A fragmented and unjust health system.

Sarah Hill MPHTM

Albert Einstein College of Medicine, MS1


April 23, 2020

The coronavirus pandemic has personally manifested as a torrent of both guilt and motivation. With that has come an overwhelming frustration with the greater structures that have influenced the destructive path of this virus. In many ways I have also been fortunate to form new connections and share in the strength and solidarity of communities around me. I’ve organized a research team of 30 Einstein medical and NYU law students to create a working database that outlines the legal implications and insurance coverage realities of providing reproductive health services including medication abortions via telemedicine during COVID-19. I joined a research response team from my alma mater working on compiling and developing contact tracing guidance for the WHO’s Global Outbreak Alert and Response Network (GOARN). I launched this journal too. By now I’ve accepted more readily that my reactions and feelings will vary throughout the course of this pandemic. I’ve also recognized that to experience all of these things is okay.

And with these ruminations, I have also been constantly considering my privilege. To have the ability to socially distance and to be in good health. To return home to my family and to have a network of friends and colleagues to connect with virtually. To be financially secure and to have good health insurance. To have running water and a roof over my head. This is what it looks like to have great privilege in the time of COVID-19. Yet many of the communities around me, many peers and close friends, patients in the Bronx and those from New Orleans do not. As such, the current coronavirus outbreak has strengthened my convictions to pursue a career as an infectious disease (ID) physician in a world with universal healthcare.

Before starting my first year at Einstein, I completed a Masters of Public Health and Tropical Medicine at Tulane University. The belief that healthcare is a human right has guided over five years of ID research on neglected tropical diseases and population health research on health disparities. When I came to Einstein, I saw an opportunity to turn this long-held conviction into substantive action, and I became involved with the organization Students for a National Health Program (SNaHP). Through organizing and direct action we advocate for a comprehensive single-payer national health program in the United States, such as Medicare-for-all.

The coronavirus pandemic has exposed the frightening reality of a fragmented and unjust health system that millions of under and uninsured Americans contend with every day. It has in many ways confirmed the harmful truth that health is not a human right in the United States. In the face of this pandemic, the shortfalls of our current health system are exacerbated by the lack of universal sick pay, the uncertainty and obstacles that undocumented immigrants face when accessing care, as well as the inhumane conditions experienced by those who are incarcerated. Considering the long history and persistence of institutionalized racism in the US, the early statistics that show us COVID-19 morbidity and mortality disproportionately affecting communities of color are not incidental. A constant phrase I have heard throughout the pandemic is “when this is all over...”. However, the disparities that have led to the exacerbation of this virus’s spread and growing death toll did not occur because of the pandemic and will not be “over” when the reproductive rate drops below one, a vaccination or effective treatment is developed, and robust contact tracing teams are rolled out.

This pandemic has unified my public health, infectious disease, and universal healthcare pursuits. Ed Yong wrote in the Atlantic, “After COVID-19, attention may shift to public health. Expect to see … a surge in students applying to public health programs … ‘Regular people who think easily about what a policewoman or firefighter does finally get what an epidemiologist does’”. This has made me grateful for my background in public health and for the professors and classmates who have trained and taught me. I am also left with a sense of urgency to put my convictions into action and engage with health policy. In my future as a physician I will have the responsibility to address how systemic inequities and health disparities impact the ability of my patients to be healthy and to access care that is right for them. The role of a physician must reach far outside the walls of a clinic or hospital. Physicians will have a responsibility to be active advocates for their patients’ fundamental needs and rights. This includes the human right to access free and comprehensive universal healthcare. Ultimately, I hope that experiencing the COVID-19 pandemic impresses upon my peers and society at large the necessity to stand up in the face of injustice not only during times of crisis, but where and whenever injustice occurs.

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