Structural Competence


National Institutes of Health Ending Structural Racism - This webpage directs users to key information and websites that describe National Institutes of Health (NIH) efforts to redress structural racism and promote racial equity and inclusion.  (Link)

Structural Competency Handouts - Developed by the Berkeley Rad Med Critical Social Medicine Collective Structural Competency Working Group, theses handouts include key concepts, a structural violence checklist, interventions, case studies and exercises.  (Link)

Structural Competency: New Medicine for Inequalities That Are Making Us Sick - This site provides access to training materials (e.g., articles, webinars, curriculum) on structural competence from a global structural competency network. (Link)

Structural Competency Working Group - The Structural Competency Working Group is comprised of healthcare workers, scholars, public health professionals, students, educators, and other community members. They help promote the training of health professionals in structural competency and have developed and disseminate open-use structural competency curricula.  (Link)

HealthBegins - Health begins upstream provides upstream education and training for healthcare professionals. Their practical, skills-oriented educational content and training materials, along with an Upstream Quality Improvement approach, is used across the country as part of curricula in universities, medical schools, and other graduate schools and continuing medical education (CME) courses.  (Link)


Ali, A., & Sichel, C. E. (2021). Reenvisioning undergraduate teaching in psychology through structural competency and radical justice. Canadian Psychology/Psychologie Canadienne62(4), 385.

Avant, N. D., & Gillespie, G. L. (2019). Pushing for health equity through structural competency and implicit bias education: A qualitative evaluation of a racial/ethnic health disparities elective course for pharmacy learners. Currents in Pharmacy Teaching and Learning11(4), 382-393.

Bailey, D. et al. (2017). Structural racism and health inequities in the USA: Evidence and interventions.  Lancet, 389(10077), 1453–1463.

Bourgois, P., Holmes, S., Sue, K. & Quesada, J. (2017). Structural vulnerability: Operationalizing the concept to address health disparities in clinical care. Acad Med., 92(3), 299-307.

Braveman, P. & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Rep. 2014;129(suppl 2):19–31.

Bromage, B., Encandela, J., Cranford. M., Diaz, E., Williamson, B., Spell, V., et al. (2019). Understanding health disparities through the eyes of community members: A structural competency education intervention. Acad Psychiatry, 43(2), 244-247.

Brown, A., Ma, G., Miranda, J., & Eng, E., et al. (2019). Structural interventions to reduce and eliminate health disparities. Analytic Essay, 109(51), 572-578.

Burson, R. C., Familusi, O. O., & Clapp, J. T. (2022). Imagining the ‘structural’ in medical education and practice in the United States: A curricular investigation. Social Science & Medicine300:114453.

Castillo, E. G., Isom, J., DeBonis, K. L., Jordan, A., Braslow, J. T., & Rohrbaugh, R. (2020). Reconsidering systems-based practice: Advancing structural competency, health equity, and social responsibility in graduate medical education. Journal of the Association of American Medical Colleges95(12), 1817.

Chambers, J. E., & Ratliff, G. A. (2019). Structural competency in child welfare: Opportunities and applications for addressing disparities and stigma. J. Soc. & Soc. Welfare46, 51.

Davis, S., & O’Brien, A. M. (2020). Let’s talk about racism: Strategies for building structural competency in nursing. Academic Medicine95(12S), S58-S65.

Downey, M. M., & Gómez, A. M. (2018). Structural competency and reproductive health. AMA Journal of Ethics20(3), 211-223.

Downey, M. M., Neff, J., & Dube, K. (2019). Don't just call the social worker: Training in structural competency to enhance collaboration between healthcare, social work and medicine. J. Soc. & Soc. Welfare46, 77.

Drevdahl, D. J. (2018). Culture shifts: From cultural to structural theorizing in nursing. Nursing Research67(2), 146-160.

Duncan, L. G. (2019). Clinical applications of structural competency: A select bibliography. In Structural competency in mental health and medicine (pp. 219-225). Springer, Cham.

Godley, B. A., Dayal, D., Manekin, E., & Estroff, S. E. (2020). Toward an anti-racist curriculum: Incorporating art into medical education to improve empathy and structural competency. Journal of Medical Education and Curricular Development7, 2382120520965246.

Grossman, L. G., Mechanic, O. J., Orr, Z., Cioe‐Peña, E. C., Landry, A., Unger, S., ... & Alpert, E. A. (2021). An analysis of social determinants of health and structural competency training in global emergency medicine fellowship programs in the United States. AEM Education and Training5, S28-S32.

Hansen, H., Braslow, J., & Rohrbaugh, R. M. (2018). From cultural to structural competency—Training psychiatry residents to act on social determinants of health and institutional racism. JAMA psychiatry75(2), 117-118.

Hansen, H., & Metzl, J. M. (2017). Structural competency. Academic Medicine, 92(3), 279-282. (Link)

Hansen, H. & Metzl, J. (2022). Structural competency in the U.S. healthcare crisis: Putting social and policy interventions into clinical practice. J Bioeth Inq,13(2), 179-83

Hansen, H. & Metzl, J. (2019). Structural Competency in mental health and medicine: A Case-based approach to treating the social determinants of health. NY: Springer Publishers.

Hansen, H., & Metzl, J. M. (2017). New medicine for the US health care system: Training physicians for structural interventions. Academic medicine: journal of the Association of American Medical Colleges92(3), 279.

