#WhiteCoats4BlackLives: Acknowledging The Political Determinants of Health

At 3PM EST on December 10, 2014, medical and dental students at over 70 schools participated in the “National White Coat Die-In.” The event was organized on Facebook and spearheaded by students at University of California, San Francisco (UCSF) School of Medicine who described the event as “a demonstration in response to the events in Ferguson and New York because #BlackLivesMatter.”

Across the country, there have been numerous protests against the grand jury’s decision in Fergurson, Mo. not to indict officer Darren Wilson who shot and killed Michael Brown, an unarmed teenage boy. Similarly, in Staten island, NY, the grand jury decided not to indict officer Daniel Pantaleo who killed Eric Garner, an unarmed black man, using a banned chokehold.


Harvard medical students | Photographer: Tamara Rodriguez Reichberg

When I saw the invite to participate in the white coat die-in, I was surprised and at the same inspired that medical students across the nation viewed police brutality and racism as an issue that should not be ignored by the medical community. The number of individuals who joined the event page on Facebook stood at a solid 2,503 as of 11PM on Dec. 10. Still, I was curious. Although I have my personal views, particularly on the importance of addressing social and political determinants of health, I wondered what other aspiring health professionals thought on this topic. What were their true motivations for participating in the national demonstration? I reached out to friends at various medical schools and asked the question:

Why did you decide to participate in the white coat die-in? Why do you think this issue matters to medicine or healthcare?

The responses were both moving and inspiring. Reading these statements I was reminded of the statement Kate Vickery, MD, MSc made at the “RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health in Washington, D.C. last weekend: “We need a social movement within medicine and outside the walls of medicine.” This, ladies and gentlemen, is a social movement.


Northwestern Feinberg medical students via image source

The responses:

Olivia Kizzie at UTexas Medical Branch School of Medicine

“We as student doctors learn about medical equality and professionalism but racial discrimination is still an underlying issue within our profession, patient care, and in the world. Somehow those values we learn early on get lost by certain professionals and we as blacks or minorities have to bite our tongue for the sake of getting by and keeping our jobs. In a patients case, they may not trust medical providers of another race. I participated in the National Coat Die-In to stand up for what is right, period. Some may disagree but hey, they don’t live in our shoes or grow up feeling like they have no place in this world. The only way to be equal or surpass the majority as a minority is working 20 times harder as early as grade school.”

Elorm Avakame at Harvard Medical School

Not everyone believes the incidents in Ferguson and Staten Island had to do with race, and there is room for productive disagreement. Regardless of your stance on those incidents, however, the fact remains that racism continues to exist in our society both in the way that individuals treat each other and in the reality that Americans of color are less well served by the social systems that shape all of our lives. This has been proven to be true of all systems including our legal system, our educational system, and especially our health care system. That is the statement we sought to make today.

As future health professionals, we recognize that the social world has real consequences for our patients’ health. We challenge current and future members of our health care system to recognize race-based disadvantages as a public health crisis and to address the failure of the American health care system to provide equitable care for racial and ethnic minorities nationwide. We also challenge ourselves and each other to confront the conscious or unconscious biases we may hold and to commit to learning about the ways that racism harms people all over this country.

 Patrick D. Atis at Rutgers New Jersey Medical School 

The day after the Eric Garner grand jury non-indictment debacle, I participated in a long discussion with other minority students in my first year class. We talked about attending the Millions March that is going to be in NY this saturday, how stereotypes affect us now that we are in the heart of Newark and what we could do to show that the way minorities and marginalized are being treated is just not acceptable. We planned to go to this march with our white coats as a statement, that stereotypes do not apply to an entire group and that these stereotypes affect us and leave us vulnerable to injustice when we do not have our white coats/scrubs (and sometimes even when we are sporting this gear). We heard about the die-in after deciding to attend the march and I thought it was a great way to show that our society’s future servants are bothered by injustice.

Why it matters? We are in a position to serve and should be doing all we can to provide for our patients and the communities we belong to. Law enforcement has a similar goal: “Serve and Protect.” These foundations in medicine and law enforcement are being revisited at a time like this in order to shape our futures. As healthcare providers, we must be aware of institutional bias, provide exceptional care for all people and pay attention to underserved communities. I can’t speak for law enforcement and if they will have this kind of heart across the board to do their part, but you’ll be sure to know the healthcare system will always be doing their part to serve our global community.

 Ayobami Ajayi at Perelman School of Medicine, University of Pennsylvania

“I decided to participate for many reasons. It was important for me to be a part of the process that leads to change. I felt like I owed it to the people who paved the way for me to be here. We are all aware of racial health disparities and how they significantly affect patient outcomes, so I think that it was important for the medical community to recognize and reflect on these injustices so that we don’t perpetuate the same biases that led to them in our patient interactions. Lying still, on the cold ground, for those four and a half minutes while reflecting on what it might have felt like to be Tamir Rice, Eric Garner or Mike Brown was powerful. Even if people didn’t understand what we were doing, it is my hope that our demonstration encouraged them to become informed because having insight can make a world of difference when treating any patient.”

Nashira Howe at Tulane University School of Medicine

“In the moments leading up to the die-in, I thought about a conversation I had with my maternal grandparents this past summer. My grandfather spoke about his time in the Deep South while doing military training in the early 1950s. Hungry after a day’s work, he and his friends would go to a local eatery for food. It was no question that they were served through a back window. At this point my grandmother interjected and said that she was “never” served from a back window. “You have food at home. Why go out to eat if you have to speak to someone through a little window at the back of the kitchen?” (Paraphrased)

In very different ways my grandparents supported the Civil Rights Movement; one by striving to live as normally as possible under laws that considered him anything but regular, and the other by refusing to support a system whose only thank you would be injustice.

I’m not sure where my niche is in all of this. I just know that I have to support my people. So if there’s a die-in, I’ll go. A boycott, I’ll join. Whatever sign of solidarity that I can show, I will, because America needs to know that the cases of Michael Brown and Eric Garner are not isolated incidents. There are too many more names for them to be isolated incidents.

So I had to participate in the die-in to show my elders that I will not just sit comfortably on their shoulders and complacently enjoy the fruits of their labor. I had to show Black boys and girls that my life as a budding health professional is not so far removed from theirs; I see and hear the injustice that goes on in their schools and neighborhoods, and it matters to me. And I had to show my future patients that I care. When a man is left in cold blood for four and a half hours, I care. When a man’s dying words of “I can’t breathe” are not met with compassion, I care. Feeling that the physician does not care or has some preconceived biases is a major reason why patients feel uncomfortable and/or withhold information in healthcare settings. And it can be difficult to successfully treat someone when you don’t know the full story.

So for as long as necessary, I’ll stand for those who can no longer stand for themselves. I’ll stand with the hope that one day, a person’s own plea, their own call for help, their own voice, will be enough. My life depends on it.”


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