Rupa Marya, a physician and musician, studies how social structures impact health. She says colonial capitalism fractures the critical relationships that keep us healthy.
By April M. Short
A widespread culture of isolation and disconnection from our bodies, each other and the planet is negatively impacting the mental and physical health of people in America and beyond—and this was true long before the pandemic. Our relatively new human social structure that is work-obsessed and separated from nature and each other leaves us scant time to connect and relate to each other, and is not aligned with our natural rhythms. This way of living has grave impacts on people’s overall health, as well as the health of the planet.
Research professor and author Brené Brown wrote about a “crisis of disconnection” in the U.S., in a 2017 article in Fast Company. That same year, U.S. Surgeon General Vivek Murthy, who also held this position under the Obama administration, referred to the problem of loneliness as an “epidemic.” In a 2021 article, psychotherapist Colette Shade detailed the isolating effects of the life structures of capitalism, and researchers have been tracking the health impacts of isolation for decades. Recent studies have found that the health effects of loneliness rival obesity and smoking.
Loneliness is a symptom of our greater culture of disconnect, and toxic American individualism. And, as with many problems (like food and housing insecurity), the pandemic has exacerbated the preexisting issues of disconnect in our society.
The edges of culture, science and medicine are circling back to the roots to prove the overarching understandings Indigenous societies have long held about human health: the mind and the body do not function separately, and humans do not function separately from the planet. All are interconnected, and our overall well-being depends on this connection.
The impacts of the global climate crisis on our mental and physical health, and on planetary health, are a reflection of how intricately connected our personal wellness is with the wellness of the planet. Psychotherapists are overwhelmed with patients experiencing eco-anxiety relating to ecological collapse, fears due to extreme weather and planetary grief. Even the COVID-19 pandemic likely stems from human destruction of wild spaces and a loss of biodiversity, driven by unchecked capitalism. As detailed in a Nature article in 2020, deforestation, rapidly dwindling biodiversity and decline in wildlife increase the risk of disease pandemics such as COVID-19.
Rupa Marya, MD, an associate professor of medicine at the University of California, San Francisco (UCSF), whose research investigates the intersections of social structures and illness, says these issues of disconnect stem from the culture of colonialism. Indigenous knowledge and understandings of ourselves as part of the web of life have been co-opted by social structures built on domination, extraction and destruction of nature for profit, she says.
With New York Times bestselling author Raj Patel, Marya coauthored a new book, Inflamed: Deep Medicine and the Anatomy of Injustice, published in 2021 through Macmillan. The book explores connections between health and structural injustices prevalent in society. Inflamed also delves into the idea of “deep medicine,” which Marya says is a way of “…understanding how social structures are making us sick and working to redesign those structures—as opposed to shallow medicine, which is to always point at the cause and the locus of suffering inside one person or one individual.”
Marya says that the book was an opportunity for her and coauthor Raj Patel “to bring our minds together around food systems and land use, medicine and biology, and histories and cosmologies. Both of us work very closely with many different communities,” she says, and “those communities really informed the story that we told, which is that our bodies, our societies and our planet are being damaged through the same cosmology that has severed our relationships with each other and to the web of life that keeps us healthy.”
Marya is also the faculty director of the Do No Harm Coalition, “a group of more than 450 UCSF health workers and students dedicated to ending racism and state violence,” and her work has explored how social factors like racism and misogyny can predispose various groups to medical conditions. She serves on the board of directors at the Mni Wiconi Clinic and Farm at Standing Rock, situated at the South Dakota-North Dakota border, and works with health leaders from the Lakota and Dakota Indigenous tribes to create a space to practice decolonized medicine. Marya also serves on the board of Seeding Sovereignty, an international entity promoting Indigenous autonomy in the context of climate change.
In addition to her work in health care, Marya is a world-touring musician—the composer and frontwoman of the Oakland, California-based group Rupa and the April Fishes. She says that traveling the world for decades and getting to know various cultures through the lens of music have broadened her understanding of health and society. She has come to realize that healing is not about fixing one problem or another, but requires a more holistic approach of re-engaging with our bodies and each other, within the context of nature.
Her primary focus now is on the work she does with the Deep Medicine Circle, a women of color-led, worker-directed 501(c)(3) nonprofit focused on decolonizing farming and restoring relationships with nature through food. The Deep Medicine Circle is “a collective of farmers, physicians, healers, herbalists, lawyers, ecological designers, scholars, political ecologists, educators, storytellers and artists” in the San Francisco Bay Area. The collective is “dedicated to repairing critical relationships that have been fractured through colonialism,” as stated on the website, and formed around an understanding “of climate change as the end-stage of colonial capitalist destruction.”
