A new series in The Lancet, led by Dr. Seth Holmes, Chancellor’s Professor of Environmental Science, Policy and Management at the University of California, Berkeley, is aiming to shift how medical professionals approach patient care by emphasizing social context alongside biological factors.
Dr. Holmes, who also co-chairs the Berkeley Center for Social Medicine and co-directs the joint medical anthropology Ph.D. program between UC Berkeley and UCSF, has spent years studying global health disparities and social hierarchies. He argues that clinical case studies—traditionally presented from a strictly medical perspective—often overlook cultural and societal influences on health.
The monthly series brings together experts from the social sciences, humanities, and community members worldwide to analyze patient cases through broader frameworks. The team created what they call a “translational social medicine toolkit,” designed to help healthcare professionals address underlying structural causes of health inequities.
“We hope that these cases will help orient health care practice and become a source of solidarity as we organize to confront obstacles to health and well-being for all in an interconnected world,” Holmes wrote in an essay introducing the series.
The first case featured a 22-year-old woman in Japan with a rare genetic disorder who encountered barriers due to fragmented medical services—a phenomenon described as “medical compartmentalization.” The team explained how such compartmentalization can harm patients whose conditions do not fit into clear categories.
“We want a middle-range theory that can be relevant in lots of other clinics, hospitals, policies and countries in the world but also really touches ground with this particular patient or case,” Holmes said. “And then we try to make sure the theory would both show the depth of social theory and be really understandable.”
Another recent article discussed a 45-year-old asylum seeker suffering kidney stone complications at the U.S.-Mexico border. After initial treatment in Tijuana, he faced difficulties obtaining adequate care while detained in an Immigration and Customs Enforcement facility. Carlos Martinez, assistant professor at UC Santa Cruz and lead author on this case study, emphasized the need for “structural intercompetency”—the ability for clinicians to recognize legal, political, economic, and social processes affecting patients’ health.
“They, of course, cannot be experts in all those systems,” Martinez said. “What we’re really asking is that clinicians become familiar with the other experts who could help in a given patient’s care.”
Holmes’s team reviewed over 400 submissions from institutions worldwide before selecting cases most relevant for exploring social concepts. Last year they organized a three-day conference in Chicago—co-sponsored by UC Berkeley and funded partly by the National Institutes of Health—which brought together doctors, nurses, researchers from various disciplines as well as community members including human rights organizers and Indigenous health workers.
“One of the goals of the team was to reach out as far as we could beyond the usual places,” Holmes said. “To support people whose lives, stories, health, health care and concepts could be really important for the world to read but who might not usually have as easy a time publishing in a place like TheLancet.”
The project builds on similar work previously published by Holmes’s group in American journals but now targets global audiences through The Lancet’s platform.
“How much can one article a month do in the midst of active authoritarian regimes? I’m not sure,” Holmes said. “But we’re all working hard to develop these articles to keep people who care about health thinking critically and aware of what’s going on, to have empathy and solidarity for people who they might otherwise consider quite different than them.”
More information about Dr. Seth Holmes is available on his website (https://sethholmes.berkeley.edu/). The introductory piece explaining this initiative can be found at The Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00994-5/fulltext), along with access to both published case studies (https://www.thelancet.com/case-studies-social-medicine).
