Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.
Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.
复制标题
DOI：
10.1097/acm.0000000000001294
复制
发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Quesada J
中科院分区：
文献类型：
--
作者：
Bourgois P;Holmes SM;Sue K;Quesada J
作者建议重振和扩展传统的社会历史，超越其狭窄的危险行为范围，使临床医生能够解决社会健康决定因素施加的负面健康后果。在这一视角下，他们概述了一种新颖、实用的医疗脆弱性评估问卷，该问卷将社会科学的“结构性脆弱性”概念应用于临床实践。提出了一种结构性脆弱性评估工具，旨在突出特定的地方等级和更广泛的权力关系通过哪些途径加剧个别患者的健康问题，以帮助临床医生识别可能从额外的多学科健康和社会服务中受益的患者。为了说明该工具如何在时间和资源有限的环境中实施(例如，急诊科)，作者对比了两个结构脆弱的患者的不同结果。在临床实践中操作结构性脆弱性，并将其引入医学教育，可以帮助卫生保健从业者更清楚、更关键、更实际地思考社会结构使人生病的方式。评估工具的使用可以促进“结构性能力”，这是一个潜在的新的医学教育优先事项，以提高对社会条件和实际后勤如何削弱患者获得医疗保健、坚持治疗和成功改变生活方式的能力的理解。在卫生保健中采用结构性脆弱性框架也可以证明有理由调动临床环境内外的资源，以改善患者立即获得护理和长期健康结果的机会。最终，这一概念可能会将医疗保健提供者导向政策领导，以减少健康差距并促进健康公平。
The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of “structural vulnerability.” A Structural Vulnerability Assessment Tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients’ health problems is presented to help clinicians identify patients likely to benefit from additional multi-disciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote “structural competency,” a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.