Should Police Violence Be Viewed as a Public Health Issue?

This piece has been updated to correct information regarding the  American Public Health Association’s position and action.

On Dec. 2, 2017, community members gathered to mark the second anniversary of Mario Woods’ death. Gwen Woods, hands on her hips and donning a T-shirt with her son’s face on it, marched the crowd down the T-Sunnydale streetcar tracks on San Francisco's Third Street to the site of her son’s death.

“I can’t let it go, you guys, because he didn’t deserve that,” Woods said, tears streaming down her face, after arriving at the site. “One thing I taught him, no matter what the plight, you have a voice. We all have a voice.”

The impact of her son's death sent shock waves throughout the community, which is still mourning his death.

Some local health professionals are advocating that the impact of police violence should be studied and treated as a public health issue. Advocates say people of color are the most at risk, yet the responsibility for providing healing resources has fallen on community members to take care of their own.

"There is a disconnect between more traditional public health and the growing field of health equity," said Sari Bilick, public health organizer at Human Impact Partners. "[There's] the folks who are really trying to transform the field of public health to look at health inequities that exist, versus the people who are more in the traditional field of public health that looks at health as a result of genetics and individual behaviors."

No Longer Written Policy

In November, the American Public Health Association governing council voted against permanently adopting a policy statement that identified a four-part strategy for preventing law enforcement violence, which the statement called a “significant” public health issue across the country.

The policy statement was temporarily adopted last year, but came up for vote again at the APHA’s last annual meeting. The association's governing council voted 65 to 35 percent against the policy's adoption, although there was a strong showing of support by some APHA members who held a rally and wore pins for the policy at the conference, according to Bilick.

"The fact that they're not passing this statement that directly impacts black and brown communities sends a message that they're not willing to stand up for those communities," Bilick said.

However, the APHA’s Joint Policy Committee reviews proposed policy statements and makes recommendations to the governing council prior to the vote to determine if the statement is evidence-based and meets the submission guidelines. The committee advised against the council’s adoption of this policy with a call for substantive improvement.

“These are people’s bodies, that’s our jurisdiction,” said Rupa Marya, faculty in the division of hospital medicine at UCSF and organizer with the Do No Harm Coalition. “I think that in general the governing bodies of the APHA are largely white, and they’re largely not affected by police violence."

The “Law Enforcement Violence as a Public Health Issue” policy statement has since been removed from the association's website.

"In this moment, I think it's really important that, as the largest public health organization, APHA takes a bold stand and doesn't shy away from publicly condemning police violence," Bilick said. "If the biggest public health org in the country takes a stand on it, that will prompt more research, more journal articles, more responses within public health to police violence."

A rewritten version of the statement is slated to be presented in fall 2018, according to Megan Lowry, a spokeswoman for the association.

Though the APHA’s policy statements shape the association’s stance on a wide range of public health topics, it does not necessarily mean the APHA is against the topic or aim of a proposal that is not adopted.

“We have policy statements on the books that allow us to address many aspects of this issue,” the association’s executive director, Georges Benjamin, said in an interview with The Nation’s Health. “Police violence is absolutely a public health issue that we have been working on for many years and one we will continue to work on.”

The association is convening a work group of members to create a new policy statement about the issue for a future vote that meets the evidence-based standard in order to pass, according to Benjamin. He said the APHA "will continue to speak out and work to protect the public from police violence."

In the meantime, there are not enough studies addressing the relationship of police interactions to people’s health or exploring prevention techniques, according to Rhea Boyd, a pediatrician who practices in Palo Alto. But she hopes the health community will still take action based on the evidence that is available.

“We don’t need data to start doing things about it,” Boyd said. “I think we can use data that we already know about exposures to violence. We can use data that we already know about racial disparities in police interactions and just put two and two together and start putting together initiatives to actually start addressing it.”

A Local Stance?

