Over the last few weeks, we’ve seen an unprecedented number of people take to the streets across the country, in the middle of a pandemic, to protest against police brutality and systemic racism. We’ve also witnessed countless instances of peaceful protestors being met with police violence. Against this backdrop, we are having conversations—in the media, on social media, and among our friends and family—about the deeply intertwined and historically embedded epidemics of injustice that people are fighting against. And many of us are coming to understand that violence perpetrated by the police, disproportionately against Black Americans, is a public health issue, too.
In some ways, this is a simple and obvious argument. “Public health is about a population being healthy. When people experience police brutality, they become unhealthy,” Sirry Alang, Ph.D., associate professor of sociology and health, medicine, and society, and founding co-director of the Institute of Critical Race and Ethnic Studies at Lehigh University, tells SELF.
But in order to understand all the ways in which police brutality truly is a threat to public health, we need to dig into the evidence. How exactly does police brutality affect public health? Why does it matter? And what does this framing mean for the way we address the problem?
Police brutality directly causes death and injury
The most direct connection between police violence and public health is the fact that police violence kills people. And perhaps the clearest indication out there that we don’t regard police violence as a public health issue is the fact that our government doesn’t even keep track of the number of people the police kill every year at a national level. Instead, we rely on incomplete compilations of data from media outlets and activist organizations: The Washington Post has tracked reported fatal shootings by police since 2015, finding that about 1,000 people die per year; the Mapping Police Violence project has reported similar numbers since 2013.
“Police brutality affects public health because it affects an indicator of population health, which is life expectancy,” Alang says. “It causes death, reduces life expectancy, and increases the death rates for particular populations.”
Those particular populations are largely BIPOC. “People of all races are impacted by police violence, Black people and indigenous people at much higher rates,” Justin M. Feldman, M.P.H., Sc.D., assistant professor in the department of population health at the NYU Grossman School of Medicine and researcher of police violence and racial/economic segregation, tells SELF. Other vulnerable groups highly affected by police brutality incude people with a mental illness, LGBTQI individuals, people experiencing homelessness, sex workers, people who use drugs, and people with low incomes, according to a policy statement declaring police violence a public health issue published by the American Public Health Association (APHA) in 2018.
You may have seen one particularly striking statistic being widely shared recently: 1 in 1,000 Black men will die at the hands of police. That number comes from a study published in the journal Proceedings of the National Academy of Sciences (PNAS) in 2019. Researchers analyzed data from 2013 to 2018, aggregated by Fatal Encounters, another effort to create a national database of deaths involving police. They found that Black men are about 2.5 times more likely to be killed by police use of force than white men; Black women, 1.4 times more likely than white women. The risk is highest for young Black men: Police violence is a leading cause of death for Black men aged 25 to 29. Among their other findings: Indigenous people are also significantly more likely to be killed by police (although those estimates are less accurate), and Latinx men are 1.3 to 1.4 times more likely (while Latinx women are slightly less likely).
Police brutality, however, “is about much more than the incidents of police killing folks,” Georges C. Benjamin, M.D., executive director of the APHA, tells SELF. “It’s also about the violence that occurs, the hostile engagements, the way [people] are treated when they’re stopped and arrested and incarcerated.” For every person who dies at the hands of law enforcement, many more are hurt badly enough to go to the hospital, Dr. Benjamin points out.
A study published in JAMA Surgery in 2017 found that there are on average 51,000 emergency room visits annually by people injured by law enforcement (based on data from 2006–2012). According to more recent data collected by the Centers for Disease Control (CDC), there were an estimated 85,075 ER visits for nonfatal injuries resulting from legal intervention in 2018, which includes police but also other law enforcement agents and on-duty military. That was not an unusual year by any means: From 2008 to 2018, there were an estimated 950,882 law enforcement–inflicted nonfatal injuries that sent people to the ER, according to CDC data. (Keep in mind, injuries that do not result in an ER visit are not included here.)
This violence affects Black people disproportionately, to an alarming degree. A study published in the Journal of Urban Health in 2016 (co-authored by Feldman) analyzed data collected from a nationally representative sample of 66 U.S. hospital emergency departments on injuries caused by legal intervention in people aged 15–34 (the highest risk age group), from 2001 to 2014. (In this study, private security guards were included alongside police officers and other legal authorities.) They found that Black people went to the ER for law enforcement–perpetrated injuries at a 4.9-fold higher rate than white people. Researchers also found that legal intervention violence increased dramatically, by 47.4 percent, over the 14-year period they studied. If we saw any particular use of force or group of people kill 1,000 people a year and send over 50,000 more to the ER, we’d call it a public health threat.
