00:00:14.880To make a donation, visit forthewild.world slash donate or find us on Patreon.
00:00:21.320If you'd like to support us in other ways, consider sharing our episodes through social
00:00:25.720media or leaving us a review wherever you listen to the podcast.
00:00:30.000Hello and welcome to For the Wild podcast. I'm Ayanna Young. Today I'm speaking with Dr. Rupa
00:00:40.340Maria and Raj Patel. But there is a biological impact of a social structure that has been
00:00:48.500put forth to us as if it were inevitable and unchangeable. And it is exactly the opposite.
00:00:55.840it is changeable and it is something we can avoid. Dr. Rupa Maria is a physician, an activist,
00:01:03.220a mother, and a composer. She is an associate professor of medicine at the University of
00:01:08.300California, San Francisco, where she practices and teaches internal medicine. She is a co-founder
00:01:14.220of the Do No Harm Coalition, a collective of health workers committed to addressing disease
00:01:19.420through structural change. She is a co-founder of the Deep Medicine Circle, an organization
00:01:24.720committed to healing the wounds of colonialism through food, medicine, story, and learning.
00:01:30.900Working with her husband, the agroecological farmer Benjamin Farr, and the Association of
00:01:37.060the Ramatush Ohlone, she is a part of the Farming is Medicine Project, where farmers
00:01:42.780are recast as ecological stewards and rematurated land and food is liberated from the market
00:01:49.040economy. She has toured 29 countries with her band Rupa and the April Fishes. Raj Patel is a
00:01:57.100research professor at the University of Texas at Austin's Lyndon B. Johnson School of Public
00:02:02.500Affairs, a professor in the university's Department of Nutrition, and a research associate at Rhodes
00:02:08.660University, South Africa. He is the author of Stuffed and Starved and the New York Times best
00:02:14.860Selling, The Value of Nothing, and the co-author of A History of the World in Seven Cheap Things.
00:02:21.720A James Beard Foundation Leadership Award winner, he is the co-director of a groundbreaking
00:02:27.220documentary on climate change and the global food system, The Ants and the Grasshopper.
00:02:33.060He serves on the International Panel of Experts on Sustainable Food Systems
00:02:37.240and has advised governments worldwide on the causes and solutions to crises of sustainability.
00:02:44.860well Rupa and Raj this is so lovely to have you back on for the wild podcast as a team like I
00:02:54.120was mentioning both of your individual episodes were so stunning and moving and I really want to
00:03:00.680direct listeners to both of those episodes in the archives and so happy to have you both back so
00:03:07.600thanks for being here today. Thank you for having us. Well, as we start off, I'd like to invite
00:03:15.740listeners to learn about your new collaborative work, Inflamed, Deep Medicine and the Anatomy of
00:03:22.440Injustice. And in it, you write, quote, your body is part of a society inflamed. COVID has exposed
00:03:31.260the combustible injustices of systemic racism and global capitalism. Demagogues around the world
00:03:38.260kindle distrust and hatred. Governments send in the police to impose order, monitor lockdowns,
00:03:45.360enforce a return to work for those who comply, and incarceration for those who do not.
00:03:51.420Everything we've made, we've made from fossil fuels, energy, food, medicine, and consumer goods.
00:03:58.380the world has been organized to burn end quote oh so you know being inflamed in the ways we are
00:04:08.760is not a natural state and we've arrived at this point because of deliberate actions
00:04:14.840so i'd love if you could both reflect on what it means to exist within
00:04:19.880inflamed bodies and inflamed environments you know when you say to live inflamed is not
00:04:27.040I don't know if you said natural. I would say that our inflammatory response, the response of
00:04:35.100the body to damage is inflammation and it's a healing response. And so to just lay on a little
00:04:44.560compassion that our bodies are doing what they do to try to heal in the midst of ongoing incessant
00:04:52.600damage. And that state of being inflamed should tell us that we are in a situation where we are
00:05:00.480encountering damage. And that can point us to how we can achieve or create a world that doesn't
00:05:14.360inflame our bodies, that doesn't inflame our planet. And so I think of inflammation as a
00:05:19.980guidepost as a way of knowing, you know, are we on the right path or not? And what we see with the
00:05:27.480rise of chronic inflammatory disease all over the world in places that have been shaped through
00:05:32.640colonial capitalism in places we call modern industrialized countries or places, we see an
00:05:39.880enormous amount of damage and toll on the human body and on the earth's body and on our societies.
