This document summarizes a certificate program on structural competence offered by the Center for Public Health Continuing Education. The program teaches practitioners to recognize how broader social, political, and economic factors impact patient vulnerability and health outcomes. It shifts the focus from individual beliefs and behaviors to the social contexts that influence health. The certificate includes webinars on various racial/ethnic groups that discuss histories of oppression, sociopolitical health barriers, and community engagement. The goal is to empower practitioners to address health inequities and stigma.

1. Advancing Cultural Competence in the Public Health and Health Care Workforce
is a free certificate program offered by the Center for Public Health Continuing
Education with funding from the NYS Department of Health.
The program is advancing the field of cultural competence by
offering training in structural competence.

2. Structural Competence
Advancing Cultural Competence in the
Public Health and Health Care Workforce
Elizabeth Campisi, Ph.D.
Program Coordinator
Center for Public Health Continuing Education
School of Public Health
University at Albany, SUNY
www.advancingcc.org

3. Dr. Jonathan Metzl developed the concept of structural competency at the
end of his 2011 book, The Protest Psychosis: How Schizophrenia Became a
Black Disease.
In 2013, he and Dr. Helena Hansen expanded on it in their influential article
Structural competency: theorizing a new medical engagement with stigma
and inequality. This certificate series program is based on that article.
We have added the concept of narrative humility to the program. It is a
philosophy of listening coined by Dr. Sayantani DasGupta. You can watch her
describe it in her 2013 Tedx talk, Narrative Humility: Listening as Social
Justice.
Where did this concept come from?

4. Structural competency seeks to shift the focus of traditional cultural
competency training from the beliefs and behaviors of individual
patients to the bigger picture: the health impacts of the social contexts
in which people live and work.
Your zip code predicts
your health better than
race or genetics do
Why?

5. Social Determinants of Health
(Source: Dalgren and Whitehead 2006)

6. Structural competency then, is the capacity of practitioners to recognize and respond to the
ways in which broad social, political and economic structures contribute to the vulnerability
and ill health of the individuals and communities we serve.

7. Structural competency training
teaches you to “discern how a host
of issues defined clinically as
symptoms, attitudes or diseases…
including
depression,
hypertension,
obesity,
smoking,
medication “non-compliance,”
trauma, and
psychosis...

8. are the outcomes of a
number of upstream
decisions about such matters
as health care and food
delivery systems, zoning laws,
urban and rural infrastructures,
medicalization, or even about
the very definitions of illness
and health.”
Source: Jonathan Metzl and Helena Hansen
(2013). Structural competency: theorizing a new
medical engagement with stigma and
inequality. Social Science & Medicine, 103, 126–133.

9. • Every story holds some element of the unknowable.
Narrative Humility
Source: Sayantani DasGupta, Narrative Medicine, Narrative Humility: Listening to the
Streams of Stories. Creative Nonfiction, Issue #52, Summer 2014
• Awareness of which stories, and whose stories, are told
and heard, and which are silenced or marginalized in
hospitals and other institutions.
• Reflexive - we can start by learning about ourselves
and how our life stories have built our own prejudices
and preferences.
• For all clinical encounters, not just for certain populations.

10. How this Structural Competency
Certificate Program
Benefits YOU

12. Staff Education Coordinators
• Online and on-demand makes it easy for shift workers.
• Can integrate with existing training or create new training
around the webinars.
• Bridges the culture of the clinic and population health, making it
relevant to Medicaid Redesign/DSRIP projects.

13. Hospital and Clinic Staff
• Provides a conceptual framework that clinicians can
use to take leadership roles in health care.
• Empowering - creates possibilities for more effective
and comprehensive treatment options.
• Addresses stigma and inequality in a way that
traditional cultural competency training does not.
• Raises awareness of power differentials present in
clinical encounters.

14. Public Health Workforce
• A cultural competency training that covers the
social determinants of health and health equity, with
some added concepts such as narrative humility.
• Includes the impact of public policies on population
health.
• Medicaid Redesign/DSRIP relevant!
• Illustrates the importance of closer ties among CBOs,
hospitals and local health departments.
• Bridges population and individual health

15. Components of the Certificate Program
Four series certificates
American
Indian
African
American
and Black
Latino/a
Asian
American

16. Historical frames of oppression
Sociopolitical barriers and challenges to health
Engagement with community activists and advocates
around health
Clinical Cases
Four “beats”

17. Program Certificate
Certificate for
American Indian
Series
4 webinars
Structure of the Certificate Program
2 Pre-requisite Courses
(take only once)
(take only once)
(take
Certificate for
Latino/a
Series
4 webinars
Certificate for
African American
and Black Series
4 webinars
Certificate for
Asian American
Series
4 webinars
Complete all 4 Series Certificates

18. Certificates
American Indian Series
Multigenerational Trauma: Effects of the Indian Boarding School Era
Women as First Environment – Bodies Telling Her/stories
Resilience from Our Roots
Urban Indian Issues in New York City and Buffalo
Latino/a Series
Latino/a Health Disparities: Beyond the Cultura Answer
Addressing Suburban Structures: Health and Latino Communities on Long Island
Being Structurally Vulnerable: “Deservedness,” Latino Migrant Laborers and Health
Structural Competency and Latino Health in Upstate NY

19. African American and Black Series
African American History for Health Care Providers
Mass Incarceration and Its Impact on Community Health
Structural Competency: A New Medicine for the Inequalities That Are Making Us Sick
Structural Competency: Engaging Stigma and Inequality in Medicine and Medical Training
Asian American Series
Structural Competency and Health Equity: Asian American Experience in New York City
Trauma and the Refugee Patient: Barriers and Strategies for care.
Violence Against South Asian Women: Understanding Cultural "Competency" of Structures that Heal
Community Health Workers Advancing Population Health Equity & Promoting Structural Competence
For more information, see our website www.advancingcc.org

20. Participants LOVE the Webinars!
“An emerging concept”
“Paradigm shift in how I look at competency”
“More effective approach than what is commonly called cultural competency,
which I have HUGE issues with.”
“It offered hope and was inspiring. It provided me with empathy”
“Clear, personal, multidisciplinary”
“Historical context was incredibly helpful and I look forward to that in future webinars.”

22. Questions?
Need advice on incorporating the certificate series into your existing training
program or on creating a new training program
based on the certificates?
Contact
Dr. Elizabeth Campisi
ecampisi@albany.edu
(518) 474-2285
Graduate Assistants
Jessica Somers
James Shuford
Advancingcc@Albany.edu
(518) 402-0330
www.Advancingcc.org

23. Metzl, Jonathan and Hansen, Helena (2013). Structural Competency: Theorizing a New Medical
Engagement with Stigma and Inequality. Social Science & Medicine, 103, 126–133.
Metzl, Jonathan (2011) . The Protest Psychosis: How Schizophrenia Became a Black Disease. New
York: Beacon Press, 2011.
References
DasGupta, Sayantani (2014). Narrative Medicine, Narrative Humility: Listening to the Streams of
Stories. Creative Nonfiction, Issue #52, Summer 2014.
DasGupta, Sayantani (2013). Narrative Humility: Listening as Social Justice. Tedx Sarah Lawrence
College, July.
Dahlgren, G and Whitehead, M. (2006). Levelling Up (part 2): A discussion paper on European
strategies for tackling social inequities in health. Copenhagen: WHO Regional Office for Europe.
Tsevat, Rebecca, et al. Bringing Home the Health Humanities: Narrative Humility, Structural
Competency and Engaged Pedagogy. Academic Medicine, 90:11, 1462-1465.
www.structuralcompetency.org