New medicine for the inequalities that are making us sick
Structural competency explores a new clinical politics for understanding the relationships among race, class, and symptom expression. In clinical settings, such relationships often fall under the rubric of “cultural competency,” an approach that emphasizes recognition of the divergent sociocultural backgrounds of patients and doctors, and the cultural aspects of patients’ illnesses. Increasingly, however, scholars and activists recognize that oft-invisible structural level determinates, biases, inequities, and blind spots shape definitions of health and illness long before doctors or patients enter examination rooms.
This evolving literature suggests that conditions that appear from a biomedical framework to result from actions or attitudes of culturally distinct groups need also be understood as resulting from the pathologies of social systems. And, that locating race-based symptoms on the bodies of marginalized persons risks turning a blind eye to the racialized economies in which marginalized and mainstreamed bodies live, work, and attempt to survive.
Structural competency converses with past models, from structuralism to structural racism, to demonstrate how institutional, political, and economic forces generating stigma are invisible to actors on the ground. But it does so with the ultimate aim of developing new platforms, practices, and agendas that address health issues in the present day; a time when structural-level disparities become more unjust at the same time that the agents producing them become more evanescent.