Inflamed: Deep Medicine and the Anatomy of Injustice

by Rupa Marya, Raj Patel

Raj Patel, the New York Times bestselling author of The Value of Nothing, teams up with physician, activist, and co-founder of the Do No Harm Coalition Rupa Marya to reveal the links between health and structural injustices--and to offer a new deep medicine that can heal our bodies and our world.

The Covid pandemic and the shocking racial disparities in its impact. The surge in inflammatory illnesses such as gastrointestinal disorders and asthma. Mass uprisings around the world in response to systemic racism and violence. Rising numbers of climate refugees. Our bodies, societies, and planet are inflamed.

Boldly original, Inflamed takes us on a medical tour through the human body--our digestive, endocrine, circulatory, respiratory, reproductive, immune, and nervous systems. Unlike a traditional anatomy book, this groundbreaking work illuminates the hidden relationships between our biological systems and the profound injustices of our political and economic systems. Inflammation is connected to the food we eat, the air we breathe, and the diversity of the microbes living inside us, which regulate everything from our brain's development to our immune system's functioning. It's connected to the number of traumatic events we experienced as children and to the traumas endured by our ancestors. It's connected not only to access to health care but to the very models of health that physicians practice.

Raj Patel, the renowned political economist and New York Times bestselling author of The Value of Nothing, teams up with the physician Rupa Marya to offer a radical new cure: the deep medicine of decolonization. Decolonizing heals what has been divided, reestablishing our relationships with the Earth and one another. Combining the latest scientific research and scholarship on globalization with the stories of Marya's work with patients in marginalized communities, activist passion, and the wisdom of Indigenous groups, Inflamed points the way toward a deep medicine that has the potential to heal not only our bodies, but the world.

Genres: Nonfiction, Medicine, Science, Health, Social Justice, Politics, History

496 pages, Hardcover

First published August 3, 2021

Reviews

[Raj Patel · Rating 5 out of 5]

Look, there's no pretending that I'm being at all objective about this. But since the Library Review and Booklist gave us starred reviews, perhaps you might enjoy reading this as much as I enjoyed writing it with Rupa!

[عدنان عوض · Rating 4 out of 5]

3.75/5

If you are a physician who is aware of the fundamental problems in conventional medicine, crossing the borders in your practice, exploring new ideas/frameworks/philosophies/practice, and trying to redefine health, wellbeing and disease; then this book will look very familiar and new at the same time. Familiar in using the same information and models you are familiar with when analysing the relationship between our body and the environment, and new on putting them under a large model of analysis: colonisation and capitalism.

If you succeeded in connecting your patients' parts: whole body instead of isolated systems. Then, body with mind and soul, instead of the body only. Then connect all of that to the environment, instead of a closed material system; then this book will connect you to broader frontiers in medicine, where every living "being" and "thing" does matter. It will introduce you to the history of the world, to communities that you almost forget about. Will be your new tool in this big journey, the journey to connect further. This book is not the first and will not be the last in this journey.

As the Moroccan Islamic philosopher Taha Abdelrahman always mentioning in his writings: we are living in a civilisation of separation. And we need to reconnect what was deeply separated and shattered in everything. Here: the web of life.

This book has the potential to be even stronger in its argument. Maybe in the future edition, Raj and Ruba will do massive editing, to re-organise the content in a more non-repetitive and structured way. Maybe even change how chapters are built from the scratch, and focus on fewer examples with further analysis. The material is pure and revolutionary, but the way the argument is laid is quite repetitive and rhetoric in some chapters.

If I have the chance to recommend an extra chapter, it would be about healthcare workers under the conventional healthcare system. They are INFLAMED as well, by a range of structural pathways: commercialisation of medicine, long working hours, overwork, lack of sleep, increasing paperwork, less time with patients, qualifications exams and courses and CMEs, understaffing, the poor outcome for chronic diseases... etc.

"Diseases of civilisation" are the ugly end to how conventional medicine is structured, and despite inflammation sets in the centre of generating this problem, it's not the only to look through it. I'm aware that this book can't cover everything but hope to see this model cover more culprits.

After reading History of the World in Seven Cheap Things, I found Patel very loyal to his framework about colonisation and capitalism and applying his analytical model to a new territory: medicine.
Moreover, Ruba Marya is a discovery for me, a name that I will follow from now on.

side note:
where is the urinary system? It will make great chapter on the global waste problem, from all industries, including medical waste.

