Defund for Health: The Public Health Argument for Defunding the Police
*Editor’s Note — ‘Defund for Health: The Public Health Argument for Defunding the Police’ is Part I of a three-part series.
It was late May, in the middle of a pandemic that attacks the respiratory system, that a video of yet another Black man choking out the words, “I can’t breathe,” hit the internet. However, what was blocking George Floyd’s airways wasn’t inflammation due to COVID-19, it was police officer’s knee on his neck for nearly nine minutes. Months earlier, a young woman and her boyfriend were asleep in their home when police broke down their door in search of a man whose only connection to the location was that he used to date the woman. Those police officers shot and killed Breonna Taylor in her home. In June, a woman was arrested, taken to jail, and found dead in her cell hours later. Video shows Priscilla Slater suffered a seizure while in police custody, yet no one checked on her until seven hours later.
These three deaths are only a sample of the lives of Black and Brown people stolen by police in 2020. Currently, there is no mandated reporting or centralized database of police killings or deaths in custody in the United States, only concerted efforts by citizens that scour news reports. Despite this lack of transparency on the part of law enforcement, it’s clear that the relationship between the police and Black and Brown people is deadly.
The killings of Breonna Taylor, George Floyd, and Priscilla Slater sparked worldwide mass mobilizations throughout the summer, with thousands of people screaming, “Black lives matter!” One way to ensure that Black lives really do matter is to defund the police.
This initiative has a long history rooted in the political aims of abolishing the police and prison industrial complex. It’s widely understood that abolishing these systems does not happen overnight and that better and more effective systems must be built up as these racist and violent systems are dismantled. To that end, within the context of this piece, defunding refers to reducing police department budgets and reallocating that funding into other municipal programs.
The Cost of Policing
Across the United States, funding for police departments is at an all-time high, around $115 billion in 2017, according to the Urban Institute. The majority of funding for police departments comes from local budgets though it can also come from the county, state, and federal levels. Lack of standard budget and operational practices makes cross-city comparisons challenging, but on average policing accounts for about 20–45 percent of cities’ annual budgets.
Government budgets are finite, and the most common programs to experience cuts are social services, including health departments. There is wide consensus among public health experts that public health funding in the US is too low. One estimate of adequate funding for public health is a $20 billion increase from current spending — a fraction of the amount spent on police.
In recent years, our collective understanding of health has begun to recognize how social determinants — the conditions of life in the places that people live, work, learn and play — directly impact health and quality of life. Police have an outsized influence on those conditions for Black and Brown people in the United States. Defunding the police has the potential for wide-ranging, positive impacts on health in the United States.
The Negative Health Effects of the Institution of Policing
Racism is a Public Health Problem and Police Are a Part of That Problem.
The American Medical Association, the American Academy of Pediatrics, the American College of Emergency Physicians and the American Public Health Association have all said that racism is a matter of public health. Additionally, twenty cities and three states have declared racism to be a public health crisis.
Racism does not just happen at an interpersonal level; it has been built into all of the systems of American society throughout history. For years, white doctors would refuse to see Black patients, and medical schools would not train Black doctors, leaving Black people without adequate healthcare and healthcare training. The practice of red-lining determined where Black people were allowed to live, frequently the most polluted parts of cities, leading to negative long-term health effects. Police departments trace their beginnings in the United States back to private security firms hired to protect property, in a time when enslaved Black people were considered property.
The vast majority of criminal statutes in the United States are designed to protect property, which means that the work that police are doing when they enforce those laws is protecting property. When they tell a homeless individual to “move along,” when they knock on the door of a “loud” party, or when they patrol around businesses looking for theft, it’s to protect the property values of the area.
But, police do not prevent crime from happening; they merely respond to crimes that have been committed. If police reduced crime, with the amount of spending on police in the United States, crime would be non-existent. If we as a society truly want to reduce crime, then we must be addressing the root causes of what leads people to commit crimes — much in the same way that healthcare professionals recommend preventative health.