Police brutality directly (and indirectly) affects mental health
“Police violence is a cause of death and injury to people who experience it directly, and then there’s this other category of police violence that perhaps has broader effects on public health,” Feldman says. “There’s growing evidence that the mental health and well-being of individuals and entire communities are affected after a high profile incident of police violence.”
Before we get into the data here, it’s worth taking a moment to reflect on why police violence against Black people in this country is uniquely traumatizing. Of course, seeing a loved one or member of any race injured or killed unexpectedly due to any cause is horrific. And although Black people are killed by the police at a rate disproportionate to their population size, about half of the people shot and killed by police are white, according to the Washington Post police shootings database.
But there are particular dimensions to the pain of seeing a Black individual brutalized or killed by a police officer that are not immediately apparent to most non-Black people, beginning with the historical weight these incidents bear and the collective trauma they evoke. “It’s really important to think about [police brutality] in the context of the American slave trade and [how] the origins of police are really rooted in slave patrol,” Alang explains. A Black person being injured or killed at the hands of the police in 2020 is a devastating reminder of that disturbing period in American history. “People’s contemporary experiences of police brutality really in every single way mirror the period of enslavement and slave patrol,” Alang says.
Police killings of Black people also represent the continued oppression and devaluation of Black lives at a systemic level. “They died because someone thought they were a threat. They died because someone didn’t value their life at that moment,” Alang says. “So it’s the stress of losing someone who looks like you, and what that means for your community…the stress of knowing that that loss is grounded in the color of your skin as a second class citizen as a Black person, or as an indigenous person, or as a Latinx person,” Alang explains.
Evidence demonstrates that police killings of Black people indeed have effects that extend far beyond the Black families or social circles that know the individual who died into Black communities across the country. A study published in the Lancet in 2018 used two sets of data—police killings of unarmed Black Americans and the self-reported mental health of Black Americans in the state where the person was killed—to see if they could establish a causal link. Of the 103,710 respondents, 38,993 of them had had at least one police killing of an unarmed Black person in their state in the last three months. Researchers found that for each additional police killing of an unarmed Black person, Black respondents living in that state reported an additional 0.14 poor mental health days. (No such correlations were found among white respondents or for killings of armed Black Americans.) Another study, this one published in the American Journal of Public Health in 2017, found that the prevalence of depressive symptoms in 1,095 mothers (93 percent of whom were African American) living in Baltimore increased significantly in neighborhoods where there was civil unrest after Freddie Gray’s death in police custody in 2015.
Police brutality impacts mental health above and beyond the actual incidents of it, though. “The thing is, it’s not just when [an incident of police violence] happens. It is the constant anticipation that it could happen to you, it could happen to someone you know,” Alang explains. The interminable uncertainty of the looming threat of police brutality can take severe psychological tolls on the people who are most vulnerable to it—i.e., the BIPOC who are most likely to be injured, killed, or traumatized at the hands of the police. This kind of stress and anticipation “is not visible to other people. It’s just part of the day-to-day experiences of groups that are disproportionately policed that the stress has become so chronic that it’s invisible,” Alang says. “[Something] that makes a stressor really chronic and really painful and significantly more associated with mental health is the uncertainty of it, [not knowing] when it will happen and when it will end,” Alang notes. “It’s that uncertain yet permanent stressor that really makes police brutality impact mental health the way that it does.”
As Dr. Benjamin puts it, “Imagine getting up every day and having to be afraid—not just to leave your house but even be in your house…of being [harmed or killed] by someone that’s supposed to be protecting you.” One study published in Epidemiology and Psychiatric Sciences in 2017 analyzed survey data from 1,615 participants in four U.S. cities (Baltimore, New York, Philadelphia, and Washington, D.C.) and found correlations between not only lifetime history of victimization by police (including physical, sexual, and psychological, as well as neglect) and distress/depression, but also how likely people believed they were to experience police violence in the future.
It’s worth pointing out here how this dynamic of fear and distrust bred by racist police brutality feeds into a self-perpetuating cycle of escalation in police encounters—leading to more violence, and even more distrust—with devastating impacts on public health. Black individuals, and especially Black men, bring this fear and stress into every interaction with police (of which Black people have many more, due to policies and practices that support racial profiling), Alang says—including what should be peaceful encounters, like when they get stopped on the street or pulled over for a traffic violation. “The problem is that increasingly those encounters are encounters that are fearful, particularly for people of color,” Dr. Benjamin says. “It’s been shown that you are being profiled totally because of your color. The police officer approaches you differently than others, approaches you as if you’re a threat or you’re not worth dignity and respect.” This fear can create defensiveness in these encounters, and sometimes aggression, he explains. “So what should be a non-escalating event becomes an escalating event.”
