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Inflamed — a review (…and a question)

Stuart Gillespie

Published: August 26, 2021


Every now and again a book stops you in your tracks.  

Inflamed: Deep Medicine and the Anatomy of Injustice by Rupa Marya and Raj Patel is one such book.

Inflamed brilliantly links globalization with biology — and everything in between — highlighting the dynamic links between inflamed bodies, inflamed societies and an inflamed planet. Step by step, going back into deep history, the authors plot the causal origins of disease and ill-health “in the multifunctional spaces around and beyond the individual body – in histories, ecologies, narratives and dynamics of power.”

Inflammation is a process, triggered by the damage or threat of damage to cells, that mobilises resources to heal injured tissue. In a balanced system, once the damage has been repaired, inflammation subsides.  But if the damage returns, over and over again, the inflammatory response goes into overdrive and starts to create harm. The ultimate source of damage is not the pathogen that infects you – the true source can only be found in deeper and wider systems and processes that render an individual more likely to be exposed (to the pathogen) and, if exposed, more likely to fall sick or die as a result. Structural racism, violence, economic deprivation, pollution, contaminated water and poor diet all combine to generate chronic inflammation.

The authors remind us that ‘diagnosis’ comes from ‘dia’ (apart) and ‘gnosis’ (to know). A diagnosis is a story pulled apart.  Conventional diagnostic narratives are out of joint because the story begins in the middle with a symptom. Doctors then go back in time to try and uncover the immediate causes, before going forwards from the symptom to prescribe a treatment. But often this doesn’t work because the story doesn’t go far back enough in time, isn’t deep enough.

The colonial worldview – on which modern medicine is based – is ahistorical, emphasizing individual health and disconnecting illness from its social and historical contexts. Modern medicine patches up bodies broken by the same system that produces the medicine.  A similar thing could be said of the global food system, which we’ll come to….

As well as being comprehensively researched and written in a style that pulls you in for hours, Inflamed is an impassioned call for justice for people who have been, and continue to be, exploited, oppressed and marginalized.

The COVID pandemic has thrown intergenerational and colonial injustice into sharp relief. In May 2020, in the UK, nearly all of the medical staff who had died of COVID-19 were from black, Asian and minority ethnic communities. Throughout the pandemic, individuals from these communities were at greatest risk.  

Individuals who were hospitalized or died of COVID-19 were a) more likely to be more infected with SARS-COV-2 in the first place (being dependent on livelihoods that put their bodies at risk of exposure, without any safety nets), and b) more likely to fall sick, become hospitalized and die (because their bodies had suffered chronic inflammation due to poor living conditions, poor healthcare, unhealthy diets, chronic stress etc).

Marya and Patel use the concept of an ‘exposome’ – the sum of a lifetime’s exposure to non-genetic drivers of ill-health – to show how such individuals are far more prone to chronic inflammation and illness than others.

Colonialism isn’t a thing of the past – it’s happening today and threatening the lives of the 370 million Indigenous people living in over seventy countries, while many states continue with their ‘policy of amnesia’.  You may not be one of them, the authors argue, but you’re affected by them — their ideologies are alive and well…and they’re making you sick. Non-communicable diseases (NCDs) like heart disease, lung disease, obesity, depression, diabetes, Alzheimer’s, auto-immune diseases — are all diseases of colonization – they didn’t exist before.

“Le microbe n’est rien, le terrain est tout”

Eleven years ago, the philosopher, David Abram wrote “the body is itself a kind of place…a terrain through which things pass, and in which they sometimes settle and sediment”

One hundred and sixty years ago, Louis Pasteur wrote “the microbe is nothing, the terrain is everything”

I first came across this amazing quote, in 2000 when researching HIV, food and nutrition security.  Later, we brought the concept of enabling (or disabling) environments into the fourth paper of the Lancet Nutrition Series (2013) and subsequent papers and blogs – showing how these environments operate at all levels from the ‘milieu interieur’ of the human body to food and health environments to social, political, economic systems. I remember the analogy of an onion with its many layers from another ground-breaking book ‘Rakku’s Story’ that I read nearly forty years ago while working in a village in southern India. Like Marya and Patel – Sheila Zurbrigg locates the causes of the death of a child (Rakku) in multidimensional spaces and colonial histories.

Each chapter of Inflamed describes a system (circulatory, respiratory, immune, reproductive, digestive, nervous, endocrine), as Marya and Patel brilliantly highlight the way they generate inflammation, how they’re linked to themselves and ultimately to human health.

This book was written by a physician and a political economist.  Its focus is on health but it is wide-ranging analyses are directly relevant to all of us who work in the food system. The chapter on the digestive system highlights the importance and links between diversity of the gut microbiome and soil biodiversity – two enabling (or disabling) environments. Mediating both are food systems.

Which brings me to the question…

The global health ‘community’ seem to be way ahead of the food and nutrition ‘community’ when it comes to digging deeper to locate the drivers of ill-health and malnutrition that originate in wider structures, systems and colonial histories.

Decolonisation and the commercial and political determinants of ill-health are being discussed, researched and, in many cases, acted upon. And yet, the nutrition and food ‘community’ remains relatively silent on these issues. Some nutrition researchers and activists work on commerciogenic causes of malnutrition, but relatively few.  Issues of power and equity are similarly neglected.  And hardly anyone is working on historical perspectives, including the influence of structural racism and colonial legacies.

In a few weeks, there’s a major United Nations Food Systems Summit (UNFSS) in which the multinational food industry is actively involved — around the ‘table’ where ‘game changing solutions’ are being discussed and decided. It does not seem to matter that many of their core businesses are major drivers of malnutrition. These new colonials are happily engaged in shaping the future in ways which are more amenable to their interests and objectives. They will continue to ‘talk the talk’ about healthy diets, as evidence mounts about their failure to act. The fox is ensconced in the chicken coop and no-one in the UNFSS inner circle seems to think this is a problem (when was the last time the tobacco industry showed up at a World Health Assembly?)

UNFSS principles of engagement are cursorily listed but are weak and do not include the crucial ‘do no harm’ principle. Big multinationals just hide behind business associations (like WBCSD) who provide cover. Yes, protests have been aired, open letters signed and many have boycotted the summit altogether. And yet, summit leaders just carry on, sounding out their mantra that this is a “people’s summit”. Silence is the main response to criticism – as if there’s ‘nothing to see here’ and that somehow our normal expectation of critical engagement and debate among peers is to be suspended this time.

Why is this?

But the bigger question is — why aren’t we, in the food and nutrition policy community, more actively engaged in the decolonisation debate, and in research and action/activism around the commercial and power-related drivers of the problem we’re (supposed to be) focused on?

Echoing Marya and Patel’s call for a ‘deep medicine’ approach, isn’t it about time we engaged in some ‘deep nutrition’?

Stuart Gillespie, 26 August 2021

[‘Inflamed’ is published by Allen Lane and available at all good non-amazonian bookshops]

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