In order to enhance the structural competency of medicine—the capability of clinicians to address social and institutional determinants of their patients’ health—physicians need a theoretical lens to see how social conditions influence health and how they might address them. The authors consider one such theoretical lens, fundamental cause theory, and propose how it might contribute to a more structurally competent medical profession.
My main reaction is that most physicians haven’t studied the history of social medicine and public health, for example, Rudolph Virchow. If they had, the importance of an upstream approach would be evident. This is beginning to change, gradually. For example at Harvard Medical School, first year students now take a required course, Introduction to Social Medicine and Global Health.
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