Emma Kikerkov RR2 : Villarosa and Structural Competencey

Structural competency is defined by Metzl and Hansen as the “trained ability to discern how a host of issues defined clinically as symptoms, attitudes or diseases… also represent the downstream implications of a number of upstream decisions…”,  or in other words, how a patient’s disease may be a result of social determinants such as race, gender, etc. (128)

One issue that illustrates the need for structural competency is the high maternal mortality rate in black women, as seen in Linda Villarosa’s article.

The way that Villarosa’s article is written effectively demonstrates the need for structural competency because both facts/figures and personal narratives reveal different aspects of the black women maternal mortality crisis.

The facts and figures demonstrate that there is undeniable proof that black women are disproportionally die in childbirth through research that indicates “an inescapable atmosphere of societal and systemic racism can create a kind of toxic, physiological stress… that lead directly to a higher rate of infant and maternal death.” (Villarosa)These statistics also indicates how little progress is made by the states in terms of maternal mortality because there are no maternal mortality review boards, none of these deaths are being properly investigated. (Villarosa)

Something that facts and figures fail to do, however, is show how healthcare providers facilitate this phenomenon. Villarosa’s and Simone Landrum’s personal experiences as pregnant black women show how black women are given lower quality care, whether is intentional or not. This discrimination can be seen when Villarosa was accused by her perinatologist of drinking and doing drugs, and again when Landrum was dismissed by her patient when asking why she was given an incorrect dose of anesthesia. (Villarosa)

With the use of personal narratives in this article, this matter is made more tangible and statistics provide evidence for the maternal mortality crisis in black women; with both of these components, Villarosa effectively provides an example of an issue where structural competency is needed.



Jonathan M. Metzl, and Helena Hansen. Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality. 2014, pp. 126–33.

Linda Villarosa. Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis. Apr. 2018, https://www.nytimes.com/2018/04/11/magazine/black-mothers-babies-death-maternal-mortality.html.

Kleinman Chapter 1 Reading Response

Emma Kikerkov

Julio Villa-Palomino

ANTH 272

January 26, 2020

Kleinman’s reading is interesting because it delineates between three concepts that are practically interchangeable in our society.

Kleinman defines illness as “the lived experience of monitoring bodily processes…”, meaning that it is how a disease influences with the way that someone interacts with the world. Examples of subjective lived experiences of illness include not being able to get homework done because of excruciating headaches or having “distracting low back pain while we sit at work” (Kleinman 4). It is imperative to make the distinction between “sickness”, which is how society influences a disorder, from “disease”, which is the empirical diagnosis to why the body is in a state of distress, and illness because all of these three terms defines the universal experience of being unwell. However, the way our biomedical system is set up, we focus on curing the disease, even though that may not stop someone’s suffering (Kleinman 6). Kleinman refers to another problem in our biomedical system, which he calls the “…materialist pursuit of the biological mechanism of disease…”, which is the emphasis on medical training and medical devices, as opposed to social and psychological aspects of medicine, therefore illness and sickness is not being addressed (Kleinman 9).  In addition, the way disease is defined, it assigns sole blame on one person, instead of addressing other factors that may be causing the disorder, such as socioeconomic status, race, etc.  In order to adequately treat someone, we need to focus on all three of these components


Kleinman, Arthur. “The Meaning of Symptoms and Disorders.” The Illness Narratives: Suffering, Healing, and the Human Condition, Basic Books Inc, 1988, pp. 3–30.

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