The 2017 Statement

This version of the statement was considered at the 2017 American Public Health Association (APHA) conference in Atlanta, GA. It was voted down by the Governing Council (65% to 35%).

The original version of the statement was passed as an interim policy at the 2016 APHA conference in Denver, CO. It can be accessed here.

The 2018 statement, which has been submitted to the APHA conference in San Diego, CA, can be accessed here. 

Summary

Keywords: Violence, gun violence, minorities, injury prevention, racism

**Note: Language that is both bold and italicized has been explicitly defined in Appendix A**

Violence by law enforcement officers result in deaths, injuries, trauma, and stress that disproportionately affect marginalized populations including people of color, immigrants, individuals experiencing homelessness, people with disabilities, members of the LGBTQ communities, and individuals with mental illness. Law enforcement officers and agencies are rarely held accountable for these acts of violence due to an insular police culture, laws interfering with investigation and prosecution around misconduct, and insufficient civilian oversight, among other factors. Practices codified in law, such as anti-immigrant legislation, policies associated with the war on drugs, the criminalization of sex work and activities associated with homelessness, have the effect of promoting and intensifying violence by police toward the aforementioned populations. While some argue that rates of violence can be reduced by intervening on the quality of policing (e.g., implementing community-oriented policing, bolstering police training, or increasing the use of body- or dashboard-mounted cameras and conducted electrical weapons), the empirical evidence in support of these approaches has notable limitations and their implementation does not align with an upstream, public health approach. Instead, a public health strategy for preventing police and other law enforcement violence should aim to reduce police presence in community members’ lives and strive for community-based alternatives. Therefore, the American Public Health Association (APHA) recommends the following actions by federal, state, and local authorities: (1) eliminate policies and practices that facilitate disproportionate violence against specific populations (including laws that criminalize these populations); (2) institute robust police accountability measures; (3) increase investment in policies promoting racial and economic equity; and (4) implement community-based alternatives for addressing harms and preventing trauma (e.g., community-led restorative justice and violence intervention programs).

Relationship to Existing APHA Policy Statements

The following APHA policy statements are relevant to the current statement:

  • APHA Policy Statement 8817(PP): A Public Health Response to the War on Drugs: Reducing Alcohol, Tobacco and Other Drug Problems among the Nation’s Youth
  • APHA Policy Statement 9123: Social Practice of Mass Imprisonment
  •  APHA Policy Statement 9926: Support for Research on the Socioeconomic Causes of Violence
  •  APHA Policy Statement 9929: Diversion from Jail for Non-Violent Arrestees with Serious Mental Illness
  • APHA Policy Statement 20128: Opposing the DHS-ICE Secure Communities Program
  • APHA Policy Statement 200914: Building Public Health Infrastructure for Youth Violence Prevention
  • APHA Policy Statement 201311: Public Health Support for People Reentering Communities from Prisons and Jails
  • APHA Policy Statement 201312:  Defining and Implementing a Public Health Response to Drug Use and Misuse
  • APHA Policy Statement LB-16-02: Law Enforcement Violence as a Public Health Issue (this policy statement updates that statement)

Rationale for Consideration

This document updates and replaces APHA Policy Statement LB-16-02: Law Enforcement Violence as a Public Health Issue, given the temporary nature of “late breaker” policy statements.

Problem Statement

Prevalence, impacts, and inequities: Violence by law enforcement officers is a critical public health issue. According to The Counted - a UK-based website and currently the most timely, comprehensive source of US data- at least 1,091 individuals were killed by law enforcement officers in the United States in 2016 [1, 2]. In 2013, there were more than 100,000 law enforcement officer-induced injuries that resulted in hospitalizations or trips to the emergency department [3]. The Centers for Disease Control and Prevention estimates that the overall cost of deaths and injuries reported in 2010, including medical costs as well as work lost, was $1.8 billion [3].

In addition to the aforementioned physical health outcomes, engagement with law enforcement has been shown to be associated with a variety of adverse mental health outcomes. For example, it is associated with symptoms of anxiety and posttraumatic stress disorder -especially when incidents are perceived as unfair or discriminatory [4,5]. In fact, repeated stops, even if not physically violent, are also associated with symptoms of posttraumatic stress disorder [4]. Studies suggest outcomes are particularly pronounced among people of color, with one suggesting that Black individuals are more likely than White individuals to report stress as a result of encounters with police [5]. This finding is of particular concern given the association between perceived racial discrimination and risk factors for chronic disease and early mortality [6]. In summary, aggressive policing is “a threat to physical and mental health,” particularly among marginalized populations [4].

These interactions are not restricted to street encounters -rather, schools are increasingly a site of law enforcement violence as the presence of law enforcement agents, known as Student Resource Officers (SRO), in schools has grown markedly since 1994 [7]. As a result, disciplinary action that historically fell under the purview of school teachers and administrators has been largely delegated to SROs [7]. Between 2010 and 2015, at least 28 serious injuries—including two cases of brain injury—were inflicted on students by SROs [8]. Notably, after adjustment for relevant covariates including behavior, children with disabilities, poor students, and students of color are at greater risk of contact with SROs, in-school restraint and seclusion, and use of force [9]. Disparities in contact with SROs have been linked with the “denial of educational and social growth,” further exacerbating social and racial inequities in acute and chronic health outcomes [10].

