Defund for Health: Alternatives to police for public health
*Editor’s Note — ‘Defund for Health: The Effects of Prisons on Health’ is Part III of a three-part series. Read Part I here and Part II here.
Since the Great Recession, the approach to government budgeting in the United States has tended towards austerity. Mandates of finding programs and places to whittle away did not end once the economy recovered either. With the exception of police and defense budgets, it seems that the funding for all other parts of society has been drying up. When citizens and residents demand better, the go-to response is that there is no money. However, money can, and should, be redirected from bloated police budgets to other departments.
Health departments at all levels of government across the country are chronically underfunded. This has become painfully clear throughout 2020 with the hamstrung responses to the COVID-19 pandemic. We saw hospitals and cities unable to provide their frontline healthcare workers with basic modes of protection from the virus at a moment that police and the national guard were raiding cities with military-grade gear terrorizing Black Lives Matter protestors. As evidenced in the disproportionate death and case rates of COVID-19, these cuts have also had devastating effects on Black and Brown communities across the country.
We know that there are myriad ways that health is impacted, including social determinants of health. The conditions in the places that people live, work, learn and play have an effect on health and quality of life and numerous government departments have an impact on those conditions and places. Funding from police departments should be reallocated into services such as:
- Childcare subsidies — children who attend early care and education see long-lasting health effects, such as improved cardiovascular and metabolic health
- Community building — block club programs not only build community but are also a community-based way of deterring crime
- After-school programming — afterschool programming has positive impacts on academic achievement, social and emotional development, preventing risky behaviors, and health and wellness
- Parks — quality parks have a variety of impacts on public health, such as increasing physical activity, reducing air pollution, improving mental health, and strengthening communities
- Social Services — school-feeding programs, free health clinics, and mental health services are just a few examples of social service programs specifically focused on health that could be properly funded or expanded
Funding programs like these also have a preventative effect on crime, the ostensible reason for the existence of police. It is important to remember though, that crime, or breaking of laws, is socially constructed. The shifting legality of things like marijuana use, motorcycle helmets, and even marital rape are key examples of the fact that what is considered a crime depends on the societal response to an action.
The bigger issue to consider is when people transgress the social contract and conflict arises. When people feel a responsibility to each other and engage in their community, conflict resolution can occur in more personable and natural ways without involving the police. It’s time to take a preventative approach to address harm through community investment that in turn improves health.
Less Police Mean Fewer Killings
When looking at police budget line items, the majority of the budget goes towards personnel costs. Reducing police budgets will inherently reduce the number of police officers.
The common argument against reducing police forces is that reducing the number of officers will mean that crime will increase. However, we know that the police do not prevent crime, they only respond after it has happened. Police are not and have never been a preventative measure when it comes to crimes. Additionally, if police funding is diverted towards programs that address the reasons why people break the law, there will be less of a need for police response. Effective investments into communities will reduce the incidents for police to respond to.
Another argument against reducing police forces is that people will feel less safe. This begs the question of which people that sentiment is referring to? Forty-six percent of Black Americans say they do not feel safe during police interactions. Considering the racist origins of modern policing, it is clear that policing in America is designed to make white people feel safe.
If there are fewer police officers in the streets, there are fewer people to perpetrate short-hand, racist policing techniques like stop-and-frisk. By reducing the number of times that a Black person interacts with a police officer, their chances of being shot and killed by a police officer are also reduced.
Invest in Community Health Programs
Every state has implemented some kind of successful community health program, ranging from cancer screenings to immunization campaigns, from emergency dental clinics to diabetes programming, from efforts to reduce hypertension to reducing food deserts. These are just some of the things that are reduced and cut when city budgets are disproportionately allocated to police.
Chronic diseases disproportionately impact communities of color compared to white communities, due in part to the unrelenting and chronic stress caused by racial profiling and targeted policing. Police funding should be reallocated toward community health programs that address and alleviate the effects of these chronic conditions.
Another use of funding could be to address the environmental factors that result in poor health among people of color. Approximately 9 million people live near hazardous waste sites and more than half of them are people of color; Black Americans are three times as likely to die from air pollution as white Americans. Environmental cleanup is typically left to companies, which are able to write off these expenses on their taxes. With taxpayers already footing the bill for environmental cleanups, more municipal funding should be allocated to these efforts. By using the money that would otherwise be spent on police to ensure clean air, water, and soil for communities, we are ensuring a healthier community for all.
Promoting Health of Sex Workers
For most sex workers, violence is their biggest health risk and law enforcement is often the perpetrator of that violence. Reducing law enforcement budgets reduces the opportunities for police to perpetrate violence against sex workers.
Repressive policing tactics are also associated with lower condom use and higher HIV rates among sex workers and have a chilling effect on seeking healthcare services. Condom distribution and HIV/STI clinics for sex workers would instead promote health, not just among sex workers but also amongst their clients, who are a part of the general population. These clinics could also prescribe and dispense pre-exposure and post-exposure prophylaxis (PrEP and PEP), helping to reduce the spread and transmission of HIV.
Additionally, because of criminalization, sex workers tend towards housing insecurity, due to the lack of tangible evidence of employment and traditional credit history. Increasing funding for shelters, both for people who are homeless and experiencing intimate partner violence, would inevitably benefit sex workers as well.
