Inflamed: Deep medicine and the anatomy of injustice
Allen Lane
THE covid-19 pandemic exposed stark inequalities globally, with socially and economically disadvantaged groups facing higher than average risks of becoming seriously ill and dying.
鈥淣ot all patients were equal,鈥� write Rupa Marya and Raj Patel in their new book, Inflamed. The authors, both academics and activists, write: 鈥淸In the US,] Black, Indigenous, and people of colour (BIPOC) were over-represented, their bodies subject to inflammation of all kinds, long before the SARS-CoV-2 virus ever settled into their lungs. Not only lack of access to health care, but systemic social and economic disenfranchisement rendered their bodies most susceptible to Covid when it hit.鈥�
Inflammation is the body鈥檚 response to infection or damage. Immune cells spring into action and a flurry of chemicals are released to promote repair and recovery 鈥� for instance, by destroying invading microbes or healing a wound. Once healing is complete and balance restored, inflammation should subside.
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But sometimes it persists, transforming the body鈥檚 healing mechanism into what the authors describe as 鈥渁 smoldering fire that creates ongoing harm鈥�. For doctors to truly identify and treat the underlying causes of ill health, the two argue, they must begin by understanding how systemic racism and inequality contribute to this type of persistent, harmful inflammation in people鈥檚 bodies.
Inflamed delves into a growing body of research examining how inequality drives health disparities. For instance, compared with white people, contributing to . They are also more likely to be exposed to environmental health hazards, such as lead in drinking water, and to live in areas with limited access to affordable, healthy food options, making it difficult to maintain a healthy diet.
鈥淗igh mortality rates in Black infants are halved when they are cared for by Black physicians鈥�
All these factors, driven by , combine 鈥渢o create a potent pro-inflammatory threat鈥�, write Marya and Patel. They add that the unequal distribution of these triggers of inflammation may explain why Black people have the highest rates of cardiovascular disease in the US.
Daily discrimination damages people鈥檚 health too, argue Marya and Patel. For instance, a found that Black men who reported directly experiencing unfair treatment by police, or hearing stories about it, had on average shorter telomeres 鈥� caps of DNA that protect the ends of chromosomes, and that shorten each time a cell divides 鈥� compared with Black and white men who didn鈥檛 report experiencing this trauma. 鈥淩acism is a cognitive load that is experienced throughout the body,鈥� write the authors.
Doctors also contribute, they argue. In the US, Black newborn babies die at more than twice the rate of white newborns. Research suggests this . Meanwhile, race-based medical practices, such as the use of an adjustment for Black race in equations used in many countries to estimate people鈥檚 kidney function, also contribute to health disparities.
Doctors need to be more aware of how someone鈥檚 environment and life experiences contribute to disease, say the authors. Even something as simple as air quality differs significantly depending on the environment, they say, with disparities within countries and between them. Most deaths linked to air pollution occur in low and middle-income countries.
Inflamed takes the reader on a journey deep inside the human body, travelling through the immune, circulatory, digestive, respiratory, reproductive, endocrine and nervous systems. In doing so, it reveals how external inequalities affect these systems and cause serious harm.