This differential targeting of marginalized populations tracks into adulthood. In 2016, Black, Latino, and Native American populations were killed by law enforcement at higher rates than white populations [1]. In fact, Native Americans are killed by law enforcement, per capita, at a higher rate than any other group in the US [1]. Black individuals are more than twice as likely to be killed by law enforcement as white individuals; however, when stratified by age and sex, young Black men are greater than four times more likely to be killed by law enforcement than their white counterparts [1]. Black and Latino individuals are also more likely to be stopped or arrested and to experience nonfatal violence at the hands of police [11-13]. Approximately half of deaths attributed to law enforcement in the United States are perpetrated against individuals with mental illness or physical disabilities [14,15]. Other groups that are highly affected by police violence include transgender, lesbian, gay, and bisexual populations [16, 17]; individuals experiencing homelessness [18]; people with disabilities [19]; sex workers [20, 21]; and people who use drugs [22]. Immigrant communities are also subject to policing from local, state, and federal immigration authorities, such as the Department of Homeland Security Bureau of Immigration and Customs Enforcement. Immigration raids result in increased levels of “immigration enforcement stress” and fear of interacting with government agents and informal social networks [23]. Policies that increase police contact, or fear of contact with police, create barriers to accessing health care and other health-supportive services for both undocumented individuals and their US citizen family members, including Medicaid, WIC, and HIV prevention services [24-26]. Fear of contacting government agencies and social isolation also creates more vulnerabilities to violence for immigrant women in abusive relationships [27]. Fear of police encounters may similarly impede access to harm reduction services for non-immigrant populations such as people who inject drugs [28].

Of note, comprehensive information on deaths, mental and physical injuries, and the frequency of encounters with law enforcement and immigration authorities is scarce. It is vital that we “track, analyze, and disseminate accurate data” about law enforcement violence [28b]. US-based data sources have been shown to be neither comprehensive nor timely. For example, the Federal Bureau of Investigation’s (FBI) Uniform Crime Reporting System reports only “justifiable homicides,” with deaths occurring on federal property (e.g., federal prisons, tribal lands, and military bases) left unreported [29]. Further, reporting occurs only on a voluntary basis. While Barber et al. found that The CDC’s National Violent Death Report System (NVDRS), is likely the most reliable, comprehensive official data source reporting deaths due to intervention by law enforcement officers, they determined that nonetheless, the NVDRS still severely underestimates these deaths [29]. As of 2016, only 32 states reported data, and at least 10% of deaths from reporting states were mischaracterized [29]. While the Death in Custody Reporting Act of 2000 and subsequent amendments require reporting by state and local law enforcement agencies of deaths that occur in their custody, members of Congress, the AFL-CIO, the NAACP, the American Civil Liberties Union, and others, have expressed concern over the Department of Justice’s lax enforcement of said law leading to substantial undercounting [30,31].  In their assessment, Krieger et al., concluded that “no reliable official [US-based] database exists on the number of persons killed by police” [2]. They suggested that the website, The Counted, is the most comprehensive and timely source of data on killings by US police [2]. Comparatively, within one week of its launch in June 2015, The Counted documented more than twice the number of deaths as would be expected based on FBI estimates [2]. Given this, the 2016 data cited above is derived from this most reputable source available to-date; however, it too likely underestimates the magnitude of the issue at hand. In response to these striking data gaps, public health scholars have noted that it is critical for reliable, real-time data on law enforcement-related deaths be gathered by public health officials via existing public health reporting mechanisms [2].


Policing as a mechanism of social control that exacerbates social inequity

Policing in the US is commonly understood as a force to deter crime. However, a review of the history of policing reveals an institution that is (1) explicitly rooted in the social control of communities deemed non-normative and (2) applied in a manner that exacerbates social inequities and generates trauma as it inflicts interpersonal harm. The disproportionate rates of police violence against marginalized communities are based in a history of de jure and de facto racism and classism.

In the 19th century, modern policing evolved from ruling-class efforts to control the immigrant working class and other members of the “underclass” in the North and from slave patrols in the South [32]. This historical trend continues as marginalized populations, whose behaviors were (and are) socially constructed as “disorderly,” continue to be targeted by police today.

Researchers have explored associations between concentrated police presence and perceived non-normative characteristics of populations. Their studies, which examine predictors of police force size, provide evidence that policing endeavors to uphold existing hierarchies by targeting perceived non-normative groups. They find that key predictors include (1) size and growth of populations of color in a given municipality, (2) racial economic inequality, and (3) poverty; these associations hold even when controlling for crime rates [33,34].  In interpreting these findings, researchers suggest that marginalized populations, who bear cultural dissimilarities from the dominant group, are seen as a threat to the social order. In turn, the criminal justice system is used as a mechanism of control [33].

The concentration of policing in perceived non-normative communities stems from legitimating beliefs that crime originates from inherently “bad” individuals and communities, not social and economic conditions [32]. Therefore, rather than address root causes of, for example, high rates of poverty and unemployment among communities of color (one demonstrated root cause being institutional racism), law enforcement is instead tasked with managing their downstream effects, in turn further exacerbating the harm. This individually-oriented, “thin blue line” ideology has persisted; however, contemporary public health’s approach of addressing social and structural determinants of health aims to counter it.

