Part 2 of a two-part podcast featuring best-selling author Raj Patel, PhD, and physician and activist Rupa Marya, MD, discussing their new book “Inflamed: Deep Medicine and the Anatomy of Injustice.”
Decolonizing Health Care
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Welcome to Code WACK!, your podcast about America’s broken healthcare system and how Medicare for all could help. I’m your host, Brenda Gazzar.
How has colonialism impacted the most vulnerable people on earth — and America’s healthcare system? What can we do to help heal our inflamed bodies, our communities and our Earth? We recently spoke to Dr. Rupa Marya and Raj Patel, co-authors of the new book Inflamed: Deep Medicine and the Anatomy of Injustice.
Dr. Marya’s a physician, activist, mother and composer. She’s also an associate professor of medicine at UC San Francisco and cofounder of the Do No Harm Coalition. Raj Patel is a research professor at the University of Texas at Austin’s Lyndon B. Johnson School of Public Affairs. He’s penned several books, including the New York Times bestseller The Value of Nothing. This is the second episode from our interview.
Welcome to Code WACK! Dr. Marya and Dr. Patel.
Q: Tell me about colonialism and what it means for the health of the most vulnerable people on Earth?
Patel: When it comes to capitalist colonialism, what characterizes it is not merely that the duties are different, but that capitalist colonialism has some boundaries between society and nature and in society, originally they were just white Christian propertied men and after a while that boundary expanded and expanded mainly through other people fighting to be recognized as part of society, and as recently as 1924, that’s when Native Americans got the right to vote in this country, so you know, we’re still seeing the unfolding of the membership of society, but one of the things about society is that if you’re in society, then you get to exploit everything that’s outside, and that means you can exploit the planet, you can put to work in nature, you can put to work those human beings who are part of nature. And what that means is that systematically, women, people of color, Indigenous communities and the planet are all suffering as a result of the operations of power that allow a few rich white guys to accumulate quite a lot of money.
Q: Thank you, Raj. Did you want to say anything more about the health of the most vulnerable people?
Marya: Well, it’s not good for them. Clearly, and it’s getting worse every day if we look at what’s happening with the Amazon, and Brazil, what’s happening with our Indigenous people, you know, in every corner of the globe, they’re being threatened and their lifestyles and their forests that they protect are being threatened. It’s not good for people who are tending the earth right now. The farmers around the world, the small to medium farmers, the peasant farmers who are doing the most work in terms of stewarding our soils in responsible ways that can impact climate change, that can draw down CO2. So when we are living in a system that dominates and puts these people in increasingly precarious situations, including the working class, it doesn’t bode well for our health. It leaves people stressed. It leaves people traumatized. It leaves them insecure in the duties that they have to their ancestral lands and to the lands that they steward, which is literally bad for all of us.
Q: Hmm. Thank you. Bringing it back home to the US, colonization is all about resource extraction for profit, and that certainly seems to be the role commercial health insurance plays in our healthcare sector – draining the financial resources of families and communities to enrich shareholders and corporate executives. What role could a program like Medicare for All play in prioritizing the needs of patients and doctors?
Marya: Oh man. So Medicare for All is just the most sensible thing that can happen right now in this country if we look at the frontline decisions that were made during COVID and I work as a physician at UCSF in the hospital and we were wondering why were we not getting tested once a week? Why are we still not getting tested once a week? We have all these workplace exposures happening. Doctors and nurses are making patients sick, even though no one’s like checking to see if that’s the way the genotype is moving, because no one really wants to know, but they were questions that we had like why are nurses in trash bags, why don’t we have enough PPE? Why don’t we have elective surgeries and we’re in the middle of a surge? Why are we not being tested and then we find out. Oh, okay there’s a healthcare executive lobbyist who has the ear of (California Health and Human Services) Secretary (Mark) Ghaly here in California and (Gov.) Gavin Newsom. And so, our policies are not being driven by what is safe for patients and what is safe for providers in the midst of a deadly pandemic.