Even stops that are not physically violent harm mental health. The APHA policy statement cites a number of studies showing a connection between stops that people perceive as discriminatory, unfair, or intrusive and symptoms of psychological distress, including anxiety, depression, and PTSD. Beyond that, survey data suggests Black individuals are more likely to report stress resulting from police encounters than white individuals—especially troubling, the APHA statement authors write, given that stress due to perceived racial discrimination is generally associated with chronic disease risk factors and early death in Black people.
Indeed, like all forms and threats of violence, “[Police violence] certainly creates stress, which we know affects a range of health outcomes,” Dr. Benjamin says. Evidence shows that the constant stress of the looming threat, the actual experience, and the devastating aftermath of police brutality in all of its forms (physical, emotional, verbal) at a personal (first- or secondhand) and societal level can have tremendous effects on the mental and physical health of people. “Those are experiences that cause stress and that wear and tear the body systems of people of color that increase the allostatic load, that cause weathering,” Alang explains. As SELF previously reported, allostatic load refers to the damaging biological effects of overexposure to stress hormones, and weathering refers to how the ongoing stress of racism can result in higher levels of disease and biological aging in Black people, including, for example, Black maternal mortality.
Police brutality also has massive indirect effects on public health by breeding mistrust in the institutions meant to keep us safe
There’s also a category of ripple effects that police brutality has on communities that are profoundly detrimental to public health but difficult to quantify due to a severe lack of data. Take the fact that police brutality, applied disproportionately to BIPOC, engenders a lack of confidence in the police. “[People] don’t believe that the police will trust them and protect them,” Dr. Benjamin explains, and this lack of faith in law enforcement makes people less likely to call on the police when they are in danger. Furthermore, “When people don’t trust the police, they don’t tell the police stuff [about] other crimes and safety threats that occur in the communities,” Dr. Benjamin says. “Crimes don’t get solved.” Police brutality in effect makes effective police work more difficult, and the communities they serve less safe, resulting in more public health threats.
Furthermore, mistrust in one institution tends to carry over into others. “Police represent ‘the man,’ whatever that man means to you…they represent in people’s minds the systems that are [working] against them,” Dr. Benjamin explains. So a lack of confidence in the police “trickles down to other institutions” and contributes to a broader “distrust of government in our society, [distrust] of anyone who’s [in] a uniform,” Dr. Benjamin says. “That carries over to people who are EMTs, people who are firefighters, people who are social workers.”
The institutional mistrust that has the most direct effect on public health is, of course, health care—another institution that is supposed to take care of all people equally, but disproportionately harms Black Americans. Police violence and perceived discrimination reinforce a longstanding distrust of medical institutions among BIPOC, which “affects public health indirectly by shaping access to health care,” Alang says. “People don’t live their lives in silos,” she explains. “When I go to the doctor, I don’t stop from being a Black woman. I still carry that racial trauma with me and that distrust.”
A study led by Alang, published in the Journal of Racial and Ethnic Health Disparities earlier this year supports this link between police brutality and medical mistrust. Researchers surveyed 4,389 adults living in U.S. cities about their past encounters with law enforcement and how much they trust or distrust medical institutions. After controlling for variables like health care access and health, they found that people who reported negative encounters with the police also reported more mistrust in medical institutions.
When people don’t think that the medical institutions have their best interests at heart, they seek care less often, Alang says. For example, in a study published in Medical Research Archives in 2018, researchers analyzed data on law enforcement (from records on 6,462 juvenile drug arrests) and prenatal health care usage (from birth files on 22,482 births) in Washington D.C. from 2005 to 2007. After controlling for other variables (like maternal education level and pregnancy risk/complications) they found that the number of drug arrests in a neighborhood was negatively associated with the levels at which pregnant women living in that area sought prenatal care.
Why it’s important that we start treating police violence as a public health issue
So, why does it matter that we see police violence is the public health issue it is? A few key reasons.
It reshapes how we think about police violence—for the general public, its victims, and its perpetrators
Framing police brutality as a threat to public health “creates a broader societal perspective,” Dr. Benjamin says. “[It’s about] letting people know that this is not a one-off effect—that it has broad societal implications for the health and well-being of communities. That’s a different way to think about it than a single event by a single officer.”
Naming police violence as a public health issue may also lessen the stigma that keeps many of its victims silent. “For people in certain communities, and if you’re Black or if you’re indigenous, the fact that [police violence] is systemic is obvious in [many] cases,” Feldman says. “But even for people on the receiving end…they feel a sense of shame over being targeted by police and like they can’t share it.” If we’re going to address police violence, we need to make its victims feel safe speaking openly about it. “Being able to share these experiences and understand it’s not an individual moral failing to have them targeted by police violently is a big part of the way forward,” he explains. It’s not unlike how talking about domestic violence and sexual abuse as public health threats we all must contend with may help survivors feel less stigmatized and more likely to speak out.