The war on drugs serves as an example of policing in working-class communities of color, ostensibly to resolve presumed pathologies associated with drug use, all while exacerbating social, economic, and health inequities. Likewise, its “tough on crime” rhetoric was a racially coded appeal to working-class whites to legitimate saturation policing in communities of color [35,36]. As Krieger notes, H.R. Haldeman -President Richard Nixon's White House Chief of Staff, was quoted as saying, “the whole problem is really the [B]lacks. The key is to devise a system that recognizes this while not appearing to” [37].  The systems-oriented nature of this endeavor, alluded to in this quotation, makes clear that the war on drugs was more than rhetorical. In fact, it provided federal enticements, including cash incentives for drug arrests, training in special weapons and tactics (SWAT) techniques, and an arsenal of military equipment, to police departments across the country [36]. By incentivizing drug arrests, loosening restrictions on searches, and creating a culture that encouraged police to repeatedly stop and search people of color going about their daily business, the federal government brought millions of people into increased contact with law enforcement [36]. The social control of drugs proved harmful to working-class communities of color, and there is little evidence that a punitive, prohibition-style drug strategy actually reduced harms associated with drug abuse [38].

The criminalization of homelessness through local and state laws prohibiting loitering and sleeping in public spaces serves as another example of policing as social control leading to violence against and incarceration of marginalized communities [18,39]. Laws that criminalize the actions associated with the experience of homelessness are costly to enforce, perpetuate homelessness, and violate basic human rights, all while having no positive impact on public health [40]. Furthermore, police officers have agreed that the criminalization of homelessness is an ineffective response to this issue, and that responsibility for addressing homelessness should lie outside of law enforcement [41].

The criminalization of sex work likewise results in high rates of police violence toward sex workers and toward transgender individuals, who are often assumed by officers to be sex workers [16]. Ultimately, laws that effectively criminalize communities place police in direct conflict with those they are meant to serve, which confounds potential reform efforts to reduce police violence.

Laws that facilitate discriminatory policing are even more concerning given the weakening of the Posse Comitatus Act and the enactment of the The National Defense Authorization Act and the 1033 program, which give away surplus military equipment to local and states law enforcement agencies [11,42,43]. The delivery of military equipment to domestic law enforcement agencies precipitates military-style training, allows military weapons to become the tools of police forces, and increases the use of SWAT teams. The impact is seen in increasingly violent tactics used by law enforcement officers, which are disproportionately applied to marginalized communities and result in higher rates of excessive use of force and extrajudicial murders by police [11].

It is important to note that this observed militarization of domestic law enforcement is facilitated by mounting investments of federal funds. While the need to invest in the social determinants of health is clear, government spending on social services such as housing assistance and education has decreased since the 1980s [44]. Yet, spending on policing increased 445% between 1982 and 2007, including a federal funding increase of 729% [18]. Likewise, state spending on corrections increased 141% (adjusted for inflation) between 1986 and 2013 [45].

 

Barriers to accountability and reform

Accountability of police officers is a major concern. Between 2005 and 2011, only 47 police officers were charged by prosecutors with a crime for their involvement in civilian deaths, and a mere 11 out of those 47 were convicted [46]. Several cultural and formal barriers impede accountability for violence against civilians and obstruct meaningful reform. These barriers include a tendency of officers and their supervisors to “protect one’s own,” which can manifest in a “code of silence”: a norm of not reporting other officers’ misconduct and protecting them during investigations [13,47]. A 2000 national survey showed that a majority of police officers agreed that it is “not unusual for a police officer to turn a blind eye to improper conduct” and disagreed that officers always report “serious criminal violations involving abuse of authority by fellow officers”[47]. News reports reveal instances of misconduct consistent with these study findings including, officers having tampered with evidence and given false accounts of events to cover up instances of brutality, while department spokespersons and public officials have publicly defended instances of violence [13,48]. Another barrier to accountability is suppression of law enforcement data related to deaths [49].

Laws and policies— such as state-based police bill of rights and police union contracts—provide law enforcement officers accused of excessive use of force or murder with a suite of protections from investigations and disciplinary action [50,51]. The Law Enforcement Officers’ Bill of Rights (LEOBoR), versions of which are law in 14 states, provides officers with protections beyond those of an ordinary citizen facing criminal charges. Although some variations exist between these state policies, common LEOBoR components include a “waiting period” that delays investigations, a shortened (e.g., 60-day to 1-year) deadline for filing charges against officers after an incident of misconduct, and the prohibition of anonymous or confidential complaints by civilians [52].

Insufficient mechanisms for oversight can also be a barrier to accountability. Although numerous cities have implemented some form of civilian oversight mechanism, most oversight bodies are plagued by a lack of true independence, a lack of authority to recommend or make policy changes that may serve to prevent future incidents, or both [53]. Limited independence can occur when these civilian bodies are (1) forced to rely on civilian investigators who are embedded within police departments or (2) are restricted to developing recommendations but must then count on members of the police force to carry out these recommendations [53]. Other bodies may be limited to reviewing specific cases and lack the authority to recommend or make policy changes that may serve to prevent future incidents [53].

As noted by Garcia and Sharif, structural racism embedded within “legal, social, and political systems...enable[s] police officers to disproportionately stop people of color, often without cause...with greater use of force [and] without any repercussions” [54]. Protective laws and policies, insufficient oversight mechanisms, and cultural norms are all barriers that inhibit law enforcement accountability, confound proposals for reform, and lead to over-policing of marginalized communities.