April M. Short of the Independent Media Institute spoke with Marya about Deep Medicine Circle, the book Inflamed, her research and how healing our relationships with food, community and the planet can heal our bodies and minds.
April M. Short: How has touring the world as a professional musician influenced your outlooks on health care and overall wellness in society?
Rupa Marya: It’s everything. I’ve always worked in medicine, and right now I work as an associate professor of medicine at UCSF, but I’ve always made sure to work in the medical environment no more than 60 percent of my time. I used to call myself the best-paid musician and the worst-paid doctor in San Francisco. The rest of my time, especially before I had children, I would tour with the band, and we would play these big concerts and festivals around the world.… For me, music has always been a form of social investigation, a way to look at, learn from and interact with different cultures around the world. It’s a way to learn about how people are engaging in what Raj Patel and I call “deep medicine.”
Deep medicine really shows how we’re interrelated and how our health cannot be viewed through the lens of individuality, but must be understood as a system level-phenomenon that emerges when systems are interacting well together. This does not just refer to body systems, but social systems and ecological systems. The ways in which history and lines of power and dynamics interact with those [social and ecological] systems will shape a positive outcome or a terrible one. And what we’re living with after 600 years of colonial capitalism around the world is the suffering health of our bodies, our societies and our planet.
The band allowed me to see these things clearly, in ways that I couldn’t see by just being a doctor in a hospital. Being a doctor in a hospital, you’re on the bleeding edge of society. You see who’s getting sick, how people are getting sick and where the sickness is registering in the bodies. You see children of farmworkers from the Central Valley coming [into the hospital] with really bizarre cancers—young people getting sick, increasingly every year. You see that people are coming in with more advanced colon cancers, are younger every year, and are dying from them. You start to see these patterns over the years. But when you travel with music, people mix you into their homes. It’s a very different dynamic from if I were to show up with a stethoscope and a clipboard.
Doctors, historically, have also been part of that same legacy of colonial violence. Lands around the world were colonized by missionaries, medics and militaries, and the work of colonial medicine wasn’t really to keep those communities that were being conquered healthy. It was to keep the conquerors healthy enough to do the job of conquest, and to extract the wealth and the resources, subjugate the labor and steal the land. When we understand that, we understand the way in which we’re trained as doctors to see, understand and learn about patterns of diseases. What you see from that perspective on health is going to be very different from what you see if you go with an artist, or an engaged community member, and meet with people eye to eye as fellow humans, engaged in this desire to see a better world, not only for ourselves, but for our children and our great-grandchildren.
Touring 29 different countries over many years, going to different communities, I started to notice the emergence of patterns around who’s getting sick and how people are getting sick. That experience really led to the work that Raj [Patel] and I did in our book Inflamed, which looks at how history and power and all these exposures to worlds designed through colonial capitalism are making us sick.
AMS: Would you share a little on your book—how it came about and how you came to the conclusions inside it?
RM: The book came about because of these insights I had while traveling with my band. I would start to notice all these different groups who were marginalized or socially oppressed—or from communities that had been colonized through Western colonization—and were suffering. People in different places were suffering in very similar ways. I started to call it a “colonized syndrome.” That was 17 or 18 years ago, and now we know that all of those diseases that I was seeing, from autoimmune disease to inflammatory bowel disease to cardiovascular disease to cancer to Alzheimer’s to substance use disorders to depression and suicide—these are all diseases that include chronic inflammation as part of their origination.
I was giving a talk at UT Austin on Standing Rock and my work there, when I was invited out there to do a medic response in the face of increasing law enforcement violence toward the pipeline resistors [at Standing Rock], the Water Protectors. I also was doing work in the naming of racist police violence as a public health threat. Raj Patel, my great friend for many years, found me and invited me to write a book with him. It was such a great honor to bring our minds together around food systems and land use, medicine and biology, and histories and cosmologies.
Both of us work very closely with many different communities. Those communities really informed the story that we told, which is that our bodies, our societies and our planet are being damaged through the same cosmology that has severed our relationships with each other and to the web of life that keeps us healthy.
