Health and Justice — The Path of Liberation Through Medicine

Rupa Marya, MD
Jun 12 · 11 min read

This is the transcript of the 2018 keynote speech at Bioneers, where I was introduced by my friend and conspirator, Black liberationist Cat Brooks, director of Anti Police-Terror Project. May this talk help people understand this uprising for justice so they can join the movement for health and wellness for all people. We cannot reform structures built on racism and violence. We must uproot them, compost them, heal the wounds and build anew.

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I want to first acknowledge the Coastal Miwok and the beings on whose land we are meeting today.

To acknowledge all the indigenous people who have trusted me, shared deep conversation with me and influenced my understanding of what it means to be a healer and what exactly is the scope of my work.

I want to acknowledge those killed by police and their families still fighting for justice.

and the UCSF Division of Hospital Medicine for supporting me in shaping a path that defines health and healing as broadly as I can imagine.

And finally my husband Benjamin Fahrer — revolutionary farmer — whose love for the Earth creates bounty and whose daily support creates the space I need to do this work.

Today I’m going to talk to you about Decolonizing Medicine.

But first I am going to tell you who I am so you have an idea where my thoughts are coming from. This image by artist Mona Caron from our forthcoming album, Growing Upward, captures a good deal of who I am. I am a daughter of Punjabi immigrants, whose parents came here in 1973 with little money but plenty of caste privilege. We grew up with family vacations driving around a VW van through the western lands. My father would stop at Reservations and make us get out and learn what had happened to the original people here. He would talk to me about colonization, because we are also a people who had been colonized by Europeans.

I am the mother of two beautiful mixed heritage boys. I am a farmer’s wife. I am a physician who works in adult medicine, witnessing society’s ills manifest in my patients bodies, a doctor who sees racism and state violence as urgent public health issues. I am a touring musician who has played in 29 different countries singing in 5 different languages with my band Rupa & the April Fishes. And to use a phrase taught to me by Miwok Elder Wounded Knee, I am an Earth Person.

What I am 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. We begin with a description of how we 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, viruses and such make us sick which led to development of antibiotics, vaccines and systems to limit the spread of infectious diseases.

Then in 1960s with the elucidation of DNA, we entered the molecular genetic era of medicine where we are still today. Here the gene creates a protein that can cause or protect from disease. How sick or well you could be was thought to be preordained to some degree by your genetics. This understanding has led to many powerful diagnostic tools and targeted therapies for specific disease processes.

And in 2004 with the discovery of the ras gene mutation’s role in colon cancer, exactly 2000 years after Roman physician Celsus described the cardinal signs of inflammation, we are entering the era of Inflammation, where 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 focusing on the impact of social stressors, which have been shown to cause chronic inflammation.

These diseases require 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 futile in a system that actually makes health impossible.

To understand the root causes of the pathologies we see today which impact all of us but affect Brown, Black 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 disintegrated — from our ancestry, from the earth, from our indigeneity, our earth-connected

selves. We all come from earth-connected people, people who once lived in deep connection to the rhythms of nature. I believe it is not a coincidence that the colonization of this land happened at the same time that Europeans were burning hundreds of thousands of witches, those women who carried the traditional indigenous knowledge of the tribes of Europe.

Colonization was the way the extractive economic system of Capitalism came to this land, supported by systems of supremacy and domination which are a necessary part to keep wealth and power accumulated in the hands of the colonizers and ultimately their financiers.

In what is now known at the US, this system of supremacy is expressed in many ways with many outcomes but we will focus on specific ones for the sake of time. First white supremacy, which created a framework that legitimized slavery and genocide. Slavery created cheap labor which is necessary for a functioning capitalist system. And genocide created unlimited access to resources, in the form of land, animal parts, minerals and raw materials which are also necessary for a functioning capitalist economy. And as capitalism functions, it further entrenches systems of supremacy.

We all know that white supremacy looks like scary people with swastikas in hoods. But it can also look like any place where there’s an abundance of white people in exclusive contexts, where power and access is not readily ceded to others.

Please remember, as I talk about these things, I am talking about systems of oppression, that we are all a part of, that we all recreate. These systems need to be dismantled.

Back to colonization and its impact. There’s white supremacy and then there’s male supremacy, AKA patriarchy, which leads to the invisibilizing of women’s labor (you know, like creating the entire human race out of our uteri) or in this context reproducing the work force and suppressing our wages, which further supports capitalism. Patriarchy also leads to femicide, domestic violence and child abuse, which we see across all groups here.

We also see human supremacy, where people feel superior to the rest of living entities, thereby subjecting living soils, seeds, animals, plants and water to horrific treatment in the name of exploiting resources, which in turn feeds the capitalist need for ever-increasing profits.

While this wheel of domination, exploitation, generation and sequestration of wealth continues, we experience as a byproduct and common pathway TRAUMA and many studies have shown us that chronic stress and trauma create chronic inflammation.

When we look at the top 10 causes of death in occupied turtle island, we see diseases that have been described to us as diseases of lifestyle, or ones that come about because of our poor choices. Maybe we eat too much fried food or don’t exercise enough. Maybe we have a genetic predisposition. What these diseases have in common in their pathogenesis is a component of inflammation, and we are just starting to parse out how social stressors and the very structure of society contributes to and exacerbates that chronic inflammatory state.

It is short-sighted to see these as diseases caused by individual poor choices in the context of a genetic predisposition. I see them as diseases that are virtually impossible to avoid, because of the system in which we live which generates a biological milieu of inflammation through trauma, chronic stress, environmental degradation and damaging food systems. I see these diseases as diseases of colonization.

Now this is not news to an indigenous person. When I met Oglala Lakota elder Candace Ducheneaux out at Standing Rock, she talked to me about how these diseases — that are so common in modern US society and more heavily so in Indian Country — are diseases that were brought by the colonizers.

