Law Enforcement Violence as a Public Health Issue

  • Date: Nov 01 2016
  • Policy Number: LB-16-02

Key Words: Violence, Gun Violence, Minorities, Injury Prevention Control, Racism


Harassment and violence by law enforcement officers result in deaths, injuries, trauma, and stress, which disproportionately affect people of color and other marginalized populations such as immigrants, individuals experiencing homelessness, members of the LGBTQ (lesbian, gay, bisexual, transgender, queer) community, and individuals with mental illness. Officers are rarely held accountable for acts of violence and harassment for several reasons, including an insular police culture, laws that interfere with investigation and prosecution around misconduct (e.g., the Law Enforcement Officers’ Bill of Rights), and insufficient civilian oversight. Numerous laws and policies have the effect of promoting and intensifying harassment and violence toward specific populations by police, including anti-immigrant legislation, policies associated with the “war on drugs,” the criminalization of sex work, and the criminalization of behaviors associated with homelessness. While some argue that rates of violence and harassment can be reduced by implementing strategies such as community-oriented policing or increasing the use of technological tools such as body- or dashboard-mounted cameras and conducted electrical weapons, limited evidence supports the effectiveness of these approaches. Instead, a public health strategy for preventing police violence and harassment should incorporate four main elements: decriminalization, robust police accountability measures, increased investment in policies promoting racial and economic equity, and community-based alternatives for addressing harms and preventing violence and crime, such as community-run 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 9815: Impact of Police Violence on Public Health (this policy statement updates that 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 9929: Diversion from Jail for Non-Violent Arrestees with Serious Mental Illness
  • APHA Policy Statement 200914: Building Public Health Infrastructure for Youth Violence Prevention
  • APHA Policy Statement 20128: Opposing the DHS-ICE Secure Communities Program
  • APHA Policy Statement 201311: Public Health Support for People Reentering Communities from Prisons and Jails
  • APHA Policy Statement 9926: Support for Research on the Socioeconomic Causes of Violence

Problem Statement

Prevalence, impacts, and inequities: Harassment and violence by law enforcement officers is a significant public health issue. According to the UK Guardian, at least 1,140 individuals 6–87 years of age were killed by law enforcement officers in the United States in 2015.[1] In addition, in 2013, there were more than 100,000 injuries caused by law enforcement officers that resulted in hospitalizations or trips to the emergency department.[2] The Centers for Disease Control and Prevention estimated that the overall cost of deaths and injuries reported in 2010 was $1.8 billion when considering both medical costs and work lost.[2]

Negative impacts are not limited to adults or to street-based encounters. Evidence is emerging that children and teens in schools are injured by in-school police officers; a review of news and advocacy group reports revealed that at least 28 serious injuries—including two cases of brain injury—occurred in schools between 2010 and 2015.[3]

In addition to physical impacts, individuals may suffer mental health consequences after witnessing or being part of negative encounters with police, including symptoms of anxiety and posttraumatic stress disorder, especially if the incidents are perceived as unfair or discriminatory.[4,5] These effects may be particularly acute among people of color; for example, one study showed that Black individuals were more likely to report stress as a result of encounters in which police used or threatened violence.[5]

Another study revealed that, across a range of neighborhoods in New York City, police presence and the associated perceived threat of harassment or violence by police was considered a top neighborhood stressor.[6] When individuals are killed by police, the family members left behind experience mental health trauma; news accounts have documented intense feelings of grief and anger and the burden of defending the loved one’s character amid reports that his or her death may have been justified.[7] In summary, aggressive policing is “a threat to physical and mental health.”[4]

Several populations already at increased risk for negative health outcomes suffer from disproportionate rates of harassment and violence by police. In 2015, Black, Latino, and Native American populations were killed at higher rates than White individuals.[1] Black individuals, as a whole, are more than twice as likely to be killed as White individuals, while young Black men are more than five times more likely to be killed 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.[8,9] Other groups that are highly affected by police harassment and violence include transgender, lesbian, gay, and bisexual populations; individuals with mental illness or with mental or physical disabilities; individuals experiencing homelessness; and immigrants.[1,10–13] In schools, similar patterns are apparent; students who are Black or Native American and students who have disabilities are more likely to be referred to law enforcement or to be arrested.[14]