On a local level, Boyd and other health advocates penned a letter to the San Francisco Police Commission to urge the city to create a coordinated effort to address all acts of violence, including police violence.

“I think there’s a lot of city agencies that would benefit from the conversation,” Boyd said. “Given the stature of the health department and the police department, they have the power to do more and to convene meetings to make a prioritized list of how we might go about this.”

This led to the Police Commission encouraging then-Mayor Ed Lee to facilitate a wraparound effort of the Police Department, Police Commission, Department of Children, Youth and Families, Department of Public Health and other city agencies to create a better public health response to violence.

“Without a meaningful public health response that intervenes in the cycle of violence, too many of our communities will continue to experience the predictable, poor outcomes that come from sustained exposure to chronic adversity and trauma,” the letter said.

It was in December 2015 that SFPD officers shot and killed Mario Woods in the Bayview district. His death spurred an uprising of community action, use-of-force reforms and a Justice Department review of the police department.

The SFPD also adopted a memorandum with the Department of Public Health for a coordinated approach when dealing with incidents that involve people in crisis, creating a Crisis Intervention Team.

Police commissioner Joe Marshall said he is not aware of any meeting between the agencies listed in the letter to address the topic at hand, though the creation of the CIT shows effort.

“I think the department has reached out in the spirit of what they suggested in the letter to create a spirit of practices that are actually put in place by using the best in public health thinking,” Marshall said. “Those things that have happened are major and have gone way beyond what was suggested in that letter because they've now become either policy or practice.”

While Boyd said the CIT and joint trainings are a step in the right direction, the effort her group hoped for hasn’t come to fruition when specifically addressing police encounters.

“Those programs can be expanded, not just to individuals who have mental illness but to everyone, really,” Boyd said. “If you would rather, when a crisis shows up in your home, have a neighbor respond to your crisis rather than an armed, militarized officer, then I think that needs to be a new service line that a collaboration between our health departments and our police departments could provide.”

The San Francisco Public Health Department declined to comment about police violence for this article.

A Long-Term and Pervasive Impact

Asantewaa Boykin, a registered nurse and co-founder of the Anti Police-Terror Project, recalls her earliest memory of the police. It brings her back to being a young girl, as she watched an officer’s dog chew through a neighbor’s leg.

She still has nightmares about it.

“As someone who understands what witnessing violence does to health, as somebody who thinks through the greater implications of any one act of violence in a community, that certainly it affects the victim who’s involved,” Boyd said. “But it has collateral damage to the immediate community and to all those who are now at risk because that type of violence is deemed in some ways acceptable or OK.”

Images of police use of force reach farther than ever before. In some cases they appear at the touch of people’s fingertips while scrolling through their news feeds, and in some cases they’ve even appeared in real time on Facebook Live.

“When you talk about trauma, [it can occur] knowing that someone down the street got murdered by police ... or when these videos go viral, and you think about how many people are impacted by these videos,” said Boykin.

The first steps toward creating accessible healing for the communities who are most impacted by police violence begin with bringing in more diverse therapists and tailoring services toward the people who most often need them, according to Boykin.

According to the U.S. Department of Labor’s 2016 statistics, 5.8 percent of psychologists are African-American, 4.2 percent are Asian and 6.9 percent are Latino.

“I know, for instance, I’ve seen a therapist, and I’m much more comfortable if that person resembles me,” Boykin said. “The traditional Western sense of therapy is not something that a lot of people of color can identify with or feel comfortable with.”

Taking Research into Their Own Hands

Marya has teamed up with other health professionals to take a study, requested by the Justice for Mario Woods Coalition, into their own hands. They plan to explore levels of trauma faced by communities impacted by police violence, especially in cases where people do not feel they experienced justice.

“I have yet to hear anyone at the Department of Public Health in San Francisco speak up about these issues in a concerted, consistent way, to be that voice in the city demanding that not only are the police trained differently, but that there’s some accountability and transparency,” Marya said.

The "justice study" will begin with an online survey that Marya and her team members will analyze.