We talked about Diabetes which I had been taught in medical school is a disease of insulin resistance. Either your pancreas doesn’t make enough insulin or your cells are not sensitive to the insulin — both ways of seeing things that are based in a sense of individualism and predetermination. On

the Standing Rock Reservation, before the damming of the Mni Sose or Missouri River, diabetes was rare. Once the river was dammed, the cottonwood forests where the people would forage for food and medicines were destroyed. By shifting the ecology through a colonizing force, the people became more dependent on the cash economy for their food and medicine and lost an essential cultural connection to their traditional ways. This tragic loss of the commons is a hallmark of capitalist society, and the impact is felt in the individual body. After the damming of the river, rates of diabetes skyrocketed. And this story is similar for tribes all over turtle island.

It’s important to recognize that it wasn’t simply becoming sedentary and consequently more obese that was the sole cause of diabetes. Colonization played a crucial role — not by changing the indigenous body but by changing the social structure around that body which in turn creates disease.

One powerful study from Alberta demonstrated that First Nations tribes that maintained their cultural continuity, specifically through language had lower rates of diabetes. Just sit with that — speaking their own language protected them from diabetes — not a low-carb paleo diet, not exercise. It also showed that self-determinism is a powerful protector from diabetes. These same factors had a protective effect against suicide for indigenous people in Canada, who experience rates 2–5 times the national average.

This example demonstrates how disease is a complex manifestation of social and biological influences on groups of individuals that results in a common expression — here, diabetes. While we can understand this clearly from the Native American experience, we must be aware that these social structures of domination produce trauma and inflammation for all of us. We are all affected.

What can we do in the face of this knowledge that can seem overwhelming, that the system in which we live is making health impossible for most people? Like the example before, simple things can have huge effects. To heal the diseases that are caused by the trauma inflicted by colonization, we must decolonize. If colonization represents a disintegration and a disconnection, we must reconnect.

Our work is two pronged — To reintegrate and to dismantle

We must reintegrate what has been divided and conquered — in our society, between our peoples, between us and the natural world around us and within ourselves. We can do that in many ways — by promoting acts that increase local autonomy and self-determinism, by exposing the myth of treating the individual as limited in its ability to address root causes of disease, by reconnecting to who we are before our respective colonization through songs, traditional knowledge, reawakening our food and medicine ways and reawakening our relationships to each other, to the earth around us and to other beings.

And we must dismantle those systems of domination that create recreate cycles of trauma and inflammation, those systems that work in service of capitalism.

This is my vision of Holistic Healthcare.

What does that look like for my work? How do I use my White Coat Privilege to address things systemically? Aside from starting to address diseases with my patients in the hospital as directly related to these phenomena, I am doing these things.

With regards to reintegration, I have been invited to help create a clinic and farm to develop the practice of decolonizing medicine at Standing Rock together with tribal members and healers, Linda Black Elk and Luke Black Elk, great grandson of Black Elk Medicine Man.

We have been developing a framework of how to offer care that centralizes Lakota cosmology and understanding of disease and health, and to create a model that can be replicable to other places in other specific contexts.

We have incredible partners including MASS Design Group and National Nurses United as well as the Do No Harm Coalition at UCSF, who are over 400 healthcare workers committed to ending systems of oppression as a way to ensuring health for all. We have raised over a million dollars thanks to generous gifts from the Jena and Michael King Foundation, Colin

Kaepernick and crowdfunding and seek $5 million more to break ground on this exciting project.

With regards to dismantling systems of oppression, I have been working on a national study of the health effects of law enforcement violence called The Justice Study. We were asked by the community who is fighting for justice for Mario Woods — a 26 year old black man who was killed by SFPD in 2015 — to create a study that would answer this question:

If the wound is police violence and the medicine is justice, what happens to our health when the medicine is not given?

We are currently gathering data which is already illuminating, showing how many areas of people’s lives are affected by police violence. We know that Native Americans, Black and Latinx people experience disproportionate rates of police violence and can see they are most impacted by the longstanding traumatic effects of the violence. How does this reality contribute to the health disparities we see? This slide shows also how we are all impacted by this violence — across all races, we are all being traumatized with black, brown and indigenous being affected more intensely. We are continuing to collect this data and will be offering it to policy makers who wish to shape community safety away from models that uphold white supremacist frameworks into ones that create safety and mitigate harm for all of us.

What I want you to remember from this talk is this.

Health is impossible when living in systems of oppression. We cannot effectively treat diabetes with a drug without addressing the systems that make diabetes so present.

We must redefine the scope of the work of healthcare to include not only care at the bedside of the individual, but dismantling the systems of oppression that create the conditions for illness.

And we finally must reintegrate — with the Earth, with each other, within ourselves. We must decolonize.

What’s Next for Me?

I am in the process of fleshing out these ideas in greater detail through co- authoring a book on these issues with writer and agro-economist Raj Patel.
I will be continuing fundraising and developing clinical methodologies in collaboration with Lakota Dakota people for the Mni Wiconi Clinic & Farm

I will be continuing data collection, analysis and reporting for TJS as well as fundraising for those efforts. Like many here, I don’t get paid for any of this important work and I hope I can receive the support I need to do it to the best of my abilities.

Finally, I will be finishing our forthcoming album, Growing Upward which is a look into these issues from a musical perspective.

How do we heal from genocide as a culture, and how do we help our native community heal as we work to stop ongoing colonial trauma?

How do we move forward in greater health if we have not healed the past?

I want to close with a song about these questions called “Stolen Land.” It is my hope that perhaps one day we will sing this together, instead of the Manifest Destiny jingle, This Land is Your Land, This Land is My Land — because it’s not.

I invite my bandmate John Eichenseer to join me.

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