The European refugee crisis has gained worldwide attention with daily media coverage both in and ... more The European refugee crisis has gained worldwide attention with daily media coverage both in and outside Germany. Representations of refugees in media and political discourse in relation to Germany participate in a Gramscian “war of position” over symbols, policies, and, ultimately, social and material resources, with potentially fatal consequences. These representations shift blame from historical, political-economic structures to the displaced people themselves. They demarcate the “deserving” refugee from the “undeserving” migrant and play into fear of cultural, religious, and ethnic difference in the midst of increasing anxiety and precarity for many in Europe. Comparative perspectives suggest that anthropology can play an important role in analyzing these phenomena, highlighting sites of contestation, imagining alternatives, and working toward them. [refugee, media, immigration, crisis, Germany, Europe]
The problem-oriented medical record is the widespread, standardized format for presenting and rec... more The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant observation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as a whole into separable "problems," the attempt to solve these "problems" as though they are independent of one another, and the mystification of translations in scale, which give rise to much of the uncertainty in medicine. Operating at the boundary of the chaotic and often ungraspable world of the suffering experience of the patient and the highly structured realm of the medical record, a patient presentation is one medium through which both a disciplined record of experience and disciplined medical practitioners are produced. This process functions to transform the human subject patient into a recognizable, generic clinical case, and the medical student into an identifiable, professional future physician.
Http Dx Doi Org 10 1080 17441692 2014 897361, May 13, 2014
Global health's goal to a... more Global health's goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, we propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it. Social medicine is a rich and relatively untapped resource for understanding the hybrid biological and social basis of global health problems. Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health's important agendas. This understanding - of global health as global social medicine - can coalesce global health's unclear identity into a coherent framework effective for addressing the world's most pressing health issues.
Global health's goal to a... more Global health's goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, we propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it. Social medicine is a rich and relatively untapped resource for understanding the hybrid biological and social basis of global health problems. Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health's important agendas. This understanding - of global health as global social medicine - can coalesce global health's unclear identity into a coherent framework effective for addressing the world's most pressing health issues.
Although immigration and immigrant populations have become increasingly important foci in public ... more Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of
morbidity and mortality follow inequities rooted in societal, political, and
economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena—social determinants of health and immigration—has resulted
in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
Every year, several hundred people die attempting to cross the border from Mexico into the United... more Every year, several hundred people die attempting to cross the border from Mexico into the United States, most often from dehydration and heat stroke though snake bites and violent assaults are also common. This article utilizes participant observation fieldwork in the borderlands of the US and Mexico to explore the experience of structural vulnerability and bodily health risk along the desert trek into the US. Between 2003 and 2005, the ethnographer recorded interviews and conversations with undocumented immigrants crossing the border, border patrol agents, border activists, borderland residents, and armed civilian vigilantes. In addition, he took part in a border crossing beginning in the Mexican state of Oaxaca and ending in a border patrol jail in Arizona after he and his undocumented Mexican research subjects were apprehended trekking through the borderlands. Field notes and interview transcriptions provide thick ethnographic detail demonstrating the ways in which social, ethnic, and citizenship differences as well as border policies force certain categories of people to put their bodies, health, and lives at risk in order for them and their families to survive. Yet, metaphors of individual choice deflect responsibility from global economic policy and US border policy, subtly blaming migrants for the danger e and sometimes death e they experience. The article concludes with policy changes to make USeMexico labor migration less deadly.
a b s t r a c t This paper utilizes eighteen months of ethnographic and interview research undert... more a b s t r a c t This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep medical professionals from seeing the social determinants of suffering of their unauthorized migrant patients.
This qualitative study employs participant observation and interviews on farms and in clinics thr... more This qualitative study employs participant observation and interviews on farms and in clinics throughout 15 months of migration with a group of indigenous Triqui Mexicans in the western US and Mexico. Study participants include more than 130 farm workers and 30 clinicians. Data are analyzed utilizing grounded theory, accompanied by theories of structural violence, symbolic violence, and the clinical gaze. The study reveals that farm working and housing conditions are organized according to ethnicity and citizenship. This hierarchy determines health disparities, with undocumented indigenous Mexicans having the worst health. Yet, each group is understood to deserve its place in the hierarchy, migrant farm workers often being blamed for their own sicknesses.
Every year, the United States employs nearly two million seasonal farm laborers, approximately ha... more Every year, the United States employs nearly two million seasonal farm laborers, approximately half of whom are migrants (Rothenberg 1998). This article utilizes one year of participant observation on a berry farm in Washington State to analyze hierarchies of ethnicity and citizenship, structural vulnerability, and health disparities in agriculture in the United States. The farm labor structure is organized along a segregated continuum from US citizen Anglo-American to US citizen Latino, undocumented mestizo Mexican to undocumented indigenous Mexican. The ethnography shows how this structure symbolically reinforces conflations of race with perceptions of civilized and modern subjects. These hierarchies produce what is now understood in medical anthropology as structural vulnerability among those with poor living and housing conditions, producing social disparities in health. The ethnographic data argue against the common presumption that social hierarchies are willed by powerful individuals by showing the structural production of these social inequalities and their concomitant health disparities.
