Policing and Population Health

Milbank State Leadership Network
Focus Area:
State Health Policy Leadership
Population Health

Research suggests that policing operates as a social determinant of population health and contributes to racial and ethnic health disparities. In this Q&A, Hedwig Lee, PhD, of the Washington University of St. Louis discusses her contribution to the Milbank Quarterly centennial issue, coauthored with Savannah Larimore, PhD, of Washington University in St. Louis, and Michael Esposito, MA, PhD, of the University of Minnesota. In the Q&A, Lee discusses policing as a form of racial violence, ways to improve the data collected on police encounters to inform best practices, and the research needed to understand policing’s impact on population health.

This piece is the seventh in a series of Q&As with authors from The Milbank Quarterly’s special issue, The Future of Population Health: Challenges and Opportunities.  

Hedwig Lee, PhD

How is policing in the United States a form of racial violence?

Historically, policing came from slave patrols; race is part of the origin story. While a lot of people want to separate policing from race, it’s important to remember that they’re indelibly intertwined.

There is over-policing in places and spaces inhabited by people of color, particularly African-American and Latinx populations. For legislatures, it’s important to highlight that violence is not just being assaulted, or experiencing excessive force or being killed, but also the daily indignities: being pulled over, having to be fearful and vigilant about interaction with the police.

What has contributed to the increased attention to researching policing and population health outcomes?

The highly publicized killings of people like George Floyd amplified the role of policing as a marker of health. Social movements like the Black Lives Matter movement also brought attention to the role of policing and population health outcomes. Additionally, journalistic efforts to collect data on who was being killed by police, which was not something being done very well by localities, brought increased attention to policing as an important social determinant of health (SDoH).

Fields like criminology, sociology, political science, and economics have focused on the rise of imprisonment and its consequences in terms of economic inequality, racial inequality, educational outcomes, and labor market outcomes, as well as what kinds of policies and practices led to the increase in mass incarceration and its disproportionality by race. Links to health are new. As the SDoH field grew and expanded, we learned social factors and context mattered for health outcomes. Incarceration, policing, and the criminal legal system became part of that story.

How do policing systems function as a racialized social determinant of health?  

Most of the individuals who come in contact with the criminal legal system are people of color and members of low-educated populations. Not only is policing racialized, but it is classed as well. There is a disproportionality in who is stopped by police, who experiences excessive force, and then who is at risk of death at the hands of police.

What kinds of data on policing are needed?

Information on deaths due to police contact, and deaths while in custody, is not collected well. There is no systematic enforcement for police agencies to report deaths to federal agencies. There is also limited demographic information to better understand potential disparities. We are lacking data about types of police contact like the use of excessive force or even traffic stops. That kind of information could help us better understand points of intervention and best practices. What are the elements of a traffic stop that allow for better outcomes and reduce disparities in risks? There’ve been discussions about police body cameras and the positive and negative consequences of using those, but it would be interesting to think about innovative ways of collecting data that could be helpful at the local level.

What “unofficial” databases help to document the relationship between policing and health?

The unofficial databases stemmed from the lack of reliable national statistics on police-related deaths The Fatal Encounters database, for example, was started as an effort to understand who is dying during police encounters. It started by scraping news reports about deaths.

What kinds of data collection and research on policing and health are needed?

There needs to be data on the extent to which policing is impacting mental health risks and physical health outcomes. There are also vicarious impacts of policing like the ways in which family members and those who are close to individuals who have had contact with police experience stress which can affect their bodies. Researchers need to think about how to collect this data using ongoing health surveys and social surveys.

Research should consider how information received over social media affects the mental health of community members or people who identify with the race of the individual who’s been killed by the police.  We also need to be thinking about policing in the school context. Some school resource officers have the ability to arrest students and others do not, so understanding what policing looks like for younger ages is critical. We need information to understand the role of school resource officers and if they have a positive or negative impact on the children who are attending schools.

What’s the role of communities in data collection?

At the locality level, it is important to engage with community members to make sure efforts to reform policing are genuine and meaningful. One Million Experiments is a website that highlights community-based projects focused on ending police violence and finding other ways for communities to be safe, and to experience healing. For example, Lead, a diversion program started in Seattle, provided alternative strategies to policing for individuals who are in contact with the police, often for things like being unhoused or having a mental health crisis. It would be great for communities running these experiments to have pre- and post-intervention data to inform best practices and benchmarks for other efforts at the policy level.

Is there anything else that you’d like to highlight in your paper?

Social control doesn’t just happen among police. There are health care practitioners, especially in the mental health care setting, who use policing practices. People weaponize the police differently. Citizens can use policing in ways that are racialized. There is a need to think even more upstream about this. If we were to improve socioeconomic wellbeing outcomes, school systems, job opportunities, and other social structures, there would be less police intervention.

There’s so much complexity in terms of the role that police officers play because officers are beholden to community members who are calling them and to enforcing the laws.  For some community members, part of feeling safe might include the police. There is not universality that all community members say that they don’t want policing. Many community members want different kinds of policing.  It’s important as researchers that we understand the positive and negative impacts of any intervention and any structure in our society.