Income inequality is making Americans sick, according to a recent, groundbreaking article in Social Science and Medicine by Jonathan Metzl and Helena Hansen. “Diseased and impoverished economic infrastructures [help] lead to diseased or impoverished, or unbalanced bodies or minds,” they contend and demonstrate. Large discrepancies in how city and state resources are allocated mean poverty and income inequality are medical issues, but ones that American doctors are “ill-prepared” to address.
Their warning, published in February’s issue of the journal, spotlights a crucial health issue in post-recession America, where many parts of the country still languish economically. U.S. physicians, they observe, “have never known more about the ways in which the pathologies of social systems impact the material realities of their patients’ lives.” At the same time, contend Metzl (director of Vanderbilt’s Center for Medicine, Health, and Society) and Hansen (a professor of psychiatry and anthropology at NYU), “many of these physicians work in a country that has never invested less in infrastructure, or done less to correct fatal and fatalizing inequities—even in the aftermath of the Affordable Care Act.”
Our liabilities as a nation are as follows:
Bridges, roads, clinics, and public transportation and food distribution programs decay in many US urban settings, along with the social programs that sustained them (Davey, 2011). Some locales prosper, while many others face a state that urban planners define as “infrastructure collapse.” As U.S. Housing and Urban Development Secretary Shaun Donovan recently put it, “you can predict the life expectancy of a child by the zip code in which they grew up” (Bostic & Lavizzo-Mourey, 2011).
Traditionally, U.S. physicians are taught to diagnose their patients’ illnesses through attention to biological systems. But that emphasis leaves them ill-prepared to address structural issues in American society, including income inequality. In response to what they see as a growing crisis, both of funding and in understanding, Metzl and Hansen introduce a five-step way of training physicians based on a method they call “structural competency.” Structural competency, they write, in ways different to earlier emphasis on cultural competency, “teaches doctors to better recognize how medical issues such as hypertension, depression and obesity sometimes represent the downstream effects of societal decisions about such factors as food distribution networks, transit systems, or urban or rural infrastructure. And it promotes societal engagement by the medical profession ‘beyond the walls of the clinic.’”
Metzl and Hansen’s article can be found here.