Structural Competency

by Michael_Koger

Cultural differences and barriers can interfere with the quality of medical care in any part of the globe.

Health care providers have encountered cultural issues in the management of patients for centuries. Culture refers to the beliefs, customs, and arts of a certain group, place, or society [1]. For many years, there has been an emphasis on cultural sensitivity of medical doctors and other health care staff as an approach to ensure good care whenever patients present to a clinic or hospital [2, 3].

Whereas this viewpoint is essential for the implementation of sound medical evaluation and treatment, researchers have determined that other issues can pose a problem with the care of patients. These may include the client’s work hours as well as access to transportation, housing, and child care. Other structures which have a role in this are food distribution networks, immigration policies, and health insurance status [2, 3].

Forms of Discrimination

There are also several forms of discrimination which create structural oppression on clients.  These include marginalization of people because of race, gender, sexual orientation, mental illness, physical disability, nationality, religion, and socioeconomic status.  In essence, these factors create an institutionalized discrimination more than an individual can on certain members of the community [2, 3].

This institutionalization considers zoning laws, economics, schools, and the legal system as these entities may have a subtle or silent form of destruction on minorities.  As a result, society may give the disadvantaged individuals positions of unimportant or somewhat powerless people.  These attitudes can influence health care providers to render medical care to them in an inadequate fashion [2, 3].

New Approach to Culture

The use of “cultural competency” for the management of these difficult situations has therefore undergone a revision which examines environmental and societal issues.  Structural competency has replaced that term.


The complexity of culture and the management of patients requires individual awareness of cultural sensitivity as well as societal intervention for environmental situations which will influence the delivery of health care.


  1. Merriam Webster Online.  (2015). 
  2. Metzl, J. and Hansen, H.  (2014).  Structural competency:  Theorizing a new medical engagement with stigma and inequality.  Social Science and Medicine, 103, 126-133.
  3. Kleinman, A. and Benson, P.  (2006).  Anthropology in the clinic:  The problem of cultural competency and how to fix it.  Public Library of Science Medicine, 3, e294.
  4. The photo shows students who are participating in a summer program at the Centers for Disease Control.  Reprinted with permission from the Centers for Disease Control/Debora Cartagena.


The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 12/10/2015, Michael_Koger
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