 

Evidence-Based Strategies to Address the Problem

A critical first step in addressing the rate of police violence is to repeal laws that promote or justify increased scrutiny of specific populations, thus redefining what falls under the purview of the police [55]. Such laws include those relating to drug use or possession, sex work, homelessness, and immigration. The logic is simple: removing justification for law enforcement intervention will reduce encounters between the police and individuals whose activities are currently criminalized. Crimes should not simply be downgraded to lower-level offenses; for example, research has revealed that marijuana-related arrest rates remain stable or increase when possession is reclassified as a lesser offense but is still considered against the law [56]. A notable exception is Massachusetts, where courts ruled to limit police enforcement of marijuana possession. Between 2008 and 2010, arrests fell by 86% [56]. Also important is advocating against new laws that would criminalize, or create harsher penalties for, activities such as civil disobedience and mass mobilizations, which are vital means by which oppressed communities can voice concerns and push for needed social change.

Investing in programs aimed at addressing the social determinants of health are critical to reducing the structural inequities that facilitate and are caused by law enforcement violence. As described above, policing as an intervention to address criminalized behaviors reproduces and sustains the inequitable social and economic conditions that precipitate intervention placing both police officers and marginalized community members at risk of injury and death. A public health approach, however, seeks to address health inequities by intervening on the social conditions that shape said inequities-including increasing access to housing, economic equity, and educational opportunity that in turn prevent and or reduce community trauma and interpersonal harm while building healthier and equitable communities. For example, the CDC recommends data-driven community level interventions and strategies that reduce concentrated poverty and provide affordable housing and quality early education [57]. Investing in communities most impacted by the inequitable distribution of resources can improve public safety, improve access to stable housing, access to mental health and substance abuse treatment, and economic opportunity [58]. Further, a World Health Organization (WHO) report on the social determinants of health recommends policy promoting health programs and interventions that focus specifically on marginalized groups to address inequities stating that any serious effort to do so must involve changing the current distribution of power within society that sustains inequity so as to benefit those marginalized groups [59].

Reprioritizing housing and homelessness services approaches provide strong examples of how a shift from criminalization to a social determinant framework can be implemented. The US Interagency Council on Homelessness strongly recommends the provision of permanent housing as a proven approach to provide stability to those experiencing homelessness. The Council states such efforts result in “higher housing retention rates, reduces the use of crisis services and institutions, and improves people’s health and social outcomes” [60]. A randomized controlled trial examining a housing intervention in Toronto, Canada, for people experiencing both homelessness and serious mental illness showed a substantial decrease in arrests among “high-need” housing first recipients during the 24-month study period [61]. The study also showed cost savings whereby every $10 invested in housing services resulted in an average savings of $15.05 for high-need recipients and $2.90 for moderate-need recipients [61]. In a systematic review of these studies, housing programs were deemed “very successful” with cost savings, particularly for recipients with mental illness [62]. As further evidence, in Miami-Dade County, Florida a 10-year plan created to end homelessness and prioritize rapid re-housing of individuals experiencing homelessness resulted in reductions in the street homeless population from 8,000 to under 800 [63].

Yet, as noted previously, financial investments have been disproportionately targeted towards law enforcement entities as opposed to these social services. Given that crime trends are at a 30-year low [18], money spent on policing could be more effectively spent on social programs to address the racial and economic inequities that persistently threaten the health and wellbeing of communities and on community-controlled approaches to public safety. This approach is a key element of the Movement for Black Lives platform, a policy agenda created by a collective of more than 50 Black organizations that calls for “a reallocation of funds at the federal, state, and local level from policing and incarceration...to long-term safety strategies such as education, local restorative justice services, and employment programs” [64].

Although greater social and economic equity is likely to lead to reductions in criminalized activities, interpersonal harm will still exist, and therefore strategies to ensure community safety will still be needed. In instances of harm or violence, approaches such as conflict mediation or intervention and restorative justice can reduce crime and harm in communities without the violence or coercion associated with policing. For instance, community-based violence intervention programs detect and interrupt potentially violent conflicts, identify and treat high-risk situations, and mobilize the community to change norms. By targeting behaviors, attitudes, and social norms related to gun violence, violence intervention programs have been able to significantly reduce homicides and nonfatal shootings in urban neighborhoods with the highest numbers of incidents [65]. These programs have had success employing violence interrupters and culturally appropriate unarmed street outreach workers who are current or former neighborhood residents --who have been able to diffuse potentially harmful or violent situations with no, or minimal, intervention by police [65]. It should be noted that in determining appropriate interventions, consideration must be given to the relations of power between parties (for example, in situations of suspected abuse, mediation would not be appropriate).

Another approach, termed “restorative justice” or “restorative practices,” aims to “repair the harm a crime has caused rather than inflicting harm on an offender” [66]. Restorative justice has been implemented as part of the criminal justice system at various phases, as well as in schools and community-based settings, and has become well established in the United States, Canada, the United Kingdom, Australia, and New Zealand over the past 40 years. Rigorous meta-analyses of restorative justice conferencing (RJC) have shown that random assignment to RJC significantly reduces repeat offending - as measured by criminal convictions or repeat arrests - over a 2-year period [66]. In summary, restorative justice serves as an innovative and effective alternative that can replace punitive and repressive approaches to safety and justice.

