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August 2017
Celeste A. Brown, MPH, Wizdom Powell, PhD, MPH, Giselle Corbie-Smith, MD, MSc, Oak Ritchie


Health Equity Implications of Police Violence

Key Points

  • Police-related killings represent a significant threat to national efforts to build more health equity.
  • When compared to non-Hispanic White males, Black males in the U.S. are 3x more likely to be killed by police than White males.
  • Implicit bias is likely a fundamental cause of police-related killings. Such biases operate at multiple systems within the police force, but are not immutable.

SUMMARY: As of August 2017, the US is on track to approach 1,000 deaths of civilians at the hands of police for at least the third year in a row. This brief provides an overview of existing evidence documenting police-related killings of civilians, and suggests key strategies to mitigate the disparate health impacts resultant from those acts of violence.

BACKGROUND: In 2015, independent groups and investigative journalists began to document in earnest the numbers of civilians killed by police officers. After the public uproar from the highly visible 2014 police killings in cities such as Staten Island, NY Ferguson, MO and more, FBI Crime Report data showed the government had grossly underestimated the number of killings by law enforcement by more than half. At least 1,152 people were killed by police in 2015 alone.[1] In 2017, so far 611 people have been shot and killed by police, which is 15 more people than this time last year.[2] It is true that armed White American males are killed in the highest numbers by police officers. However, minority males, especially unarmed Black males, are disproportionately killed by police compared to their percentage of the US population.

African Americans make up only 13.2% of the US population, yet they accounted for 26.5% of all civilians killed by law enforcement in 2015. In 2016, while 2.9 per million people killed by police were White, 3.23 per million were Hispanic.[3]

This year, African-American males, who make up only 6% of the US population, remain the unarmed group most often killed by police, at 26%.[4] Bystander and body-camera recordings have attributed to increased visibility of these killings, but the country seems to have advanced only in the technology by which it tracks police violence in this country, not in any methods to prevent the untimely and disproportionate deaths of minorities.

  • Boys and men of color are killed by police at disproportionately higher rates
  • This worsens the already high rates of mortality suffered by minority males[20]
  • Witnessing and/or experiencing police brutality leads to significant mental health deficits, exacerbating existing disparities
  • Over-policing increases mistrust in the police force by minority groups.

ANALYSIS OF KEY HEALTH EQUITY CONCERNS: Health disparities suffered by minorities in this country are well-established. Black men have the lowest life expectancy in the United States as the group most likely to die from conditions such as heart disease, stroke, and even treatable cancers like prostate cancer. Hispanic men are twice as likely to die of diabetes complications than White men. Black men are also 53 times more likely die from homicide than white men.[5] Adding to these existing disparities are significant population health impacts of police-related killings. [6]  Underlying racial biases that lead to policies resulting in increased searches and arrests of, and violence against racial and ethnic minorities also deserve critical attention. For example, Hispanics make up only 17.6% of the population, but compose 30% of arrests and 23% of all searches.[7] There has also been shown to be a correlation between the number of stops by police and the invasiveness of police encounters with increasing levels of stress and anxiety, even resulting in biological shifts in the brain’s reasoning.[8] Black men report more anxiety and post-traumatic stress disorder (PTSD), and more morbidity from these psychiatric conditions, than their white counterparts.[9] As a final piece of evidence against the practice of increased policing of minorities, researchers have shown in multiple studies that more searches and seizures has not had an association with reductions in crime, and that when whites are stopped they are more likely found to carry contraband than minorities.[10]  The trauma wrought on minority Americans from racially-motivated over-policing and violence is considered influential enough on the overall health of minority Americans that public health researchers have recommended that police-related killings should be reportable or notifiable conditions.[11]

RECOMMENDATIONS

Research

  • Documentation of police-related killings in a publicly-available database
  • Measure the long-term individual and population health burden of police-related killings, unwarranted searches, arrests and imprisonment
  • Investigate

Clinical Practice

  • Screen patients at high-risk for police-violence for depression, anxiety and psychological trauma
  • Train clinicians to practice trauma-informed care, especially those clinicians in communities that suffer violence by police disproportionately
  • Support clinicians’ mental health by teaching self-care practices to avoid compassion fatigue and secondary trauma

Policy

  • Screen officers for implicit bias; conduct trainings to change harmful stereotypes
  • Address systems-level policies that can prevent undue violence against and over-policing of minorities  

RESEARCH RECOMMENDATIONS: Several steps can be taken to thoughtfully advance the evidence base on the health equity impacts of police-related killings. First, we advocate for support of the ongoing measurement and documentation of police-related killings, in a database that is easily accessible to all civilians. Second, we recommend studies that measure the longitudinal public health burden of police-related killings, of unwarranted searches and arrests, and imprisonment of minorities. Third, we recommend investigating the effectiveness of interventions addressing racial and ethnic bias within the US police force. Research has shown that trainings that address implicit bias are effective, and that belief in stereotypes can change, but more investigation is needed to determine if there is sustained behavior change after formal instruction has ended.[12]

Fourth we recommend investigation in methods for improving community mental health in the wake of police killings.[13]

CLINICAL PRACTICE RECOMMENDATIONS: Outside of treating the physical ailments of nonlethal violence inflicted upon their patients, clinicians can incorporate secondary prevention to address the mental health consequences of police violence by screening for depression, anxiety, PTSD or other psychological trauma. Clinicians should be educated on what makes an individual high-risk for positive screening, and on culturally appropriate methods for conducting these screenings.[14] Members of clinical teams who are trained in trauma-informed care (TIC) should be engaged in addressing the psychological and mental health outcomes of police-inflicted violence.[15] TIC training will be most important for those clinicians who have a direct experience with, and proximal relationship to communities that suffer violence by police at a disproportionate rate (that is, minority physicians, and first responders who work in communities of predominantly minority patient populations). Further, these clinicians will need greater support and training for self-care methods to address compassion fatigue and secondary traumatic stress.[16]

