- Promoting a More Comprehensive Way of Understanding “Structural Competency”
Through intertwining personal narrative and facts/figures, Villarosa is able to incorporate several aspects of structural competency using a pertinent issue in American social infrastructure. One way in which Villarosa does this is through addressing the second core competency—what Metzl and Hansen call “developing an extra-clinical language of structure” (129). Villarosa focuses on how illness is impacted by communal infrastructure by mentioning that “For black women in America, an inescapable atmosphere of societal and systemic racism can create a kind of toxic physiological stress, resulting…directly to higher rates of infant and maternal death.” She purposefully chooses to direct the reader’s attention to societally-embedded factors as roots to individual healthcare problems like those of Landrum. This complements Metzl and Hansen’s advocacy of employing epigenetics to connect the realms of healthcare and societal structures—an area they believe is growing in understanding “the impact of social environments on metabolisms or genetics [whereas] concepts of actual social structures and social forces lag behind” (129). In this case, Villarosa goes beyond analyzing the present tendency of “social environments” and instead traces maternal health issues of black women to both historical and current racial structures that undermine these women. In doing so, Villarosa presents a powerful image of how illness can be explored as a complex interplay with structural and systemic issues.
- Hinderances to Understanding “Structural Competency”
Although using facts/figures in conjunction with a personal narrative provides various advantages to understanding structural competency, there are some drawbacks to this method that hinder it as well. Throughout most of her article “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis,” Villarosa narrows specifically on Simone Landrum and her encounters with maternal healthcare. Although there are a few references to the population of American black mothers, the focus of the article is mainly on this one individual. This can be seen as a hinderance to understanding structural competency in that Metzl and Hansen promote the use of structural competency to shift clinical perspective “from an exclusive focus on the individual encounter to include the organization of institutions and policies” (127). In several instances throughout the article, Villarosa decides to emphasize Landrum’s own experiences in the context of an individual life, detracting from the main purpose of structural competency as one that places an individual in a bigger context of systematic societal organization.