Amid the dual crises of a global pandemic and a reckoning with systemic racial injustice, health workers and health educators are grappling with a momentous question that hovers between personal and professional: how much of an activist should a health care worker be?

Doctors, epidemiologists, and nurses are increasingly abandoning their characteristic reticence in favor of direct advocacy. They raised early alarms, in op-eds and on cable news programs, about the disproportionate toll the Covid-19 pandemic was taking on communities of color. In the wake of the killing of George Floyd, the activism has intensified: they are circulating petitions, ramping up educational outreach, and organizing sit-ins to fight police brutality and systemic racism. They are joining marches and organizing their own; more than 10,000 health care workers donned their white coats and scrubs to march through downtown Seattle to show their support for the Black Lives Matter movement.

This outpouring of activism is the most visible manifestation of years of stirrings among health care workers — particularly younger members of the profession — to speak out more publicly on behalf of their patients and the societal ills that shape those patients’ health needs. It’s a marked departure for an industry that has long implied that doctors should not play a role in social justice movements, in the name of “objectivity” — and may be an uncomfortable sea change for some in the profession.

In interviews, more than a dozen activists who work in health care told STAT that publicly speaking out against racism was not just vital for society, but also a key part of healing the patients in their care.

“If we, as physicians, are really truly in this profession to heal and to help our communities be healthy, we need to be engaging beyond the doors of the clinic and the doors of the hospital,” said Nathan Chomilo, a pediatrician and founding member of Minnesota Doctors for Health Equity.

Edwin Lindo, a lecturer at the University of Washington School of Medicine and one of the organizers of the march in Seattle, said: “I don’t even think it’s advocacy. I mean, advocacy suggests that you’re doing something extra. I actually think this is an obligation of physicians — to do the work that changes the conditions outside of the clinic.”

Doctors and other health care workers are taught — and sometimes even required — to keep their beliefs to themselves. Some have argued that medicine should focus myopically on objective observation of biology — disease processes, cellular structures, and symptoms. Speaking out about political causes could undermine a patients’ trust in a doctor’s medical opinion, or even dampen the broader public trust in science and medicine.

Physicians have some “extra baggage and responsibility” when they engage on any issue in the public sphere, said Ford Vox, medical journalist and commentator who also practices brain injury medicine.

“You’re speaking not just for yourself, but to some extent for the profession as a whole, and that it is theoretically possible for folks to do something that demeans what it means to be a physician,” he said. “It’s quite possible for physicians to get themselves into trouble and do all sorts of things that are out of bounds and bring disrepute not just to them but to the really quite sacred doctor-patient relationship and it is important that you do not violate one code of ethics in order to achieve other aims.”

Vox said he thinks speaking out in the current moment is “entirely valid and appropriate,” and he hasn’t heard of any health care workers stepping out of bounds.

But the “extra baggage” has clearly informed the medical industry’s perspective on protests and other forms of activism in the past. In 2011, physicians in Wisconsin were sanctioned by the state medical association for writing doctors’ notes to excuse political protestors from their day jobs. And just six years ago, administrators at Brown University threatened medical students with disciplinary actions after they organized a peaceful protest in response to the deaths of Michael Brown, Philandro Castile, and Sandra Bland.

Organizer and physician Estell Williams, holding her daughter Estella, addresses a crowd of thousands of health care workers outside Harborview Medical Center in Seattle.

But the health care workers who spoke with STAT said they do not believe there should be a line between provider and activist — especially with respect to social issues like racism, with its massive, well-documented effect on the health outcomes for Black people and other people of color.

“The idea, I think mistakenly so, was that there isn’t bias that exists in medicine. It’s a neutral playing field,” said Estell Williams, a surgeon at the University of Washington and one of the organizers of the march in Seattle. “People are just now understanding or coming to terms with the fact that, you know, that isn’t the case.”

“To be a part of a clinical response without having serious critical consciousness and political education as the foundation of that clinical response … is to be complicit with oppression and systems of oppression have always, always been a part of medicine because they’re a part of humanity,” said Michelle Morse, a physician and one of the co-founders of the Campaign Against Racism.

If anything, both Chomilo, from Minnesota Doctors for Health Equity, and Williams, the University of Washington surgeon, suggested the collective power and privilege physicians hold within society is an underutilized force for change.

“Leveraging the title, the position of privilege, the power that I have now, allows me to further elevate the voices of those who are often forgotten because they don’t have the MD,” Williams said.

Chomilo added: “The fact that we have those two letters after our name means that, for good or for bad, we go to certain tables and people will listen to us more than people who aren’t physicians.”