The European refugee crisis has gained worldwide attention with daily media coverage both in and ... more The European refugee crisis has gained worldwide attention with daily media coverage both in and outside Germany. Representations of refugees in media and political discourse in relation to Germany participate in a Gramscian “war of position” over symbols, policies, and, ultimately, social and material resources, with potentially fatal consequences. These representations shift blame from historical, political-economic structures to the displaced people themselves. They demarcate the “deserving” refugee from the “undeserving” migrant and play into fear of cultural, religious, and ethnic difference in the midst of increasing anxiety and precarity for many in Europe. Comparative perspectives suggest that anthropology can play an important role in analyzing these phenomena, highlighting sites of contestation, imagining alternatives, and working toward them. [refugee, media, immigration, crisis, Germany, Europe]
The problem-oriented medical record is the widespread, standardized format for presenting and rec... more The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant observation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as a whole into separable "problems," the attempt to solve these "problems" as though they are independent of one another, and the mystification of translations in scale, which give rise to much of the uncertainty in medicine. Operating at the boundary of the chaotic and often ungraspable world of the suffering experience of the patient and the highly structured realm of the medical record, a patient presentation is one medium through which both a disciplined record of experience and disciplined medical practitioners are produced. This process functions to transform the human subject patient into a recognizable, generic clinical case, and the medical student into an identifiable, professional future physician.
Http Dx Doi Org 10 1080 17441692 2014 897361, May 13, 2014
Global health's goal to a... more Global health's goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, we propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it. Social medicine is a rich and relatively untapped resource for understanding the hybrid biological and social basis of global health problems. Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health's important agendas. This understanding - of global health as global social medicine - can coalesce global health's unclear identity into a coherent framework effective for addressing the world's most pressing health issues.
Global health's goal to a... more Global health's goal to address health issues across great sociocultural and socioeconomic gradients worldwide requires a sophisticated approach to the social root causes of disease and the social context of interventions. This is especially true today as the focus of global health work is actively broadened from acute to chronic and from infectious to non-communicable diseases. To respond to these complex biosocial problems, we propose the recent expansion of interest in the field of global health should look to the older field of social medicine, a shared domain of social and medical sciences that offers critical analytic and methodological tools to elucidate who gets sick, why and what we can do about it. Social medicine is a rich and relatively untapped resource for understanding the hybrid biological and social basis of global health problems. Global health can learn much from social medicine to help practitioners understand the social behaviour, social structure, social networks, cultural difference and social context of ethical action central to the success or failure of global health's important agendas. This understanding - of global health as global social medicine - can coalesce global health's unclear identity into a coherent framework effective for addressing the world's most pressing health issues.
Although immigration and immigrant populations have become increasingly important foci in public ... more Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of
morbidity and mortality follow inequities rooted in societal, political, and
economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena—social determinants of health and immigration—has resulted
in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
Every year, several hundred people die attempting to cross the border from Mexico into the United... more Every year, several hundred people die attempting to cross the border from Mexico into the United States, most often from dehydration and heat stroke though snake bites and violent assaults are also common. This article utilizes participant observation fieldwork in the borderlands of the US and Mexico to explore the experience of structural vulnerability and bodily health risk along the desert trek into the US. Between 2003 and 2005, the ethnographer recorded interviews and conversations with undocumented immigrants crossing the border, border patrol agents, border activists, borderland residents, and armed civilian vigilantes. In addition, he took part in a border crossing beginning in the Mexican state of Oaxaca and ending in a border patrol jail in Arizona after he and his undocumented Mexican research subjects were apprehended trekking through the borderlands. Field notes and interview transcriptions provide thick ethnographic detail demonstrating the ways in which social, ethnic, and citizenship differences as well as border policies force certain categories of people to put their bodies, health, and lives at risk in order for them and their families to survive. Yet, metaphors of individual choice deflect responsibility from global economic policy and US border policy, subtly blaming migrants for the danger e and sometimes death e they experience. The article concludes with policy changes to make USeMexico labor migration less deadly.
a b s t r a c t This paper utilizes eighteen months of ethnographic and interview research undert... more a b s t r a c t This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep medical professionals from seeing the social determinants of suffering of their unauthorized migrant patients.
This qualitative study employs participant observation and interviews on farms and in clinics thr... more This qualitative study employs participant observation and interviews on farms and in clinics throughout 15 months of migration with a group of indigenous Triqui Mexicans in the western US and Mexico. Study participants include more than 130 farm workers and 30 clinicians. Data are analyzed utilizing grounded theory, accompanied by theories of structural violence, symbolic violence, and the clinical gaze. The study reveals that farm working and housing conditions are organized according to ethnicity and citizenship. This hierarchy determines health disparities, with undocumented indigenous Mexicans having the worst health. Yet, each group is understood to deserve its place in the hierarchy, migrant farm workers often being blamed for their own sicknesses.
Every year, the United States employs nearly two million seasonal farm laborers, approximately ha... more Every year, the United States employs nearly two million seasonal farm laborers, approximately half of whom are migrants (Rothenberg 1998). This article utilizes one year of participant observation on a berry farm in Washington State to analyze hierarchies of ethnicity and citizenship, structural vulnerability, and health disparities in agriculture in the United States. The farm labor structure is organized along a segregated continuum from US citizen Anglo-American to US citizen Latino, undocumented mestizo Mexican to undocumented indigenous Mexican. The ethnography shows how this structure symbolically reinforces conflations of race with perceptions of civilized and modern subjects. These hierarchies produce what is now understood in medical anthropology as structural vulnerability among those with poor living and housing conditions, producing social disparities in health. The ethnographic data argue against the common presumption that social hierarchies are willed by powerful individuals by showing the structural production of these social inequalities and their concomitant health disparities.
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Papers by Seth Holmes
morbidity and mortality follow inequities rooted in societal, political, and
economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena—social determinants of health and immigration—has resulted
in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
morbidity and mortality follow inequities rooted in societal, political, and
economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena—social determinants of health and immigration—has resulted
in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.