00:05:46.480And so it's a, you know, in some way, it's 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 follow what it's saying.
00:06:00.360I think that's one of the reasons why we wrote Inflamed, is because it's also possible to live, you know, in this world filled with inflammation, and to remain in denial.
00:06:12.560And in fact, capitalism, colonial capitalism, requires that we do remain in denial. And so it's entirely possible, for instance, this is just a ripped-from-the-headlines observation, 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,
00:06:34.920that our Secretary for Agriculture announced that he didn't approve of the European Union's
00:06:42.080pesticide policy because it restricted things. And what we needed was more free markets. And
00:06:46.420the people who are really blazing the trail on this were the Brazilians. And so it's entirely0.89
00:06:51.980possible to have all these signals and to meet them with a kind of grave cognitive dissonance,
00:06:57.980because capitalism doesn't permit the kind of diagnosis, the kind of storytelling that
00:07:03.780we set to share and inflame. Thank you so much, both of you, for
00:07:11.860laying the foundation for this conversation with that. And I wanted to bring up that
00:07:18.800our modern life brings us into contact with a high degree of non-genetic drivers of health and
00:07:26.580illness, which you call the exposome. So can you explain first what this exposome is and how
00:07:35.300thinking of health from the perspective of the exposome may challenge our notions of what is
00:07:41.400healthy and what degree of health is even possible in a world of overconsumption and climate crisis?
00:07:48.440when it comes to chronic inflammatory disease um so the diseases that most people will encounter
00:07:57.560in their lifetimes if they live in a society constructed through colonial capitalism which
00:08:04.760includes you know most of the global north and now some of the global south is are these diseases
00:08:11.140like cardiovascular disease or diabetes or cancer um and cancer in increasingly younger people0.97
00:08:17.700I just saw a 34-year-old lady with, you know, widely metastatic colon cancer, which is becoming0.85
00:08:23.360increasingly common. All of these diseases are diseases where chronic inflammation is playing0.56
00:08:29.100a role in how the diseases manifest. And what we know by studying genetically identical twins
00:08:37.560is that these diseases, environment and social and environmental factors are more predictive
00:08:44.400of the onset of these diseases than even genetic factors. And that becomes really important when
00:08:50.980we think about how we manage them on a population level, that focusing on individual risk or
00:08:59.160individual strategies really becomes a futile way of having a measurable outcome difference
00:09:08.740on a population level of these diseases. And, you know, the more, you know, as countries like India
00:09:16.600or, you know, countries in Africa become industrialized or modernized, what happens
00:09:23.620shortly thereafter is a rise in these kinds of diseases. So it is necessary for us to understand
00:09:30.880what the diagnosis is. So if we're constantly looking at diabetes as just a dysfunction of
00:09:37.420pancreatic cells or dysfunction of our own cells responding to insulin, then we're not really
00:09:42.840looking at why is there a global rise in diabetes in societies that have been shaped through this
00:09:48.440mindset, this colonial mindset. And when you start looking upstream in the social factors
00:09:56.840that are driving these diseases, then you can start to actually make changes that will have
00:10:02.520outcomes, different outcomes. And so that's why we focus in the book on really outlining
00:10:08.460where the pathology is. It's not in our bodies. Our bodies are responding quite healthily to
00:10:16.040a pathological world. And if we want to start to see differences in health outcomes, we have to
00:10:21.280start redesigning that pathological world. And we have to redesign it in ways that are antithetical
00:10:27.240to the understandings of colonial capitalism.
00:10:30.820So the mentality of extraction, the mentality of othering,
00:10:34.480whether it be people who are brown, black, or differently abled,
00:10:38.600or women of different genders, or the water and the mountains and the salmon.
00:10:44.680So the level of othering that had to happen in order for colonialism to achieve its aims
00:10:50.620has deeply damaged our relationships to each other.
00:10:53.960And that has had consequences for our own bodies. And so 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 a another level of diagnosis so that we can make base our actions off of a real understanding of why we are sick.