This is doubly true, the health care workers said, during a pandemic that has claimed so many Black lives, at such disproportionate rates. The coronavirus pandemic has thrown the realities of racial disparities within the healthcare system into stark relief, especially for the health care workers on the front lines. Black Americans are dying at nearly twice the rate that would be expected based on their share of the population; in some states, they are dying three times faster.

“We had a public health crisis that exposed a lot of systemic and underlying racist institutions in our society and then it kind of dovetailed right into another public health issue, which is police brutality,” said Taison Bell, a critical care and infectious disease physician at the University of Virginia. “Now we’re starting to see more directly what these connections are, and the profound impact it has on the Black and Brown community.”

There are early signs, too, that the institutions of medicine — medical schools, hospitals, trade associations — are beginning to change with them.

The American Medical Association, for example, did not issue a statement in 2013, when George Zimmerman’s acquittal for the shooting of Trayvon Martin inspired the launch of the Black Lives Matter movement, or in 2014, when Michael Brown’s shooting sparked protests in Ferguson, Missouri and around the country.

In the wake of George Floyd’s death, however, the AMA issued a statement condemning police brutality and organized a series of discussions around health equity and how police brutality detrimentally impacts the health of Black communities.

Unlike in 2014, Brown University’s dean of medicine signed onto the university president’s note of support for the Black Lives Matter movement. And in Seattle, alongside the march that drew thousands of health care workers who wanted to affirm their support for the Black Lives Matter movement, several major University of Washington health and science schools — the schools of medicine, of pharmacy, of dentistry, of nursing, of public health, of social work — publicly offered their support, too.

Many of the activists, however, said the institutions of medicine still have a long way to go to combat the racism inherent in the medical field. Black Americans have been discriminated against in nearly every aspect of medicine, from medical schools to hospital jobs and even in their acceptance at major medical organizations like the American Medical Association.

Shewit P. Giovanni, a physician, becomes emotional while listening to speakers at Seattle City Hall where thousands of health care workers gathered to protest police brutality.
Health care workers marched from Harborview Medical Center.

Physicians and other advocates have called on hospitals to directly dismantle the systemic racism within their own walls, through training programs and comprehensive diversity initiatives for hiring and promotion. They’ve called on medical schools to distribute reparations as recompense for their role in perpetuating slavery. And medical students, too, have pushed for a more robust curriculum that implements anti-racism training and centers health equity as a foundational framework, through organizations like the Student National Medical Association.

We need to “look within our institutions, beyond just implicit bias and beyond just recognizing, like, ‘I need to do the work of anti-racism,’” first-year medical school student LaShyra Nolen said. “But also looking at, ‘How do we change the structures that we had in place that are extremely problematic and harmful to black people, patients in our communities?’”

The activists who spoke with STAT emphasized that their fight is also about broader, structural changes to society. They also want to lend their voices to combat the social problems shaped by systemic racism — housing insecurity, food deserts, air and water pollution — that have contributed to the long histories of racial violence endemic to law enforcement and medical institutions alike.  In recent petitions, health care workers have asked government officials to redistribute police department budgets and make public statements acknowledging that police brutality and white supremacy should be considered public health issues.

Thousands of health care workers gathered at Seattle City Hall to listen to speakers and community organizers.

And while much of their activism looks like the anti-racism activism others are engaging in around the world, there are also nontraditional forms of activism for health care workers, too. Many doctors, nurses, and medical students have taken part in training that help them serve as protest medics, rushing to the frontlines to help protestors who’ve suffered tear gas exposure or dehydration.

Other physicians see their research itself as a way to inform activism. Utibe Essien, a physician and health equity researcher at the University of Pittsburgh, published a paper in May highlighting the lack of comprehensive race, ethnicity, and language data related to COVID-19 testing, infection, and death rates.

At its core, the research underscores the evidence-based facts of the disparity, he said. But just taking on the issue is its own form of engagement, he said.

“If I can put data to those social factors that folks are advocating [for], I think that that’s kind of the lane and the role that I’m hoping to play,” Essien said.

In some ways, the medical profession has been edging toward activism for some time, even on more political issues. Growing numbers of physicians have come out in support of Medicare for All in recent years, mobilizing rallies and marches in support of a single-payer health insurance system. When the National Rifle Association pressured doctors to “stay in their lane” and not weigh in on issues of gun control, social media exploded with photos of health care workers treating victims of gun violence in a digital protest centered on the hashtag #ThisIsOurLane.

Much of the push toward activism has come from a younger generation of doctors and medical students. White Coats for Black Lives sprung out of student protests at medical schools in 2014, and other student groups, including the Student National Medical Association, which have facilitated workshops to train physicians to be more socially conscious and culturally competent, according to president Osose Oboh.

