What does it mean to have a healthcare system that serves everybody? And what can physicians do to address the ways in which societal challenges impact our diagnoses?
Rupa Marya, M.D., is exploring these concepts through numerous projects aimed at researching our current medical climate and collaborating with marginalized populations to make healthcare more effective and compassionate.
Following is a transcript from Marya’s 2018 Bioneers keynote presentation, in which she discusses her research and vision for the future of medicine. Watch the full keynote video here.
View more keynotes, transcripts, and more from the 2018 Bioneers Conference.
Rupa Marya:
I am the daughter of Punjabi immigrants who came to this country in 1973, with little money but plenty of caste privilege. We grew up with family vacations driving a VW van around the Western lands. My father would stop at the reservations. He would make us get out and listen and learn and look, and see what had happened to the original people of this land. He would talk to me about colonization, because we are also a people who had been colonized by Europeans.
I am a mother of two beautiful mixed heritage boys, and I am a farmer’s wife. I’m a physician who works in adult medicine, and who witnesses society’s ills manifest in my patients’ bodies, and a doctor who sees racism and state violence as an urgent public health issue. I’m a touring musician who has played in 29 different countries, singing in five different languages with the band Rupa and the April Fishes. To use a phrase taught to me by a Miwok elder, Wounded Knee, I am an Earth person.
What I’m going to describe for you is a system of domination in which we live, and what I believe are the direct health consequences of that system for all of us. I’ll begin with a description of how we have come to understand disease in a modern post-industrial context. In the 1850s, the germ theory was developed, which described how organisms such as bacteria and viruses made us sick. That led to the development of antibiotics and vaccines and systems to limit the spread of infectious disease.
In the 1960s, with the elucidation of DNA, we entered the molecular genetic era, where we are today. Here the gene creates a protein that can cause or protect from disease. How sick or well you were was thought to be preordained somehow by your genetics. This understanding has led to many powerful diagnostic tools and targeted therapies for specific diseases.
In 2004, with the discovery of the role of RAS gene mutation in the development of colon cancer, exactly 2,000 years after Roman physician Celsus described the cardinal signs of inflammation, we are entering the era of inflammation. Instead of a reductionist approach to understanding disease, we are seeing how many pathways lead to chronic inflammation, which in turn creates the conditions for illness.
Today we will be talking about the impact of social stressors, which have been shown to cause chronic inflammation. These diseases require more systemic approaches, not simply focusing on the individual, but rather moving our gaze to the structures of society, helping us see how the individual pursuit of health is actually futile in a system that makes health impossible.
How Colonization Affects Health
To understand the root causes of pathologies we see today, which impact all of us but affect black, brown and poor people more intensely, we have to examine the foundations of this society, which began with colonization. To me, to be colonized means to be disconnected and dis-integrated from our ancestry, from our Earth, from our indigeneity, our Earth-connected selves. We all come from Earth-connected peoples, people who once lived in deep connections with the rhythms of nature. I believe it is not a coincidence that the colonization of this land happened at the same time Europeans were burning hundreds of thousands of witches, those women who carried the traditional indigenous knowledge of the tribes of Europe.
Colonization is the way the extractive economic system of capitalism came to this land, supported by systems of supremacy and domination, which are a necessary part of keeping the wealth and power accumulated in the hands of the colonizers and ultimately their financiers.
In what we now know as the United States, this system of supremacy is expressed in many ways and with many outcomes. Today, we will focus on specific ones. First, white supremacy, which created a framework that legitimized slavery and genocide. Slavery created cheap labor, which is necessary for a functioning capitalist system. Genocide created unlimited access to resources in the form of land, animal parts, minerals, and raw materials, which are also necessary for a fully functioning capitalist economy. As capitalism functions, it further entrenches these systems of supremacy.
We all know that white supremacy is the scary guy with the swastika and the hood. But it can also look like any place where there is an abundance of white people in exclusive contexts, where power and access is not readily ceded to others.
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