And if that’s the case, these entities have proven themselves defunct in terms of stewarding the public health and the common good and as we are approaching more disasters, more floods, more freezings, more wildfires, we need to have a healthcare system that can bring everybody in, and we need to have one where no one is afraid to access health care. So whether you’re undocumented, whether you are poor that you know that you can come and get health care and not be saddled with a lifetime of debt. And you know people don’t come to us who are in precarious economic situations and are far along in their disease processes because they’re afraid to be saddled with debt and it’s horrific to see. I just can’t even tell you how many patients I’ve seen just so crippled by fear of their finances when they should be spending the last few weeks with their families, of their lives, you know. Is this really the world we want to be in?
And so I’m working on a Healthy California for All Commission to try to move for single payer in California, and I’m very much supportive of that. And then on the national level, absolutely I think this could be a really big step and just making sure everyone can come under the care. So instead of those resources being extracted from the public good, in terms of health to go to pay shareholders and corporate executives, we just get rid of that C-suite, and we start focusing all that money into paying for patient care and paying for like the best care that we can provide.
I think that that will help open, you know, make it easier to deal with something like a pandemic or climate change, the climate health crises that are coming and that are already here. And it will also help diversify the kinds of health care that can be given, so in the work that we’re doing with the Healthy California for All Commission, it’s imperative that it’s not just the Western science medicine people, the MDs out there who are covered, but also a whole array of medical treatments that are helpful to people and that have data and have benefits, proven benefits for people whether it’s addressing food as medicine, and really looking at farmers as our frontline healthcare workers who should be paid like doctors and nurses to steward our soils to take care of our water and to provide people with food, like food should be a human right here in such a wealthy nation and not food that’s tainted by pesticides but healthy food, nutritious food that is grown on biodiverse soils. So it’s an interesting time to really think broadly about what health is and what health means, and what we can do to secure the health of our people and our planet at the same time.
Patel: Yeah, so having grown up with single payer health care in Britain, I mean I think it’s absolutely fantastic and we’ve seen, you know, the NHS giving people money so they get the bus home rather than extracting their last penny from them while they die in an ICU. It’s necessary but not sufficient. One of the ideas we have in Inflamed is that what we need is a care revolution, a revolution of care and repair, and the importance of reparation is I think illustrated quite nicely by the NHS in Britain, right? Who was in the front lines, who was still dying disproportionately under the huge wave of COVID in Britain despite an NHS that people were very excited about and were banging their pots and pans in the street in order to support? You know it was working class and people of color. And if we don’t have these societal transformations that recognize the damage that Britain in particular but that the state has caused in frontline communities, then we will have a healthcare system, that’s really like a food bank right that that’s there as a sort of safety net, a last resort for the most vulnerable people, which is to say the people who’ve been most affected by colonialism and unless we address that, the structural issues that are long historical issues. We’re going to end up with, you know, basically, a sort of a safety net and a rather frayed and impoverished safety net, rather than a system of care and transformation that we need in order to be able to heal the planet.
Q: Thank you. So Dr. Marya you mentioned the Healthy California for all Commission that Governor Gavin Newsom appointed to achieve access to health care for all Californians through a unified financing system, including single payer. What’s the latest with the Commission and what’s that experience been like for you?
Marya: I think the funniest part has been watching people like Dr. (Richard) Pan and Assemblyman (Jim) Wood kind of do this Red Scare technique, which has been sort of amusing to hear these words in the midst of so many people dying and losing their jobs and being in economic straits. In COVID just like, oh well you know Medi-Cal is so bad and then we’re going to have it so bad if we have you know a public healthcare system and it’s just terrible they’re gonna be these long wait lines and blah blah blah blah. And it’s just been amazing to see how tone deaf that is with what, you know, Californians overwhelmingly support, which is to have a public health system, to have a system that is a single-payer system.