00:11:14.520And to pick up what Rupert put down there, the idea of diagnosis is something that, I mean, when doctors are diagnosing, they're telling a story and they're telling a story from a sort of, you know, a narrative vocabulary that is itself a product of this colonial capitalism.
00:11:35.320And 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.
00:11:45.420You know, if diabetes is something that happens inside your pancreas and therefore is something that you yourself are responsible for, then, you know, at some level, you know, there's always the sort of victim blaming that accompanies the sort of narratives of dysfunction and disease.
00:12:04.140But 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.
00:12:18.480And 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 the food running out to the arrival of the next paycheck.
00:12:37.900Those kinds of loans come with interest rates, the 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 that the social forces act on everyone.
00:13:02.320I mean, 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. And 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 Rupert was just talking about.
00:13:29.820So 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 species extinction.
00:13:41.480And it is an entirely unrelated thing about climate change. Then you are going to silo your responses.
00:13:46.280But if your diagnosis is as global as the problem and as systemic as the problem, and we talk a lot in this book about us being systems within systems, then 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.
00:14:07.600yeah gosh there's so much there in both of your responses and oh i'm thinking through the degree
00:14:17.080of exposure you know just makes me wonder about the ways we often lack a deeper understanding
00:14:23.020about what environmental health means and throughout the book you connect our health
00:14:29.040as individuals to the health of our ecosystems you know be that the rivers that connect us
00:14:35.080the salmon that feed us or the soil that grows our food and in many ways our own health mirrors
00:14:41.800that of the earth but this cannot remain metaphor alone the earth is so clearly
00:14:49.540i mean i want to say that the earth is so clearly hurting right now and raj i'm particularly
00:14:57.540thinking about your background and researching global food systems what is at risk when we
00:15:03.280lose connections to our waterways, foodways and lifeways? Well, I mean, we've already experienced
00:15:11.740the consequences of thinking that food is the sort of thing that appears magically on the
00:15:17.020supermarket shelf. And that is a disconnection, of course, with the hands that tend the food
00:15:24.080and with the people behind the food. And as Rupert was saying, you know, those people are not just
00:15:30.260field workers or farmers or grocery store clerks, but they are also rivers and the microbial life
00:15:40.920of the soil and the winds and the rain. And by forgetting that and by commodifying food and being
00:15:50.620subject to the narratives of food always on demand, but never with people in the picture,
00:15:58.640And 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 care that we can give and the care that we receive and we are currently receiving.
00:16:17.600But if we don't acknowledge that, if we aren't sensitive to it, if we have our capacity for care eroded by the market, and it's abundantly clear now that Adam Smith was wrong. 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.
00:16:42.780But increasingly, a range of very interesting experimental economics has pointed out that
00:16:49.260people, in fact, care less for one another when they interact with each other through
00:17:03.460So what we lose are our fellow beings.
00:17:07.960And what we lose are the cultures in which we sing those fellow beings.
00:17:11.300And when 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, you know, tending for our microbiome.
00:17:29.580But 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.
00:17:44.200So that's what 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 if we don't reestablish these connections.
00:17:54.080I 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,
00:18:21.000the proper development of our nervous system, the training of our endocrine system, it becomes
00:18:26.740abundantly clear that our wellbeing is completely dependent upon the other, you know, all these
00:18:33.160entities that are in and around us and that reach out into the world and form that ecotone or that
00:18:39.080transition zone between my body, the universe inside of me and the universe outside. And so,
00:18:45.840So the misunderstanding of colonial capitalist approaches of, oh, well, we can just then
00:18:53.280a culture, an indigenous person in the Amazon's gut microbiome, culture their feces and give
00:19:00.980it to people in little pills, that reflects the deep misunderstanding because this microbiome
00:19:06.720that is so vital for our health is a living reflection of all of our relationships.
00:19:10.720It is not a commodity that can easily be bought and sold.
00:19:16.240And so it is such a moment of awakening for us as creatures, as people, as doctors, as
00:19:25.860people involved in health and wellness to critically look at the storylines that we've
00:19:31.860been told and where they're failing us and look to storylines that have been more robust
00:19:38.660and lasted much longer that have continued to nurture biodiversity and health and excel
00:19:47.920And so it's a great time of changing the narrative.