I'm a physician and this book represents me.

Highly recommended, and for many re-reads.

[Morgan Blackledge · Rating 5 out of 5]

A classic Alcoholics Anonymous (AA) witticism goes: an old fish asked a young fish “how’s the water?” to which the young fish replied “what the fuck is water?”

The point of it is, we may not understand or even perceive the shit were swimming in, because…we’re in it.

Like wearing a mask and not knowing it, because you’ve always worn it, you don’t even think to take it off and turn it around and have a look.

Until someone somehow asks you to do exactly that.

And even then you may feel incredulous about the very notion.

What’s a mask?

What’s water?

What are you talking about?

Who the fuck are you?

In these metaphors, the “mask” and the “water” are colonialism and advanced global capitalism, and the psychological, social, medical and environmental catastrophes they bring.

Of course the fish in “water” metaphor fails on a certain level.

Because in the case of us “fish” and the toxic “water” were all swimming in, it’s the young fish that are the ones who can’t help but knowing, and unfortunately, it’s the old fish who seem to can’t help but don’t!

Inflamed is about a lot of things.

But perhaps more than anything.

It’s about colonialism and late capitalism.

And what living, and breathing, and eating, and viewing our selves, and viewing each other, and viewing the planet, and viewing the world, from within the “water” and through the “mask” of colonialism and capitalism does to our minds, our bodies, our selves, our hearts, our brains, our relationships, our culture, our communities, our souls, our (literally) everything.

Inflamed asserts:

The world is on fire.

Our food and water is poisoned.

The philosophies religion and politics of rational self interest and entitlement are murdering the commons.

Danger and despair are hanging in the air.

In fact, the air IS danger and despair.

And so it is no wonder at all, that our bodies and brains, our relationships, our EVERYTHING is inflamed.

And when everything is inflamed.

Illness is no longer abnormal.

Illness is everything and everywhere.

How does one “do medicine” in that context?

As healers.

What (exactly) are we doing when we target a “symptom” occurring within an “individual” and treat it with a salve, or tincture, and never even think about the “mask” and the “water?”

That’s like plucking one “diseased” fish out of a tank filled with toxic sewage, and giving it a vitamin or an antibiotic, and then dropping it right back into the toxic sewage.

What the fuck good is that?

And if this is what we’re doing, are we part of the problem or part of the solution?

In AA we say:

“It’s not the THING, it’s the thing BEHIND the thing, that’s the thing.”

Inflamed is about the toxic thing that all of the other things are submerged in.

As therapists we can keep looking at the thing, behind the thing, behind the thing, behind the thing ad nauseam, without getting at the thing the things are swimming in.

The “mask” and the “water”.

We may think we’re doing good if we’re chasing things behind things.

And shit, if we make a nice little paycheck while we’re doing it, than we can call that a win/win.

After all, this is capitalism, and we all have to eat, right?

Well what if the “capitalism” part that we’re all just resigned to accept and operate within IS the problem?

Inflamed Authors Rupa Marya and Raj Patel ask:

What are we doing, if we are offering mindfulness-based stress reduction to someone who is dying of exposure?

At that point, is the therapist part of the problem or part of the solution?

Inflamed is about the toxic exposures, and structural and systemic inequities, and the environmental degradation, and the poisonous world view, and the lack of critical distance that causes “disease”.

Deep medicine is the term the authors offer as a kind of BIG healing, that looks at the “mask” and the “water” of capitalism and colonization and issues an invitation for healers of all varieties, to (a) acknowledge that we have a problem, (b) except that we are part of the problem, and (c) become part of the BIG solution.

Apartheid was a system of institutionalised racial segregation that existed in South Africa and South West Africa from 1948 until the early 1990s (copied and pasted straight from Wikipedia).

Marya and Patel assert that Medical Apartheid is happening RIGHT NOW in 2022, and RIGHT HERE in the USA.

By Medical Apartheid they simply mean.

Poor people.

Black, indigenous, and people of color (BIPOC).

And increasingly everyone except for the most fortunate.

Are exposed to higher health risks and inadequate or even iatrogenic (harmful) systems of medicine.

With global capitalism and colonialism burning the world down, and selling N94 masks and mRNA shots as the solution.

