Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice
Open accessAbstract
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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- Authors
- Hansen, H., & Metzl, J.
- Affiliations
- Nathan Kline Institute for Psychiatric Research (US)
- Vanderbilt University (US)
- Corresponding author
- Hansen, H.
- ORCID
- Venue
- Journal of Bioethical Inquiry
- Published
- 2016-05-13
- Volume
- 13
- Issue
- 2
- Pages
- 179-183
- ISSN
- 1176-7529 (ISSN-L)
- 1872-4353
- PMC
- PMC4920691
- OpenAlex
- W2388430956
- Cited by
- 78
- References
- 33
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 11 · 2023: 5 · 2022: 8 · 2021: 7 · 2020: 13 · 2019: 11 · 2018: 4 · 2017: 6 · 2016: 1
- FWCI
- 13.66
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Bioethical Inquiry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K01DA032674)
- Topics
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- structural competency, social determinants of health, clinician training, epigenetics, personalized medicine, environmental interventions, clinical teaching, racial desegregation, health disparities, police torture, systemic racism, harm reduction, addiction, drug policy, interdisciplinary collaboration, health policy
- MeSH terms
- Delivery of Health Care, Health Services Needs and Demand, Humans, Organizational Innovation, Politics, Public Policy, United States, Health Care Reform, Healthcare Disparities
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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