Structural Competency and Personal Narrative – Katy Meier

Prompt: In describing the experience of being black and pregnant, Villarosa intertwines a personal narrative and facts/figures. Explain why might or might not be an effective way to better understand Metzl and Hansen’s concept of “structural competency?”

Structural competency is an educational approach devised by anthropologists that focuses on the social and economic structures of healthcare and involves training in 5 core themes. These include factors that shape clinical encounters, structural language outside the clinic, defining culture in structural terms, creating structural interventions, and structural humility (Metzl and Hansen 126). Metzl and Hansen portray structural competency as an action-oriented approach requiring education, arguing that “clinicians require skills that help them treat persons that come to clinics as patients, and at the same time recognize how social and economic determinants, biases, inequities, and blind spots shape health and illness” (Metzl and Hansen 127). However, they describe the premises of structural competency with a very abstract and theoretical attitude which manifests itself in the genre and language they employ. Metzl and Hansen publish this article in the academic journal titled “Social Science and Medicine”, targeting their research towards a scholarly audience interested in theory. In addition, their use of matter of fact and generalized language to describe overall conditions of “food deserts” and “zoning laws, economics, schools, and courts,” furthers this abstract tone of the article as opposed to inclusion of personal narratives (Metzl and Hansen 127). It pairs this objective language with action-oriented and encouraging language such as “our call for structural competency” (132) and “clinical training must shift its gaze” (127) in order to motivate the reader to apply this theoretical approach to medical education. Unfortunately, I think these literary devices detract from the personal implications of a structural competency approach, creating a detached feeling in the reader. I believe that the literary devices employed by Villarosa more effectively portray the important purpose and core meaning of structural competency through how she interweaves personal narratives with statistics. Since Villarosa is working within the genre of a popular news article, she has the advantage of using photographs, hyperlinks, dialogue, and block quotes to communicate more clearly the core principles of structural competency and its urgent need. Metzl and Hansen’s journal article explicitly state the core principles of structural competency and the need for it to be put into practice. On the other hand, Villarosa conveys the same idea but uses more subtle and implicit techniques that elicit emotion from the reader, communicating the idea of structural competency in a more impactful manner. Villarosa uses Landrum’s story to embody the social and economic structural difficulties addressed in Metzel and Hansen’s article. And uses Giwa to exemplify the positive effects of a structural competency approach in action because she was aware of the structural barriers faced by Landrum yet managed to navigate them and make the birth of Landrum’s fourth child a better experience. Ultimately, I believe that focusing on a specific situation that embodies structural competency, as Villarosa did, is a more effective communication method as opposed to exploring the theoretical framework of a concept as Metzl and Hansen did.


Works Cited

Metzl, Jonathan M, and Helena Hansen. “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality.” Social Science & Medicine, vol. 103, 2013, pp.126–133.

Villarosa, Linda. “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis.” The New York Times, The New York Times, 11 Apr. 2018,