In school-based settings, restorative practices serve as an alternative to suspensions, expulsions, and referrals to law enforcement and focus on addressing negative behaviors by generating dialogue among the perpetrator, the victim, and others affected [67]. In Denver, rates of suspensions and referrals to law enforcement dropped significantly after the implementation of a restorative justice program [67]. While some restorative justice conferences are facilitated by police, the field of public health widely acknowledges the importance of community-centered interventions [68]. Future programs might increase their ability to achieve community transformation by ensuring that the populations most affected by law enforcement violence lead program design and implementation.

Finally, improving surveillance of law enforcement violence is necessary to understand the scope of the problem and address it effectively. Existing surveillance systems have the capacity to maintain a comprehensive database of fatal encounters with law enforcement officers. The International Classification of Diseases under “Legal interventions (Y35-Y36)” outlines codes for injuries and fatalities caused by law enforcement officers, while the National Violent Death Reporting System (NVDRS) maintains a census of violent deaths among US residents and nonresidents that occur as a result of intentional self harm, assault, terrorism, unintentional exposure, undetermined intent, and legal interventions [69,70]. These codes, however, do not adequately capture the context of violent interactions with law enforcement officers, and offer vague and inconsistent guidance about types of injuries and types of law enforcement officers included. With minor changes and policies that mandate the reporting of fatal interactions with law enforcement officers, the existing systems have the potential to be successful surveillance tools. State and local public health agencies could serve as the independent monitors of law enforcement violence and can create better data analysis and collection by adding “legal intervention” to the existing list of reportable conditions that medical examiners and coroners report [2]. By modifying reporting strategy, state and local public health agencies could share data with state attorney generals for further investigation [71].

 

Opposing Arguments and Evidence

This statement proposes a reduction in police presence—through decriminalization, diverting funding from policing to investing in social equity, and community-based alternatives for addressing harms—as a mechanism for addressing law enforcement violence. These strategies are sometimes criticized due to concerns they will increase crime, decrease public safety, and harm public health. However, research suggests that a public health strategy towards addressing law enforcement violence, specifically the action steps proposed in this statement, have negligible effects on these measures. Additionally, in proposing a public health strategy, this statement argues that tactics based in the criminal justice system (e.g., community-oriented policing, use of body-mounted cameras and TASERS, and increases in officer training) may not address the health implications of law enforcement violence.

Opposing Argument #1: Decriminalization harms the public’s health

Decriminalization of a variety of activities and behaviors, such as drug possession and minor traffic violations, is often met with concern that doing so will negatively affect the public’s health. For example, opponents often cite that the decriminalization of drugs leads to an increase in drug use and higher rates of traffic accidents. While the concern for negative health effects from drug use is legitimate and further research on this topic is warranted, the concerns of harm to the public’s health are not supported by available drug decriminalization research at this time. For example, the longest known evaluation of a decriminalization effort was undertaken in Portugal, which decriminalized all drug use in 2001. Data from Portugal, when compared with either Spain or Italy, showed increased uptake of drug treatment, reductions in opiate-related deaths and infectious diseases, and increases in the quantity of drugs seized by the authorities due to shifting police resources from minor possession crimes to a focus on traffickers [72]. In the United States, concerns regarding increased traffic accidents due to marijuana legalization have not been realized, but more data are needed. Fatal traffic accidents in Washington have remained stable over the first two years of legalization, although there have been increases in the percentage of drivers tested for drugs at autopsy and found to have THC present [73]. According to a large study done by the National Highway Traffic Safety Administration, there is no statistically increased risk of traffic accidents due to marijuana use [74]. Furthermore, many organizations have released reports supporting drug decriminalization to improve human rights and public health across the world such as the Office of the United Nations High Commissioner for Humans Rights [75a], UNAIDS [75b], and the United Nations Office on Drugs and Crime [75c]. The Drug Policy Alliance cites data showing that drug decriminalization reduces the number of people arrested and incarcerated, increases uptake into drug treatment, and reduces costs by redirecting resources from criminal justice to health system [76]. Existing APHA policy supports a public health strategy on drug use, marked by recommendations for an end to the criminalization of drugs and drug consumers, and prioritization of treatment and harm reduction strategies [77]. Finally, the World Health Organization recommends that countries work towards the decriminalization of drug use and sex work as a means of reducing known barriers to health services and treatment [78].

Opposing Argument #2: Increased police funding protects the public’s health

A commonly-held belief is that police are needed to protect the public from harm and violence, and that cutting police budgets will adversely affect communities. However, the body of evidence does not lead to the clear conclusion that more policing leads to less crime [79]. When police forces abruptly withdraw from neighborhoods, as in the case of police strikes, increases in crime occur only around property crimes and not violent crime [79]. Further, an incremental increase in police numbers is not linked to a decrease in violent crime [79]. In fact, a meta-analysis of studies published between 1973 and 2013 aimed at assessing the association between the police force size and crime rates did not find a statistically significant relationship [80]. Increased police presence as a crime deterrent in the hopes of increasing the perception of arrest risk was also found not to be statistically significantly associated with crime rates [81]. In the case of school resource officers, there likewise is no evidence that crime has been reduced in schools or that school resource officers have prevented any mass shootings [82]. Ultimately, these data suggest that while police presence has been shown to protect property, it has not been shown to protect human life -the latter of which is of primary concern to public health. Still, spending on policing has increased substantially over the last few decades, as noted above [18]. Proponents of increases in police funding argue that the current 30-year low in crime trends is a result of this increased investment. However, as the Congressional Budget Office notes, multiple drivers can explain this reduction in crime including demographic and economic changes -a finding for which several researchers have provided support [83, 84].