Alang also sees another perhaps unexpected potential benefit to reframing the problem as one that is perpetrated systemically rather than individually. “It [may] also make it more likely that police officers think about their role in public health—think about themselves as agents of population health,” she says. “Like if they really are to serve and to protect, and we know that their actions are a social determinant of health, I think that that gets to them.” Although many of the responses we’re currently seeing by police unions and the like suggest otherwise, Alang’s hope is that addressing police violence as a public health issue may ultimately make officers more likely to want to figure out how they can also be a part of the solution.
It can lead to more resources and research
Right now, “There’s growing research but…it’s hard to get the research funding for it and it’s hard to get good data,” Feldman says. As you may have gathered from reading this article, the data here are kind of scattershot. The fact that we can’t even answer the most basic questions about police brutality—like how many people suffer from it—both reflects what a nonpriority the issue is and prevents us from fully understanding the issue, let alone remedying it.
The hope is that by framing police violence as a public health issue, our public health institutions (like the National Institutes of Health) will invest in it as seriously as any other public health issue, Feldman says. “Data is like bread and butter in public health. So we can’t really do policy without data,” Alang explains. Better funding and more research will give us more precise, reliable, and comprehensive data to understand the problem and identify the potential interventions and policy solutions that could help fix it.
Beyond the statistics, though, we need to gather raw data on the lived experiences of police brutality’s victims—firsthand and secondhand—if we want to craft solutions that actually help them. “That data is not just numbers…I think we have to prioritize people’s stories,” Alang says. “Because if we have policy-making around police brutality or defunding the police, etc.. [and] those policies aren’t grounded in the experiences of people that are more likely to experience police brutality, then it’s not really going to make a difference,” she explains. “Policies often reflect the decision and experiences of the people who make them, and so we have to include communities that are disproportionately impacted in both the research and policy making around police brutality.”
We need more research to understand at a granular level the ripple-out effects on the families, friends, and communities that lose someone to police violence. “We don’t even know enough about how people cope and deal with [losing a loved one to police violence],” Alang explains. She cites the example of Atatiana Jefferson, a 28-year-old woman who was shot and killed by a white police officer through the bedroom window of her Texas home in October 2019. (The officer, who was responding to a call from a neighbor citing concern for Atatiana’s open door, was indicted for murder in December.) Less than a month later, Atatiana’s 58-year-old father, Marquis, died of a heart attack. In January of this year, Atatiana’s mother, Yolanda Carr, died from congestive heart failure. “I’d like to know how her parents dealt with [their] loss and grief,” Alang says. “What policies could have made it easier for them? Why did they die? What kinds of stressors did they have from losing their daughter to police brutality?”
While studying the issue with the depth it deserves is essential, we don’t need to wait for more data to come in to do something about it. “I don’t think any of us who study this are saying we need more research before we act,” Feldman explains. “It’s like COVID-19. There’s a lot of uncertainty, but with COVID we’re saying we need to act now because it’s such an emergency, even if we don’t understand the dynamic of the disease. Same thing with police violence. We need urgent action [and] we also need more research.”
What that urgent (and longer term) action might look like in terms of policy and reform is another discussion that we won’t get deep into here. But for a sampling of the kinds of measures broadly supported by public health experts, we can look to the the APHA position paper’s recommendations for five evidence-based strategies to be implemented at all levels of law enforcement:
(1) Eliminate policies and practices that facilitate disproportionate violence against specific populations (including laws criminalizing these populations), (2) institute robust law enforcement accountability measures, (3) increase investment in promoting racial and economic equity to address social determinants of health, (4) implement community-based alternatives to addressing harms and preventing trauma, and (5) work with public health officials to comprehensively document law enforcement contact, violence, and injuries.
The key is, again, approaching it as a problem we all need to deal with. “It needs to be a collective societal response, and everybody needs to be part of this. And we [public health] are willing to be part of that solution,” Dr. Benjamin explains. “Public health is saying let’s identify the problems, and let’s put our tax dollars in an effective way to solve the problems.”
It may help us reframe other systemic inequities as public health problems
“I think that highlighting police brutality as a public health issue might help us think about how we frame some of the inequalities and inequities in our other systems as public health issues,” Alang says.
While it’s important that we hone in on the problem of police brutality, we also need to see it as one piece in a series of interlocking systems of oppression. “Police brutality is just one indicator of white supremacy, it’s just one indicator of structural racism,” Alang says. “Systems of oppression go hand in hand, [so] we can’t just isolate and treat police brutality.”
We need to look upstream, Alang says, and understand how racism and white supremacy permeate and operate in all of our institutions—the health care system, the educational system, the criminal justice system—and understand how these systems impact public health, Alang explains. “That way we can actually get to the point where we can achieve larger structural changes.”
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