00:19:53.320I feel like you both are really speaking to this interconnectedness of so many worlds
00:20:01.200And whether it be our more than human kin or our communities of other humans, our ecosystems.
00:20:08.780And, 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.
00:20:29.500And 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?
00:20:47.600I mean, 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.
00:21:11.840You know, when the Romans were busy hollonizing the Mediterranean, they had to invent a term for cities that were not subject to the same sorts of duties that Rome was.
00:21:23.280So you could be part of the Roman Empire, but you weren't quite Roman because you were immunes.
00:21:28.540Also, you were part of a city that was free and not subject to the same duty.
00:21:34.640So in Latin, that's immune, civitatus liberae et immunes.
00:21:40.520So munera is the term for duties. And so you don't have to do them immunists. 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 the forces that marshal along those borders are part of modern medicine.
00:21:58.740But in addition to colonialism projecting 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.
00:22:20.800because if you're thinking about what is exploitable, what is it that we can cast to
00:22:26.260the winds? What is it that we can set fire to? What is it that we can work to death? Then nature
00:22:31.580falls in that category. And so you have to be outside society in order to be exploitable.
00:22:36.680Inside society, it's usually propertied white Christian men that started off society and then0.92
00:22:42.000gradually through struggle, more people were able to enter society. And that struggle is far from
00:22:47.620over. But the sort of operation of power between society on the one hand and nature on the other
00:22:55.880is one that is ongoing. And it's a process of domination that really, we can date to the 1400s
00:23:01.900in particular, really to 1492 and the invasion of the Western Hemisphere by colonial capitalists
00:23:10.540from Europe. But that was accompanied by a certain vision of medicine. And I want to hand it over to
00:23:15.740Yes. 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, in other, you know, territories so that they could exploit the land, the resources, the labor, the people.
00:23:45.740It 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, fast forwarding several hundred years to COVID, and we still haven't seemed to learn our lesson.
00:24:04.580And so those ways of thinking pervade the, you know, modern medical mindset where, you know, you have in the hospital where, you know, I'm sitting here at the hospital right now where people don't look, you know, that where patients personhood is, is, you know, degraded.
00:24:25.560the way that we learn in medicine does not uphold or uplift a patient as the expert in their body
00:24:32.720and their disease. Often, you know, doctors are interrupting patients within the first
00:24:38.500minute of discussion. So we're not trained to understand how to listen or how to value
00:24:48.300the expertise and personhood of other people on the healthcare team of nurses. So the whole
00:24:54.940hierarchies and systems of medicine fall along these class, race, and other social hierarchies
00:25:01.540that actually prevent us from giving excellent care. And that's really where the work of
00:25:07.200decolonizing and understanding, you know, how to work together in other ways that uplift and bring
00:25:14.100into the fold other knowledge systems, other ways of knowing and other experiences that can deepen
00:25:22.200and really enriching an understanding of disease and an understanding of how to get better.
00:26:49.700To 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.
00:27:01.440Instead of the restoration that sleep and melatonin afford, the allostatic load that racism brings effectively leaves Black people sleeping with one eye open, end quote.
00:27:12.340So I'm wondering, what are the tangible impacts of having such a high allostatic load?