Marya and Patel are ABSOLUTELY NOT anti vaxers.

They are saying YES to mask use and YES to vaccines, and YES to social distancing.

Absolutely!

And also challenging us to please look at the system that is the pandemic, and climate catastrophe, and medical apartheid, and…

Find language.

Forge meaning.

Build community.

And…

Fucking do something about it.

Become liberated.

Create something new.

The exposome is what Marya and Patel define as the summation of all the toxic exposures that an individual incurs over a lifetime.

This includes exogenous toxicities such as toxic chemicals and toxic organic pathogens from environmental and occupational sources, but also exposures to chronically active endogenous stress hormones and neurotoxins occurring via biological and psychosocial stressors.

Homeostasis refers to how our bodies and brains and social systems and environments maintain balance.

Allostasis refers to the “opposing processes” that become engaged when an organism, or organization becomes “out of balance”.

When our bodies and brains are under assault.

Our immune system‘s react by releasing pro-inflammatory cytokines, which aid the healing process in acute situations, but inflame the system over longer, chronic exposures.

Marya and Patel assert: as the world burns, and we breath it all in, so do our bodies and brains and relationships, and families, and communities, and cultures.

We are inflamed as we are in flames.

Chronic illnesses such as heart disease, digestive disease, respiratory disease, reproductive disruptions, chronic pain, addiction, and mental illnesses ensue.

Walt Whitman quipped “we contain multitudes”.

Marya and Patel posit that many of the billions of micro organisms that evolved with us, and live within us, our microbiome, which are absolutely essential to our health and survival, are LITERALLY going extinct.

Dysbiosis refers to the micro-biome mass extinction events happening in our bodies, analogous to the mass extinction currently underway in our environmental biome.

Loss of micro-biodiversity (extinction of certain types of bacteria) in our gut-biome causes chronic gut diseases such as: Inflammatory bowel, Crohn’s disease and other types of chronic gastrointestinal and digestive disorders.

Depression is also linked to gut health.

Marya and Patel assert that disruption of the microbiome, and environmental despoliation are products of colonialism, industrialism, and advanced global capitalism.

The knock on effects of colonialism and global capitalism are domination, exploitation and extermination.

Hydroelectric projects kill salmon populations, along with the other myriad animals and indigenous people that depend on the salmon to survive.

Industrial agricultures chronic use of toxic pesticides like Roundup are killing all of us, with BIPOC farm workers getting the most and the worst of it.

Factory farmings chronic use of antibiotics is murdering our gut biome and so much more.

Modern medicines chronic use of pharmaceutical and surgical interventions, that themselves cause illness, disease and dependence (iatrogenesis) are failing, utterly FAILING under the strain of COVID-19.

All of it occurring within an addiction crisis, occurring within a financial crisis, occurring within a housing crisis, occurring within a police violence crisis, occurring within an ecological disaster.

And all of which is rotten, utterly shot through with the perspectives, products and byproducts of colonialism and advanced global capitalism.

What (exactly) does one mindfull breath at a time mean when we’re meditating in a gas chamber?

What does “self-help” mean when the only REAL solution is at the level of the system?

We can do better!

Liberation suggests something more than simple freedom.

Liberation connotes the ability and commitment to work and sacrifice and grow in the service of something BIG, something meaningful, something true, something good, something worthy of devotion, something worth living for.
 
Revolution, in its most redeemable sense, suggest cadres of like-minded individuals, joining together in solidarity, and upending old, outdated and otherwise oppressive modalities, in order to create something new, something better, something that is more effective, and hopefully something that is more sustainable in the long term.
 
Evolution occurs via the variation, selection, and retention, of genes, traits, information, knowledge and behaviors, adaptive to environmental and psychosocial pressures and in the service of survival and reproduction, transpiring over generations, within the lifespan of the individual and within the context of the milieu, echoing from the distant past, and hopefully into the distant future. 
 
Recovery is about becoming liberated from the confines of chronic illness, addiction, mental illness and stultifying systems of oppression, via acceptance of what is, coupled with a lifetime commitment to estimable actions, born of fearless self-inquiry, clarification of what matters most, connection to a healing community, and in service to a higher purpose.
 
