A Public Health Proposal For Modern Policing  

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Aligning some of the functions of public safety and public health can improve the way that policing operates in the U.S., and absolve the “iatrogenic” harms caused by the criminal justice system, says a paper published in the Journal of Community Safety and Well-Being.

According to the paper’s authors, Fellows of the Health in Justice Action Lab, acknowledging that a police action has been iatrogenic―a medical term referring to inadvertent harm caused by a physician, but which has been applied to criminal justice―is a first step towards increasing law enforcement accountability.

Policing that places more emphasis on deterrence and incapacitation rather than rehabilitation and retribution, can aggravate problems like homelessness, mental distress and drug use that often bring individuals into contact with law enforcement.

But a public health approach informed by behavioral health and science can have a positive effect, says the paper, based on conversations from the 6th International Law Enforcement & Public Health (LEPH) Conference, which was held virtually this year in March.

The article was written by Jeremiah Goulka and Leo Beletsky, joined by post-doctoral researcher and former Vermont police chief Brandon del Pozo.

The authors call for establishment of a “common language” between health and law enforcement personnel that could align their goals and work more closely.

“Policing has often been impervious to evidence demonstrating that some practices are ineffective or harmful, or that interventions with proximate positive effects foster negative ones that manifest in the long term,” the paper said.

“The public health–informed approach will require building a willingness to change based on evidence.”

Historical measures of police work, like increasing the number of arrests or the seizure of guns and drugs have little to no relationship to crime rates, said the paper.

The paper lays out four steps that could help bring policing and public health together in a way that minimizes harm.

The first step “would commit police to acting based on evidence rather than the simple prerogatives afforded by law, and to use caution when the endpoints being pursued are minor,” said the authors.

An End to ‘Healthwashing’

According to the article, law enforcement has a tendency to “healthwash” policies to make them appear as working in the advancement of public health, even though still continuing to iatrogenically harm the community.

The authors use the criminalization of drugs in the name of public health as an example.

Like medical professionals, law enforcement is supposed to “protect citizens, help communities, and avert even greater harms,” said the authors.

“If Americans are anxious for police leaders to reframe their work in a sweeping way, health care providers and public health officials can supply the language, methods and metrics that would help them do so, while affirming the core police responsibilities of protecting life and helping communities thrive.”

The second and third steps focus on shifting some current police functions concerning situations of drug use or mental health emergencies to other workers, such as social workers or health professionals.

In the case of a mental health emergency, the authors suggest that it might be more effective for law enforcement to co-respond to situations with mental health professionals, and even defer to a social worker, depending on how dire the situation was.

“Like general practitioners referring patients to specialists, police can vector people to interventionists or hubs that will provide the proper services, with the proper training and resources,” said the authors.

However, situations concerning drug use or abuse should almost always be directly handled by specialists, said the authors, observing that the historic police response to drug crimes has been “a dismal failure.”

The last proposed step is to increase support for evidence-based health services as alternative to harsh policing tactics.

“In the same way medicine should minimize the number of patients it needs to treat to preserve health, police should minimize the number of interventions necessary to promote safety,” said the authors.

The authors noted that while many police departments across the country claim to prioritize public health, few actually do.

While a public health-policing shift would benefit the community as a whole, it would especially help persons of color, who are more likely to have a dangerous interaction with the police than a white person, the authors said..

“These crises provide tragic support for the increasingly widespread acknowledgement that racism is a public health emergency and the growing contention that policing is one, too,” said the authors.

“Policing is viewed by most officers as a type of treatment meant to secure or preserve public safety, but taking this idea seriously means acknowledging that, like chemotherapy, even the best-intentioned treatments can cause harms.”

Editor’s Note: A growing number of police departments across the country are already partnering with mental health professionals in so-called “Crisis Intervention Teams.”

Access the full report here.

Additional Reading: Can U.S. Policing Be Saved?

Emily Riley is a TCR justice reporting intern.

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