Police Shootings of Black Males: A Public Health Problem?

Mary Beth Nierengarten, MA

Disclosures

February 17, 2016

Numbers Tell the Story

Last year, 1134 people were killed by police in the United States. Of these, a disproportionate number were black: 7.13 deaths per 1 million people, compared with 2.91 for white persons, 3.48 for Hispanic persons, 1.34 for Asian persons, and 3.4 for Native Americans.[1]

For young black men, the numbers are even worse. Black men aged 15-34 years, who comprise only 2% of the US population, accounted for 15% of all police-involved deaths—a rate five times higher than that among white men of the same age.[1]

The publicized deaths of black men (and, to a lesser extent, black women) over the past couple of years have made this issue highly visible. What has emerged with stronger urgency from this visibility is the need to treat these shootings as a public health issue—one akin to tracking outbreaks of contagious diseases that, if left unchecked, wreak havoc on affected populations by both driving up mortality rates and affecting the socioeconomic well-being that fosters healthy communities.

The call to treat police shootings of black males as a public health issue is not new. It falls within a continuum of decades of work done by the Centers for Disease Control and Prevention (CDC) and other organizations to recognize violence as a public health issue.[2] In 1998, police violence was recognized as a public health issue by the American Public Health Association in a policy statement that recommended strategies for reversing the trends of what it described as a disproportionate impact of police violence on people of color.[3] And in 2002, the World Health Organization recognized excessive use of force by police as a form of violence.[4]

Implementing concrete steps to treat police violence as a public health issue has been slow. However, the current spotlight on police shootings of black men has given new urgency to the need for physicians and other healthcare professionals to help prevent what many perceive as a growing, albeit modifiable, epidemic.

Police Shootings as a Public Health Issue

Several recently published studies have proposed concrete steps to making police shootings, particularly of black men, a public health issue.[5,6,7,8,9] The first step is convincing people to see this as a public health issue and the advantages of doing so.

"Labeling it a public health problem and using the public health approach means focusing on prevention rather than blame," said David Hemenway, PhD, professor of health policy in the Department of Health Policy and Management and director of the Harvard Injury Control Research Center, Harvard TH Chan School of Public Health, Boston, Massachusetts. Hemenway, along with his colleagues, is engaged in ongoing research on police as victims as well as police as shooters. "It means stepping back and thinking about all the things that can be done, by all aspects of society, if we really decide this is a public health problem we need to address."

"Public health brings another lens," said Nancy Krieger, PhD, professor of social epidemiology in the Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health. "It allows for reframing an issue to include a public health perspective that focuses on prevention."

This is similar to what is currently being done with the opioid epidemic and sex trafficking, said Krieger. For example, considering sex trafficking of young girls and boys as a public health issue has switched the focus away from the criminal justice framework of treating these young people as juvenile delinquents and lawbreakers to understanding the family histories and societal issues that led these young people to be vulnerable to sex trafficking.

"This changes the frame for talking about prevention," she said. "That is one of the key things public health does. It looks at the social determinants of health and starts to raise the policy questions of what needs to be changed, rather than seeing these as individual cases for prosecution only."

Need for Reliable and Accurate Data

In a recent study that outlines several concrete steps that policymakers can take to address police shootings of black males as a public health issue,[5] Keon L. Gilbert, DrPH, assistant professor in the Department of Behavioral Science and Health Education, St Louis University College of Public Health and Social Justice, St Louis, Missouri, emphasizes the collection and analysis of data as the first key step to drive policy decisions.

"We don't really have good, reliable data to capture the issue," he said, adding that although the CDC and FBI collect these data, it is difficult to get a good sense of the scope of the problem because police departments are not mandated to report these forms of death and other incidents of police shootings.

Hemenway and Krieger agree that accurate and reliable data collection is the first critical step in making police shootings a public health issue. Such data, according to Hemenway, help in three principal ways: (1) to show that there is a problem and where it is, (2) to indicate the kinds of interventions that could make sense to solve the problem, and (3) to evaluate those interventions. "You need good data and analyses to do all three," he said.

To date, however, comprehensive data are limited in the United States. The statistics provided in the opening paragraph of this article come from a website called "The Counted," initiated in January 2015 by the UK newspaper the Guardian. The website collects data on US police shootings.

According to Hemenway, the need for the United States to better track its own numbers is highlighted by what he and his colleagues found (in a not-yet-published study) to be big underestimates of the real numbers of police shootings found in both homicide reports and vital statistics. Although he said that good estimates are available through the CDC's National Violent Death Reporting System,[10] he emphasized that data are currently available only in 32 states, and the system is not fully funded to track incidences in all 50 states.

Police Shootings as a Notifiable Issue

One way to capture data more comprehensively, according to Krieger, is to treat all law enforcement deaths (including law enforcement agents killed in the line of duty) as notifiable conditions, similar to reporting domestic or child abuse. In a recently published essay, Krieger and colleagues[6] make the argument that law enforcement-related deaths are public health data and not solely criminal justice data, given that they involve issues related to public health.

"Any mortality outcome is ultimately a public health issue," she said. "We in public health are also concerned about mortality rates that are unfair, preventable, and unnecessary, as well as differences in death among different social groups."

She emphasized the role of physicians in helping to capture these data. "Physicians could be alert to asking patients about their awareness or the impact of police violence on their direct health or on their community," she said—highlighting that not only the deaths themselves, but also the effect of trauma on the communities in which these shootings occur, make this a public health issue.

In the essay, Krieger and colleagues[6] write, "The direct effects and spill-over effects matter for public health and medicine alike, as reflected in the impact on emergency medical services, trauma units, mental health, and the trust required to deliver and implement any government-sponsored program, public health or otherwise."

Physician Participation

One way in which this issue spills over into the clinical setting is the opportunity for physicians and other healthcare professionals to become more aware of police shooting of black males as a public health issue. This includes raising their awareness of the pervasive racial attitudes that often underlie interactions between people in positions of power (eg, police officers, physicians) and those not in power (eg, citizens, patients).

To fully understand and address police shooting as a public health problem, Gilbert emphasizes the need to look at this phenomenon in the broader context of institutionalized racism and how this affects the health of black persons. For clinicians, this means being aware of their own potential biases when treating patients of color and being held accountable for interactions that may result in poorer treatment plans and quality of care (for example, by offering only one treatment option, on the assumption that a patient of a certain race may not adhere to other potential treatments).

Along with increasing awareness and accountability, clinicians also can take some concrete steps to address police shootings as a public health issue:

  • Treat police shootings as a notifiable condition;

  • Help find resources to alleviate the trauma to individuals and communities associated with the shootings (Hemenway pointed out that physicians are good at using teachable moments to make a difference in their patients' lives, citing the example of finding appropriate social services for patients who come in with gunshot injuries);

  • Offering mental and preventive health services to communities with high levels of violence and policing[5]; and

  • Raising the consciousness of the medical community about this form of violence, and using their considerable intellectual and professional knowledge to solve problems.

"Medical professionals have a voice that people listen to and our communities respect and value," said Gilbert. Hemenway concurred: "I bet that if you get half a dozen smart clinical physicians together and give them a task of making recommendations for how clinical physicians could help reduce police shootings, they could come up with some interesting and useful ideas."

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