Reduce Prison Populations
In American society, the idea of justice has become synonymous with punishment. The criminal justice system’s tools include imprisonment, curtailing rights and privileges, and monetary restitution. As it stands, there are no formal programs geared towards seeking justice that is restorative rather than punitive.
That is not to say that other methods of obtaining justice do not exist. Restorative justice approaches work with people who have harmed and who have experienced harm to determine what it would take to restore the relationship. Transformative justice approaches work with communities to identify and prevent the ways that interpersonal harm happens. Both approaches focus on healing and community-based accountability.
Restorative justice is used in a variety of settings, schools being a particularly common one. Early research into the implementation of restorative justice at schools is promising, with reports of increased student connectedness, greater community engagement, and improved academic achievement.
By diverting people who cause harm out of prisons and into restorative justice programs, their health and well-being are not subject to the inadequate and inhumane conditions of incarceration. In fact, a condition that comes up in many restorative justice procedures is a requirement for the person who caused harm to attend therapy. While incarceration is a net negative for overall health, restorative justice programs may not just be neutral but rather a net positive for overall health.
By reallocating police funding––funding that directly impacts the number of people in prisons––toward community justice programs, community health will improve, and crime, as we understand it, will become obsolete.
Investing in Community Mental Health Response
After the deinstitutionalization movement of the 1960s, there was no funding for alternative mental health services to fill the gap created. As a result and over time, police became de facto mental health frontline workers, responding to calls of people experiencing mental health crises. Surveys show that 10 percent of police budgets go towards responding to and transporting people who are in a mental health crisis, or approximately $918 million nationwide.
That money could instead be allocated to a trained, specialized response team of mental health professionals and other mental health services.
If someone is experiencing a psychotic break, armed law enforcement officers are unlikely to de-escalate the situation. If instead, social workers and mental health professionals respond, they would be able to make assessments and respond in an appropriate manner with the health and well-being of the person at the forefront of their response. Just as we have paramedics available to respond to acute physical health crises, we could be funding a similar service for acute mental health crises. A new program in Denver doing just this has already yielded promising results.
Investing in preventative mental health services would also likely reduce the number of acute mental health crises that occur. Mental health services across the United States are underfunded and understaffed. Waiting lists to see a professional are often long and if one is able to get past that barrier, many services are prohibitively expensive. Increasing funding for accessible mental health care would not only be a boon for communities, but it would also reduce the number of situations where police are called.
Effective Substance-Use Programming
The “War on Drugs” has had devastating effects on individuals and communities. The targeted focus has consistently been on drug users and the sellers, and not the driving forces that lead someone to use or sell. Additionally, the prosecution of people with substance-use disorder, or addiction, is not grounded in theories about health. Rather than spending money on policing people who use drugs, we should be funding a variety of programs that promote health and recovery.
Harm reduction practices acknowledge that risky behaviors are unlikely to stop entirely, and so seek to minimize the problematic effects of these behaviors. There are a variety of harm reduction practices and all have compounding health benefits. Opioid substitution programs allow people who have become opioid-dependent to safely manage and treat their addiction. Illicit opioid use, and related overdoses, reduce in areas that utilize substitution therapies. Safe injection sites provide injecting-drug users a place where if they were to experience a medical emergency, such as an overdose, someone would be able to provide assistance. Syringe service programs allow people to trade in used needles, which become dull and contaminated, for new ones, reducing the spread of bloodborne diseases like HIV and wounds. Naloxone is a drug therapy that can rapidly reverse an opioid overdose, and doing distributions and training in communities particularly hard-hit by the opioid epidemic can reduce the number of deaths. There are other kinds of harm reduction strategies, such as behavioral therapies and counseling, that can be used for other substances, including alcohol.
For decades, the standard for recovery programs, and the one that has frequently received a lion’s share of funding, has been the 12-step program. However, research shows that the 12-step program has between a five and 10 percent success rate. There are a number of other therapies that have better success rates that often do not receive adequate funding or support. Cognitive-behavioral therapy, dialectical behavioral therapy, and family behavior therapy all have been used to address substance-use disorder. Contingency management, which provides rewards for positive behaviors, is also used to treat dependency on a variety of substances. There are pharmacological therapies or drugs that can reduce the cravings or effects of withdrawal, that are promising treatments. Like any other chronic illness, the treatment and therapy for substance-use disorder depend on the individual and the option that works best for them should be easily and readily available to them.
Prioritize Health and Defund the Police
Take a look at the budget of any of the top 50 cities in the United States and it’s almost a guarantee that the largest line item is the police department. Municipal funding is a zero-sum game — the increased funding of one department results in the decreased funding of another one. As police budgets have ballooned over the years to more than $100 billion total nationwide, health and social services’ budgets have been consistently whittled away.
Individuals in the United States spend more on healthcare services than any other high-income country. Part of that spending is for health issues that are linked to police. If we began to prioritize the health and well-being of the people living in the United States, it should start by defunding police departments and funding any number of health programs, especially programming that can undo the health harms caused by police in Black and Brown communities.
Part of the call to defund the police is a call to reimagine what your community could look like. By defunding the police, we have an opportunity to create healthier, more equitable communities for all.
Christine Bedenis was a 2018–2019 Global Health Corps fellow and worked at the Communications and Resource Mobilization Fellow at Art & Global Health Center Africa in Malawi. They currently work at GlobeMed as the Communications and Development Manager.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
