Featuring physician and activist Rupa Marya, MD and best-selling author Raj Patel, PhD discussing their new book “Inflamed: Deep Medicine and the Anatomy of Injustice.”
INFLAMED: Colonialism, Climate Change & Health Care
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Welcome to Code WACK! Your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host Brenda Gazzar.
What’s the connection between the inflammation in our bodies and the inflammation of 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 is 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 best seller The Value of Nothing.
Welcome to Code WACK! Dr. Marya and Raj!
Marya: Code WACK! Sounds about right!
Q: (Laughter) Right. We’re calling code wack on America’s broken healthcare system. Your book Inflamed: Deep Medicine and the Anatomy of Injustice, was published in early August. How did the two of you come together to write this book and why did you pick this topic?
Marya: Well, we met many years ago as friends together at a protest against GMO foods, and our work has been in relationship and in conversation with each other for several years in terms of frontline work — myself in communities who are struggling for health and dignity and Raj, with peasant farming groups, and people also defining their criteria for health and dignity in different places of the world, and, yeah, it was time to write a book about medicine and Raj is the perfect person to do it with.
Q: Got it, Raj. Did you want to add anything to that?
Patel: Other than Rupa was being invited to the Dell Medical School here at the University of Texas at Austin to talk about her work around police violence as a medical and healthcare issue. And as I was driving Rupa back to the airport, we realized that there was just a lot more to say, a lot more that needed to be said and a lot more that the medical students really weren’t getting in terms of their education because there had been so many attempts to reframe medicine but none have gone as wide as they need to and so we really wanted to bring together our sort of joint expertise, and we, you know, our conversation, we realized as we pulled up to the airport, needed to go on for much, much longer and so it has.
Q: And what year was that that you had that conversation?
Marya: In 2018.
Q: Wow. I feel like you did a lot of research in a short time for this book.
Marya: Well, a lot of these ideas have been around in our minds, you know, for decades in our work and starting to notice patterns in the hospital and looking at the bodies of different people getting sick and noticing trends and starting to ask deeper questions about why people are getting sick in the ways that they are both in the hospital and then in my work as a traveling musician, where I would often use music as a way to investigate what was going on in the intersection between society and health and when you travel with a band with music people let you into their homes in a different way than when you travel, you know, as a researcher, as a doctor. And so I was really fortunate and blessed to have a lot of profound discussions, and you know really mind-shifting conversations with different groups who are leading the movements around health sovereignty around the world right now so it’s exciting to see you know like the folks shutting down line three right now I’ve learned so much from the Indigenous female leadership in these lands.
Q: Wow, thank you. So what’s the connection between inflammation in our bodies and inflammation on our earth?
Marya: The inflammatory response is the body’s way of addressing damage or the threat of damage, and so you know it’s an evolutionarily conserved response that involves the immune system, the endocrine system, the nervous system — so many of these anatomical systems that we used to think of as distinct and discrete even the gut all wrapped up in this response that you know traverses throughout the body. And when that damage is ongoing and there’s no chance for the body to restore and repair itself, then the inflammatory response unabated becomes a source of damage itself. And so we look at that through the lens of, you know, all the diseases that impact people who live in modern industrialized places — places that have been structured through colonialism — all of those people are suffering to some degree from inflammatory disease.
And so we look at, you know what is the cause of that inflammatory disease and that the diagnoses that we’ve been trained to do in medicine, which limit us to individuals and what’s going on in their bodies is not sufficient to addressing the patterns that we’re seeing which are population level and planetary, and therefore we offer a new diagnosis that allows us to make these connections between the inflammation that’s happening, you know, in our bodies and on the planet and, you know with climate change and COVID, both of these system levels arrangements show how we need system-level solution and they’re interrelated as we’re seeing right now with the wildfires and how wildfire smoke predisposes people to getting COVID .They think that COVID is probably traveling on the particulate matter in wildfire smoke, they’re also seeing that when you inhale wildfire smoke the toxic inflammatory response in the lungs responding to the particulate matter that’s inhaled from wildfire smoke is actually setting people up to worse outcomes if they happen to get COVID. So it’s like a double triple whammy. These things are interrelated. But maybe Raj, do you want to share a story?
