Petty JP, Metzl JM, Keys M. Developing and Evaluating an Innovative Structural Competency Curriculum for Pre-Health Students.  Journal of Medical Humanities,(2017) 38: 459, doi:10.1007/s10912-017-9449-1;

Structural competency has emerged as an important new framework for understanding relationships between medical and social domains. Structural competency (Metzl 2010; Metzl and Hansen 2014; Metzl and Roberts 2014) builds on cultural competency to provide a framework that imparts to medicine the notion that matters of race, ability, sexual orientation, socioeconomic class, or other markers of difference shape interactions between patients and doctors. Whereas cultural competency focuses mainly on identifying clinician bias and improving clinical communication, structural competency emphasizes diagnostic recognition of the economic and political conditions that produce health inequalities in the first place. Structural competency calls on healthcare providers not only to recognize how institutions, markets, or healthcare delivery systems shape symptom presentations but also to mobilize for correction of health and wealth inequalities in society.