00:27:17.860so that's a study that we were looking at there isn't it's just such an intense study that showed
00:27:26.220that you know usually when people fall asleep you get a dipping in your blood pressure um which you
00:27:32.840know your body is relaxed um your hormones are relaxed um and your blood pressure falls and
00:27:40.860what they found is that black Americans don't have that dipping. And I believe in that study,0.88
00:27:48.280they compared it to black Africans. So it wasn't a genetic thing, which people love to say it is
00:27:55.180from the social conditions of being black in America. And so that reality of being in a state
00:28:00.440of chronic stress is not saying that there's like a biologically essential, you know, predetermined
00:28:06.380fate of being sick if you're black, but there is a biological impact of a social structure that has
00:28:15.120been put forth to us as if it were inevitable and unchangeable. And it is exactly the opposite.0.93
00:28:22.900It is changeable and it is something we can avoid. And what we see when we talk about health
00:28:28.520disparities, whether it's COVID or cardiovascular disease or stroke or Alzheimer's is that,0.97
00:28:35.220you know, oh, Black folks have worse outcomes, Indigenous people have worse outcomes. Well,0.99
00:28:38.500this must be from, you know, poor access to healthcare. Yes, that's a part of it,
00:28:42.360but that's not the whole story. And the whole story isn't also just, you know, the, you know,
00:28:47.760oh, well, you just didn't have enough money, or you just didn't have enough XYZ. It's the whole
00:28:51.820architecture of society has been built to crush the bodies of Black, Indigenous, and Latinx folks1.00
00:29:00.400in this country. And around the world, you see similar dynamics with caste in India,0.95
00:29:06.340these systems of domination that have been put in place that degrade our relationship to each
00:29:11.300other and that make oppression a daily reality. It's impacting our body's ability to even get
00:29:18.840rest and restore. And so poor health outcomes for folks suffering under that gradient
00:29:27.440are going to be inevitable, which to me, as a doctor in the hospital where I'll see people come
00:29:33.560in, it feels like, and this is what we talk about in the book, this is a form of biological warfare
00:29:38.900that if our societies never give us an opportunity to be healthy, that's where the predetermination
00:29:45.060comes in. It's not from our genes. It's not like there's people who are genetically predisposed
00:29:49.340to being unhealthy. But if the world around them is constructed in a way that will ensure their
00:29:54.920poor health, they're going to be unhealthy. So how do we collectively work across lines to
00:30:01.600make a different outcome, to change the script, to change what's happening? And, you know, when I
00:30:08.560just gave a presentation at the UC level around their climate justice work and, you know, someone's
00:30:14.780response was, oh, you know, but changing capitalism is so big and like, how do we do this? And, you
00:30:19.300know, other people are like, well, this is, you know, capitalism is too big to fail or it's too
00:30:22.860big for us to imagine this. And these are some of the same arguments that came around when the U.S.
00:30:28.320had slavery and people who are very invested in keeping chattel slavery in place would come up
00:30:33.680with these same arguments. Like this is just too essential. This is too necessary. And it's time
00:30:38.840for us to say no. Like the abuse of the earth and the abuse of each other, the abuse towards
00:30:44.600especially black and brown bodies, it's not necessary. It's not essential. And if this1.00
00:30:50.340economic system requires it, then let's get rid of this economic system. Let's create other ones
00:30:55.440that will start from a place of care and start from a place of health so that all of us can have
00:31:01.560the opportunity to be healthy. Yes, I'm with you there. I want to go back to something that was
00:31:13.160spoken about at the beginning of our conversation, or at least debt was brought into the conversation
00:31:19.980And one of the undergirds of our social structure is debt.
00:31:26.480In Flamed, 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.
00:31:38.500We see this as a through line to our present day where so many people carry massive amounts of debt because of our poor systems of care.
00:31:48.120This 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?
00:32:09.740Well, we can't. I mean, you're right, Ayanna, that debt has always been an important technology of colonialism.
00:32:18.540You know, in Malawi, for instance, when the British came and needed workers, what they did was very simple.
00:32:25.300They just imposed a hut tax that initially families paid off by selling off their livestock.0.88
00:32:31.240And once they had sold everything that could be sold, they were left with the only thing left, which was their labor power.0.83
00:32:37.920And 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 benefited the British Empire.
00:32:50.740And that technology persists. 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.
00:33:07.600So 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.
00:33:20.640But what Britain can insist on is the kind of debts that it is able to control through its membership of the board of the International Monetary Fund and the World Bank.0.74
00:33:31.020Those kinds of debts cannot be discharged.
00:33:33.020They can be postponed as they were in a moment of very brief and very frugal generosity under COVID.
00:33:39.420But in general, that kind of debt is not the sort of thing that the Global South has ever imagined to be able to free itself of.
00:33:47.040There 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.
00:33:57.640They'll tell you, oh, yes, we've got some very exciting debt forgiveness plans.
00:34:03.020But they know full well that this is just a temporary mechanism to merely tamp down the wildly excessive numbers of debt repayment.
00:34:11.820But there will still there will never come an end point where the South does not owe the North.
00:34:16.760Whereas, 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.
00:34:26.860And that debt is, you know, again, the product of colonial capitalism.