Opposing Argument #3: Interventions should aim to implement novel policing strategies (e.g., community-based policing, body-cameras, and TASERS), not reduce police presence

Some have argued that use of specific policing strategies, such as community-oriented policing (COPS), will reduce law enforcement violence. COPS emerged as one in a line of nearly constant police reform efforts beginning in the 1920s but, most directly, out of the crisis of legitimacy police departments experienced after the urban rebellions of the late 1960s [85]. COPS is based on the assumption that building relationships between law enforcement officers and communities will increase the effectiveness of policing efforts; although COPS strategies have changed over time and exhibit little consistency across departments, they may include assigning specific patrol officers to a single neighborhood, encouraging partnerships with community organizations and other city agencies, and emphasizing problem solving in conjunction with the community [18]. COPS encourages police to draw on “a wide array of tools that take them well beyond their limited use of the criminal law,” arguably “significantly broaden[ing] the reach of the police, perhaps giving them even more discretion” [85].

The effectiveness of COPS has been studied extensively, with numerous investigations—including a 2014 meta-analysis—showing that this approach has little impact on crime prevention or community members’ feelings of safety; however, COPS does seem to be associated with increases in citizen satisfaction and perceived police legitimacy, and decreases in perceived disorder [18,86]. While COPS continues to be offered as a reform in the aftermath of high-profile police killings, little or no research has examined the effects of COPS programs on law enforcement violence. The Chicago Police Department, whose Chicago Alternative Policing Strategy (CAPS) was lauded as an effective COPS model and helped pave the way for the national COPS program, is under continued scrutiny for police brutality and killings [13].

Few studies of community-oriented policing critically interrogate the nature of partnerships that police develop with communities through COPS programs and who is included and excluded in the “community” to be engaged. An important exception is a grassroots research project conducted by a community group in Chicago that visited CAPS meetings in neighborhoods across the city, focusing on neighborhoods affected by gentrification [87]. The group reported that police officers encouraged the mostly white, property-owning residents who attended CAPS meetings to surveil their neighbors. Officers instructed residents to report minor infractions such as loitering and public drinking and to call the police to report anyone who seemed “out of place,” a highly subjective decision that draws on the observer’s implicit bias. The researchers concluded that “rather than facilitating broad-based, cooperative solutions, CAPS meetings train small, self-selecting groups to monitor their neighbors—and to turn to law enforcement interventions more frequently and quickly,” increasing “surveillance of a community’s most vulnerable residents or visitors” [87]. As previously noted, there is great variation in what constitutes COPS and how these programs are implemented; however, the CAPS study raises important questions about the perpetuation of social and racial discrimination. Seventy percent of police departments across the United States report COPS activities [88]. This suggests that this model is compatible in practice with more aggressive policing styles that include police militarization, increased surveillance and racial profiling, and “broken windows” or “zero-tolerance” approaches.

Another tactic argued to address law enforcement violence is the use of technological tools, such as conducted electrical weapons (commonly known as CEWs or TASERS), or body and dashboard-mounted cameras. While CEWs may be less lethal than handguns, since 2001 they have been associated with more than 500 deaths, 90% of which occurred when the victim was unarmed [89]. Risk of adverse effects from TASER shocks is higher in people who suffer from pre-existing cardiac conditions, or who are experiencing drug intoxication [89]. Adverse consequences of CEW shocks are also higher for individuals after a struggle [89]. Recognizing the dangers of these weapons, both Amnesty International and the United Nations Committee on Torture recommend restricting use of CEWs by police to situations in which they would otherwise use lethal force [89,90].

Increased funding for body-mounted cameras is often put forth as a reform measure to reduce law enforcement violence because of the presumed increase in transparency and accountability offered by these devices. An oft-cited example of the success of body cameras in reducing law enforcement violence is in Rialto, California, where police officers have been wearing cameras since February 2012. Reports of use of force dropped by 50% in the first year of implementation, and citizen complaints dropped by 88% [91]. However, a national study of more than 2,000 departments revealed a statistically significant relationship whereby the use of wearable body cameras was associated with a 3.64% increase in fatal police shootings of civilians. The use of dash cameras did not reveal a statistically significant relationship with the number of fatal police shootings of civilians. The authors hypothesized that police may be less reluctant to use deadly force given camera footage to the contrary has not hampered police claims of justifiable homicide [92]. Also due to law enforcement protections, body cameras do not ensure transparency or accountability, since there is no guarantee that law enforcement agencies must make that information publicly accessible.

Issues of protocol and intentional sabotage raise additional serious questions about the efficacy of body and dashboard-mounted cameras in decreasing law enforcement violence. A combination of inconsistent, unclear, and nonexistent protocols regarding when to activate body cameras may give officers discretion over their use and lead to selective recording. In fact, one third of police departments using body cameras do so without written policies [93]. As a result of these policies (or their absence), cameras may not be activated during critical moments. Recordings may also be deleted by police with a recent examination of dash-camera video footage in Chicago showing that 80% was missing sound due to error and “intentional destruction” [94]. Even when key events are recorded, these videos do not necessarily increase accountability. High-profile examples include the cases of Eric Garner and 12-year-old Tamir Rice, whose deaths were recorded but did not lead to indictments of the officers involved. In instances in which a code of silence is institutionalized and structural barriers to accountability exist, such as the LEOBoR, the use of video will not ensure public safety.

