Transcript: Dr. RUPA MARYA and RAJ PATEL on Deep Medicine /259
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Hello and welcome to For The Wild Podcast, I’m Ayana Young. Today I’m speaking with Dr. Rupa Marya and Raj Patel.
Dr. Rupa Marya But there is a biological impact of a social structure that has been put forth to us as if it were inevitable and unchangeable, and it is exactly the opposite, it is changeable and it is something we can avoid.
Ayana Young Dr. Rupa Marya is a physician, an activist, a mother, and a composer. She is an associate professor of medicine at the University of California, San Francisco, where she practices and teaches internal medicine. She is a cofounder of the Do No Harm Coalition, a collective of health workers committed to addressing disease through structural change. She is a cofounder of the Deep Medicine Circle, an organization committed to healing the wounds of colonialism through food, medicine, story, and learning. Working with her husband, the agroecological farmer Benjamin Fahrer, and the Association of Ramaytush Ohlone, she is a part of the Farming Is Medicine project, where farmers are recast as ecological stewards of rematriated land and food is liberated from the market economy. She has toured twenty-nine countries with her band, Rupa and the April Fishes, whose music was described by the legend Gil Scott-Heron as “Liberation Music.”
Raj Patel is a research professor at the University of Texas at Austin’s Lyndon B. Johnson School of Public Affairs, a professor in the university’s department of nutrition, and a research associate at Rhodes University, South Africa. He is the author of Stuffed and Starved and the New York Times bestselling The Value of Nothing, and the coauthor of A History of the World in Seven Cheap Things. A James Beard Foundation Leadership Award winner, he is the codirector of a groundbreaking documentary on climate change and the global food system, The Ants and the Grasshopper. He serves on the International Panel of Experts on Sustainable Food Systems and has advised governments worldwide on the causes of and solutions to crises of sustainability.
Well, Rupa and Raj, this is so lovely to have you back on For The Wild Podcast as a team, like I was mentioning, both of your individual episodes were so stunning and moving and I really want to direct listeners to both of those episodes in the archives, and so happy to have you both back. So thanks for being here today.
Dr. Rupa Marya Thank you for having us.
Ayana Young Well, as we start off, I'd like to invite listeners to learn about your new collaborative work, Inflamed: Deep Medicine and the Anatomy of Injustice. In it, you write, “Your body is part of a society inflamed. Covid has exposed the combustible injustices of systemic racism and global capitalism. Demagogues around the world kindle distrust and hatred. Governments send in the police to impose order, monitor lockdowns, enforce a return to work for those who comply and incarceration for those who do not. Everything we’ve made, we’ve made from fossil fuels: energy, food, medicine, and consumer goods. The world has been organized to burn.” Being inflamed in the ways we are is not a natural state. We have arrived at this point because of deliberate actions. I would love it if you could both reflect on what it means to exist within inflamed bodies and inflamed environments?
Dr. Rupa Marya You know, when you say to live inflamed is not, I don't know if you said natural, I would say that our inflammatory response, the response of the body to damage is inflammation, and it's a healing response. So, to just lay on a little compassion that our bodies are doing what they do to try to heal in the midst of ongoing, incessant damage. That state of being inflamed should tell us that we are in a situation where we are encountering damage and that that can point us to how we can get, how we can achieve or create a world that doesn't inflame our bodies, that doesn't inflame our planet. So I think of inflammation as a guidepost, as a way of knowing are we on the right path or not, and what we see with the rise of chronic inflammatory disease all over the world, in places that have been shaped through colonial capitalism, in places we call modern industrialized countries or places, we see an enormous amount of damage and toll on the human body and on the Earth's body and on our societies. And so it's, in some way, a real gift that our bodies have this alarm system, and it's ringing nonstop. Our job now is to listen to it and to and to follow what it's saying.
