Health & Medicine hosted a forum this past Friday, March 17th where presenters and attendees explored how public health can aid in prevention efforts and policy change toward counting police-involved injuries and deaths. Our discussion intentionally had a broad focus on decriminalization of people generally, and more specifically on people of color and people living in poverty. In light of this discussion and related inquiry surrounding our choice of topic and speakers, we drafted this blog post to help frame 1) police violence as a public health (and health equity) issue and 2) how we can move toward police accountability.

UNDERSTANDING POLICE VIOLENCE AS A PUBLIC HEALTH ISSUE
The United States has the highest rate of police-involved shootings and killings in the world, yet tracking both injuries and deaths from these interactions requires new surveillance and data collection systems. Although there have been recent efforts at the Federal level to improve the collection of data on arrest-related deaths, there remains a need for the U.S. to develop a system for collecting and transparently reporting data about both deaths and injuries from law enforcement. Also, there is a need for assurance that the data being reported is true and accurate. This data is needed as a matter of public accountability and for the purpose of advancing prevention.

This issue is particularly relevant as policing that disproportionately impacts communities of color and people living in poverty has spawned growing social movements and advocacy. Healthy Chicago 2.0, the public health improvement plan for Chicago, identifies the reduction of mass incarceration and inequitable police attention in communities of color as a public health goal and priority for the city (found on page 65 of Healthy Chicago 2.0). Related to these efforts, Health & Medicine recently made recommendations to the Chicago Department of Public Health (CDPH) on measuring structural racism in Chicago. Measuring the degree of inequity in deaths and injuries resulting from the actions of law enforcement could help CDPH measure and work to prevent and address structural racism (and other isms) revealed in the data.

In the U.S., we have a public health system that reports on notifiable diseases and deaths occurring in over one hundred large cities nationwide. A notifiable disease (or condition) is any condition that is required by law to be reported to the appropriate governmental agency. According to a 2015 paper from social epidemiologist Nancy Krieger, the cumulative total of people killed by the police in 2015 significantly surpassed the number of people killed by myriad other notifiable conditions that public health professionals succeed at counting. To make the comparison clear: 842 people were killed by the police in 2015; 585 people were killed by pneumonia and influenza. The number of people killed by the police in 2015 was closer to the number of cases of Hepatitis A (890 cases), but Hepatitis A is a notifiable condition. The number of people being killed or injured by law enforcement is significant and deserves to be systematically counted.

Health equity is a process of assuring that all people have what they need to thrive as a means of achieving the goal of eliminating the systematic, unfair, and modifiable differences in health status and outcomes observed across different population groups. Discrimination based on race, gender, class, ability—both mental and physical—and age are evident in policing, arrests, violence from police, and in prosecution and incarceration all hinders health equity by disadvantaging those who are targeted. In addition to the immediate threat to health and freedom resulting from discriminatory policing, further disadvantages are often faced by those impacted through policies and practices that discriminate against individuals with criminal records in such areas as loans, housing, education, and employment.

POLICE VIOLENCE AS PUBLIC HEALTH DATA
Using an intersectional lens and applying the concept of sanctuary for all people, the forum discussion included the voices and experiences of those communities who have been historically over-policed and whose lives have often been disrupted—and health threatened—by the trauma of police violence. After much internal discussion, it is chiefly because of this trauma that the voice of the police was not included in this event. Last Friday, our presenters framed how the public health system could work to advance police accountability. This did not require the participation of police departments as speakers, although they were welcome to attend the event to listen and learn.

It is noteworthy that based on the existing data, the problem of law enforcement-related deaths and injuries is large and longstanding within the institution of policing, indicating a lack of accountability. Modern day police have been in existence in the U.S. since the mid-1800s. Given almost two centuries of existence, why haven’t the police figured out an accurate way of measuring injuries and deaths due to legal intervention? Why do we not have data that would help ensure an accountable police force?

Those are worthwhile questions to explore. In order to help find answers, public health professionals can do what we are well-equipped to do: count deaths and injuries stemming from police encounters.

Once police violence is required to be a notifiable condition, public health professionals have a responsibility for surveillance, monitoring, and control of the issue. The decision to not accurately quantify police-involved deaths and injuries is political in nature—as is the decision to do so.

If we care about the health of all people, including those being policed and law-enforcement themselves, then we, as public health professionals, should apply our skills and expertise in counting data on morbidity and mortality to the public health crisis of police-involved injuries and deaths in order to advance health equity.

Suggestions for further reading: APHA policy statement on law enforcement violence as a public health issue