Nina Saxena, a physician, marches with thousands of other health care workers protesting police brutality against Black communities.

That has put medical schools at the forefront of the debate — and at the center of calls to improve the medical profession’s understanding of racism.

Tomás Díaz, an emergency physician at the University of San Francisco, said many medical students spend more time studying rare diseases than broader, systemic factors that impact many more people.

“Racism is a chronic exposure that is affecting a huge number of people, just in absolute terms, so the idea that it’s not something that we should be studying seems silly to me,” Díaz said.

And while medical schools have begun to include course offerings around the social determinants of health, health justice courses are mainly student-led electives with no institutional support nor funding, according to Jennifer Tsai, a physician and a founding member of the White Coats for Black Lives national chapter.

“If it became very clear that a medical school as an institution required educational reform around something like biochemistry or anatomy, they would never ask a group of first year medical students to be tasked with the job of reforming that education, designing curriculum and implementing it with no other institutional resources,” Tsai said. “But yet that is what happens across the nation when it comes to issues of policy, equity, racism, racial equity, transgender health, women’s health.”

Díaz also cautioned that medical schools — even the institutions of medicine alone — could not do all of the work to address inequity in health care.

“If some students’ first exposure to learning about racism, in a very real way, is in medical school, it’s already too late,” he said. “Ultimately, solutions out of the field of medicine are not going to be sufficient.”

For Essien, the health equity researcher at the University of Pittsburgh, that’s precisely why health care workers’ activism is so important — to make it clear how deep an impact racism has had on American health care, and to try to be part of the solution.

“I don’t know what moment will come from the death of George Floyd. I don’t know what moment will come from the Coronavirus crisis,” he said. “But I think that there is a good and big opportunity for us to expand the message towards our colleagues that this is not just a one and done moment, that this is the moment for us to truly take social justice and health seriously, and more importantly, really try and stamp out health disparities in our generation.”

Ruth Hailu is a former intern for STAT and a rising senior at Harvard University. She can be found on Twitter at @ruth_hailu_. 

  • The article says: “it is important that you do not violate one code of ethics in order to achieve other aims.” There is no data yet on the effect that standing shoulder-to-shoulder, even with masks on, has on spreading the virus. But public health officials say this is risky behavior. And the doctor’s duty is to first do no harm. Do I want my doctor engaging in behavior that could potentially give me the virus at our next visit? Not so sure about that. Maybe doctors can find a safer way to support the protests without risking yet more lives.

  • Great historical synopsis as well as thought-provoking article! Looking forward to reading more articles from Ruth Hailu!

  • As Condolezza Rice has begged her fellow black Americans look to the schools first. As highly regard black writer Dr. Shelby Steele says over and over look to black families, with 75% of black children born to single women. As beloved black economist Thomas Sowell has said over and over “stop making us victims.” This is a land of opportunity: look at Ophra Winfrey, a billionaire, how much has she spent mentoring black children and adults or contributing to non-political organizations. And what about billionaire black celebrities and billionaire black althetics; what are they doing to mentor and donate. It seems the doctors also, in this article, who have the most money, what are they doing besides protesting. Little will be accomplished until these folks step up.

  • Clearly the marching doctors, nurses etc totally ignore that they are setting the worst possible example for Covid spread. Far too many simple people will now think that if the Doc can be so close to other people, so can they. This high-risk activity will have dire consequences in stretching the “time of Covid”. In participating, they also ignore that as they risk putting themselves out of commission (infected with Covid). What good does that do, when (not if) a huge shortage of health care workers hits?

    • Being anti-racist doesn’t have to mean demonstrating in huge crowds. It can start by simply saying “Racism isn’t a Black problem that white people can chip in and help them out with. Racism and police brutality are human rights violations that will only end when white people realize it is incumbent upon them to actively choose to participate in changing the currently unacceptable status quo”

  • Health care workers throwing into the wind the distance etc measures that curb Covid spread, marching in close proximity to yelling members of the public – without immediate self-isolation for 2 weeks – ought to get their license looked into. I for one would switch doctors if mine participated and thus willingly and knowingly put me and other patients at risk for Covid virus transfer. A huge responsibility of health care workers in this time of Covid is to avoid spread. There are many other means to participate in whatever movement turns one on : digitally, TV ads, petitions, etc etc. Any activity that puts patients and co-workers at risk is wrong.

  • The idea that science and healthcare are apolitical is completely laughable.

    Do we not set priorities by budgets? Can we really say that medicine is impartial by zip code? Is there not a history of medicine committing true atrocities against black bodies (check the history of gynecology or the ever referenced Tuskegee experiments or the injustice at the heart of the most important cell strain in research).

    Racism is a public health crisis and I hope these marchers are prepared to do the hard work of earning the trust of the black community.