It is increasingly apparent that the religions, philosophies, politics and methodologies of brutal tribalism and unbridled rational self-interest are dividing us, devouring the commons, entangling us in a web of toxic misinformation and dependence, and in so doing, murdering our vitality, our mental health, our families, our communities, our planet, and for lack of a better word, our souls.

We need LIBERATION!

We need liberation NOW!

This book is LIBERATING!

This book gives life.

A must read.

[Peter Baran · Rating 3 out of 5]

One of the core parts of my old day job was to train student politicians how to lobby and argue with the college and other external stakeholders. And basically there were two main lessons that were at the heart of it. The first was make sure they know what you are talking about - avoid jargon and neologisms that they might not understand .Even if you have explained it, the rule of word-play is also applicable - one neologism or bit of jargon (or one pun) per sentence. The second rule was keep it simple - but more importantly - if you have made your point : stop. One good argument is better than four good arguments and one bad one. Inflamed made me think of these rules, not least because while the subject of medicine was outside my professional expertise, the decolonising part of this book wasn't. And whilst concepts around decolonising all institutions tend to have a lot in common, there are other core aspects of decolonising medicine which are about examining the legacy of the scientific method, institutional and historical biases - before we consider what can be reinstated from traditional medicine and the overall harm done by an institutionally racist society,

But there's a reason why the publisher didn't put Decolonising Medicine on the cover of the book.

This is an impeccably researched treatise with a central metaphor of Inflammation - when the body reacts, and sometimes over-reacts, to illness and stimulus. Marya and Patel see a parallel with the social response to injustice within society as a kind of inflammation, and while it is a neat metaphor, they do kind of beat it to death. But that's OK because on their journey around the body, and its various traumas and how they can be explained, or drawn back to historical trauma, they will repeat this and other similar metaphors until they seem to form part of the argument, rather than just a technique. And that's part of my problem with the book. I have no problem with the premise or indeed conclusions and the book is meticulously referenced. It is apparent to me that that healthcare outcomes differ between ethnicity due to inequalities baked into the system (poverty, poor housing, access to care), as well as explicit racism. That living somewhere globally where mega-farms use poisonous chemicals will effect you, but perhaps four to five generations on. Where Western medicine is built on shaky racist foundations that it hasn't got out of its system, and an inability to think holistically or treat traditional medicines with anything but contempt. But even I, a sympathetic fellow traveller, found its offhand references to traumatic "exposomes" as a given difficult to sqaure with also a sense of back to the land embracing of traditional medicine. And I think the problem is that the book is aimed sort of at me, but even more at healthcare sceptics, wellness gurus who dabble in yoga and ayahuasca (though they do give ayahuasca tourism a kicking in places). Your central argument is already great, you don't need to bolt on some of the shakier ones.

The other problem with the book, which is one they freely acknowledge and try to deal with in the last chapter, is what to do about it. And when the solution is nothing but a wholesale rethink of how healthcare fits into society, where only a fair society will produce fair healthcare and that's nothing short of revolution away, it can make it all feel a touch futile. Not least as the whole point of a holistic deep medicine approach literally cannot be done in a piecemeal fashion - its about the commons and a common approach. I thought Inflammed was a fascinating read, and a close read will almost certainly give you jumping off points for further reading and activism. But it was also a rather depressing one too, and one that I thought would have been a bit more powerful if shorter and punchier..

[Enya · Rating 1 out of 5]

I was very excited to read this book, but as I read this book it was very disappointing to see that the authors continue the legacy of doctors being uncritically fatphobic. There are anecdotes and weak correlations related to weight loss that is shared without any context or critique. This book references abolitionist thinking right at the beginning, but somehow manages to ignore ties between abolition and fat liberation when activists have been talking about this for decades and even longer. Furthermore, the equating of fatness and poor health doesn't just happen once or twice, it happens throughout the whole book so it just becomes impossible to ignore and ruined the entire book for me.

[Sarah Jaffe · Rating 5 out of 5]

I knew I was going to enjoy it but it gave me gifts I utterly didn't expect and that is always an extra joy.

[George Austin · Rating 1 out of 5]

Embarrassingly shallow, constantly introducing topics, presenting a basic viewpoint and making no attempt to acknowledge the complexity of the issues. The only explanation offered for the source of problems discussed in the book is "settlers" and capitalists. Read if you want an echo chamber, if you want to understand issues through learning all of the pertinent facts, look elsewhere.