Raj Patel I think that's one of the reasons why we wrote Inflamed is because it's also possible to live in this world filled with inflammation, and to remain in denial. In fact colonial capitalism requires that we remain in denial. So, you know, it's entirely possible, for instance that, on the same day that the U.S. Fish and Wildlife Service announced the extinction of more than a dozen species just from the United States alone, that our Secretary of Agriculture announced that he didn't approve of the European Union's pesticide policy, because it restricted things and what we needed was more free markets, and, you know, the people who are really blazing the trail on this were the Brazilians and so you know, it's entirely possible to have all these signals, and to meet them with a kind of grave cognitive dissonance, because capitalism doesn't permit the kind of diagnosis, the kind of storytelling that we we set to share in Inflamed.
Ayana Young Thank you so much, both of you for laying the foundation for this conversation with that, and I wanted to bring up that our modern life brings us into contact with a high degree of nongenetic drivers of health and illness, which you call the exposome. Can you explain, first what this exposome is, and how thinking of health from the perspective of the exposome may challenge our notions of what is healthy and what degree of health is even possible in a world of overconsumption and climate crisis?
Dr. Rupa Marya When it comes to chronic inflammatory disease, so the diseases that most people will encounter in their lifetimes, if they live in a society constructed through colonial capitalism, which includes, you know, most of the Global North, and now some of the Global South are these diseases like cardiovascular disease, or diabetes, or cancer, and cancer in increasingly younger people, I just saw a 34 year old lady with widely metastatic colon cancer, which is becoming increasingly common. All of these diseases are diseases where chronic inflammation is playing a role in how the diseases manifest and what we know, by studying genetically identical twins, is that these diseases, social and environmental factors are more predictive of the onset of these diseases than even genetic factors. That becomes really important when we think about how we manage them on a population level. That focusing on individual risk or individual strategies really becomes a futile way of having a measurable outcome difference on a population level of these diseases. As countries like India, or you know, countries in Africa become industrialized or modernized, what happens shortly thereafter is a rise in these kinds of diseases.
So it is necessary for us to understand what the diagnosis is, so if we’re constantly looking at diabetes just a dysfunction of pancreatic cells or dysfunction of our own cells responding to insulin, then we're not really looking at why is there a global rise in diabetes in societies that have been shaped through this mindset, this this colonial mindset? When you start looking upstream in the social factors that are driving these diseases, then you can start to actually make changes that will have outcomes, different outcomes and so that's why we focus in the book on, on really outlining where the pathology is, it's not in our bodies, our bodies are responding quite healthily to a pathological world. If we want to start to see differences in health outcomes, we have to start re-designing that pathological world, and we have to redesign it in ways that are antithetical to the understandings of colonial capitalism. So the mentality of extraction, the mentality of othering, whether it be people who are Brown, Black, or differently abled, or women, or have different genders, or the water, and the mountains, and the salmon. So the level of othering that had to happen in order for colonialism to achieve its aims, has deeply damaged our relationships to each other and that has had consequences for our own bodies. Diagnosis has to be precise, and it has to be accurate, and so that is what we are trying to offer in this book is another level of diagnosis so that we can base our actions off of a real understanding of why we are sick.
Raj Patel To pick up what Rupa put down there, the idea of diagnosis is something that, when doctors are diagnosing they're telling a story, and they're telling a story from a sort of a narrative vocabulary that is itself a product of colonial capitalism. And so there are certain ways in which, you know, if, if we're thinking about individual pathologies, then it's always the victim that is at some level at fault. You know, if diabetes is something that happens inside your pancreas, and therefore, it's something that you, yourself are responsible for, then, you know, at some level, there's always this sort of victim blaming that accompanies the sort of narratives of dysfunction and disease. But when you break open diagnosis, to be able to say, look, one of the things that is generative of suicidal ideation is debt and the horror of losing, or not being able to provide for one's family. And if that is true, and we have plenty of resources in the book to show that it is, then the kinds of payday loans that working class Americans and working class people around the world, but particularly Americans take in order to be able to bridge, you know, the food running out to the arrival of the next paycheck, those kinds of loans come with, you know, interest rates, APR of 600%, and if we were to eliminate them, we would see suicide drop by 1.9%, and accidental drug overdose rates drop by 8.9%.
