Inflammation accompanies almost every disease in the modern world, including heart disease, cancer, inflammatory bowel disease, Alzheimers, depression, obesity, diabetes, and more. Even the difference between a mild and fatal case of COVID-19 is the presence or absence of systemic inflammation.
The pandemic is among the factors contributing to renewed public awareness of the immune response that is inflammation. But what if we looked at our world and the societies within it as examples of not just real, but metaphorical, inflammation as well? What if the inflammation of our arteries and that of the planet are linked? These are among the questions explored by Dr. Rupa Marya, internal medicine specialist at UCSF, and journalist and research professor Raj Patel in their new book “Inflamed: Deep Medicine and the Anatomy of Justice.” The two join host Evan Kleiman to discuss how racial violence, economic precarity, industrial pollution, poor diet, and even the water you drink can inflame you.
The following interview has been edited for length and clarity.
KCRW: Tell us about yourselves and what led you to collaborate together on this new book.
Rupa Marya: “In addition to being a doctor, I'm a co-founder of the Do No Harm Coalition, a group of health workers dismantling structures of oppression in order to get health for our communities. And I am a mother and a musician with the band Rupa and the April Fishes. And it was really my work in music that brought me to communities and places where you could really see the intersection between society and illness. What I started noticing over my 15, 20 years of touring to these different communities is that people who are suffering under the brunt of colonialism were experiencing inflammatory disease in much more profound, impacted ways.
And so I started to think about this as I was going in between my work … on tour with the band and then back in the hospital at UCSF, and I started to see these parallels, and started reading people's bodies in the hospital through this language of history and power, and looking at how the systems around us are making us sick. And in my friendship with Raj and looking at his work in the food systems and with communities, there were a lot of parallels in thinking about why people are getting sick and the ways in which we are.”
Raj Patel: “I'm a research professor in the Lyndon Baines Johnson School of Public Affairs here at the University of Texas in Austin. And I'm one of the members of the International Panel of Experts on Sustainable Food Systems. I got here by doing a lot of work around studying peasant movements and food systems. And through this collaboration with Rupa, I came to understand that ... what I was seeing when I was lucky enough to be an activist on the ground with peasant movements in different parts of the world was not just stuff happening around food, but stuff happening around medicine.
In a lot of communities around the world, food and medicine are things that are coextensive. There's no hard and fast line between one and the other. And … what I got to understand a lot better was why a lot of the food system is also a part of the medicine system outside the confines of the United States.
Approximately what percentage of global human deaths are from environmental factors in air, water, or soil?
Patel: “In 2012, a quarter of all human deaths were traceable to environmental factors in the air, water, and soil.”
Marya: “So while environmental causes have been connected to 25% of global deaths, chronic inflammation is now thought to be the most significant cause of death in the world today, with more than 50% of all deaths globally attributed to inflammation-related diseases.”
How does inflammation we see from things like sugar and fat-laden foods fit in with your larger connection to class, history, and society?
Patel: “We had the great pleasure of talking to Valerie Segrest, who is part of the Muckleshoot Food Sovereignty Project. The Muckleshoot Nation was for a long time where Seattle is now. And Val was talking to us about how, for example, a lot of the food ways that her people and her nation had for generations lived with were high in fat. And the way that Western nutrition and nutritionism transformed that is to selectively isolate little components in the food and decide that things were good or bad for you. And that was part of a longer process in which, for example, the confectionery industry and the sugar manufacturers ganged up and tried to make sugar the good guy and fat the bad guy.
But the way in which we think about food — it’s always salt, fat, and sugar, and ‘Oh, isn't this all bad! — is itself a product of colonial capitalism. It atomizes our food into individual components, rather than understands our food as part of rich food ways that are about relationships between humans, for example, and the Salmon Nation. And Val was telling us a great deal about how there are treaties between certain human nations and the Salmon Nation [which] involve duties of care and respect.
And care and respect is absolutely not the way that we're taught to think about our food. It's sort of looking at the side and checking off whether the appropriate vitamins are there, or whether it conforms to our high carb or low carb or high protein or a low protein diet, as opposed to understanding the food that goes through us as part of cycles of food and medicine of which we are inextricably a part.”
To take that a step further, even individual workers who are part of production are not seen as part of any spiritual whole. We're just a cog, which has become so visible during this period of COVID. And we're seeing this pushback of people not wanting to return to work. Could you speak to that a bit?
Marya: This is exactly related to the food system. What Raj was just speaking to was the integration of people into the web of life, into the whole system, within systems that support vitality and health. And what colonial capitalism has done is change those relationships categorically, around the world, of people to the web of life. The web of life has become increasingly frayed, and is at the point of collapsing our planetary weather patterns, our ability to know when seeds are going to sprout, the timing with the insect population, even the presence of the insect population.