[Nic Yeager · Rating 5 out of 5]

‘Inflamed’ Shows How An Unjust World Is Making Us Sick

Nic Yeager

Texas Observer


When a wave of Anglo homesteaders laid their false claims to the sprawling Texas plains in the 1860s and 1870s, an extremely profitable invention followed close behind: Barbed wire. It was the end of the open range—the Mexican rancheros, old-school cowboys, and Indigenous communities who had tended the land saw how it was suddenly sectioned off and sequestered. Enormous, roaming buffalo herds were nearly driven to extinction, in large part because government policy was to kill them and starve tribes, but also because the wire cut off surviving buffalo from their grazing lands and water. Food that humans once plucked from the earth now sat behind sharp fences, withering in the hot sun. Mexicans throughout the Southwest coined a phrase: Con al alambre vino el hambre. With the barbed wire came hunger.

What happens to our health when capitalism and colonialism tear apart natural environments? These are the deeply rooted dynamics that concern the authors of Inflamed: Deep Medicine and the Anatomy of Injustice, published this month. Raj Patel and Rupa Marya find similar stories from across the world and ask how those forces have affected our bodies. The results are not equal: In Texas, outside the barbed wire, it was oppressed people and animals who starved. Yet the authors argue that collectively, our health has suffered from a destructive path of human history defined by actions as small as putting up a fence: Our bodies, and the world around us, are inflamed.

A sweeping project that draws on natural sciences, sociology, economics, and history, Inflamed offers a compelling argument for studying inflammation in 350 pages of stunning research and inspired language. Guiding us through vast realms, disciplines, and histories, into strange and beautiful corners of the world, this book contends that we are all sick and gives us the tools to dismantle the systems that are making us so. Marya and Patel write in the book’s first words: “Your body is inflamed. If you haven’t felt it yet, you or someone close to you soon will.” Inflammation accompanies almost every illness in the modern world: heart disease, cancer, inflammatory bowel disease, Alzheimer’s, depression, obesity, diabetes. It’s a symptom of a larger problem, they write. But the future can be different.

Patel, a professor in the LBJ School of Public Affairs at UT Austin, has a background in studying food systems and was formerly involved with peasant movements in Zimbabwe and South Africa. Marya is a physician and professor of medicine at UC San Francisco who has worked closely with the Ohlone tribe in the Bay Area and was invited by Lakota health leaders and elders to help run a community clinic at Standing Rock. Throughout the book, Patel and Marya, who do not identify as Indigenous, apply Indigenous systems of knowledge and the principles of ecology to make their case. They present a cure: The deep medicine of decolonization. Inflamed defines colonial medicine as a dehumanizing, disconnective force that still instructs health systems all over the world, and powerfully argues the need for different models of medicine, healing, and understanding life and the body.

The book describes the inflammatory response as the body’s “ancient and powerful mechanism to heal itself.” When your immune system needs to respond to damage or a threat, cells and molecular messengers in your body take part in a complex, choreographed set of interactions to restore your internal balance or heal your wound. However, there are two different types of inflammatory responses: Acute or chronic. The acute inflammatory response is brief, when activity increases sharply in the face of a threat or injury and then resolves when the threat has passed or the damage is repaired. Chronic inflammation is when it doesn’t end: The threat doesn’t pass, so living cells under duress don’t stop signaling. Your immune system learns that it cannot rest and inflammation rages on. Our lives have more chronic stressors than they used to: Authors note that while we once faced the acute stress of a bear running after us, now we face the chronic stress of paying essential bills, working under precarious conditions, or feeling unsafe daily on the street because of our race or gender.

Oppression is traumatic, and trauma is inscribed in the body, the authors write. Recent data shows that severe COVID-19 is overexpressed in socially oppressed groups, and not just because of greater exposure or medical racism. “The same infection is expressed differently in different groups because of how the immune system has been toned over time,” or in other words, when your immune system is toned for a reality in which threats are always impending, it’s always inflamed. Chronic social defeat, a technical term describing “repeated and inevitable loss in moments of social conflict,” leads to overexpressed pro-inflammatory signaling proteins.