But what this means is that the exposome is a way of understanding the social forces act on everyone, even if you feel like you haven't been othered, you are a straight white guy, if you are part of the working class, then you too, have been oppressed. Of course, the reason we bring in both the colonial and the capitalism is to show that this is an ongoing process in which workers across the world are being wrung dry. And that's not happening equally, it's happening along these colonial fault lines that Rupa was just talking around. So if we're interested in the story that knits this together, as opposed to a story that says, “Well, this is an individual problem over here, and over here is some other entirely unrelated problem around it species extinction, and here is an entirely unrelated thing about climate change,” then you are going to silo your responses. But if your diagnosis is as global as the problem and a systemic as the problem, and we talk a lot in this book about us being systems within systems, then, you know, our responses have to be equally systematic, and have to start dissolving this idea of the sort of atomic individual that was created by colonial capitalism in the first place.
Ayana Young Yeah, gosh, there is so much there in both of your responses. And, I'm thinking through the degree of exposure, you know, just makes me wonder about the ways we often lack a deeper understanding about what environmental health means, and throughout the book, you connect our health as individuals to the health of our ecosystems, you know, be that the rivers that connect us, the salmon that feed us, or the soil that grows our food. In many ways our own health mirrors that of the Earth, but this cannot remain metaphor alone. The Earth is so clearly also hurting right now, and, Raj, I’m particularly thinking about your background in researching global food systems. What is at risk when we lose connections to our waterways, foodways, and lifeways?
Raj Patel Well, I mean, we've already experienced the consequences of thinking that food is the sort of thing that appears magically on the supermarket shelf and that is a disconnection of course with the hands that tend the food, and with the people behind the food. And as Rupa was saying, you know, that those people are not just field workers, or farmers, or grocery store clerks, but they are also rivers, and, you know, the microbial life of the soil, and the winds, and the rain. And by forgetting that, and by commodifying food and being subject to, you know, the narratives of food always on demand, but never with people in the picture, and again, using that broad conception of people that we use in the book, then we lose, not only the capacity for understanding our connections with one another, but also our allies, our friends, the the care that we can give, and the care that we receive, and we are currently receiving. But if we don't acknowledge that if we don't, if we aren't sensitive to it, if we aren't, if we have our capacity for care, eroded by the market, and you know, it's abundantly clear now that Adam Smith was wrong, the Adam Smith believed that when people get together and transact in a market, they are made more cosmopolitan, and made more aware of the world and in all its diversity. But increasingly, a range of very interesting experimental economics has pointed out that people in fact care less for one another when they interact with each other through the market. And of course, the beings that don't transact with us in the market are entirely peripheral to our vision of what the world is when we look at the world through the goggles of money. So what we lose our our fellow beings, and what we lose are the cultures in which we see those fellow beings, in which we recognize them, and in which knowledge drawn from and shared with, and taught by these fellow beings is cast to the wind, only to be snatched back occasionally, when it turns out that there may be some therapeutic benefits to say, tending for our microbiome.
But again, the only ways in which this vast knowledge becomes then commercially useful is precisely when it can be condensed into a pill for us to swallow, but never to be sung and to be shared and to be exchanged freely. So we lose a great deal, and not only have we lost a great deal, but we stand to lose everything that matters to us, if we don't reestablish these connections.
Dr. Rupa Marya I just think that that is such a brilliant way of understanding and framing, you know, what we are facing and, you know, when we look at the microbiome of the gut, and the body, and how many individuals you could say, or how many collections or communities of other organisms are so vital for a proper response of our immune system, the proper development of our nervous system, the training of our endocrine system, it becomes abundantly clear that our well being is completely dependent upon the other, you know, all these entities that are in and around us, and that reach out into the world and form that ecotone, or that transition zone between my body, the universe inside of me and the universe outside. And so, you know the misunderstanding of colonial capitalist approaches of, “Oh, well, we can just then culture an Indigenous person in the Amazon’s gut microbiome, their feces and give it to people in little pills”, that reflects a deep misunderstanding, because this microbiome that is so vital for our health is a living reflection of all of our relationships, it is not a commodity that can easily be you know, bought and sold. It is a such a moment of awakening for us, as creatures, as people, as doctors, as people involved in health and wellness to critically look at the storylines that we've been told and where they're failing us and and and look to storylines that have been more robust and lasted much longer, that have continued to nurture biodiversity and health and excel at that and so it's a great time of changing the narrative,
Ayana Young I feel like you both are really speaking to this interconnectedness of so many worlds, and whether it be our more than human kin, or our communities of other humans, or our ecosystems, and, you know, it's interesting because even though this interconnectedness is so clearly true, this individualistic philosophy that we live under, you know, in dominant culture really ignores our dependence upon other beings. And it also, I think, just shows how this strict neoliberal individualism dictates much of how we go about the world. And I'm wondering, how did we get to this point, and particularly in medicine, what tradition does this represent?
