POLICING AND PUBLIC HEALTH
Before the current crisis in American policing reached its boiling point, there was already a recognition that policing plays a significant role in shaping health outcomes. Based on the number of incidents of deadly use of force, the American Public Health Association had declared policing as a “public health crisis” in 2018. Beyond a few notable exceptions, calls for reform had failed to gain real traction. The killing of George Floyd and ensuing national protests against police brutality have shifted this landscape.
The Health in Justice Action Lab focuses on less recognized health impacts of policing, going well beyond the direct use of force. In the area of substance use and addiction, there is a growing body of evidence that documents how policing shapes health risk for people who use drugs. For instance, police activity encourages people to consume drugs in more risky settings. It can shape access to harm reduction and treatment services. Enforcement activities and prosecutions can also affect the willingness of witnesses to seek help during overdose events, especially if those involved are people of minority communities.
Polices roles in the COVID-19 response have followed similar patterns. Officers enforced orders to “flatten the curve” with varying intensity, adding the risk of infection to the existing set of negative health sequelae of law enforcement encounters. Often, the most severe enforcement actions targeted the more vulnerable members of the public, including racial and ethnic minorities, the unhoused, and economically marginalized people.
Beyond the individual level, policing also cascades to health harms to social networks and communities. Our research has demonstrated how policing limits the impact of policy reforms on the population level, highlighting the gap between law on the books and law on the streets. For instance, intensive drug market enforcement can be iatrogenic, causing illicit drug supplies to become more dangerous. When overdose rises as a consequence, legislatures that pass Good Samaritan laws to save lives see less benefit than hoped due to police treating overdoses as crime scenes, making people wary of calling 911.
Finally, the institution of policing as it currently stands harms front-line officers. Officers’ physical and mental health are taking a heavy toll, ranging from untreated alcohol and substance use disorder to suicide. There is a crisis of burnout within the ranks, with leading contributors including fear of needle stick injuries and fentanyl exposure, massive cumulative stress, a debilitating sense of futility toward addiction, and distraction from other activities that are more central to police’s core crime prevention mission.
Our team has been working to better understand and redress the negative impacts of policing for nearly 20 years.
Unmasked: Impacts of Pandemic Policing, Emmer et al. 2020
Police enforcement of COVID-19 provisions fell disproportionately on Black and brown communities.
Police Encounters Among Needle Exchange Clients in Baltimore: Drug Law Enforcement as a Structural Determinant of Health, Beletsky et al., Am J Pub Health 2015
Syringe service clients in Baltimore reported frequent police contact in immediate vicinity of program locations, despite stated policy that no enforcement activity take place in these locations. Black clients reported more frequent contact than whites.
Examining the Spatial Distribution of Law Enforcement Encounters among People Who Inject Drugs after Implementation of Mexico's Drug Policy Reform, Leo Beletsky et al., J Urban Health 2014
Frequent police encounters can act as a deterrent to substance use treatment access.
Officer needle stick injury risk (full text here)
Prevalence and Correlates of Needle-stick Injuries Among Active Duty Police Officers in Tijuana, Mexico, Mittal et al., Journal of the Int'l AIDS Society 2016
Police officers experience frequent on-the-job needle stick injuries, but lack training on how to prevent and address this occupational health risk.
Training to Reduce Emergency Responders' Perceived Overdose Risk from Contact with Fentanyl: Early Evidence of Success, Winograd et al., Harm Reduction Journal 2020
Police officers have high levels of incorrect knowledge about the risk of overdose from casual fentanyl exposure.
An Assessment of Opioid-Related Overdoses in Massachusetts 2011-2015, Massachusetts Department of Public Health 2017
Compared to the rest of the adult population, the opioid-related overdose death rate is 120 times higher for persons released from Massachusetts prisons and jails.