Traditionally, U.S. physicians are trained to diagnose their patients’ illnesses through attention to biological systems. But Metzl, director of Vanderbilt’s Center for Medicine, Health, and Society, and Hansen, a professor of psychiatry and anthropology at New York University, contend that training in biology alone leaves doctors woefully unprepared for understanding how people’s health is determined as much by their zip code as their genetic code.
Writing in the February 2014 issue of Social Science and Medicine, Metzl and Hansen introduce a novel, five-step way of training physicians based in a method called “structural competency.” Structural competency teaches doctors to better recognize how medical issues such as hypertension, depression and obesity sometimes represent the downstream effects of societal decisions about such factors as food distribution networks, transit systems, or urban or rural infrastructure. And it promotes societal engagement “beyond the walls of the clinic” by the medical profession.
Metzl coined the term “structural competency” in his book, The Protest Psychosis, as an expansion of the “cultural competency” concept that caregivers have struggled with for decades. Structural competency has since become the theme of a number of conferences and symposia at medical centers throughout the United States.
Metzl and Hansen write that “the politics of the present moment challenge cultural competency’s basic premise: that having a culturally sensitive clinician reduces patients’ overall experience of stigma or improves health outcomes.” Instead, they argue that cross-cultural communication need to be paired with the trained skill to recognize how “structural” factors lead to worse health outcomes—and with recognition that helping people “medically” must sometimes also involve improving their lives economically and socially.
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 social change. “The competency that results from such efforts helps clinicians develop, not the hubris of mastery, but the humility to recognize the complexity of the structural constraints that patients and doctors operate within,” Metzl and Hansen write.
In Spring 2014, MHS will initiate an ongoing interactive series titled Hot Topics in MHS. The aim of this series is to engage with the controversies and contested terrain that emerge at the nexus of medicine, health, and society. The first two events in this series are:
April 9, 2014: The Politics of Childhood Vaccines
4:00pm-5:30pm: Colloquium: “The Legitimacy of Vaccine Critics: What’s Left after Autism?,” Anna Kirkland, Associate Professor of Women’s Studies and Political Science, University of Michigan
Location: Light Hall 208
Reception to follow.
Co-hosted by Vanderbilt Department of Political Science and Program in American Studies
All events are free and open to one and all.
February 11, 2014: Boundaries and Bodies: Current Debates in Sex and Health
11:00am-12:30pm: Panel, Boundaries and Bodies – Ken MacLeish, Aimi Hamraie, Ariane Cruz (PSU), Jonathan Metzl
Location: 201 Alumni Hall
4:00pm-5:30pm: Colloquium: “Dark Desires: Black Female Erotica,” Ariane Cruz, Assistant Professor, Department of Women’s Studies, Pennsylvania State University
Location: MHS, 300cc Calhoun
Reception to follow.
Co-hosted by Vanderbilt Women’s and Gender Studies