A separate study that was published last year, titled “SOS: Stress on the Streets,” explored police practices in Ohio with a specific focus of the impact on black people. The study was conducted by three nonprofit organizations: Human Impact Partners, Ohio Justice and Policy Center and Ohio Organizing Collaborative.

“This report shows that for many black people in the United States the perceived color of their skin means more uneasy interactions with police than others in our society, and stress and anxiety that in turn result in poorer physical and mental health,” it reads.

The report’s recommendations rang true with the calls from local health advocates: Involve public health departments to enhance transparency and study the health impacts of policing practices and help resolve systemic issues.

But Bilick said this approach is not apparent in most local public health departments.

"That first step of getting public health departments to even prioritize this as something that they should be collecting data on is a big jump from what people are doing now," Bilick said.

The Question of the Role of Police

There are differing opinions as to whether police have a place in collaboration with health providers in the healing process from their impact.

Although Boykin would like to see more health care professionals facilitate healing from trauma induced by law enforcement, she does not want police institutions to be involved.

“That’s like asking someone who has been abused to go sit down and have a conversation with the person that abused them,” Boykin said. “We would not apply that equation in any other situation. It would be considered ridiculous.”

Marshall, on the other hand, believes police should be involved. “Absolutely, because they’ve caused a lot of damage,” he said. “This is what I tell people. Police aren’t going anywhere. So you gotta make it work. You gotta change it if you want to make it work.”

The next important focus for the department, he said, is getting all officers trained in crisis intervention. Currently about a quarter of the department is trained. He added, “I think we’re making strides here, but it's something you have to work at all the time.”

And some believe the police have more work to do when it comes to reform and transparency to allow people to truly heal.

“Without that accountability, there’s no reason for people to feel like they’re safe within their communities,” Marya said.

Community Fills the Gap

Thirty years ago, Marshall co-founded an organization, Alive and Free, which created a unique approach to addressing trauma in young people. He authored a prescription that treats violence like a social disease by identifying and addressing risk factors.

“Therapy is a bad word to them because they’ve been involved with therapists who look at them like they’re crazy,” Marshall said.

Through weekly peer meetings, he creates a sense of trust.

Marshall said he sees therapy-like results without labeling the meetings as such. It has become an outlet for young people to talk about issues they face without feeling judged.

“They’ve been to funerals, the neighborhood is decimated, death is all around them, their fathers are in jail and now they have a lot of emotional residue,” Marshall said. “These young people are faking it all the time because they’re hurting all the time. This is literally the walking wounded pretending like they got it all together. They don’t.”

Boykin, co-founder of the APTP, also helped to create an group with a goal of sustainability.

The coalition focuses on ending murder and violence against communities of color by law enforcement agents. Boykin described it as a multigenerational and multi-ethnic group of organizations and community members that is “unapologetically black-led.”

“It kind of started to feel like we were waiting for black folks to be murdered by police and then we were reacting to that murder, versus doing something that was sustainable,” Boykin said.

The coalition trains first responders to teach them how to treat injuries, conduct trauma-informed investigations and connect people with support and means of healing. The group believes this approach works as a preventative measure that addresses the need for healing before and after anticipated trauma.

They provide those affected by police violence with their database of healers, such as acupuncturists, marriage family counselors, nurses and massage therapists to make available for victims and their families. The coalition holds monthly support groups with leaders who are people of color.

Still, health advocates hope to alleviate some of this responsibility that has fallen on the community.

“It’s our job as health care professionals,” Boyd said. “This is the gap where community organizing has stepped in, but the weight of this belongs on health care professionals.”

Boyd also believes that health care professionals have the responsibility to give validity to the mental and physical effects police violence has on communities.

“All of the rest of the people who hold fear, who hold shame, who don’t feel secure in their daily environment, that’s real and it’s not in your head,” Boyd said. “And it could affect you long term, and I think people are owed something because it will affect them long term.”