If you take a look at life expectancies in the United States and then disaggregate by race and sex, Black men have the lowest life expectancy overall. This has been true since 1900, though the gap has steadily decreased from 34 years to four.
To see how police violence impacts the number of years that Black lives, sociologist Elizabeth Wrigley-Field calculated the lifetime number of years stolen from people killed in police encounters. Her research found that for every 100,000 Black men, 5,696 years are taken during police encounters. A recent Harvard study shows that Black Americans are more than three times more likely than white Americans to be killed by police. In fact, Black men have a one-in-1,000 chance of being killed by police violence in their lifetime. It is important to note that the data set that is used in this study may be incomplete because it comes from a citizen aggregation effort, rather than direct reporting from police departments.
It’s clear that policing has a disproportionate effect on the lives of Black people in the United States, one that leads to their early deaths.
Racial Profiling Increases Stress; Increased Stress Decreases Health
In recent years, health research has shown that cortisol, the primary stress hormone, is linked to chronic disease. When a person is placed in a stressful situation, the body responds by releasing hormones throughout the body. Cortisol works to curb functions that are nonessential or detrimental in a fight or flight situation, including immune responses, the digestive system, and the reproductive system. Usually, once the stressful situation ends, the hormones subside, however when people live their lives under constant stress the cortisol never has a chance to subside.
Research shows that Black men have higher levels of cortisol throughout the day when compared to white men. While Black men experience the same chronic health conditions that are related to increased cortisol that white men do, the onset of these conditions is earlier, more severe, and more poorly controlled. When considering the overall conditions that contribute to increased cortisol, and when controlling other demographic factors, it’s impossible to ignore the effect that policing and hyper-surveillance has on Black people, particularly Black men. Police are a direct contributor to the chronic health conditions of Black people.
There are a number of documented policing tactics that specifically target people based on their skin color. Non-moving violations, or tickets for things that are not related to driving, are disproportionately given to Black people and people of color — a phenomenon more widely referred to as “driving while Black.” Black drivers are about twice as likely to be pulled over as white drivers, even though white people drive more. Additionally, the traffic stops of Black drivers are frequently used as a pretense to search their vehicles. The threat of being pulled over and ticketed looms over Black drivers every time they get behind the wheel.
Stop-and-frisk refers to a situation where a police officer stops an individual on the street, then decides that the person needs to be searched with a pat-down. The threat of being stopped and searched is a part of many Black people’s lives.
Police training focuses on immediate and fast responses to any perceived threat. Decades of media portrayals of Black people have reinforced racist stereotypes of Black youth being dangerous, and police are not immune to these biases. Overcoming bias requires slowing down and reassessing your initial understanding of a situation. Fighting bias is incompatible with policing practices and no amount of reform or training can change that. These policing practices, among others, inherently place Black and Brown people, particularly men, under more stress than white people.
Criminalizing Sex Work and its Impact on Public Health
Sex workers are overwhelmingly women, according to research from the Urban Institute. That same report shows that Black respondents were the largest represented racial category. Violence against women has been deemed an urgent public health priority by the World Health Organization. It’s linked to known risk factors for poor health, such as drug and alcohol abuse, smoking and unsafe sex.
In the United States, sex work is largely criminalized. In recent years, much of the business arrangement aspects of sex work — setting appointments, negotiating rates, and clarifying services — had moved online. However, in 2018 the FOSTA-SESTA Act, in an effort to curb sex trafficking, made much of that illegal, pushing sex workers back out into the streets. It is on the streets that sex workers are most likely to come into contact with police.
Interactions with police have negative impacts on sex workers’ health. Police squads that target sex workers have high incidences of corruption. There are multiple cases that show that the officers themselves perpetrate violence against the sex workers in exchange for “looking the other way.” Additionally, because it is difficult to determine whether someone is a sex worker or not, things like having multiple condoms are used as evidence. This drives more sex workers to not use condoms. Sex workers are twice as likely to be HIV positive or have an STI, and less likely to use barrier protection methods with clients due to the policing.