Raj Patel I can talk a little bit about the reason that we use the idea of colonial capitalism, and the reason that it's important to have both those terms is because while colonialism has been happening for a while, and in fact, colonialism, when it was conducted by the Romans, gives us the language of some of our medical terminology, you know, when the Romans were busy colonizing the Mediterranean, they had to invent a term for cities that were not subject to the same sorts of duties that Rome was, so you could be part of the Roman Empire, but you weren't quite Roman, because you were you were part of a city that was free, and not subject to the same duty. So in Latin, munera is the term for duties and so from there, immunity comes and what we'll talk a little bit I think about how the language of self and other and the borders and that the forces that that march along those borders are a part of modern medicine, but you know, in addition to colonialism projection a certain kind of institutionalized difference, capitalism deploys that with an additional kind of ferocity by turning the world into society and nature, and this sort of cleavage, of the two is important to observe because if you're thinking about what is exploitable, what is it that we can cast to the wind? What is it that we can set fire to? What is it that we can work to death? Then nature falls in that category, and so you have to be outside society in order to be exploitable. Inside society it's, you know, usually propertied, white, Christian men that started off society, and then gradually through struggle, more more people were able to enter society, and that struggle is far from over, but the sort of operation of power between society on the one hand and nature on the other is one that is ongoing, and it's a process of domination that really, you know, we can date to the 1400s in particular, really, to 1492 and the invasion of the Western Hemisphere by colonial capitalists from Europe, but that was accompanied by a certain vision of medicine, and I want to hand it over to Rupa.
Dr. Rupa Marya Yes and that pervades, you know, if you look at the colonization of lands around the world, medicine was a part of that project. So these lands were colonized by missionaries, medics, and militaries, and medicine, you know, looking at tropical medicine was basically developed to keep Europeans healthy in other, you know, territory so that they could exploit the land, the resources, the labor, the people. It wasn't there to keep the Indigenous or Native populations healthy, and then when it was extended to the Native populations, it was only because they realized that disease could spread, sort of where we are today, you know, fast forwarding several 100 years to COVID and we still haven't seemed to learn our lesson. So those ways of thinking pervade the modern medical mindset, where, you know, I'm sitting here at the hospital right now and patients' personhood is, you know, degraded. The way that we learn in medicine does not uphold or uplift a patient as the expert in their body and their disease. Often, you know, doctors are interrupting patients within the first minute of discussion. So we're not trained to understand how to listen or how to value expertise and personhood of other people, on the healthcare team, of nurses. So the whole hierarchies and systems of medicine fall along these class, race, and other social hierarchies that actually prevent us from giving excellent care. And that's really where the work of decolonizing and understanding you know how to work together in other ways that uplift and bring into the fold, other knowledge systems, other ways of knowing and other experiences that can deepen and really enrich in an understanding of disease and an understanding of how to get better
Ayana Young Yeah, that makes a lot of sense. Another thing that you both mentioned in the book is the allostatic load (the chronic build up of stress) that comes with being Black in America, syaing “To be Black in the United States is to be confronted with daily acts of discrimination—sources of stress that manifest as higher blood pressure even while we are asleep. Instead of the restoration that sleep and melatonin afford, the allostatic load that racism brings effectively leaves Black people sleeping with one eye open.” What are the tangible impacts of having such a high allostatic load?