POLICY RECOMMENDATIONS: Implicit bias screening and education should be the hallmarks of policy enacted to discover the root causes that lead to unnecessary police violence. Ample research shows that preconceived negative stereotypes about minorities will influence an officer’s decision to mischaracterize a situation or individual as threatening, and to shoot their firearm at a suspect.[17],[18] Systems-level changes should be considered as well, and may prove to be more reliable methods to change improper practices until it is determined which interventions are most effective at addressing implicit biases. Systems-level changes can include, for example, a change in hiring practices to focus on individuals with higher executive functioning who exercise better self-control and reasoning. Others advocate for adding objectivity to standard policing procedures, by adding checklists to routine protocols like traffic stops, and delegating interrogations or paperwork to officers not directly involved in the pursuit and arrest of a suspect.[19]

CONCLUSIONS: The disproportionate killings of minority civilians by police officers has reached the public consciousness at a tenuous time in the country; many watch on and feel paralyzed by the enormity of the tragedy. As health care providers and researchers, taking a stand in professional spaces against police brutality may be a challenge, but it is required because of the damaging health implications to those entrusted to our care. Our unified endorsement of systems-level policy changes, clinical calls-to-action, and research priorities will engender a positive change in the attitudes and relationships between the police and the communities they serve. Our duty as scholars, and as citizens, is to decrease dissonance and implement collaborative solutions to this issue.


REFERENCE:

[1] MappingPoliceViolence.org.

[2] The Washington Post. (2017). Fatal Force database of fatal shootings by police.

[3] The Guardian (2015). The Counted: People killed by police in the US. Retrieved from https://www.theguardian.com/us-news/ng-interactive/2015/jun/01/the-counted-police-killings-us-database.

[4] Sullivan J., Thebault R., Tate J., Jenkins J. (2017). Number of fatal shootings by police is nearly identical to last year. The Washington Post. Retrieved from https://www.washingtonpost.com/investigations/number-of-fatal-shootings-by-police-is-nearly-identical-to-last-year/2017/07/01/98726cc6-5b5f-11e7-9fc6-c7ef4bc58d13_story.html?utm_term=.5b3380832fe3.

[5] Graham G., Gracia JN. (2012). Health Disparities in Boys and Men. Am J Public Health, 102(2), S167.

[6] Marakechi M. (2016). What the data really says about police and racial bias. Vanity Fair Hive. Retrieved from: https://www.vanityfair.com/news/2016/07/data-police-racial-bias.

[7] Downs K. (2016). Why aren’t more people talking about Latinos killed by police? The Rundown. Retrieved from http://www.pbs.org/newshour/rundown/black-men-werent-unarmed-people-killed-police-last-week/.

[8] Geller A., Fagan J., Tyler T., Link BG. (2014). Aggressive Policing and the Mental Health of Young Urban Men. American Journal of Public Healt,  104 (12), 2321-2327.

[9] Alang S., Calpine D., McCreedy E., Hardeman R. (2017). Police Brutality and Black Health: Setting the Agenda for Public Health Scholars. Am J Public Health, 107(5):662-5.

[10] Bump P. (2016). The facts about stop-and-frisk in New York City. The Washington Post. Retrieved from https://www.washingtonpost.com/news/the-fix/wp/2016/09/21/it-looks-like-rudy-giuliani-convinced-donald-trump-that-stop-and-frisk-actually-works/?utm_term=.0e7cf4079081

[11] Krieger N., Chen JT., Waterman PD, Kiang MV., & Feldman J. (2015). Police killings and police deaths are public health data and can be counted. PLoS Med, 12(12), e1001915.

[12] Devine PG., Forscher PS., Austin AJ., Cox WTL. (2013). Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. J Exp Soc Psychol. 48(6): 1267–1278

[13] Gibson JL. (2009). On legitimacy theory and the effectiveness of truth commissions. Law and Contemporary Problems, 72(123).

[14] Williams MT., Malcoun E, Sawyer BA., et al. (2014). Cultural Adaptations of Prolonged Exposure Therapy Treatment and Prevention of Posttraumatic Stress Disorder in African Americans. Behav Sci, 4(2): 102-24.

[15] Bassuk EL, et al. (2017). Universal design for Underserved Populations: Person-Centered, Recovery-Oriented and Trauma Informed. Journal of Health Care for the Poor and Underserved, 28(3).

[16] Train KJ., Butler N. (2013). A pilot study to to test psychophonetic methodology for self-care and empathy in compassion fatigue, burnout and secondary traumatic stress. Afr J Prim Health Care Fam Med, 5(1): 497.

[17] Eberhart JL, et al. (2004). Seeing Black: Race, Crime, and Visual Processing. Journal of Personality and Social Psychology. 87(6):876-893.

[18] Correll J., Park B., Judd C., Wittenbrink B. (2007). The influence of stereotypes on the decision to shoot. Eur. J. Soc. Psychol. 37: 1102–1117

[19] Weir K. (2016). Policing in black and white: Police departments are eager for ways to reduce racial disparities- and psychological research is beginning to find answers. Monitor on Psychology, American Psychological Association, 47(11): 36.

[20] Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; Vol. 65, No. 4. Hyattsville, MD: National Center for Health Statistics. 2016.