Hansen H, Metzl J
New York University, New York, NY, USA.
Nathan Kline Institute, Orangeburg, NY, USA.
J Bioeth Inq. 2016 Jun;13(2):179-83. doi: 10.1007/s11673-016-9719-z. Epub 2016 May 13.
This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine.
《生物伦理探究杂志》的本次专题研讨会阐述了结构胜任力：临床从业者如何对健康的社会和制度决定因素进行干预。这将需要培训临床医生，使其认识到健康方面的结构障碍并采取行动，从医学以外的领域借鉴富有想象力的结构性方法，并与医学以外的学科和机构开展合作。本卷中展示了在所有这些层面上有效工作的案例研究。撰稿人从多个角度例证了结构胜任力，从表观遗传学对个性化医疗中环境干预的影响，到临床医生针对疾病根本原因采取行动、解决临床培训中的权力滥用问题、消除城市种族隔离以减少健康差距、解决警察实施酷刑的系统性原因，以及在惩罚性毒品法律面前实施减少成瘾危害项目等方式。这些撰稿人共同展示了临床医生在打破健康方面的系统性障碍中可以发挥的独特作用，以及美国医疗保健系统从美国以外和临床医学以外采用创新方法所带来的益处。