Another oft-touted reform is mandatory training to reduce implicit bias of law enforcement officers against communities of color. This training is predicated on the understanding that officers’ decisions to use force are influenced by unconscious biases, such as associations between Black individuals and criminality [95]. While the existence of these biases is well established, little is known about their actual effects on behavior [95]. Furthermore, no experimental studies have attempted to measure the impact of implicit bias reduction interventions on law enforcement officers [96].

Other methods of training police have been proposed to decrease police use of force including Crisis Intervention Team (CIT) training and generalized de-escalation training. CIT-trained officers are taught to recognize people suffering from mental illness crises, de-escalate the situation, and link these people with mental health care rather than arrest. Data on CIT shows, in general, more diversion from arrest and, instead, linkage to services [97a]. There is less data on the relationship between CIT training and use of force, but one study suggested that CIT training also results in less application of force during the initial encounter [97b]. While this data is hopeful, it has its limitations. CIT training traditionally has only applied to individuals perceived as suffering from mental health crises. In addition, much of the data is not based on actual policing outcomes with citizens, and is instead from surveys of officers based on scenarios in the classroom [97a].  

Officers generally receive limited de-escalation training—one study found that for every one hour of de-escalation training officers received, they had eight hours of force training [98]. There has been a national push over the last 4 years to increase de-escalation training for police officers in the hopes of decreasing use of force by the police. This has been met with resistance from police chiefs and the national Fraternal Order of Police [99]. Leaders from these groups have pointed out that de-escalation training and the current force training are diametrically opposed, and have expressed fear that hesitation to use force may put officers’ lives at risk. The press, and others, frequently use Dallas, Texas as an example of successful implementation of de-escalation techniques. The Dallas Police Department’s internal data shows that in 2009 the department received 147 excessive force complaints and made 74,000 arrests, but after implementing annual de-escalation training, within three years arrests were down to 61,000 and within five years excessive force complaints were down to 53 [100]. In response, many scholars point out that these evaluations are methodologically limited, failing to control for multiple other factors such as the police department’s use of body cameras, decreased crime rates, complaint fatigue on the part of the citizenry, slower 911 response times, and so on. Formal, independent studies with control groups are necessary to determine the effectiveness of this training approach. Whether de-escalation training, in the context of training that emphasizes on use of force, will actually lead to less law enforcement violence, remains to be seen.

Lastly, one must also consider the investment of money and resources required to conduct additional police training, particularly given that police departments are already so well resourced. If such training is to be implemented, funding should come from existing law enforcement budgets, leveraging savings resulting from eliminating enforcement of laws that do not promote public safety.

Of note, President Obama’s Task Force Report on 21st Century Policing recommends further officer training as well as COPS and body and dash cameras. It does not incorporate upstream, public health strategies to address root causes of law enforcement violence. While it acknowledges the unrealistically ever-expanding responsibilities of police officers and that policies related to issues such as drug use, sentencing, and incarceration affect policing, it unfortunately deems these policies to be “beyond the scope of a review of police practices” and does not make specific recommendations in their regard. Nonetheless, this acknowledgement lends support for the proposal of an upstream, public health strategy to address law enforcement violence that instead focuses on reducing law enforcement presence in people's lives altogether while striving for community-based alternatives [101].

In all, this statement aims to make clear that efforts to incrementally improve police behavior are at best inefficient and at worst, perpetuate harm. The problematic notion that intensive police presence is the antidote to inequality is inherent in these opposing arguments. Even if some of the strategies reviewed in this section demonstrate some benefit, they fall short of addressing the fundamental causes of the issues that law enforcement are deployed to address. Moreover, they obscure the fact that police presence in marginalized communities is about maintaining control. By contrast, this statement seeks to mitigate the detrimental health effects of police violence by calling for an upstream, public health approach.

Conclusion

While public safety is surely essential for public health, as a society we have delegated this important function almost exclusively to the police. Evidence shows that US policing has failed to deliver safety, placing an inequitable burden of harm -both mental and physical- on socially and economically marginalized populations. Indeed, as argued by Geller et al., “any benefits achieved by aggressive proactive policing tactics may be offset by serious costs to individual and community health” [4]. Community-centered strategies for addressing harm and violence have the potential to increase public safety without the violence associated with policing. Investment in these strategies, as well as those that address racial and social inequities, provide a promising way forward toward strengthening communities while reducing the harms associated with policing.

