Perspective: We lay down; now it’s time to stand up

December 16, 2014

Livy Low image

(Photo courtesy Livy Low)

Hannah Keppler
Student, Albert Einstein College of Medicine

Last Wednesday, thousands of students at more than 70 medical schools across the country staged “white-coat die-ins” to make a statement about racial injustice, including as it manifests itself in our health care system.

As one of these students, I lay on the ground for 7 minutes, the same amount of time that Eric Garner’s body lay on a Staten Island sidewalk after he was choked to death by police. While I laid there, I thought about the systemic injustices in our society and how I and other students could effect change.

When we first donned our white coats, my classmates and I took an oath to “do no harm.” To me, taking that oath was making a pledge to always respect and honor the value of human life.

Looking at current inequalities in the health care system, it’s clear to me that not all lives are valued equally. Racial disparities persist, often insidiously. One study found that there is an excess of 83,570 African American deaths per year due to health disparities. [1]

How can we explain this persistent inequality? Racial disparities are endemic in our society, not because of some kind of accident but because of deliberate decisions made over many years.

The “war on drugs” wasn’t an accident, nor was the “ghettoization” of the inner cities while many in white America received bank loans and government subsidies to move to the suburbs. Nor is it a coincidence that our inner-city public school systems are crumbling, that Black and Latino neighborhoods have limited access to fresh, healthy food, or that that more than 60 percent of the people currently in prison are people of color. [2]

These patterns constitute institutional racism. So how do we challenge it?

Well, since we’re medical students we should probably start with the system to which we will dedicate most of our lives. There are many aspects of our health care system that need fixing, but I think the most glaring issue is that, despite an inordinate amount of money being funneled into health care (almost 20 percent of GDP), many people are either left out completely or left with very insufficient coverage.

Unfortunately, a disproportionate number of those with inadequate access to health care are Black and Latino, thus creating striking racial inequalities.

Even after implementation of the Affordable Care Act, 32 million people in this country will remain uninsured [3], and those who are insured under low-cost insurance plans may avoid seeking care because of high deductibles and co-pays. In addition, people on Medicaid may not receive the same quality of care as people with private insurance because so many doctors refuse to accept patients with Medicaid.

I believe that health care is a human right. The fact that so many people in our country are denied access to health care is a profound injustice.

I recently listened to a longtime ER nurse and health care advocate recount a few stories of the many injustices she’s seen over the years. She spoke of women who had showed up in the ER with advanced cervical cancer because they hadn’t been able to afford basic preventative pap-smears. She cited patients who cut their pills in half to make them last longer and then ended up in the ER with preventable heart attacks. Her stories made me realize just how many lives could be saved if people had access to comprehensive health services.

After careful study, I’ve come to the conclusion that achieving universal health care by means of a single-payer system would be a big step towards achieving health care equality. In a single-payer system, no one would ever be denied medically necessary care because of inability to pay, which happens constantly in our current system.

When it comes down to it, the biggest barrier to achieving universal health care right now is lack of political will. People have to organize and demand it, and we as health care providers have a special role to play in this fight.

The time is now for medical students to get political. I think traditionally we’ve shied away from this, but momentum is building and we need to see it through.

I’m not suggesting that all medical students should storm the White House and demand action from President Obama. Let’s start by looking locally, for example at our own medical schools. How about setting up a meeting with your dean to talk about integrating education about health disparities into the medical school curriculum? How about during the next hypertension lecture, we spend 10 minutes having a discussion about inequalities in access to healthy food?

And if we want to see societal change, let’s look beyond our schools to our local, state and national representatives. It’s easier than you think to call them up and make an appointment; you’re a constituent and they want to hear from you. Be persistent. Approach them with a deliberate request. It could be something small related to your community, or something bigger like the New York Health bill, or a national single-payer bill such as Rep. John Conyers’ “Expanded and Improved Medicare for All” Act, H.R. 676.

Many medical students participated in the die-in not only to raise awareness about health disparities and make a statement, but also to demand action from our schools and communities. In order for action to be taken we must be specific and deliberate about what we want. That is going to take a lot of hard work, but I have faith that if enough students organize we can change things.

Medical students have a pivotal role to play when it comes to creating a more equitable health care system, whether it be by supporting single payer, working to eliminate bias, or combating other forms of injustice.

Our voices will not be silenced. Our white coats convey a message about who we are and our value system. We need to stand up and defend those values, whether it be in the exam room or out on the streets. On Wednesday we lay down and people listened. Now it’s time for us to stand up and take action.



1. David Satcher, George E. Fryer, Jr., Jessica McCann, Adewale Troutman, Steven H. Woolf and George Rust. What If We Were Equal? A Comparison Of the Black-White Mortality Gap In 1960 And 2000 Health Affairs, 24, no.2 (2005):459-464

2. American Friends Service Committee. Facts about the mass incarceration of people of color in the U.S. (2013)

3. Millman, Jason. Who is still uninsured under Obamacare – and why. The Washington Post, (2014)