Dr. Rupa Marya So that's a study that we were looking, it's just such an intense study that showed that, you know, usually when people fall asleep, you get a dipping in your blood pressure, which you know, your body is relaxed, your hormones are relaxed, and your blood pressure falls, and what they found is that Black Americans don't have that dipping, and I believe in that study, they compared it to Black Africans - so it wasn't a genetic thing, which people love to say, it is from the social conditions of being Black in America. So that reality of being in a state of chronic stress is not saying that there's like a biologically essential, you know, predetermined fate of being sick if you're Black, but there is a biological impact of a social structure that has been put forth to us as if it were inevitable and unchangeable. It is exactly the opposite. It is changeable, and it is something we can avoid.
What we see when we talk about health disparities, you know, whether it's COVID, or you know, cardiovascular disease or stroke, or Alzheimer's, is that, you know, Black folks have worse outcomes, Indigenous people have worse outcomes, or this must be from, you know, poor access to health care, yes, that's a part of it, but that's not the whole story and the whole story isn't also just, you know, “Oh, well, you just didn't have enough money or you just didn't have enough XYZ,” it's the whole architecture of society has been built to crush the bodies of Black, Indigenous and Latinx folks in this country and around the world, you see similar dynamics with caste in India, you know, these systems of domination that have been put in place that degrade our relationship to each other, and that make oppression a daily reality, it's impacting our body's ability to even get rest and restore.
So poor health outcomes for folks suffering under that, you know, under that gradient, are going to be inevitable, which to me, as you know, a doctor in the hospital where I'll see people come in, it feels like, and this what we talked about in the book, this is a form of biological warfare, that, you know, if our societies never give us an opportunity to be healthy, that's where the predetermination comes in. It's not from our genes. It's not like there's people who are, you know, genetically predisposed to being unhealthy. But if the world around them is constructed in a way that will ensure their poor health, they're going to be unhealthy. So how do we collectively work across lines to make a different outcome, to change the script to change the, to change what's happening?
I just gave a presentation at the UC level around their climate justice work and you know, someone's response was, “Oh, you know, but changing capitalism is so big and like, how do we do this?” And you know, other people are like, well, this is, you know, capitalism is too big to fail, or it's too big for us to imagine this. And these are some of the same arguments that came around when the U.S. had slavery and people were very invested in keeping chattel slavery in place, would come up with these same arguments like this is just too essential, this is too necessary. And it's time for us to say no, like the abuse of the Earth, and the abuse of each other, the abuse towards especially Black and Brown bodies, it's not necessary, it's not essential, and if this economic system requires it, then let's get rid of this economic system. Let's create other ones that will start from a place of care and start from a place of health, so that all of us can have the opportunity to be healthy.
Ayana Young Yes, I'm with you there. I want to go back to something that was spoken about at the beginning of our conversation, or at least, debt was brought into the conversation and one of the undercurrents of our social structure is debt and in Inflamed, you explain both the colonial dependence upon debt economies in order to create structure and control, and the continuation of these debt practices to uphold capitalism. We see this as a, you know, through line to our present day where so many people carry massive amounts of debt because of our poor systems of care. This is especially harmful when we consider the staggering amount of medical debt that exists in the United States. And I’d just love to hear your thoughts on the interconnected nature of debt and health, and really, when the cure is unaffordable, and debt inducing, how can we possibly heal?
Raj Patel Well, we can't. I mean, you're right, Ayana that debt has always been an important technology of colonialism. You know, in Malawi, for instance, when the British came and needed workers, what they did was very simple. They just imposed a hut tax that initially families paid off by selling off their livestock and once they had sold everything that could be sold, they were left with the only thing left, which was their labor power and so in order to discharge the debt that the British had imposed on them, all of a sudden they found themselves working in mines, working on plantations, working in ways that befitted the British Empire, and that technology persists. You know, and I think one of the greatest tricks of colonial capitalism has been to pretend that there are certain debts that can be and should be discharged and certain ones that can't. So although Britain extracted from India $45 trillion worth of material and wealth, that's not a debt that Britain ever thinks that can be repaid, but what Britain can insist on, is that the kind of debts that it is able to control through its membership of the board of the International Monetary Fund at the World Bank, those kinds of debts cannot be discharged, they can be postponed as they were in a moment of very brief and very frugal generosity and under COVID. But in general, that kind of debt is not the sort of thing that the Global South is ever imagined to be able to free itself off. You know, there is not a politician in Britain or the United States or anywhere in the Global North that can see an end to this process of indebtedness, they'll never tell you that they'll tell you, “Oh, yeah, so we've got some very exciting debt forgiveness plans”, but they know full well that this is just a temporary mechanism to merely tamp down the wildly excessive numbers for of debt repayment. But there will still never come an end point where the South does not owe the North. Whereas in fact, if one looks at climate change, if one looks at species loss, if one looks at the future of the planet, it's entirely the case that the North owes the Global South a great deal.