Patel and Marya explore the pro-inflammatory functions of debt, stress, violence, and trauma, drawing from data on the health outcomes of poor, Black, and Indigenous people specifically. However, they take care to make distinctions across the globe: For example, while they show that food and health apartheid means people of the Global South bear a heavy burden, they note that certain infection and gastric cancer rates are low in Black Africans, but high in Black Americans. Water and air pollution, monoculture farming that strips our guts of important microbes, and social oppression precondition the bodies of Black people in the United States, they write, so when they encounter the same bacteria, they are far more likely to develop gastric cancer.

Just like our bodies, the planet is also inflamed, the authors write. The wildfires that are raging worldwide are related to the inflammation in our arteries. This is not a metaphor: Each year millions of people die, inflamed, by the consequences of fire. Even if we begin to address the climate emergency, it will take generations to clear the effects from our lungs. The authors make a strong case that our planet is like our bodies: The alarm signals are blaring so loud that they are hurting us. Something is terribly wrong here.

Deep medicine is their word for turning to the root causes and improving our ill health through deep structural change. This means coming to Indigenous communities not with pity, but to ask for guidance. In a chapter on digestion, they interview Native food nutrition educator Valerie Segrest of the Muckleshoot Food Sovereignty Project. She teaches about decolonized food systems, and says her first lesson is to start reversing colonial thinking about the web of life, to stop seeing “nature” as separate from “society.” The next is to take her students to their huckleberry meadow from the top of a hill to see how their tribe had been drying berries and facilitating prescribed burns for thousands of years. “Despite colonial forces seeking to exterminate the web of life, abundant knowledge about it remains.”

Throughout the book, Indigenous activists and healers offer insights into the pleasure and beauty that define deep medicine. We explore other marvels of science and history in detail: We hear about the salmon that once pumped nutrients through the entirety of the Pacific Rim coastline; the secret, essential lives of microbes, which can be passed down through our ancestors’ bodies or by breathing in the soil that settles on our windowsills; and the women healers and herbalists who were slandered as “witches,” and thus silenced of their medicinal knowledge in the 1600s.

Inflamed is utterly fascinating, and beyond that, spiritually potent. At times, it feels almost visionary. In these pages, as in our world, everything is connected. For readers seeking promise and meaning while struggling to survive through the COVID-19 pandemic, our environment’s rapidly intensifying collapse, and the plagues of systemic racism and global inequality, this book offers a wise and welcome interpretation. It argues that the web of life can be restored, and that harmony, and collective liberation, is possible.

[ro · Rating 1 out of 5]

Oops I don’t need able bodied people to tell me what I know about my own body, great ideas expressed through terrible frameworks. Not much relationality with the sick and suffering here.

[John C Hornberger · Rating 1 out of 5]

Biased evidence and interpretation to support prespecified hypotheses.

Part of establishment medicine UCSF faculty. Does know or at least acknowledge difference between association and causation. Cherry picks evidence that support the goals stated on last page, redistribution of wealth through reparations from north to south. Is the solution really to do unto others what was done unto your ancestors? No need to work with white men, etc. Isn't this just perpetuation of the things the author abhors? Real change is needed but it requires better ideas than expressed here. How about something like the multinational accords for climate change? Want a good read with real explanations and real solutions, Benjamin Ho's "Why trust matters."

[hallie · Rating 4 out of 5]

This book is a great introduction to thinking critically about the state of our health today— health as individuals, as a society, healthcare as an institution, and the perspectives that are often overlooked and intentionally left out of the narrative. The book is set up as an analysis of injustices, separated and organized by organ systems of the body, but with the space to see the connections between issues and the body as a whole throughout the book so that we can begin to move beyond the rigid and harmful framework of healthcare that we live in today.
Overall, I loved this book.
However, I give it four stars because the organ systems chapters that make up the bulk of the book at times confused me, and I think it’s simply due to the amount of topics the authors would bring up in each chapter. Perhaps examining fewer in more detail would have helped me (or maybe if I read slower?? food for thought).
Aside from that, I give the introduction and conclusion 5 stars because they are PHENOMENAL. The book is written as a duet between the two authors, but the final chapter includes a dialogue of each speaking individually, and to me, that was one of the most beautiful moments in the book.
Give this a read, but allow it to be a slow read that you sit with. Understand that many issues it tackles are heavy—maybe reading with someone you love would be a good way to approach this, so that you can care and support each other and have conversations about challenging topics when needed.