So that’s been amusing and interesting to watch, like how you they’re speaking at these engagements with the healthcare industry lobbyists and why are those folks even involved in this discussion, I don’t know, because we have a duty to the public. We don’t have a duty to these corporations, and with the public and the public good right now, any delay getting access to care, to COVID care, any delay in someone coming to the hospital is another you know potential person who died when they didn’t have to die. We have effective treatments now and people, you know we’re much better at treating this disease than we were a year ago, but people are still hesitant to come if they are undocumented or they’re uninsured and I don’t want to call the ambulance and I don’t want to, you know, be in the emergency room and run up a bill. It’s like these are things that people should not be thinking of right now and so, you know we have another meeting coming up. I’ll keep going and push them to be more transparent and more accountable to the public in this conversation.
Q: Ok, thank you. A United Nations working group recently came out with its damning climate report that the UN Secretary General called a code red for humanity. How does the report’s findings tie into the findings and recommendations of your book?
Patel: Well, we begin the book, observing that the world’s on fire and the fact is there is now a branch of medicine or various branches of medicine geared towards treating the consequences of climate change, and those consequences range from a predictable heat stroke to worsening conditions for asthmatics to trauma and neurological disease, and there is a spectrum of diseases that are going to accompany climate change, that are entirely foreseeable and predictable and expensive. This is always the thing that baffles me about the United States. We spend 19% of our GDP on health care. Single payer health care systems are half that and do a much better job. And, of course, right now, as our planet heats up, our government is not doing the right thing. We’re still letting Line 3 go ahead, for example. We’re still encouraging the fossil fuel industry with subsidies. And part of the medicine we talk about in the book is the medicine of care and repair for the planet, and that means moving away from an economy, and an ecology that sets things on fire because the consequences are as we mentioned before, ones that will inflame the planet and inflame our bodies simultaneously.
Marya: It’s also moving away from the concepts that, you know, white men can save us or save the planet. So if there’s this move in regenerative agriculture that’s stacked with all these white male talking heads, who are out there on social media posting, you know, anti-vax statements and sharing like quasi-data with Ivermectin which will delay someone coming to care with COVID, where you know, these are folks who are spreading harmful disinformation that actually can impact Black and Brown communities who are dying from COVID, and so really having an analysis of, you know, is the people who’ve brought it to this point, is the mindset that brought us to the point, going to get us out of this? If capitalism, and its architecture of power has brought us to the point of a planet that’s on fire, and a healthcare system that is defunct, is that going to fix it? No it’s not. So who do we look to?
We look to the Indigenous people. We look to the farmers who’ve been doing this work for centuries trying to protect their seeds and their knowledge and their relationships. They are people who’ve been resisting capitalism for hundreds of years and they do a great job of it. So let’s uplift those people and those leaders and try to build a culture of care, informed by what they can teach us and so that’s really an important part of what we’re articulating and I should say, that doesn’t mean there’s not a role for white men right or not a role for people of European descent? There’s a role for all of us and that’s what’s so powerful about this work is decolonizing must involve all of us collectively together, but it must involve us together restructuring the dynamics of power that have brought us here. So there’s a lot of learning and unlearning to do and it’s messy and it’s unsettling and it’s challenging, but it’s also beautiful because there are kinds of relationships that can exist when those power structures are removed that never have had a chance to exist. There’s a kind of interaction that can happen, a kind of solidarity that can grow across lines that have been dividing us for a couple centuries.
Q: Can you each respond in 30 seconds, and this will be the final question. What can we as individuals do to help heal our bodies, our communities and our Earth?
Marya: We can join up with collectives, who are already doing that work. That’s what we can do.
Patel: Uh, yeah, and we can abandon the idea that there’s a pill for whatever it is that ails us. There isn’t anything that can be put into capsule form. The great sort of liberating moment here is the joy and human connection that the pharmaceutical industry and the insurance industry wants to take away from us, but we can rebuild back. That’s what capitalist colonialism has prevented us from enjoying and something that we can, I think, re-embrace again.
Thank you, Dr. Marya and Dr. Patel. Their new book is Inflamed: Deep Medicine, and the Anatomy of Injustice.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.
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