It should be noted that although the best available data have been provided above, comprehensive information on deaths, injuries, mental health impacts, and frequency of encounters with police is scarce. Currently, the UK Guardian’s website is the most comprehensive and timely source of data on killings by US police.[15] While the Federal Bureau of Investigation (FBI) collects data on police-involved killings, it relies on voluntary reporting from police departments, resulting in significant undercounting.[1] However, as Krieger and colleagues argue, such data could—and should—be gathered by public health officials via existing mechanisms.[15]

Shootings of law enforcement officers are also an important concern, particularly in the wake of attacks targeting police, such as the ambush resulting in the deaths of five Dallas Police Department officers in July 2016 and the attack on three officers in California in October 2016.[16] The killings of officers are tragic and must be prevented. In 2015, 51 law enforcement officers were killed in “felonious” incidents (i.e., they were shot, assaulted, or struck by a car).[17,18] The safety of police officers must be maintained, and this should not prevent lawful actions to address the problem of police violence.

Racist policing as a mechanism of social control: The disproportionate rates of harassment and violence by police against people of color and other marginalized communities are founded on a history of racism and classism, much of which was written into laws.[19] Policing was necessary to “regulate threats to the interests of the powerful” in order to maintain class and racial inequality.[20] 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.[21] Many of these same populations continue to be targeted by police today, including people of color, immigrants, sex workers, and those using substances—groups whose behaviors were (and are) perceived as “disorderly”[4] and whose very existence as threatening. Early policing espoused a belief that crime originated from inherently “bad” individuals rather than from social and economic conditions.[21] This “blaming the victim” ideology has persisted to the present but is now countered by the public health approach of addressing social and structural determinants of health.

For example, institutional racism is a determinant of health that contributes to high rates of poverty and unemployment among communities of color, in turn leading to the kinds of illegal activities that, when seen in isolation, can make police presence appear justified. Studies examining predictors of police force size provide evidence that policing exists to uphold existing hierarchies. Communities of color with cultural dissimilarities are seen as a threat to the social order, and thus the criminal justice system is used as a mechanism of control.[22] The proportion of the population that is Black and the size and expansion of groups of color are associated with police force size in a given municipality, independent of crime rates.[22–24] For instance, police force size in states bordering Mexico has increased as the Latino population has grown.[25] Class and inequality matter as well; in a recent analysis of 66 cities with populations above 250,000, the absolute number of individuals of color in a city was not as important as economic disparities such as median income differentials between Whites and individuals of color.[23]

The so-called “war on drugs” marked important developments in policing as a form of social control of communities of color. A conservative reaction to the gains of the civil rights movements, the “tough on crime” rhetoric was a thinly veiled racially coded appeal to working-class Whites.[26] But the “war on drugs” was more than rhetorical: 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.[26] One critical element was the shift in the meaning of the Fourth Amendment such that “reasonable suspicion” rather than “probable cause” could be grounds for police searches, which became the justification for racist policing in New York and Washington, DC.[8] Under these policies, anyone in areas identified as sites for drug dealing, which were primarily Black and Latino neighborhoods, could be stopped and searched. By incentivizing drug arrests, loosening restrictions on searches, and creating a culture that encouraged police to constantly stop and search people of color going about their daily business, the federal government brought millions of people under the scrutiny of law enforcement and into the criminal justice system.[26]

These policies contributed to increasing racial disparities in incarceration rates and directly influenced the mass incarceration of Blacks and Latinos. Black Americans constituted nearly 1 million of the 2.3 million individuals incarcerated in 2008; Blacks and Latinos combined accounted for 58% of the prison population.[27] A study conducted by the Virginia Bioinformatics Institute showed that the increase in imprisonment of Black males since 1980 has not been matched by a similar increase in Black male criminality.[28]

While the issue of mass incarceration intersects with the problem of racist overpolicing and police violence in many ways, one pathway involves the rise of private prisons. Mass incarceration has created fiscal issues in many states, with the annual cost of a single prisoner starting at $30,000 per year.[29] Some local governments, struggling to balance their budgets, have turned to the private prison sector. Private prisons, which are run as a business for the sake of shareholder profits, often have operating parameters, such as a guaranteed 80% occupancy rate at all times, written into their contracts with states.[26] This situation creates economic incentives for states to increase sentencing for minor infractions, which leads to overpolicing and may lead to increased police violence, often in communities of color.