And that debt is again the product of colonial capitalism and it is writ large and it is writ small, it's writ small through the debt that we bear every day. But, you know, part of the technology of the future that we're excited about in Inflamed is what is it to imagine a different world? And we can imagine a world where there is public healthcare, we can imagine a world where education is free, we can imagine a world with all of these things, and that world isn't too far away. I mean, look, I grew up under free health care, and it's still racist, but people don't die discharging themselves of medical debt that they do here in the United States, or in the United Kingdom, the National Health Service, again, made possible by trillions appropriated from everywhere else in the world, is nonetheless an example of a service that is available to everyone and beloved by everyone. And that was put into place, not because it was affordable, but because it was the only thing that conscience would allow, which gets to Rupa’s point, right, that, you know, if it's too expensive to have healthcare for everyone, then the numbers are being done wrong. But it is not the case that we can, in good conscience, allow ourselves to live on a planet where we are not caring radically for one another.
So you know, that is the idea of debt and a debt jubilee is important. It is important that we recognize the debts that the Global North owes the Global South, that patriarchy has occasioned, that racism has occasioned, that the stealing of the land on which we find ourselves has occasioned, and repair and make reparation for that. But also that we recognize that you know that debt is a way in which capitalism maintains its power, and by declaring a jubilee, we might be free, at least from that element of capitalism's domination of our lives and free to dream something much better.
Ayana Young Yes, I think dreaming something much better is necessary at this point. The imagination battle that we're living within needs to be won by our dreams and imagination. So I'm really with you there and, we're just so obviously living in an afflicted world, and with this comes a longing for healing. However, modern medicine and cure based initiatives often serve merely to treat symptoms and in turn, this comes to reproduce many of the issues that caused the issues in the first place. For instance, you write, “Trying to solve air pollution by creating more rich-only spaces with air conditioning and filtration just makes it worse for everyone, as the machines spew out heat and demand energy to generate electricity, burning more fossil fuels in order to protect the wealthy from the effects of the fires.” Can you elaborate on this extractive and consumptive cycle and the ways deep medicine may liberate us from it?
Dr. Rupa Marya Yeah, it's, you know, it's funny that it's beyond the imaginings. Because, you know, for example, here in the Bay Area, in East Oakland, where I live, there's this foundry, the AB&I Foundary that has been spitting toxic emissions into the air every Thursday, it smells really bad, and all throughout like this heavy cloud over East Oakland and people who live around the AB&I foundry, get to experience a confluence of air polluting particles from the 880 freeway, because all the trucks had to go down the 880, not over the 580, which is parallel to the 880, but has more white people living around it. So the flatlands of Oakland really get crammed with multiple chronic air pollution impacts, but the AB&I Foundry puts a particularly toxic, you know, hexavalent chromium, which is a heavy metal aerosolized into the air, it's been associated with cancer, and other health problems. When you look at the life expectancy of people who live near that foundry, that's 10 years less than the people who live by the 580 freeway. So these things have a real impact on our health.