Hardeman, R. R., Medina, E. M., & Boyd, R. W. (2020). Stolen breaths. New England Journal of Medicine, 383(3), 197– 199.

Harvey, M., Neff, J., Knight, K. R., Mukherjee, J. S., Shamasunder, S., Le, P. V., ... & Holmes, S. M. (2022). Structural competency and global health education. Global Public Health17(3), 341-362.

Harvey, M., McGladrey, M. (2019). Explaining the origins and distribution of health and disease: An analysis of epidemiologic theory in core master of public health coursework in the United States. Critical Public Health, 29(1), 1-13.

Hunt, J. E. (2022). Making space for disability studies within a structurally competent medical curriculum: Reflections on long covid. (Link)

Krishnan, A., Rabinowitz, M., Ziminsky, A., Scott, S. M., & Chretien, K. C. (2019). Addressing race, culture, and structural inequality in medical education: A guide for revising teaching cases. Academic Medicine94(4), 550-555.

Kyere, E., Boddie, S., & Lee, J. E. (2022). Visualizing structural competency: Moving beyond cultural competence/humility toward eliminating racism. Journal of Ethnic & Cultural Diversity in Social Work, 1-13.

Manchanda, R. (2013). The upstream doctors. (e-book). NY: TED Conference Publishers. (Link)

Martinez-Hernaez, A., Bekele, D., Sabariego, C. et al.  (2021). The Structural and Intercultural Competence for Epidemiological Studies (SICES) guidelines: A 22-item Checklist. BMJ Global Health, 6:e005237. doi:10.1136/bmjgh-2021-005237

McCluney, C. et al. (2018). Structural racism in the workplace: Does perception matter for  health inequities. Social Science Medicine, 199, 104-114.

Metzl, J. M., & Hansen, H. (2018). Structural competency and psychiatry. JAMA psychiatry75(2), 115-116.

Metzl, J. & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Sciences and Medicine, 103:126-133.

Metzl, J. M., & Roberts, D. E. (2019). Structural competency meets structural racism. The Social Medicine Reader, Volume II: Differences and Inequalities, Volume 2.

Metzl, J. & JuLeigh, P. (2017). Integrating and assessing structural competency in an innovative prehealth curriculum at Vanderbilt university. Academic Medicine, 92(30), 354-359.

Metzl, J., Petty, J. & Olowojoba, O. (2018).  Using a structural competency framework to teach structural racism in pre-health education. Social Science & Medicine, 199:189-201.

National Institute on Minority Health and Health Disparities. (2022). Structural racism and discrimination: Ending structural racism. Retrieved from https://www.nimhd. srd.html

Neff, J., Holmes, S. M., Knight, K. R., Strong, S., Thompson-Lastad, A., McGuinness, C., ... & Nelson, N. (2020). Structural competency: Curriculum for medical students, residents, and interprofessional teams on the structural factors that produce health disparities. MedEdPORTAL, 16, 10888.

Neff, J. A. (2016). Teaching structure: Lessons learned from curricular innovations in structural competency. Theses. UC Berkley (Link)

NIH Steering Committee. (2022). UNITE Progress Report. Bethesda, MD: NIH. Retrieved from

Orr, Z., & Unger, S. (2020). The TOLERance model for promoting structural competency in nursing. Journal of Nursing Education59(8), 425-432.

Orr, Z., Machikawa, E., Unger, S., & Romem, A. (2022). Enhancing the structural competency of nurses through standardized patient simulation. Clinical Simulation in Nursing62, 25-30.

Petty, J., Metzl, J. M., & Keeys, M. R. (2017). Developing and evaluating an innovative structural competency curriculum for pre-health students. Journal of Medical Humanities38(4), 459-471.

Salhi, B., Tsai, J., Druck, J., Ward‐Gaines, J., White, M. & Lopez. M. (2020.  Toward structural competency in emergency medical education. AEM Education and Training 4: S88-S97.

Shim, R. S. (2021). Dismantling structural racism in psychiatry: A path to mental health equity. American Journal of Psychiatry178(7): 592-598.

Torres, R. J. (2023). An Evaluation of a Structural Competency Training for School Nurses. Link

Tsevat, R. K., Sinha, A. A., Gutierrez, K. J., & DasGupta, S. (2015). Bringing home the health humanities: Narrative humility, structural competency, and engaged pedagogy. Academic Medicine, 90(11), 1462-1465.

Vora, S., Dahlen, B., Adler, M., Kessler, D. O., Jones, V. F., Kimble, S., & Calhoun, A. (2021). Recommendations and guidelines for the use of simulation to address structural racism and implicit bias. Simulation in Healthcare, 16(4), 275-284.

Waite, R., & Hassouneh, D. (2021). Structural competency in mental health nursing: Understanding and applying key concepts. Archives of Psychiatric Nursing, 35(1), 73-79.

Wrenetha, J., Reed, M., Swanson, B. & Schoeny, M. (2022). The need for a bold research agenda to address structural racism. Nursing Outlook, 70(50, 694-695.

Woolsey, C., & Narruhn, R. A. (2018). A pedagogy of social justice for resilient/vulnerable populations: Structural competency and bio‐power. Public Health Nursing35(6), 587-597.

Woolsey, C., & Narruhn, R. (2020). Structural competency: A pilot study. Public Health Nursing37(4), 602-613.