Laws that apply disproportionately to other marginalized communities similarly increase their contact with police and risk of harm. For example, the criminalization of homelessness through local and state laws prohibiting loitering and sleeping in public spaces has led to heavier policing of people experiencing homelessness.[10] The Western Regional Advocacy Project has collected nationwide data demonstrating the ongoing harassment and needless suffering of those experiencing homelessness as a result of arrests for sleeping in public places.[30] For those experiencing homelessness, arrests may disrupt sustained employment and public benefits; result in expensive court costs, which reduce their chances of securing housing; and lead to incarceration.[31] Laws that criminalize the implicit actions involved with the experience of homelessness not only are costly to enforce but perpetuate homelessness and violate basic human rights.[32]

The criminalization of sex work likewise results in high rates of police harassment toward sex workers and toward transgender individuals, who are often assumed by officers to be sex workers.[11] Similarly, federal pressure on local police to enforce immigration policies has increased contact between immigrant communities and police.[10] These laws place police in direct conflict with communities that they ostensibly serve, which confounds potential reform efforts to reduce police harassment and violence.

Laws that lead to discriminatory practices are even more concerning given the reversal of the Posse Comitatus Act, which led to militarization of the police.[8] This change allowed military training and weapons to become the tools of police forces, while use of SWAT teams increased.[8] The impact is seen in more violent tactics used by law enforcement officers, which are disproportionately applied to people of color and other marginalized communities.[8]

Barriers to accountability and reform: Several cultural and formal barriers impede accountability for use of force and harassment against civilians and obstruct meaningful reform. This impact is illustrated by the fact that a mere 47 police officers—an average of five per year—were charged with a crime for their involvement in killings that took place between 2005 and 2011, and only 11 of those 47 have been convicted.[33] Cultural barriers to accountability and reform 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.[34] Although little research has been done on the topic, 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.”[34] News reports reveal instances of misconduct consistent with these cultural norms; officers have 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.[35,36]

Laws and policies that protect law enforcement from investigations and disciplinary action further insulate police who use excessive force from punishment or other consequences.[37] 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.[38]

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, or both.[39] Limited independence can occur when these bodies are forced to rely on civilian investigators who are embedded within police departments and thus become more biased toward police over time or when civilian bodies are allowed only to make recommendations and must count on members of the police force to carry out these recommendations.[39] 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.[39]

As noted by Garcia and Sharif,[40] 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 without any repercussions.” 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 overpolicing of communities of color.

Evidence-Based Strategies to Address the Problem

A critical first step in addressing the rates of harassment and violence by police is to repeal laws that promote or justify increased scrutiny of specific populations, thus redefining what falls under the purview of the police. Such laws include those relating to drug use or possession, sex work, activities associated with homelessness (e.g., loitering, sleeping in public spaces), and immigration. The logic is simple: removing justification for law enforcement intervention will reduce negative contacts between the police and individuals whose activities are currently criminalized. Crimes should not simply be downgraded to lower-level offenses; 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.[41] A notable exception is Massachusetts, where courts ruled to limit police enforcement of marijuana possession. Between 2008 and 2010, arrests fell by 86%.[41]

A second key strategy to reduce harassment and violence by police is to address the root causes that lead to crime and to contact with the police, including unstable housing, economic inequity, limited educational opportunities, and racial discrimination. Political analysts have long acknowledged the connection between social conditions and violence. In 1967, the Kerner Commission identified inadequate housing and education, high unemployment rates, and racial discrimination as key factors leading to violent clashes between Black populations and the police and recommended improved access to social resources and the end of discriminatory policies as critical steps to prevent further unrest.[42] The field of public health has been exploring the connection between violence and social circumstances for decades while acknowledging that further research is needed.[43] APHA has recognized stable housing as a key intervention to decrease recidivism among the formerly incarcerated and has called for “access to services, benefits, and civil rights, such as food subsidies, public housing, voting rights, health care, and employment,” as a means to reduce rates of recidivism.[44]