Police are Not Mental Health Professionals
In the 1960s, there was a movement to close down mental health institutions across the country. However, after these places were closed, there was no increase in community-based mental health services. Without specialized support services from qualified professionals, police have ended up becoming frontline mental health workers. As a result, many of the people who were forced out of mental health institutions have been cycled into jails and prisons.
In comparison to numerous other professions, the amount of time that American police spend in training is short. The training that they do receive is to identify the potential threat in any situation and to use their presence to react quickly and aggressively to that perceived threat. When police encounter people with mental illness, they will undoubtedly identify some kind of threat, to which their training tells them to yell commands and draw weapons. These actions not only escalate but can destabilize a mental health crisis even further. The person may try to flee or become aggressive themselves, or if they are having a psychotic break or delusions may be unable to respond to orders. Countless news stories have shown that this has led to tragic outcomes.
We know that policing produces an “us versus them” mentality among officers which fosters aggressive tactics and approaches to citizens. When an officer spends most of their time in an antagonistic position, it’s nearly impossible for them to change their mindset when it comes to dealing with someone in a mental health crisis. Even when officers have undergone specific training for dealing with mental health issues, they still end up escalating, when people with mental illness need calming and de-escalation.
People with mental illnesses, particularly those who are in the homeless population, do better with people who are able to establish long-term relationships and trust. Armed police are not only unable to do this, but cost significantly more than trained mental health and social workers. The fact that police are armed is an implication of coercion, which frequently drives people who are homeless and mentally ill into further isolation.
The interaction of police and people with mental illness has repeatedly turned deadly and having a mental illness has become criminalized. Policing is an inappropriate tool to respond to people with mental illness.
The Criminalization of Substance-Use Disorder
Medical professionals have long recognized substance-use disorder, commonly referred to as addiction, as a chronic disease. However, it appears to be the only medical condition that is not only criminalized but also actively pursued by law enforcement.
Nearly two-thirds of incarcerated people have a substance-use disorder, however, only 11 percent of them receive any treatment behind bars. Without treatment, many people who are incarcerated end up being abruptly cut off from the substances they are addicted to, which can result in major health issues. Priscilla Slater died from a seizure while in jail, likely from alcohol withdrawal, according to the county medical examiner. The United States is currently in the middle of an opioid crisis, and it has long been known that withdrawals from opioids can be deadly. When the police target people who have a substance use disorder, they may ultimately be sentencing them to a painful death.
The history of drug enforcement in the United States is inherently racist. Prohibition laws in the early 20th century were introduced when it became clear that minority populations were the primary users of a substance, thus allowing legal targeting and control of them. Nixon built his campaign by appealing to white Southerners with a “law and order” approach. However, most criminal laws are state and local issues, not federal. Nixon turned to drug enforcement because it was at a federal level and he knew that they had long understood racial animus in them. When Reagan expanded the “War on Drugs”, he did so by characterizing drug use as an individual problem, which diverted funding and support away from treatment and decriminalization. Clinton further grew the federal investment in the drug war by increasing penalties, creating three-strike laws, and setting aside $16 billion to build prisons and expand police forces. Police militarization, and the corresponding bloated budgets, traces its roots to this expansion.
Policing in the United States is Bad for Public Health
While George Floyd, Breonna Taylor, Eric Garner, Priscilla Slater, Freddie Gray, Sandra Bland, and Tamir Rice, and so many more, lost their lives at the hands of police, we will never know the names of the people who have lost their health because of policing. The young Black man who developed hypertension in early adulthood, after being needlessly pulled over or searched multiple times. The sex worker who became HIV-positive because she was too scared to carry multiple condoms. The middle-aged man with bipolar disorder who cycles in and out of jail because there are no state services available. The woman who is repeatedly profiled by police because of her substance use disorder. We will not know the names of the people who have lost years of their life and died slow deaths because of the way they are targeted by police. Their lives matter, too.
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.