And that's a problem. These relationships between food, medicine, the web of life, and people have been categorically changed over the last 600 years through relationships that were put in place by colonialism and codified through our systems of capitalism, which are all about extraction and concentrating wealth and health in an increasingly small number of people.”
Could you describe stress, inflammation, and the idea of homeostasis, and how they work with one another?
Marya: “Over the last 10 or 15 years, the study of inflammation and inflammatory disease has really taken big leaps and strides. In medicine, we now understand that almost all the diseases I treat as a hospital medicine doctor at UCSF ... have inflammation as a major part of the onset and development of these diseases. And so what we know about inflammation is that it is the body's natural, healthy response to the threat of damage or damage. So in getting a paper cut, you have an inflammatory response that goes to heal the wound. This is a corrective response of the body. It's an ancient response of the body, and when the wound is healed, the inflammatory response turns off. This is a healing response.
But when the damage keeps coming to the body, whether it's through air pollution, dietary chemicals, pesticides in our soils that end up in our foods, police violence, living in extremely close quarters, or living without access to potable water, there's all sorts of different kinds of stressors. In the presence of that ongoing damage, the inflammation never stops. And our bodies are constantly trying to reset the optimum working condition, which is called homeostasis.”
Talk about the analogy you make between salmons and rivers to hearts and blood vessels.
Marya: “We got to interview Chief Caleen Sisk, who is the Winnemem Wintu chief who has been working at the base of Mount Shasta, where her people are from, on restoring the health of the salmon. And she's been opposing the raising of the Shasta Dam because it's been destroying the ecology of the rivers that have been vital to salmon health. What we see is the rivers are the Earth's vasculature. The salmon are bringing the nutrients [of] phosphorus and nitrogen from the ocean back into our forests.
So you can find nitrogen that comes from the ocean up in the tallest parts of a Douglas fir tree growing right next to a river that's fed by salmon. The salmon are really moving the phosphorus and all these nutrients, and they're feeding all the animals that are part of these ecosystems where they travel, including humans. And so that movement of nutrients is a vital part of the whole ecosystem of Salmon Nation. And we're seeing what happens when rivers don't have their salmon. This whole ecosystem in the Northwest along from Alaska all the way down to Big Sur in California is stressed.”
Talk about Puerto Rico before and after Hurricane Maria from a food import standpoint.
Patel: I prefer to talk about Puerto Rico before and after the impact of colonialism. ... But the greater crushing of food systems has happened [more] with the moments of first contact that began the story of us being separated from our food systems and medicine systems by the story of colonial capitalism. And I think the reason to think about Puerto Rico as an Indigenous island colonized, rather than as an island just wrecked by climate change ... is because it helps us understand the outside of this problem.
If we're interested in the bigger picture of what a better food system might look like, then the recent past isn't a great place to look. ... We have to go back a lot further to be less alienated from our food system than what the modern colonial food system has left us legacies with. ... [We have] to look for how it is that the world in which we find ourselves has become broken by colonial capitalism. And we might mend our food system not by hoping for just less bad U.S. imperialism, but for a process of … 21st century decolonization that would look a lot like the kind of work that Rupa is doing with the Deep Medicine Circle in occupied Ohlone territory, also called the San Francisco Bay Area.”
What is deep medicine?
Marya: “Deep medicine is, in effect, looking at the health of systems, populations, communities, and interactions between communities, in addition to the health of individuals. ... That includes the health of the water, the soil, and the health of all the people. And so when you recognize that an injury to one is an injury to all, you're working from the place of deep medicine. Deep medicine would look like understanding that if we just vaccinate the global north and leave the global south to develop its own scary variants, those will come back to bite all of us. We have to develop a practice of getting everyone into the circle, because we cannot afford to leave anybody out. Not just because it'll inadvertently affect us, but because to care for the other is actually how we care for the self.
And that goes to caring for the soil. We know that biodiverse soil holds more water and sinks more carbon, and that microbiology on the soil ends up on our food. And that ends up impacting our exposures to different microbes. And the more microbes we have in our environments, the more our bodies can adjust and harmonize to those other entities. In fact, our guts in United States urban dwellers have the least biodiverse guts on earth. And a lot of that has to do with how sterilized our environments have become, from everything from the soil to the food to our cleaning products and what they're doing to our homes.
And so deep medicine is working on the structural level to advance health for whole systems. It's incorporating and bridging things that Indigenous communities have been doing for thousands of years. We are doing a project called Farming as Medicine where we're reframing farmers as ecological stewards. And their work is to grow food for people and give that food away so that people who are most oppressed by our social structures have access to the healthiest foods to heal their bodies and their gut. And so then you understand that farmers are really our first health care workers and they should be uplifted and paid like that. And not only in their health care work by providing nutrient dense food, but in their health care work of stewarding our soils, because it really is our soils that will help repair the whole ecosystem.”