How can we resist those cosmologies and insist upon ones that are from our own traditions and from the traditions of the people whose land we occupy here in Turtle Island? Many of the Indigenous communities are working to reawaken their own remembering about those systems of knowledge and ways of living that were purposefully subverted and silenced through colonialism.
What we saw and cover in our book is that colonialism, and colonial capitalism specifically, is truly a system that has caused fractures and damages to critical relationships that keep us healthy, in the express interest of concentrating wealth in increasingly fewer hands, and extracting and exploiting the land and the people. To heal from that, we must repair those relationships and repair those ways of knowing that have been purposely silenced, which means bringing back languages, bringing back songs, bringing back ceremonies and bringing back cosmologies that actually allowed humans to live well together on land.
AMS: Would you share about Deep Medicine Circle (DMC) and the work you’re doing there?
RM: As Raj [Patel] and I were finishing up the book, and I was watching people get really sick from COVID, I felt like I couldn’t continue working in the same way, understanding now what I did about health—after reading thousands of papers, stories and accounts, and piecing them together in the way that we have [in the book]. I ended up creating Deep Medicine Circle with several close friends, and then bringing in a team of people who could help bring this work forward.
Our work through the Deep Medicine Circle is to heal the wounds of colonialism, specifically through food medicine, restoration, stories and learning. And the learning is an unlearning. We got ourselves started [in 2021] and we are in full-running mode, because it’s time.
Our farming as medicine work was the cornerstone of DMC’s first year, which is really reframing what farming is. Farming has been a very damaging practice, as practiced through a Western lens, and through extractive lenses. We are advancing systems of Indigenous traditional ecological knowledge and agroecology together, to heal not only the people but also the Earth.
That work has four components. The first one is giving land back to Indigenous people and asserting their sovereignty in their own homeland, and partnering with them to generate food for the people.
The second part is to assert that farmers are the stewards of our health, both in terms of how they steward the soil (which is the ecological engine of life) and water, and how they grow nutrient-dense food. We need to pay our farmers like we pay our doctors and lawyers.
The third part is decommodifying food. All the food we grow is liberated from the market system and given to the people who need that kind of food the most. For example, right now, organic, healthy food that won’t shatter your gut microbiome but will instead nurture it is only available to people who are wealthy. And those people tend to be predominantly white and South Asian in this [American] society.
The last thing we do is insist upon reawakening the way in which food and medicine have been co-extensive throughout our history. All people have food as medicine. It’s storied, it’s relational, it’s deep. It’s not just simply, “Oh, I have diabetes, let me eat this red carrot.” It’s not a prescription. It’s not a pharmaceutical intervention. It’s a real awakening of our relationships to these beautiful beings [plants] that have accompanied humanity for hundreds of thousands of years now.
We are on a 38-acre farm in Ramaytush Ohlone territory [in the San Francisco Bay Area]. We are working to move that land back to a Ramaytush Ohlone Indigenous land trust that’s also women-run, and that work is part of the medicine circle now. It’s called the Land Back Solidarity Program, and it’s run by our operations director, Hasmik Geghamyan, who also happens to be a lawyer who just wants to give land back. She’s been helping several California groups get their land back, and she wanted to internalize that into DMC and make it a core part of our work. She is helping to set up the land trust.
Land back efforts aren’t just reparations for what has happened here in California with the genocide of the Indigenous people, but it is also about how we get back into better ecological balance. We know that Indigenous groups who steward land around the world do better than private or public entities in nurturing biodiversity. That is because of their cosmologies, their relation and their moralities around the personhood of all entities that support life. So, the understanding that the water is a person, the soil is a person, the rocks are people, the animals are people.
The work of dismantling our care for one another came through the colonial capitalist cosmology of separation. When you think of the intellectual tools that were needed to justify murdering everybody and taking their land… that mentality required that those people didn’t have personhood, that they weren’t actually real people, or they weren’t sentient beings. Some of them were “three-fifths” of a human being legally, here in the United States. The violence that has been done to people of color around the world came with a set of intellectual tools employed by colonizers that have permeated every aspect of every social structure that has been made ever since.
So when we say “land back,” we’re saying: let’s bring that other system of cosmologies and understandings and relationships back into our consciousness as settlers, because we know that that will give us different outcomes. When we are honoring each other, honoring the water, honoring the soil, honoring the web of life and understanding how we are a part of all of it, then we get different outcomes, even as guests on somebody else’s land.