Patel: One example that we have in the book is where we follow a smoke particle. We follow it from fields that have been set ablaze by a mixture of very bad historical policies that range from British colonialism to American exports of certain kinds of farming technique and technologies and so you see in India, for instance, how this smoke particle will journey from a field that once sustained vibrant life, which is now essentially sort of a green desert and travels all the way into the lungs of a woman who is a waste picker in one of the most polluted cities on earth in Delhi. And so the world is on fire through climate change and through the bad policies that exacerbate climate change but as a result, the inflammatory response in the body as the smoke particle goes in those inflammatory responses can range from Alzheimer’s to heart disease, and death in this particular case through a heart attack. But, you know, that they are of a piece, because the planetary inflammation and body inflammation are not metaphors for one another, but they are caused by one another, and it is usually frontline communities in this case, working class women in the poorest and most polluted places in India, who are on the frontlines.
Q: Got it. What about societal ills like racism? How does that play into all this?
Marya: Well, what we found that was so fascinating is that structures of damage and racism is one of them, air pollution, and the structural racism that makes Brown and Black people in this country more predisposed to living in places that have air pollution, that, that was another form of damage, and that racism drives inflammation on all sorts of levels in the body, and so that these structures that reinforce racism, whether they’re redlining or predatory loans or, you know, the crappy foods that are put into the neighborhoods of predominantly Brown and Black people. All of these things are systems of damage that predispose Black and Brown people to worse health outcomes.
Then you look at the healthcare industry itself, whether it’s the lack of access to care, from the private insurance company, the capitalist private for profit insurance companies to, you know even if everyone had access to care, still the structures and medicine themselves are racist so, you know, once you’re in the hospital, then you have to confront all the ways you know, the hospital has been arranged through colonial lines of power, and all of these things, you know, end up having a terrible outcome for Black and Brown people which is why we call on really starting to look at decolonizing medicine and that isn’t simply one thing like getting access to health care, which is important, but it’s then redefining the lines of power within our systems of health care so that it actually serves all people, which is not what it does right now.
Q: So the book rejects the logic of personal responsibility, to a certain degree, when so much of what shapes our health, is beyond individual control, like social, ecological, and biological circumstances that contribute to chronic illness. Some people might read that and come away feeling powerless over their health? How can we take back power over our health beyond personal choices? For example, how can we support policies that support well being?
Marya: Go for it Raj.
Patel: Right now, of course, we’re in a moment where this whole idea of personal choice is being weaponized to render us individual, and to forget our duties to one another. So for example, the vaccine debate – honestly, it’s baffling. You may hear that in my voice that I am not from, I was not born in the United States. And from Britain, the perspective on American vaccine hesitancy is just one of pure, pure bafflement. We don’t understand in Britain why quite so many people are quite so angry about their duties to one another. I mean it’s interesting what I mean in Britain we have something good that approaches the condition of Medicare for All. We have the National Health Service, and that is not a panacea as Rupa was just saying, you’re actually on the frontlines of Black, Asian and minority ethnic communities in the United Kingdom, and that work, it remains a project to bring about certain kinds of justice and equality in that situation. But nonetheless, the way that people are rising above this sort of cult of individualism is precisely by working together. That’s one of the big ideas that we have in the book is that, you can’t decolonize medicine as individual therapy.
And in fact, to imagine that there is a therapist for you who will help you decolonize is to get it precisely wrong. This is only the kind of work that can be done together. But that’s why it’s so emancipating, it’s not solitary, it’s not about you leaning back on the couch and talking about your mother. This is about us taking care of one another so that we can all decolonize together and I think that’s, that’s actually ultimately, this kind of movement building that’s required if we’re interested in transforming medicine and health and food and our planet.
