Inflamed review: How poverty and injustice make you sick

By Layal Liverpool

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.

“Not all patients were equal,” write Rupa Marya and Raj Patel in their new book, Inflamed. The authors, both academics and activists, write: “[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.”

Inflammation is the body’s response to infection or damage. Immune cells spring into action and a flurry of chemicals are released to promote repair and recovery – for instance, by destroying invading microbes or healing a wound. Once healing is complete and balance restored, inflammation should subside.

But sometimes it persists, transforming the body’s healing mechanism into what the authors describe as “a smoldering fire that creates ongoing harm”. 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’s bodies.

Inflamed delves into a growing body of research examining how inequality drives health disparities. For instance, Black people in the US are more likely to earn less and have more debt compared with white people, contributing to chronic stress. 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.

“High mortality rates in Black infants are halved when they are cared for by Black physicians”

All these factors, driven by systemic racism, combine “to create a potent pro-inflammatory threat”, 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’s health too, argue Marya and Patel. For instance, a 2018 US study found that Black men who reported directly experiencing unfair treatment by police, or hearing stories about it, had on average shorter telomeres – caps of DNA that protect the ends of chromosomes, and that shorten each time a cell divides – compared with Black and white men who didn’t report experiencing this trauma. “Racism is a cognitive load that is experienced throughout the body,” 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 mortality rate is halved when Black infants are cared for by Black physicians. Meanwhile, race-based medical practices, such as the use of an adjustment for Black race in equations used in many countries to estimate people’s kidney function, also contribute to health disparities.

Doctors need to be more aware of how someone’s 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.

Source: Humans - newscientist.com