[Antony Monir · Rating 3 out of 5]

The rating I’m giving this book is mainly due to the way it is written and not because of the content. I agree with most of what is written in this book and it was definitely and enlightening read. Our health is affected by much more than why think and this book shows how important politics is for everyone’s health. However, the authors should’ve edited the book a little bit more because it seems to not follow any structure and it feels like a collection of essays and not a book with a defined form. It is also surface level at many points which is disappointing given the length of this book. In the end, this is a great book with subpar execution yet I see it being a very important tool for social justice activists who want to focus on healthcare. Final rating: 3/5.

[Amelia Armstrong · Rating 5 out of 5]

!!!!!!! I cannot recommend this book enough. Thank you Raj Patel and Rupa Marya for highlighting the intersecting injustices that impact the individual and the collective, and for directing great attention to what must be done about it. One of the most important books I’ve ever read.

[Tyara · Rating 3 out of 5]

To quote Paris Geller: I have one word for [the authors]: edit.

[Laya · Rating 4 out of 5]

Fully appreciate the project of this book and it is pretty radicalising to know the actual biological effects of the structures of capitalism. Only that I wish it had more tighter focus on medical history and/or anthropology like the immunology chapter as I felt it veered off sometimes out of its main focus. Nevertheless, I’ll be recommending this book to many people now.

[Sheena · Rating 5 out of 5]

this a fascinating, gut-wrenching, 100% need to read!!! They slam you with all the facts and then they back that shit up again and again.

My favorite part was when they called out Singapore for how they dealt with migrant workers during COVID :)

[Owd Ellob · Rating 4 out of 5]

I'd give this 5* but I think the next edition can be even better. This is a special book because it dares to speak fluidly, lyrically about biology and anthropology, how our body, our health, is intimately linked with the environment ( or exosome ). And not in a wishy-washy way, but jam packed full of historical and scientific evidence all fully referenced.Personally I would prefer more of the biology and less idealisation of indigenous cultures in places ( chapter 5 on the reproductive system for instance ). I take the point that 'Western' city people have a lot to re-learn about living with nature from peoples who live closer and in valve with it. But in places I thought the narrative goes too far. I'm pretty sure indigenous peoples are just as capable of the same barbarity and ignorant behaviour as the rest of us. ( See Steven Pinker's 'The Better Angels of Our Nature: Why Violence Has Declined.") That said I see the point of comparing ourselves in the 'West' to the rich culture of the peoples we have stamped upon. The thesis reminds me of Denis Nobles reposte to the (popular and yet wrong ) interpretation of Dawkin's selfish gene book. Inheritance and evolution is less about the survival of base pair sequences, and more how an unbelievably complicated piano genotype is played. Life is the music that results as gene keys are pressed. Some of this music can be the result of something we can call free will. For our survival we need to learn how the rest is about avoiding inflammation, through sheer 'colonial' thought idiocy.

[Mike Hartnett · Rating 2 out of 5]

I really did not enjoy this. There’s valuable information and perspectives worth considering here; they’re just buried under an obsession with buzzwords, a college freshman’s blind enthusiasm for leftist causes, a failure to critically engage with utopian visions of a better world, and a metaphor about inflammation stretched so thin it could cover virtually any problem on earth. It felt preachy and condescending in the ways I associate with the worst kind of “I joined a new club and I’m going to tell you about it” behavior. And I wanted to be in the club!

[Allison · Rating 3 out of 5]

Could have trimmed down some- lots of really long block quotes, too many examples without linking them together (something I’m working on in my writing). Useful info but felt like there could have been more focus on the medicine side of things, instead of rehashing topics many readers are already familiar with

[Janani Sundaresan · Rating 5 out of 5]

Extremely, extremely required reading for anyone going into healthcare, care work or community work. Thankful to have learned a lot that my past educations failed to center in terms of decolonization and being part of a community in need of healing - one of the best books I've read! Left me knowing that there is a lot to be done in my own education and our collective unlearning of capitalist colonial systems.

[Melissa Heide · Rating 5 out of 5]

Brings together many different disciplines that are typically (and narrow-mindedly) siloed: medicine, colonial history, history of science, indigenous narratology, critical theory, environmental activism and philosophy, and the list goes on.

I wish I’d had access to this when I developed a chronic illness of unknown etiology while in graduate school.