    • “check the history of gynecology or the ever referenced Tuskegee experiments or the injustice at the heart of the most important cell strain in research”

      Anything that occurred before I was born is something I am not responsible for. And I’m not responsible for anything merely on the basis of superficial criteria such as skin color.

      I am responsible for things I have done or for things others have done when I was responsible for their actions. Nothing else.

      And I hold everybody to the same standards that I hold myself to. If you act like a racist, if you talk like a racist and if you treat people differently based on skin color – you’re a racist regardless of your skin color.

      And beware of the people who think that you should be held to a lower standard because of your skin color – what their really saying is that they don’t think that you can live up to the standards set for others.

    • Colin – Those historical events still impact the quality of care minority populations receive today and the health outcomes they experience. That history continues to have real impacts on current healthcare outcomes for Black Americans. The effects of segregation and Jim Crow laws have been long-lasting across this country and are still being dismantled in parts of the U.S. South. Your statements are indicative of an attitude that perpetuates systemic racism and the contributing policies because you, personally, “take no responsibility.” You purport to believe racism is only an individual action when there is ample evidence in social work, public health, and medicine to show those individual racist actions contribute to broad societal acceptance of policies and practices that disproportionately impact people who are not White.

    • “Those historical events still impact the quality of care minority populations receive today and the health outcomes they experience.”

      How about some specific examples?

      “Your statements are indicative of an attitude that perpetuates systemic racism and the contributing policies because you, personally, “take no responsibility.””

      Wrong. It does not perpetuate anything. Claiming that I’m somehow responsible for things that occurred long before my parents were born merely because of my skin color is racist. Things that happened before our parents were born and not an excuse to hold grudges. History is something you learn from – and then move on. You punish the people responsible but not their descendants.

      Using your logic we should still be hating the Japanese, Germans, Italians, and Spanish for things they did during those times. We don’t because we recognize that it’s wrong to blame people for things that happenned before they were born.

      And claiming that I’m responsible for something that happened decades before I was eve born – because of my skin color? That’s as racist as you can get.

      Martin Luther King would be ashamed of you.

  • This is officially just a religion now. The tearful videos of white Celebrities confessing their sins. The lack of nuance in conversation. One of the commenters below is absolutely right. Medical professionals had no business going to protest because of possible exposure and yet they did it anyways. Normally they would be stripped of their credentials for even endangering their patients but this will not happen. Sacrifices must be made to the gods of anti-racism. Meanwhile the data is stubbornly inconvenient for the movement. Police shootings are commensurate with crime rates in the neighborhoods the police. In communities were fewer people get shot by community members There are fewer police shootings. we don’t even have any data on the rates of unregistered firearm ownership in black communities. The movement lacks the Ability to see that it is historic racism that leads to poverty and poverty is causing the civilization to Erode in these communities. I for one will be taking note of any photos I see of physicians like the one above and I will find out how patients can begin the process of lawsuits against hospitals who fail to protect their patients from doctors who are in the blm cult and willfully exposing their patients to whatever the hell they picked up in these mass gatherings.

  • Which means that from now on we will have to suspect that what they are telling us is tainted by their political views. Apparently the medical community didn’t learn from the scientefic community what happens when people suspect that what you’re saying is more agenda driven than science drive.

  • How about if this activism included urging women not to have children with multiple men with none of the men staying in the picture to help raise the children. Numerous studies have shown that children raised in families without a father in the picture have much worse outcomes that children raised in two parent families. Somehow I don’t think this will happen because it is not politically correct. All this preaching and posturing described above has more to do with publicly displaying one’s wokeness than to actually caring about patient welfare

  • In reference to your statement: “It is important that you do not violate one code of ethics in order to achieve other aims,” I think this is the chief point. I have not heard of any health care spokesperson claiming that the shoulder-to-shoulder protests, even when protesters are wearing masks, would not contribute to the transmission Covid-19. This being the case, I would not want my doctors to have me in their office when they themselves have knowingly exposed themselves to the virus. It is a very poor message to send to 76-year-olds like me. Do our lives matter? We are the ones who need to see doctors, and we need them to be willing to keep themselves safe for us, if not for their own families. Do their political rights to this kind of self-expression (when many other completely safe ways of self-expression already exist), trump our needs to continue to live?

    • It’s all about politics. Liberal protests and rallies are good but Republican protests and rallies are bad.

      Even worse when they flat out lie to us about the uptick in coronavirus cases being because of the re-opening of the economy instead of the riots. If it were the re-opening of the economy then the uptick in cases would have occurred a month ago.

      Look at the issue with that malaria drug. It wasn’t science that declared it dangerous – it was politics.

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