Conference – STRUCTURAL COMPETENCY: New Medicine for the Institutional Inequalities that Make Us Sick

Jonathan Metzl and Helena Hansen, Organizers

Friday, March 23, 2012.  10:30am-5pm.

NYU Department of Social and Cultural Analysis, 20 Cooper Square, NY, NY, 10012.

Event is free and open to the public, but space is limited.  Please RSVP at

This one-day working conference explores a new politics for understanding the relationships among race, class, and symptom expression. In clinical settings, such relationships often fall under the rubric of “cultural competency,” an approach that emphasizes recognition of the divergent sociocultural backgrounds of patients and doctors, and the cultural aspects of patients’ illnesses.

Increasingly, however, scholars and activists recognize that oft-invisible structural level determinates, biases, inequities, and blind spots shape definitions of health and illness long before doctors or patients enter examination rooms.  This evolving literature suggests that conditions that appear from a biomedical framework to result from actions or attitudes of culturally distinct groups need also be understood as resulting from the pathologies of social systems.  And, that locating race-based symptoms on the bodies of marginalized persons risks turning a blind eye to the racialized economies in which marginalized and mainstreamed bodies live, work, and attempt to survive.

The interdisciplinary scholars assembled for this working conference will debate how biomedicine might more directly engage with structural forces even as it works to better understand and treat particular persons.  Its central argument is that a host of issues defined in the clinical arena as “symptoms” (depression, hypertension, obesity, smoking, medication “non-compliance,” trauma, psychosis) need to be more fully addressed as the downstream implications of a number of upstream decisions (food delivery systems, zoning laws, urban infrastructure/infrastructure failure, medicalization, diagnostic codes) if they are to be effectively addressed in clinical and cultural domains.  And, that increasing scientific awareness of the ways in which structural pressures produce symptoms in individual patients—through cortisol levels or epigenetic mechanisms, for instance—needs to be better coupled with medical models for structural change.

Structural competency converses with past models, from structuralism to structural racism, to demonstrate how institutional, political, and economic forces generating stigma are invisible to actors on the ground.  But it does so with the ultimate aim of developing new platforms, practices, and agendas that address health issues in the present day; a time when structural-level disparities become more unjust at the same time that the agents producing them become more evanescent.

Specific questions that the working conference will address include:

  • What structures help define illness and health?  To what means, and to what ends?
  • What methods exist (or need to be developed) for training clinical eyes to see social contexts?
  • What competencies and interdisciplinary sensibilities are required in order to act on these structures?
  • Which imaginative structural approaches to promoting social justice might medical and public health practitioners adapt from practitioners and activists in fields outside of medicine?
  • What alliances and new forms of coalition need to emerge in order to impart structural change?


10:00am Welcome: Mary Louise Pratt, Chair, NYU Department of Social and Cultural Analysis

10:10am Introduction: Structural Competency

Jonathan Metzl (Vanderbilt University) Helena Hansen (New York University)

10:40am    Bruce Link and Jo Phelan (Columbia): Seeing the Structure of Inequality

11:10am Panel 1: Structure: Theoretical Models

Philippe Bourgois (U Penn): Structural Vulnerability

Dalton Conley (NYU): Structures of Socioeconomic Status

Alondra Nelson (Columbia): Structures of health activism

Michael Ralph (NYU): Structures of liability

Moderator: Emily Martin (NYU)

12:30pm    Lunch on-site

1:15pm     Mindy Fullilove (Columbia): Urban Restoration as Competent Medicine

1:40pm     Panel 2: Competency: Structural Intervention

Jack Geiger (CUNY): Origins and Future of Competent Social Medicine

Ernie Drucker (John Jay): Incarceration and Drug Policy as Key Sites of Intervention

Mehret Mandefro (Truth Aid): Visual Media as Structural Intervention

Irène Matheiu (Vanderbilt) Medical Student Deliveries to Food Deserts

Kathryn Church (Ryerson University): Service User Activism

Moderator: Rayna Rapp (NYU)


3:10pm     Break

3:20pm     Roundtable:  Discussion and Future Steps

Marc Gourevitch (NYU)

Kim Hopper (Columbia, NYU, Nathan Kline Institute)

Brad Lewis (NYU)

Neely Meyers (George Washington)

Thuy Linh Tu (NYU)

Moderator: Jonathan Metzl

4:30 Closing Remarks Helena Hansen and Jonathan Metzl

Post-Conference Film Event:

5:00 Robert Anderson (NYU): Introduction and Screening of Film: All of Us (Mehret Mandefro, 2008)

(Pizza and Light Snacks)

5:40 Faye Ginsburg (NYU): Film Discussion with Mehret Mandefro

6:30 Poststructural Decompression (ie, after party)  (Location TBA)

Co-hosted by the NYU Department of Social and Cultural analysis and the Vanderbilt Center for Medicine, Health, and Society as a part of a new collaborative venture between the two units.

Co-Sponsors: NYU Medical Center Division of Medical Humanities, Center for the Study of Recovery in Social Contexts, Nathan Kline Institute

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