Instead of cultural competencies, Helena Hansen, an assistant professor of psychiatry and anthropology at New York University, and a research psychiatrist at the Nathan Kline Institute for Psychiatric Research, along with her colleague Jonathan Metzl at Vanderbilt University, are proposing that medical students be trained in structural competencies.
At its core, this training would be a crash course in the social determinants of health, an area that Hansen says has historically been seen as the domain of public health, not medicine. But she and Metzl are out to change that, and Hansen thinks the increased focus on holding providers (and insurance companies) responsible for the outcomes of their patients may help to push this effort along. In a Social Science & Medicine Journal article last year they argue: “clinical training must shift its gaze from an exclusive focus on the individual encounter to include the organization of institutions and policies, as well as of neighborhoods and cities, if clinicians are to impact stigma-related health inequalities.”
A simple example of the possible impact of this shift is a study at University of California San Francisco, where through electronic medical records, providers were required to fill in a question about the patient’s housing status. The providers whose form included this question were more likely to include social interventions in the patient’s treatment plan.
http://m.colorlines.com/archives/2014/07/a_new_way_to_fight_health_disparities.html
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