Across the United States and internationally, “housing first” approaches to homelessness have been used as an alternative to criminalization. In 1993, the Board of Commissioners in Miami-Dade County, Florida, created the Miami-Dade County Homeless Trust. The trust dedicated 1% of alcohol and beverage sales to homeless and housing services.[45] In addition, a 10-year plan was created to end homelessness and address new priorities: housing first and rapid rehousing. The program reduced the street homeless population from 8,000 to under 800.[45] Interactions with police officers and arrests, unfortunately, have not been tracked since the program’s implementation; however, one can assume that a decrease in homelessness reduces the number of interactions with police. Similar programs exist in Houston, Texas, and Salt Lake City, Utah.[46,47] A randomized controlled trial examining a housing first intervention in Toronto 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.[48]

While the need for intervention might be significantly reduced through greater social and economic equity, interpersonal harm will still exist, and therefore strategies to ensure community safety and security will 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. Community-based violence intervention programs targeting behaviors, attitudes, and social norms related to gun violence have been found to significantly reduce homicides and nonfatal shootings in urban neighborhoods with the highest numbers of incidents.[49–51] These programs have had success employing unarmed street outreach workers who are current or former neighborhood residents and have been able to diffuse potentially harmful or violent situations with no, or minimal, intervention by police.[49–51] 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.”[52] Restorative practices have been implemented as part of the criminal justice system at various phases, as well as in schools and community-based settings, and they have become well established in the United States, Canada, the United Kingdom, Australia, and New Zealand over the past 40 years. They serve as innovative and effective alternatives that can replace punitive and repressive approaches to safety and justice. Rigorous meta-analyses of restorative justice conferencing (RJC) have shown that random assignment to RJC significantly reduces repeat offending over a 2-year period.[52] Implementation of RJC is highly cost-effective, particularly relative to the cost of crimes prevented, at a ratio of between 3.7 to 1 and 8.1 to 1.[52]

RJC may also benefit victims. London crime victims who were randomly assigned to participate in RJC, in addition to traditional court proceedings, were half as likely to experience clinical levels of posttraumatic stress disorder.[53] 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.[54] In Denver, rates of suspensions and referrals to law enforcement dropped significantly after the implementation of a restorative justice program.[54] It should be noted that while some restorative justice conferences are facilitated by police, the field of public health widely acknowledges the importance of community-centered interventions.[55] Future programs might increase their ability to achieve community transformation by ensuring that the populations most affected by police violence lead program design and implementation.

Opposing Arguments/Evidence

Decriminalization of a variety of activities and behaviors, such as drug possession and minor traffic violations, has been proposed to decrease overpolicing, mass incarceration, and police violence. There is concern, however, that doing so will negatively impact health through increased crime and/or increased drug use and its attendant consequences, such as traffic accidents. While data on the effects of decriminalization are limited and require further investigation, neither of these concerns are supported at this time. One example with the longest follow-up evaluation available is the country of Portugal, which decriminalized all drug use in 2001. Data from Portugal, when compared with either Spain or Italy, shows increased uptake of drug treatment, reductions in opiate-related deaths and infectious diseases, and increases in the amounts of drugs seized by the authorities due to shifting police resources from minor possession crimes to a focus on traffickers.[56] 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 2 years of legalization, although there have been increases in the percentage of drivers tested for drugs at autopsy and found to have THC present.[57] 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.[58] Although more investigation is needed on the various effects of decriminalization, the data currently show that the benefits in terms of reducing police violence likely outweigh the possible risks.

A common assumption is that police are needed to protect the public from harm and violence, and cutting police budgets will adversely affect communities. However, the body of evidence on the link between police strength and crime does not lead to the clear conclusion that more policing leads to less crime.[59,60] When police forces abruptly withdraw from neighborhoods, as in the case of police strikes, crime does seem to increase.[60] However, an incremental increase in police numbers is not clearly linked to a decrease in violent crime.[60,61] In the case of school-based police officers, whose presence in schools has grown since the 1990s, there likewise is no evidence that crime has been reduced in schools or that school-based officers have prevented any mass shootings.[62] Notwithstanding the ambiguity of the evidence, spending on policing has increased 445% since 1982, including a federal funding increase of 729%.[10] Proponents of increases in police funding argue that the current 30-year low in crime trends is a result of this increased investment. However, others, including the Congressional Budget Office, suggest that demographic and economic changes drove the decrease.[10]