00:34:32.040and it is writ large and it is writ small. It is writ small through the debts that we bear every
00:34:37.680day. But part of the technology of the future that we're excited about in Flamed is, well,
00:34:46.620what is it to imagine a different world? And we can imagine a world where there is public health
00:34:51.300care. We can imagine a world where education is free. We can imagine a world with all of these
00:34:55.120things and that world isn't too far away. I mean, I grew up under free health care and it's still
00:34:59.860racist, but people don't die discharging themselves of medical debt that they do here in the United
00:35:06.660States. In the United Kingdom, the National Health Service, again, made possible by trillions
00:35:12.840appropriated from everywhere else in the world, is nonetheless an example of a service that is
00:35:17.660available to everyone and beloved by everyone, and that was put into place not because it was
00:35:22.240affordable, but because it was the only thing that conscience would allow, which gets to Rupert's
00:35:26.600point, right? That if it's too expensive to have healthcare for everyone, then the numbers are
00:35:31.860being done wrong. But it is not the case that we can, in good conscience, allow ourselves to live
00:35:35.900on a planet where we are not caring radically for one another. So the idea of debt and a debt
00:35:43.740jubilee is important. It is important that we recognize the debts of the global north owes the
00:35:48.680global south, that patriarchy has occasioned, that racism has occasioned, that the stealing
00:35:55.520of the land on which we find ourselves as occasion, and repair and make reparation for
00:36:01.380that, but also that we recognize that debt is a way in which capitalism maintains its
00:36:09.500power, and by declaring a jubilee, we might be free at least from that element of capitalism's
00:36:15.540domination of our lives and free to dream something much better.
00:36:17.880yes i think dreaming something much better is necessary at this point the imagination battle
00:36:27.620that we're living within needs to be uh won by our dreams and imagination so i i'm really with
00:36:35.920you there and yeah it's you know we're just so obviously living in an afflicted world and
00:36:44.560with this comes a longing for healing. However, modern medicine and cure-based initiatives often
00:36:51.480serve merely to treat symptoms. And in turn, this comes to reproduce many of the issues that
00:36:58.600caused the issues in the first place. For instance, you write, quote, trying to solve air pollution by
00:37:05.560creating more rich-only spaces with air conditioning and filtration just makes it worse for everyone,
00:37:11.900as the machines spew out heat and demand energy to generate electricity,
00:37:16.900burning more fossil fuels in order to protect the wealthy from the effects of the fires, end quote.
00:37:23.040So I'm wondering if you both could elaborate on this extractive and consumptive cycle
00:37:28.460and the ways deep medicine may liberate us from this.
00:37:34.420Yeah, it's, you know, it's funny that it's beyond the imaginings because, you know, for example,
00:37:41.020here you know in the bay area in east oakland where i live there is a there's the this foundry
00:37:48.560the abni foundry that has been spitting toxic emissions into the air every thursday it smells
00:37:55.100really bad and all like throughout like this this like heavy cloud over east oakland and people who
00:38:01.680live around the abni foundry um get to experience a confluence of um air polluting particles from
00:38:10.100the 880 freeway, because all the trucks had to go down the 880, not over the 580, which is
00:38:19.540parallel to the 880, but has more white people living around it. So the flatlands of Oakland
00:38:24.700really get crammed with multiple chronic air polluting impacts. But the AB&I foundry puts a
00:38:34.320particularly toxic, you know, hexavalent chromium, which is a heavy metal aerosolized into the air.
00:38:40.640It's been associated with cancer and other health problems. And when you look at the life expectancy
00:38:46.480of people who live near that foundry, that's 10 years less than the people who live up by the 580
00:38:51.360freeway. So these things have like real impact on our health. We also learned that the combined
00:38:58.620impact of air pollution and like chronic air pollution and COVID that people who were exposed
00:39:06.000to chronic air pollution ended up having more severe outcomes when they got COVID. And then
00:39:10.480we learned that the people who were forced to breathe the toxic air from the wildfires
00:39:15.700also had worse outcomes with COVID. And there was also concern that the actual virus was traveling
00:39:22.660on the particulate matter and spreading along the particulate matter from wildfires and air
00:39:28.500pollution. So when you see the confluence of these things, you just realize like what a disaster
00:39:33.280this is and has been for people, you know, and looking at the maps of COVID in Alameda County,
00:39:41.100it's those people who live around the foundry. Again, the people who are in the flatlands of
00:39:46.120Oakland who are having the worst outcomes from COVID. And so we have these spare the air days
00:39:53.380in the Bay Area where you're not allowed to burn your fireplace. But on spare the air days,
00:39:58.800the AB&I foundry continues to release its, unleash its toxic load into the air in that area.
