  Google Scholar 

  • Metzl, J., and D. Roberts. 2014. Structural competency meets structural racism: Race, politics, and the structure of medical knowledge. AMA Journal of Ethics 16(9): 674–690. http://journalofethics.ama-assn.org/2014/09/spec1-1409.html.

    Google Scholar 

  • Olshansky, S.J., T. Antonucci, L. Berkman, et al. 2012. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Affairs 32(3): 1803–1818.

    Article  Google Scholar 

  • Pathman, D.E., T.R. Konrad, E.S. Williams, W.E. Scheckler, M. Linzer, and J. Douglas. 2002. Physician job satisfaction, job dissatisfaction, and physician turnover. Journal of Family Practice 51(7): 593.

    PubMed  Google Scholar 

  • Reich, A.D., H.B. Hansen, and B.G. Link. 2016. Fundamental interventions: How clinicians can address the fundamental causes of disease. Journal of Bioethical Inquiry 13(2). doi:10.1007/s11673-016-9715-3.

  • Spickard, A., S.G. Gabbe, and J.F. Christensen. 2002. Mid-career burnout in generalist and specialist physicians. The Journal of the American Medical Association 288(12): 1447–1450.

    Article  PubMed  Google Scholar 

  • Tsevat, R.K., A.A. Sinha, K.J. Gutierrez, and S. DasGupta. 2015. Bringing home the health humanities: Narrative humility, structural competency, and engaged pedagogy. Academic Medicine 90(11): 1462–1465.

    Article  PubMed  Google Scholar 

  • Woolf, S.H., and P. Braveman. 2011. Where health disparities begin: The role of social and economic determinants—and why current policies may make matters worse. Health Affairs 30(10): 1852–1859.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. New York University, New York, NY, USA

    H. Hansen

  2. Nathan Kline Institute, Orangeburg, NY, USA

    H. Hansen

  3. Vanderbilt University, Nashville, TN, USA

    J. Metzl

Authors
  1. H. Hansen
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  2. J. Metzl
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Correspondence to H. Hansen.

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Hansen, H., Metzl, J. Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice. Bioethical Inquiry 13, 179–183 (2016). https://doi.org/10.1007/s11673-016-9719-z

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  • DOI: https://doi.org/10.1007/s11673-016-9719-z

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