The influence of social inequalities on health and health care has been widely documented1. The current challenge is determining how to train health professionals to reduce the impact of these inequalities within health care organizations as well as through direct patient care.1 , 2 The integration of health disparities and the social determinants of health into medical curricula has not yet been adequately addressed. While efforts are being made, most educational initiatives focus on the patient and not the societal constraints leading to disparities.3

The research by Neff and colleagues4 is an interesting and novel effort to address the effects of social structures such as economic, judicial or educational systems on health inequality, through the delivery of structural competency training to residents working with disadvantaged patients. The 3-hour training session aimed not only to raise awareness, but also to equip residents with the skills to respond to the downstream effects of societal structure. The session concluded with a discussion of practical and impractical strategies for dealing with the detrimental effects of social structure. Residents reported increased awareness of the effects of social structures on patients’ health, as well as distress at the lack of practical tools to address these issues. The authors ponder whether these residents might be more receptive to training because their residency already emphasizes care for the underserved, or whether the impact might be yet stronger in residencies with less of a focus.

Research findings highlight the difficulties involved in educating health professionals on the social determinants of health and societal structures. Health care organizations are usually not the culprit in unwarranted differences between populations; as such, the role, scope and strategies health professional can adopt for reducing these unwarranted differences is still not clear. A recent literature review by the Institute of Medicine’s Global Forum on Innovation in Health Professional Education found that current educational efforts to address social determinants are delivered mostly in a classroom setting and lack practical strategies for how health professionals can address these differences.2 For medical educators, this study provokes thinking on how we may address the issues of social structures and health inequality, looking beyond the classroom or even clinical setting, and thinking of practical strategies to train future generations.