[Magdelanye · Rating 5 out of 5]

this may be the most important book of the year, at least.
I need a bit more time to come up with a review.

[Mary · Rating 5 out of 5]

One of the best books I've read this year. This is the book I've always wanted. Incisive, thoughtful and comprehensive analysis of health injustice.

[Juan · Rating 5 out of 5]

This anti-colonial, anti-capitalist book is one of the best current works on healing that I've read. This book is a reclamation of the body and soul, a path to healing and reclaiming one's humanity. Reading this book is healing in and of itself; it encourages one to consider healthcare in a new light and to recognize that oppressive institutions have a lot to do with our illness and disease, as well as how we are all interconnect to the web of life. This is a must-read for anybody seeking a better, healthier future. 

[Patricia · Rating 4 out of 5]

A powerful read where you learn a lot and have a lot to think about afterwards! A great gift book for those in the healing arts!

[Katy · Rating 5 out of 5]

Very interesting and so easy to read. There was nice connection between the chapters but they felt separate enough that it wasn't overwhelming.

[Vaishnavi · Rating 5 out of 5]

This book was the missing chapter in all the biology textbooks I read growing up. It has allowed me to look beyond cells and the self to define health, toward the social, ecological, political and interpersonal factors that contribute to our sense of ease or disease. Brilliant book… I’ll be thinking of the case studies and poetic storytelling for a long time to come.

[Sara · Rating 4 out of 5]

Pinpointing the strong relationships between our health and where we live and what we eat and breathe, this book also goes back into history to show how colonialism and capitalism have directly affected our planet both through mining and farming practices. America and especially Britain caused huge tracts of land to be ruined while they extracted natural resources strictly for the wealth they might bring the few in total disregard for the health of native peoples. This has persisted through the centuries so that vast areas are polluted still. Many low income residents constantly breathe chemicals thus experiencing high rates of asthma and cancer. Farms have been planted with just a few crops over and over requiring chemicals for fertilizer and pesticides, thus polluting the ground water as well as rivers and reducing the variety of foods available.

[Joseph · Rating 1 out of 5]

If one can get through the narrative arrogance the authors assume, they have a good premise that many public health advocates and luminaries like Michael Marmot, Anne Case and Angus Deaton and others have highlighted— that where you live, work and play can “get under your skin” and negatively impact overall health and well-being. (The authors don’t cite important research that medical care is only responsible for approximately 15% of preventable mortality, whereas behavior, environment, genetics, etc., have much more impact on how long you might live.)

The authors bring a treacly political screed about colonization and its attendant horrors that we have to decolonize our entire society. The authors don’t seem to understand that the literature they cite that suggests poverty, stress, violence, pollution, etc., is the product of an empiric, Enlightenment approach that attempts to discover seminal truths that can guide improvement. Yes, it has its biases, faults and gaps but to just say that because this knowledge didn’t benefit everyone equally means that the knowledge is somehow suspect misses the act of discovery versus how it was it was implemented. If a drug gets discovered and commercialized and makes someone rich and leads to patients not receiving it, it is a fault of politics, policies and procedures made within political structures that “spoiled” the opportunity for justice and equality. It doesn’t mean the knowledge gain from the scientific discovery is faulty.

Patrick Porter, writing in the February 2022 issue of “The Critic” writes, “Ironically, assertions about separate ways of knowing resemble the very world view that helped drive colonialism in the first place, that “we” have reason, self-mastery and science, “they” have spirit, superstitions and emotions… this effectively excludes non-westerners from science and reason, since it treats modern science as a “local tradition of the West, as the indigenous knowledge of the non-Western subaltern is a local knowledge of his culture.”

Does Dr. Marya treat her hospitalized patients at UCSF with only knowledge gained from indigenous cultures? Of course not, which is why the “activist” label allows one to play politics while more serious individuals are actually trying to get effective policies to address these inequities in health that come from “colonized” data.

[Janani Chinnam · Rating 5 out of 5]

A must read for anyone who wants to understand how capitalism and other socioeconomic factors have damaged and inflamed our communities and bodies. Packed with research and stories of global stress, loss, and care. I learned more from this book than I have learned in my lifetime about the true, multi-generational, biological effects of colonization.

“people in the united states must live more simply so that others might simply live” - on consumption