We also learned that the combined impact of air pollution, like chronic air pollution and COVID that people who are exposed to chronic air pollution end up having more severe outcomes when they get COVID, and then we learned that the people who were forced to breathe a toxic air from the wildfires also had worse outcomes with COVID and there was also concern that the actual virus was traveling on the particulate matter and spreading along the particulate matter from wildfires and air pollution. So when you see the confluence of these things, you just realize like what a disaster this is and has been for people, you know, and looking at the maps of COVID in Alameda County, is those people who live around the Foundry again, the people who are in the flatlands of Oakland, who are having the worst outcomes from COVID and so we have these spare the air days in the Bay Area where you're not allowed to burn your fireplace, but on spare the air day is the AB&I foundry continues to, you know, release its toxic load into the air in that area and it just always has befuddled me. I have spoken to the county health department, I've spoken to the mayor of Oakland, I have talked to everybody about this health hazard, going all the way up to the California EPA, the U.S. EPA, and the inability to act on industry. “Oh, well, they have a special title exemption to pollute our air.” “Oh, well, we can't do that. Because it's not under our jurisdiction.” “Oh, we can't make a health order.” So the levels of inability to act to stop toxic industry is shocking. In the United States, and you can see the same with PG&E, like how many people does PG&E get to kill with its wildfires, and they're still operating, they're still working! You know, if I was killing that many people in the hospital, I would lose my license. So how do these industries get the free pass to work with such abandon, reckless abandon, and endanger our lives?
So these are things that, you know, it's easier for people to imagine letting PG&E continue than just shutting them down and starting to build microgrids throughout California, based on small solar, community owned energy entities. So that kind of the shift in perspective has to come from the ground up, it's not going to come from the politicians. The whole COVID response here in California was being really overseen by healthcare lobbyists who are representing the executives and the healthcare systems that made record profits, as our nurses were standing in trash bags. So where the power lies in our society is constructed in this way and it will take a great deal of effort from the ground up to change it. And that's what needs to be done at this point.
Ayana Young Yeah it's interesting, we've been talking about so many facets that have created this disease in us and especially within marginalized communities, and I'm thinking about trauma and you know, we have spoken to trauma in different ways, but I wonder if you could explain how our health and especially marginalized communities health reveals the cycles of violence, and both generational trauma and inequity?
Dr. Rupa Marya Well trauma is really registered and held in the body and manifested through chronic inflammatory states, and so all the diseases that we're talking about in our book, Inflamed are diseases that are really impacted by trauma, and what was really striking for me to learn about and to research more deeply in writing this book was how trauma is translated down on into the cellular level of our bodies. It's literally changing the way our cells act, and how they express these molecular mediators that drive inflammation in our body. So trauma and healing from trauma is critical in this work. It's critical that we both stop the causes of trauma and simultaneously engage in methods to heal the trauma. This way, you know, for the medical community to learn about trauma, to learn about how medicine itself has been an active trend, you know, a traumatizing experience for lots of different kinds of people. Once we are leading with the trauma informed lens, it can shift and change the dynamics in medicine and how we heal and the array of possible therapeutics we can offer to people to help them move their bodies and move their lives into a place that can heal from trauma.
The other thing that really surprised me in this work, in this research, was how our bodies can heal, that, you know, the damage that happens to the body that generates the inflammatory response, when that damage is stopped when you move into a dynamic that is no longer damaging, that is restoring, that that inflammation can can be soothed. And that is the hope, is that the knowledge that we can construct other ways and it can look as simple as a public smoking ban. Here's an example of, you know, something that happened in California, we banned public smoking, it took a couple decades because of the fight with the tobacco industry that wanted to continue to allow people to be poisoned by their products. But once California instituted its public smoking ban, rates of fatal heart attacks and strokes dropped, actually dropped more than what we've seen from any medic medicine, any pharmaceutical, any cardiovascular research, interventional, whatever that we do the fancy things we do in medicine, just simply saying you can't smoke in public. That kind of action is a policy level design of the world around us that had radical impacts or transformative impacts on our bodies. So if we can do that with smoking, can we do that with pesticides, can we do that with eliminating all of the inputs into our soil that damaged our soil microbiology, because we know as fossil fuel based inputs are put into the soil, they damage the the fungal to bacterial ratio, you get less of the delicious globulin, it just a glycoprotein secreted by fungi to hold the soil together and act as a sponge. Those beautiful ecological relationships in the soil are destroyed through the use of these chemicals. They're the same chemicals that are driving up global temperatures. So when we can decide, you know, these industries can no longer be allowed to privatize the gains and socialize the costs, because we're paying for it. I just drove through Kern County last week on Indigenous peoples day, and so much of the soil was in the air, California is turning into a dust bowl because of these agricultural practices. So this is an important time to start imagining how we redesign our world, by dethroning the industries that have been wreaking havoc on public health for centuries. And by demanding our place and our right to be healthy, and our right for our grandchildren, our great grandchildren to breathe healthy air and to drink healthy water. And so that insistence is growing, and it must grow a lot stronger and all of the tactics of movement building and organizing will be required. And so it's an important time to start getting involved.