Action Steps

Therefore, APHA:     

  1. Urges federal agencies, localities, and states to add death or injury by legal intervention to their list of reportable conditions, including the CDC adding legal interventions to their list of Nationally Notifiable Conditions. More specific criteria should also be created to clearly delineate surveillance protocols of legal interventions and include other law-enforcing agents beyond law enforcement officers, in order to allow federal, state, tribal, and local public health agencies to better serve as timely independent monitors of law enforcement violence.
  2. Urges that Congress fund the National Institute of Justice and the Centers for Disease Control and Prevention to conduct research on the health consequences, both individual and community-wide, of police violence, particularly exploring the disproportionate burden of morbidity and mortality among people of color; people with disabilities or mental illness; people who are experiencing homelessness; gay, lesbian, bisexual, and transgender populations; and immigrant populations.
  3. Urges that Congress also fund the National Institutes of Health to study the effectiveness of policy- and program-based interventions that may decrease law enforcement violence, including decriminalization, increased investment in social determinants of health, and community-based alternatives that promote public safety, such as violence intervention and restorative justice.
  4. Urges federal, state, tribal, and municipal governments to fund programs that meet human need, promote healthy and strong communities, and reduce structural inequities (economic, racial, and social)--such as employment initiatives, educational opportunities, affordable housing, and other social goods--including by using resources currently devoted to law enforcement.
  5. Urges federal, state, tribal, and municipal governments to advance equity and justice by decriminalizing activities shaped by the experience of marginalization, and eliminating police enforcement of regulations designed to control marginalized people , including but not limited to drug use and possession, sex work, loitering, sleeping in public, minor traffic violations (e.g., expired registrations, jaywalking, not signaling a lane change, broken taillights), and residing in the United States without documentation; and to also ensure that decriminalized offenses don’t lead to collateral offenses. An existing precedent is the Massachusetts’ Decriminalization of Misdemeanors Law.  
  6. Urges federal, state, tribal, and municipal governments and law enforcement agencies to engage independent organizations in a review of law enforcement agencies’ formal and informal policies and practices in order to eliminate those that lead to disproportionate violence against specific populations. Examples of such policies and practices may include racial and identity profiling, stop and frisk, gang injunctions, and enforcement of laws that criminalize homelessness.
  7. Urges federal, state, tribal, and municipal governments to divert funding from law enforcement agencies to community-based programs that address violence and harm without criminalizing communities, including mental health intervention, violence prevention and intervention, and conflict mediation programs, particularly in the communities currently most affected by police violence.
  8. Urges federal, state, tribal, and municipal governments and law enforcement agencies to reverse the militarization of the police, including by eliminating the acquisition and use of military equipment and reducing the number of SWAT teams and the frequency of their deployment.
  9. Urges state legislative bodies to eliminate legislative provisions that shield police officers from investigation and accountability and  urges municipal governments (both executive and legislative branches) to negotiate police union contracts to eliminate barriers to identifying, investigating, and addressing possible police misconduct.
  10. Urges law enforcement agencies and oversight bodies, in partnership with public health researchers, practitioners, and ethicists to review and to strictly enforce police guidelines, including codes of ethics, and international human rights standards, with strong disciplinary measures for the abusive or negligent use of force and firearms.
  11. Urges law enforcement agencies and oversight bodies to provide full public disclosure of all investigations of police brutality and excessive use of force as well as access to recordings of any incidents in question, which should be deemed public property. These materials could be made public through an online database.

Appendix A: Glossary Terms

  • Violence: Consistent with the World Health Organization domains of violence, law enforcement violence has been conceptualized to include physical, psychological, and sexual violence as well as neglect (i.e., failure to provide assistance) [17, 22, 103]. Psychological violence includes stops with little probable cause, as well as verbal abuse [22]. While all forms of violence are important to consider, this statement focuses on physical and psychological violence.
  • The Department of Homeland Security Bureau of Immigration and Customs Enforcement (ICE): the largest investigative unit under DHS; it works with other federal and local law enforcement agencies—including local police departments—to enforce migration policy [18].
  • The Counted: draws from official US databases, media outlets, social media, and crowdsourced websites (such as Fatal Encounters and Killed by Police) to deaths attributable to direct encounters with law enforcement, including, “people who were shot, tasered and struck by police vehicles as well as those who died in police custody” [1].
  • Thin blue line ideology: according to Chicano historian Edward J. Escobar (1999) in Race, Police, and the Making of a Political Identity: Mexican Americans and the LAPD, 1900-1945, “Chief of Police William H. Parker Described the LAPD as ‘the thin blue line’ that stood between civilization and chaos” [104]. This idea assumes that social problems are due to concentrations of ‘pathological’ people in certain areas, and require police to keep 'those' people from harming others. This ideology takes people-with-problems and represents them as problems to be suppressed, detained, or deported, and fails to examine fundamental social-structural issues that linked with unwanted behaviors, and, as such, fails to consider complex strategies to resolve these issues. Moreover, this way of viewing people and issues of safety is countered by a public health approach of addressing social and structural determinants of health.
  • War on drugs: “President Reagan officially declared the current drug war in 1982, when drug crime was declining, not rising. From the outset, the war had little to do with drug crime and nearly everything to do with racial politics. The drug war was part of a grand and highly successful Republican Party strategy of using racially coded political appeals on issues of crime and welfare to attract poor and working class white voters who were resentful of, and threatened by, desegregation, busing, and affirmative action. In the words of HR Haldeman, President Richard Nixon’s White House Chief of Staff, ‘[T]he whole problem is really the blacks. They key is to devise a system that recognizes this while not appearing to” [36].
  • COPS: a tactic based in the criminal justice system with little to no evidence towards crime prevention.  Thus, this statement instead proposes recommendations based in the practice of public health -such as, incorporating community-based alternatives to matters undermining the public’s health.

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