00:40:07.060And it just always has befuddled me. I've spoken to the county health department. I've spoken to
00:40:11.600the mayor of Oakland. I have talked to everybody about this health hazard and going all the way
00:40:18.920to the California EPA, the US EPA, and the inability to act on industry. Oh, well, they have
00:40:28.080a special title exemption to pollute our air. Oh, well, we can't do that because it's not under our
00:40:33.520jurisdiction. Oh, it's not a health, we can't like make a health order. So the levels of inability
00:40:40.380to act to stop toxic industry is shocking in the United States. And you can see the same with PG&E,
00:40:48.200Like how many people does PG&E get to kill with its wildfires?
00:45:25.300the other thing that really surprised me in this work in this research was how our bodies can heal
00:45:33.120that you know the the damage that happens to the body that generates the inflammatory response
00:45:39.720when that damage is stopped when you move into a dynamic that is no longer damaging that is
00:45:46.780restoring that that inflammation can, can be soothed. And that is the hope is that the knowledge
00:45:56.860that we can construct other ways, and it can look as simple as, you know, not as simple, but as
00:46:04.720small as a public smoking ban. Here's an example of, you know, something that happened in California,
00:46:11.460we banned public smoking. It took a couple decades because of the fight with the tobacco industry
00:46:18.280that wanted to continue to allow people to be poisoned by their products. But once California
00:46:24.760instituted its public smoking ban, rates of fatal heart attacks and strokes dropped. Actually
00:46:31.440dropped more than what we'd seen from any medicine, any pharmaceutical, any cardiovascular
00:46:38.440research, uh, interventional, whatever that we do, the fancy things we do in medicine,
00:46:43.740just simply saying you can't smoke in public. That kind of action is a policy level design of
00:46:50.340the world around us that had radical impacts or transformative impacts on our bodies.
00:46:56.000So if we can do that with smoking, can we do that with pesticides? Can we do that with eliminating
00:47:00.880all of the inputs into our soil that damage our soil microbiology? Cause we know as fossil fuel
00:47:07.700based inputs are put into the soil they damage the the fungal to bacterial ratio they make that
00:47:14.080that um you know you get less of the delicious glomulin um which is a glycoprotein secreted by
00:47:20.440fungi to hold the soil together and act as a sponge that those those beautiful um ecological
00:47:28.460relationships in the soil are destroyed through the use of these chemicals they're the same
00:47:33.400chemicals that are driving up global temperatures. So when we can decide, you know, these industries
00:47:39.060can no longer be allowed to privatize the gains and socialize the costs, because we are paying
00:47:46.440for it. I just drove through Kern County last week on Indigenous Peoples Day, and so much of
00:47:52.100the soil was in the air. California is turning into a dust bowl because of these agricultural1.00
00:47:57.700practices. So this is an important time to start imagining how we redesign our world by dethroning
00:48:08.000the industries that have been wreaking havoc on public health for centuries and by demanding our
00:48:15.320place and our right to be healthy and our right for our grandchildren, our great-grandchildren
00:48:20.540to breathe healthy air and to drink healthy water. And so that insistence is growing and it must grow
00:48:28.040a lot stronger and all of the tactics of movement building and organizing will be required. And so
00:48:35.340it's an important time to start getting involved. Yes, I couldn't agree more. And
00:48:43.520I was so struck by your explanation that, quote, colonial cosmology sees things where persons once were.
00:48:56.620What once was alive with personhood, a forest, a river, a mountain, becomes inanimate, disconnected from ecologies, open to exploitation in the United States.
00:49:08.920This mindset is enshrined into law, end quote.
00:49:13.100And as we conclude, I think it's particularly important to remember that you both recognize the importance of medicine and health beyond the social constructions of capitalism and colonialism and racism in which they currently reside.
