Health, Humanities, and Society Program

Narrative and Historical Perspective

This competency addresses the ways in which health knowledge and practice can be improved through attention to narrative’s structures and functions and through an informed historical perspective. The narrative component of this competency trains students both to understand how stories work and to analyze the stakes and effects of the particular plots and conventions from the professional and popular cultures of health. It teaches students to see the ways in which interpersonal interactions are necessarily structured by the stories we tell and receive from others, and that these stories are built from what is said, from what is not said, and from the material, social, and cultural factors that shape those narratives. Finally, narrative competency asks students to understand the complexity of point of view and the degree to which our stories are never wholly our own, encouraging them to consider what our ethical obligations are given the structural and interpersonal complexities of narrative. The historical competency teaches students to interrogate the histories (genealogies) of contemporary health thought and practice, in addition to appreciating the contingency of these histories. The study of health and healthcare will certainly look different in the future, and a competence in historical perspective equips students to understand how, why, and under what conditions historical change happens.

Observation

This competency trains students to attend more critically and carefully to health topics and to become better observers. Drawing from the distinct expertise of particular disciplines and interdisciplinary approaches this competency trains students to attend differently to the subjects of knowledge and to the objects they observe. This competency prepares students to answer questions that include: What assumptions, technologies, and ways of thinking structure our observations? What are the histories of observation and attention and what can we learn about our own ways of attending and observing from this history? How do different disciplines and interdisciplinary approaches help us attend and observe differently—particularly in ways that make space for ways of knowing that are different from our own? How can we work toward ways of attending and observing that are more ethical, equitable, and inclusive? And, how can we remain aware of the ways in which our own methods and observations have been shaped by our training and lived experience and work toward remaining open to new ways of seeing and knowing?

Ethics and Judgment

Healthcare is, at various levels, governed by a variety of foundational moral values and principles, such as justice, beneficence, and non-maleficence—but the application of these values and principles is no simple matter. These values often present conflicting recommendations and it is often unclear what each value or principle recommends. This pair of competencies prepares students to understand and adjudicate these difficulties, preparing them to make responsible informed decisions. Students will learn how to identify the ethical contours of a wide variety of healthcare debates at various levels of organization, including individual, interpersonal, social, and cultural levels. A key component of this competency is rigorous and informed analysis and an ability to articulate and identify value-laden judgments.

Structural Competency

This competency challenges students to recognize how social, environmental, and biological forces interact to promote wellness or to produce illness. Students will learn how systemic forms of injustice and exclusion (such as racism, sexism, homophobia, and ableism) lead to disparities in health outcomes or healthcare delivery. Students will also study the historical origins of American healthcare institutions as a platform for understanding our rapidly changing health policy landscape. This will include how some social problems come to the attention of—and fall under the purview of—the medical profession, and the reasons why patients may resist medical social control and pursue care through complementary and alternative medical practices. Students will also learn to appreciate how patients experience acute or chronic illness and why they may describe those experiences in a language distinct from that used by healthcare professionals. This training in what Jonathan Metzl has called “structural competence” opens up opportunities to “observe and imagine structural interventions” that can improve health and healthcare (Metzl and Hansen 2014).