Marya: And there’s also the liberatory aspect of not blaming the victim. So that you know, the way that we treat people with diabetes or experiencing obesity or, you know, chronic kidney failure, that they did something wrong, they must have done something, eaten poorly, they just didn’t exercise enough. But when you look at the way the systems are structured around a lot of those communities and people, there’s no way they can avoid diabetes, there’s no way they could avoid cancer. And so it shows how…. And there’s something, I call that, there’s a liberatory space in that for imagining health as a possibility, through changing those circumstances that it isn’t about personal failure, and to suggest that it is is cruel and that’s something that we say in the book, you know, the rising rates of diabetes in Indigenous communities around the world, Indigenous communities that have been structurally altered through colonial lines of power, that diabetes is a reaction to those genocidal practices and so if we want to make a dent in that, those health outcomes, we have to start looking at restructuring, like empowering the communities to reclaim and redefine their cultural practices around food, medicine, and their health, as opposed to just simply supplying everyone with endless supplies of insulin that cost more and more. And so that’s really, you know, where do you want to make the impact and how do you want to make the impact and as a physician, my practice is with individuals, but that can only take me so far in addressing the kinds of suffering I’m seeing at a larger scale.
Q: Right. Can you give us an example of a connection between disease and the food supply or food chain. I remember there were some interesting examples in the book.
Marya: Well, one thing that I found fascinating and you can see this in a lot of Indigenous communities, looking at the Dakotas Lakota Dakota territory where the Missouri River was dammed … and when the Missouri River was dammed just after that, the rates of diabetes went through the roof because when the Missouri River was dammed, the Cottonwood Forest where the people historically had harvested their foods and foraged for foods and medicine were flooded. So not only were the buffalo killed and then the people were enclosed on these reservations, these nomadic people who were some of the fiercest, most fierce resisters of colonial terror in the United States, but then once they were enclosed, they were then subjected to the commodity foods, where they don’t have their traditional food system so here’s the lard and the processed foods, and the refined sugars and flours and these things that their bodies had never had any history of that, that, that literally denude the gut microbiome that provides a really powerful antidote to inflammatory disease, right, and so the damming of a river caused the skyrocketing of diabetes through this stage after stage of altering the world, around these bodies that had been in harmony and in relationship with the entire web of life around them until colonialism, until the genocide of 60 million-plus buffalo, which was actually intentionally done. It’s not as if it was whoops, you know that just sort of happened. These policies were intentionally done to rip people away from the things that gave them strength and power, and for the folks in the plains, it’s the buffalo, which is the spiritual center of their communities as well as their food, their medicine their clothing, their shelter, and so to kill the buffalo was really to cripple a culture, it was a genocidal tactic.
And so, watching then as cultures reclaim their identities and reclaim their languages, for example there are Indigenous tribes in what is now called Canada who speak their language and are protected against diabetes when you control for all the other regular things that you think that diabetes is caused by like body mass index or these other things. So, you know, what is it about language and knowing who you are and understanding your relationship to the world around you that protects against diabetes and what does that say about the onset of diabetes? What is actually causing diabetes, that’s above and beyond I’m eating too much sugar. Of course the food system plays a huge role in what foods are available, and there are other things that are playing a role in what’s driving this inflammatory disease which we now understand diabetes is an inflammatory disease.
Q: Huh. It seems to me that feeling safe and feeling belonging and feeling at home might be a part of that. What do you think?
Marya: I think absolutely in that study, there was a lot of discussion of knowing who we are, the sense of knowing who one is and where one belongs as sort of a cosmology of understanding plays an important role and for me that was one of the most surprising parts of the book was seeing how much stories impact inflammation. Are you, are you listening to stories or, or having to internalize stories that tell you the world is a scary place where you could be shot by police just by walking on your street or, you know, being stopped for a broken taillight? Those stories are important to hear because they’re real, but then those stories again inflict another kind of damage. And so how then is racism, a form of biological warfare that is predisposing, you know, Black and Brown people in this country to worse health outcomes? And it’s not just simply like white and black you can see the same thing happening in India with us, you know the caste dynamic and, and, you know, Hindu nationalism impacting other other groups so it’s wherever you have a system of domination that that separates us from our relationships to each other in the web of life.
(5-second stinger)
Thank you Dr. Rupa Marya and Dr. Raj Patel. We’ll hear more about their new book “Inflamed: Deep Medicine and the Anatomy of Injustice” in the next episode.
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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