That work also then resituates the power dynamic of the farmers and the workers who are settlers, so that we are working under the Indigenous people of the land and working together with them. We are working with the understanding that their sovereignty is critical in the work that we’re doing. It has to start there, because the soil is alive. If we understand that the soil is made of the bodies and the beings that have been here for tens of thousands of years, which includes the Indigenous people, we understand that the soil knows what happened here. The soil is missing the language and the songs and the way in which it was honored. That is part of the musical work that we are doing. This is where being an artist is actually really critical, because what we’re doing isn’t simply looking at data points; it’s reawakening our relationships. Those relationships, to me, are very musical.
AMS: Could you expand a little on how the Indigenous way of relationship between humans and the Earth can extend to address the wider issues of societal health and the climate crisis?
RM: If we moved all the land back to Indigenous people and they could assert their sovereignty over all the land, just in the United States, we would probably have much more rapid action on climate change than we have right now. We definitely would. Indigenous grandmothers running pipeline resistance have cut greenhouse gases by 25 percent—which is way more than anything that any policy that has come out of the United States or Canada.
This is not to say that there are not problematic dynamics among different Indigenous groups or with specific people, but it’s to understand the systems of knowledge, which are primarily carried by women. This is why the work of rematriation is so important, which is reasserting the women’s places of authority in tending land, tending food, tending soil, tending water and caring for these things. Because these entities are critical for everybody’s health. When we tend to do something that’s good for everybody, good health emerges as a phenomenon. It is an emergent phenomenon. It’s not a characteristic of one person or one thing. It’s an emergent property of systems working well together. We know that especially in this land, it’s the Indigenous women who are really carrying that work forward.
AMS: You mentioned that DMC started last year in 2021. How did the pandemic affect or intersect with the beginnings of the work you’re doing there?
RM: For probably eight or nine years, these ideas have been sitting in me as something I knew we should do… and then with the pandemic it was like, “We need to do this right now. We absolutely need to do this.”
Sixty-seven percent of people who were coming into the ICU with severe COVID were malnourished when they hit the door. When we look at the injustices of who’s getting sick and how people are getting sick, we know that it’s Black and brown people. We know that it’s people who are suffering under the brunt of social oppression from colonial structures.
How can we create spaces where those structures are dissolved, dismantled and rearranged? That’s the work that we are doing with the Deep Medicine Circle.
AMS: I am curious to hear a little bit about your work as a co-investigator on the Justice Study, looking at the links between police violence and health outcomes, especially in Black and brown and Indigenous communities, as well as your other medical research looking into how social structures influence health.
RM: Well, first, racist police violence is an urgent public health crisis. When there is no justice for that violence, the community’s health suffers exponentially. That wasn’t a surprise. The surprise for me was that everyone is being traumatized by racist police violence. Whether you’re white, Black, brown or Asian, everyone was experiencing trauma through seeing these videos of state execution happening in the streets. It amounts to extrajudicial execution.
The police are causing widespread trauma. When you look at that, you think—what is a society that has chosen to prioritize private property? Say someone was stealing a car, or we thought they were going to steal something or do something illegal. There is an insistence on policing instead of providing mental health support and the resources people need to succeed and to thrive.
And it’s not just policing that’s the problem. If you look at Oakland right now, the school district board is trying to shut down eight schools and merge several more, and they’re predominantly Black and brown schools. These are the people who have been most impacted by COVID. These are the children who are missing their family members from COVID. These are the children of essential workers, who’ve been sickened and lost income from COVID. Those are the schools we’re going to close? Really? That’s the kind of ongoing racist violence that’s the problem. The lack of justice through all of these government and social institutions, created through colonial capitalism, is part of the same injury structure affecting people of color.
And it is not just people of color, but also poor white people—I say that, because the Black Panthers were wise enough to work together with poor white people, and to really identify the problem. The problem isn’t one person; the problem isn’t even a group of people. The problem is the racist and classist structures that were and are created to keep property in the hands of some people, and to withhold the rights of other people. That has been made no more obvious than during the COVID pandemic when the rhetoric is like, “Get yourselves back to work, get your kids back in school—and there are no masks and no air filtration.” We’ve seen who has gotten sick [and the racial disparities relating to access to social benefits and health care during COVID].
Unfortunately, it’s going to take us years to understand COVID. It is not an upper respiratory virus. It is a cardiovascular virus. It has affected the pancreas. It has affected the brain. It will take us years to understand what the exact impact of these infections is, especially on people who are already crippled through chronic social oppression in the United States.