00:49:29.120And there is hope for a medicine that brings us closer to the earth and to healing.
00:49:34.440So I would just love if you could paint a picture of what health and perhaps even more
00:49:40.220importantly, care looks like from the perspective of deep medicine.
00:49:45.900Well, deep medicine is recognizing that health exists beyond individuals.
00:49:53.180Health is an emergent phenomenon of systems within systems working in their optimum state.
00:50:01.300so we can try to get health as an individual but we will not be as successful as getting
00:50:09.460health for whole communities together and how communities intersect and by that i mean human
00:50:16.060and the more than human communities i mean the water and and the air and the microbes and the
00:50:22.360and the forest and so deep medicine is understanding how all of those things must intersect
00:50:28.840to create health and that we have to open our perspectives and our ways of knowing to all the
00:50:37.340keepers of deep medicine, not just the, you know, the doctors or the healthcare workers that are
00:50:42.820farmers, that are, that are frontline, you know, indigenous grandmothers standing up against line
00:50:48.180three right now, that these are all health. These are all people working for health. And that these,
00:50:54.360when we work together and collectively and across disciplines together, we can create a different
00:51:00.900kind of reality. We can create a health for everybody. When we start imagining food as a
00:51:07.960right, as it has been for thousands of years before capitalism, where our food and medicine
00:51:13.240have always been coexistent, they haven't been separated from each other. And there's still that
00:51:17.900way in many cultures around the world. When we insist upon our medicine being outside of the
00:51:26.740tiny vocabulary of pharmaceuticals, not that we abandon science, Western science, or we abandon
00:51:32.400even those pharmaceuticals, but that we abandon the logic of domination that they have been
00:51:37.320structured by, and that we take back our right to have access to these things to be healthy when we
00:51:43.600need them, and that we incorporate the full range of languages and vocabularies of medicines,
00:51:49.880be they plant medicines, medicines of song, medicines of relationships, in order to achieve
00:51:56.420a vision and a reality of our health. So these, you know, practices are not, you know, just,
00:52:04.560I'm not just talking about things that don't exist. These are things that are an active
00:52:08.000practice in communities around the world today. And so how do we connect with and work and learn
00:52:15.100with those communities to advance their health agendas, especially our indigenous communities
00:52:19.840in their territories? Today, I'm speaking to you from the occupied and unceded Ramatosh
00:52:26.000Baloney territory, what is now called San Francisco. And we are working with an organization
00:52:32.440we formed called the Deep Medicine Circle with indigenous people and settlers together
00:52:37.300working to decolonize our food and medicine and that project that work has been so beautiful
00:52:44.680because it shows how it sometimes it's just a simple uh imagining and that's what we were
00:52:51.980talking about in the book is like the importance of exercising our imaginations of looking to art
00:52:57.800and looking to other ways of knowing that can lift our vision up a little bit higher so that
00:53:03.340we can see beyond the enforced horizons of colonial capitalism to another world that's
00:53:09.560sitting there waiting for us, you know, with open arms. And that world needs us really badly right
00:53:15.080now. Yes. Oh, Rupa, I'm so appreciative that you took us through some really intense and
00:53:26.640challenging topics but you're leaving us with this vision and I would say for me like a type
00:53:35.200of confidence that another world is possible and we just need to be brave and bold and consistent
00:53:42.660and believe that we can do this together and we can change the system that is you know
00:53:50.540kind of strangleholding us a bit so yeah I just really appreciate this listening journey you took
00:53:57.860us through and thank you so much for your work and your devotion and your dedication and Raj I
00:54:04.760you know really appreciate you too I know he had to jump to a class but I'm so grateful to you both
00:54:11.300and for your book Inflamed and I really really want listeners to go pick up that book and dive
00:54:19.800deeper. And again, it's inflamed deep medicine and the anatomy of injustice. Thank you so much
00:54:27.180for giving us an opportunity to talk about this book. Ayanna, thanks for your awesome work.
00:54:39.760Thank you for listening to For the Wild podcast. The music you heard today was by Roma Ransom
00:54:45.220and Lindsay Mills. For the Wild is created by Ayanna Young, Erica Ekrem, Francesca Glassbell,