Structural vulnerability: operationalizing the concept to address health disparities in clinical care
Authors: Philippe Bourgois , Seth M. Holmes,, Kim Sue,, James Quesada,
Publication Year: 2017
Last Updated: 2019-10-07 14:55:16
Journal: Academic Medicine:
Keywords: structural vulnerability framework, structural vulnerability assessment, social history, Socialdeterminants of health, structural competency
Short Abstract:
The authors propose reinvigorating and extending the traditional social
history beyond its narrow range of risk behaviors to enable clinicians to address
negative health outcomes imposed by social determinants of health. In
this Perspective, they outline a novel, practical medical vulnerability assessment
questionnaire that operationalizes for clinical practice the social science
concept of “structural vulnerability.”
A structural vulnerability assessment tool designed to highlight the pathways
through which specific local hierarchies and broader sets of power relationships
exacerbate individual patients’ health problems is presented to help clinicians
identify patients likely to benefit from additional multidisciplinary health and
social services. To illustrate how the tool could be implemented in time- and
resource-limited settings (e.g., emergency department), the authors contrast two
cases of structurally vulnerable patients with differing outcomes.
Operationalizing structural vulnerability in clinical practice and introducing it in medical educationcan help health care practitioners think more clearly, critically, and practically
about the ways social structures make people sick. Use of the assessment tool
could promote “structural competency,” a potential new medical education
priority, to improve understanding of how social conditions and practical logistics
undermine the capacities of patients to access health care, adhere to treatment,
and modify lifestyles successfully. Adoption of a structural vulnerability
framework in health care could also justify the mobilization of resources
inside and outside clinical settings to improve a patient’s immediate access to
care and long-term health outcomes. Ultimately, the concept may orient
health care providers toward policy leadership to reduce health disparities
and foster health equity.
Abstract:
Operationalizing structural vulnerability in clinical practice and introducing it in medical educationcan help health care practitioners think more clearly, critically, and practically
about the ways social structures make people sick. Use of the assessment tool
could promote “structural competency,” a potential new medical education
priority, to improve understanding of how social conditions and practical logistics
undermine the capacities of patients to access health care, adhere to treatment,
and modify lifestyles successfully. Adoption of a structural vulnerability
framework in health care could also justify the mobilization of resources
inside and outside clinical settings to improve a patient’s immediate access to
care and long-term health outcomes. Ultimately, the concept may orient
health care providers toward policy leadership to reduce health disparities
and foster health equity.
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