This work is intersectional. It’s along all of these axes and requires understanding the roots of policing: the slave patrols, returning runaway slaves and keeping the natives under wraps. These are the roots of policing in the United States. Should we be shocked that we’re seeing disproportionate killing of Black and Indigenous people by the police? No, this is what they were designed to do.
Why do we tolerate it? That’s the question. Why do we accept that, rather than insist upon the Black New Deal, the Red Deal or the Green New Deal—which are frameworks of justice and reparations? They are frameworks of advancing an economy of care for one another and for the Earth. That’s really where we’re at right now. We won’t actually have peace until we all collectively demand it, until that’s where we want to go.
AMS: You’ve spoken about decolonizing food and wellness and our relationships with each other and the Earth. Could you expand a bit on your work around decolonizing medicine, and specifically your work with the Dakota and Lakota tribes at Standing Rock?
RM: When we understand that medicine was a part of the trifecta of colonization (as I mentioned: militaries, medics and missionaries), we have to understand that medicine itself is infected with the same racial and sexist craziness as the rest of our world.
There was a recent study that showed that women who were operated on by male surgeons were 32 percent more likely to die than women who had female surgeons. But when female surgeons operated on men or women, there was no difference in outcome based on the patient’s gender. Another way of framing this is: neglect on the part of male doctors is leading to the death of women, and not men. But no one is really talking about this or changing it.
It’s the same with Black women dying of perinatal complications. Black mothers giving birth in New York are 12 times more likely to die than their white counterparts. That’s not an error, that’s not a mistake. That is built and baked into the system.
If we want a medicine that is just, if we want a medicine that upholds our values and perspectives and traditions and is understanding of who we are and why we are sick, then we must decolonize the very structures of medicine. That work is happening in front-line communities, in the pipeline resistance camp with our Indigenous community members. It is also happening in farmworker communities. It’s happening in freedom clinics. It’s happening in many different spaces where the relationships that modern medicine has created are being put on trial and obliterated. This is because they’re not serving the people who are suffering the most under the violence that modern medicine has brought, which is colonialism.
AMS: Circling back to the Deep Medicine Circle: how can people support this work, and how might other communities use this example to launch similar work in their own regions?
RM: What we’re doing over the next three years is creating a toolkit. We’re identifying groups around the country and around the planet who could partner in the ways that we have with landowners, Indigenous people, farmers and municipalities to redefine the food system locally. We would like to convene those groups in 2025 down at our farm and do a sharing of this toolkit. It will include everything from policy, to training, to sharing how we overcame certain obstacles and hurdles and how this work has been growing.
Our hope is that this toolkit can spread like seeds. We don’t have any interest in being the organization that coordinates with people and organizations all across the country. We don’t want to colonize through this model. We want to share it as an example and have people locally adopt it and run with it.
In every urban and peri-urban environment around the country, this work can secure our climate and food systems. It can make seeds resilient to climate change. It can increase the sovereignty of food systems in those peri-urban and urban environments. It can bridge the urban-rural divide. It can get land access secured for Black, Indigenous and brown people who have historically been pushed off land and are limited in their access to it.
It can also reframe farming as an act of care, which would automatically make the fossil fuel-based input that conventional agriculture relies upon obsolete. We don’t need them. We don’t use them. It would give average, everyday people the experience of zero-barrier access to the most beautiful, healthy, organic food you could imagine. That medicine is something that’s available to all.
We’re definitely fundraising right now. We’re also looking and tapping into the policy work around how to get this funded, the way that our streetlights are funded, the way that our Muni drivers are funded, so that this becomes an expectation of civil society.
I think it starts with support from philanthropists, and we’ve been very grateful for the generous support we’ve received. We are continuing to raise funds for the work we do in DMC. When we get the toolkits out, then we start to really help people tap into those spaces of funding from a policy perspective. That will keep this work growing in scale. Not scale in terms of getting larger in scale, but in terms of staying small and replicating, which is what ecological farmers do around the world.
This article was produced by Local Peace Economy, a project of the Independent Media Institute.
April M. Short is an editor, journalist and documentary editor and producer. She is a writing fellow at Local Peace Economy, a project of the Independent Media Institute. Previously, she served as a managing editor at AlterNet as well as an award-winning senior staff writer for Santa Cruz, California’s weekly newspaper. Her work has been published with the San Francisco Chronicle, In These Times, Salon and many others.