Ayana Young Yes, I couldn't agree more and I was so struck by your explanation that, “Colonial cosmology sees things where persons once were. What once was alive with personhood—a forest, a river, a mountain—becomes inanimate, disconnected from ecologies, open to exploitation. In the United States, this mindset is enshrined into law.” As we conclude, I think it is particularly important to remember that you both recognize the importance of medicine and health beyond the social constructions of capitalism, colonialism, and racism in which they currently reside. There is hope for a medicine that brings us closer to the earth and to healing. Can you paint a picture of what health, and perhaps even more importantly, care looks like from the perspective of deep medicine?
Dr. Rupa Marya Well, deep medicine is recognizing that health exists beyond individuals, health is an emergent phenomenon of systems, within systems, working in their optimum state. So we can try to get health as an individual, but we will not be as successful as getting health for whole communities together and how communities intersect. And by that, I mean, human and more than human communities, I mean, the water and the air, and the microbes and the forest, and so deep medicine is understanding how all of those things must intersect to create health. And that we have to open our perspectives and our ways of knowing to all the keepers of deep medicine, not just the you know, the doctors or the the healthcare workers, that are farmers that are that our frontline, you know, Indigenous Grandmothers standing up against Line 3 right now that these are all health, these are all people working for health. And that when we work together, and collectively and across disciplines together, we can create a different kind of reality, we can create a health for everybody, when we start imagining food as a right as it has been for 1000s of years before capitalism, where our food and medicine have always been coexistence, they haven't been separated from each other. And they're still that way in many cultures around the world.
When we insist upon our medicine being outside of the tiny vocabulary of pharmaceuticals, not that we abandon science, Western science, or we abandon even those pharmaceuticals, but that we abandon the logic of domination that they have been structured by, and that we take back our right to have access to these things to be healthy when we need them, and that we incorporate the full range of languages and vocabularies of medicines, be they plant medicines, medicines of song, medicines of relationships, in order to achieve a vision and and a reality of our health. So these, you know, practices are not, you know, just, I'm not just talking about things that don't exist. These are things that are an active practice and communities around the world today. And so how do we connect with and work and learn with those communities to advance their health agendas, especially our Indigenous communities in their territories?
Today, I'm speaking to you from the occupied and unseated Ramaytush Ohlone territory, what is now called San Francisco and we are working with an organization we formed called the Deep Medicine Circle, with Indigenous people and settlers together, working to decolonize our food and medicine, and that project, that work has been so beautiful, because it shows how it sometimes it's just as simple as imagining. And that's what we were talking about in the book is like, the importance of exercising our imaginations, of looking to art and looking to other ways of knowing that can lift our vision up a little bit higher, so that we can see beyond the enforced horizons of colonial capitalism, to another world that's sitting there waiting for us, you know, with open arms, and that world needs us really badly right now.
Ayana Young Yes. Oh, Rupa, I'm so appreciative that you took us through some really intense and challenging topics, but you're leaving us with this vision and I would say for me, like a type of confidence that another world is possible and we just need to be brave and bold and consistent and believe that we can do this together, and we can change the system that is, you know, kind of strangle holding us a bit. So yeah, I just really appreciate this listening journey you took us through and thank you so much for your work and your devotion and your dedication. And Raj, I really appreciate you too, I know, he had to jump to a class, but I'm so grateful to you both and for your book Inflamed and I really, really want listeners to go pick up that book and dive deeper. And again, it’s Inflamed: Deep Medicine and the Anatomy of Injustice.
Dr. Rupa Marya Thank you so much for giving us an opportunity to talk about this book, Ayan thanks for your awesome work.
Francesca Glaspell Thank you for listening to For The Wild Podcast. The music you heard today was by Roma Ransom and Lindsey Mills. For The Wild is created by Ayana Young, Erica Ekrem, Francesca Glaspell, and Julia Jackson.