While police ostensibly exist to reduce crime, they are also tasked with protecting public safety. A public health perspective should expand the notion of public safety to consider the detrimental health outcomes associated with policing, including stress, anxiety, and other mental health impacts as well as the physical injuries and death that can result from violent encounters. The inequitable burden of police harassment and violence experienced by communities of color, particularly Black communities, demonstrates that police in fact do not protect all members of the public from harm or violence. 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] Given that crime trends are at a 30-year low,[10] 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 well-being 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 long-term safety strategies such as education, local restorative justice services, and employment programs.”[63]

Of course, different styles of policing exist, and some may be more “effective” or less violent than others. A “standard” approach to policing emphasizes an even distribution of efforts to reduce crime and “disorder” across an entire city. While this approach provides the basis for policing in many departments across the country, “little evidence exists that such approaches are effective in controlling crime and disorder or in reducing fear of crime.”[61] In contrast, a “hotspot” approach focuses police resources in areas of high crime. While this approach boasts empirical evidence of crime reduction without accompanying displacement of crime to neighboring areas,[61] it may lead to aggressive targeting of residents in the “hotspot,” particularly individuals from groups who are already criminalized, such as young Black men. Empirical evidence also suggests that “problem-oriented policing” reduces crime.[61] The basic premise of problem-oriented policing is that police should work with people to identify problems in their communities and then target efforts to address those problems. While this approach may seem sensible, it is not always benign in its application. Some argue that aggressive, “zero-tolerance” policing based on the broken windows thesis is, in fact, “problem oriented.”[64] Key elements of zero-tolerance policing include aggressive enforcement of “quality of life crimes” (e.g., loitering, public urination, and public intoxication) and “stop and frisk.” That these practices violate human rights and lead to racial disparities has been clearly documented.[65–67] Furthermore, police are necessarily unequipped to deal with the complex root causes from which community-identified problems may stem, including factors such as economic disinvestment and structural racism.

Of all of the approaches to policing, community-oriented policing (COPS) has perhaps received the most attention as a possible solution to police violence.[68] 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.[10] 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.”[64]

COPS is not a new idea; it emerged as one of a line of nearly constant police reform efforts beginning in the 1920s but, most immediately, out of the crisis of legitimacy police departments experienced after the urban rebellions of the late 1960s.[64] 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, perceptions of disorder, and police legitimacy.[10,69] 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 police violence. The Chicago Police Department, whose Chicago Alternative Policing Strategy (CAPS) was lauded as an effective COP model and helped pave the way for the national COPS program, is under continued scrutiny for police brutality, killings, and illegal detentions.[35,70]

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.[71] 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.”[71] As previously noted, there is great variation in what constitutes COPS and how these programs are implemented; however, the CAPS study raises important questions that should be explored in other locations. The fact that 70% of police departments across the United States report COP activities suggests that this model is not incompatible in practice with more aggressive policing styles that include police militarization, increased surveillance and racial profiling, and “broken windows” or “zero-tolerance” approaches.

Still others argue that technological tools, such as conducted electrical weapons (commonly known as CEWs or tasers), or body- or dashboard-mounted cameras are an effective means of reducing excessive force and abuse. While CEWs may be less lethal than handguns, they have been associated with more than 500 deaths since 2001, 90% of which occurred when the victim was unarmed.[72] TASER International, which produces CEWs, warns that death or injury may result from use on people who are pregnant or who have medical conditions such as a previous spinal injury, low bone density, or orthopedic hardware[73]; however, these conditions are often invisible to officers. Although TASER also warns against repeated, continuous, or simultaneous exposures,[73] reports of police repeatedly stunning victims are not uncommon. One example is the death of Allen Kephart in San Bernardino, California; Kephart was shocked 16 times after being stopped for an alleged traffic violation.[72] 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.[72,74]

Increased funding for body-mounted cameras is often put forth as a reform measure to reduce police violence because of the presumed increase in transparency and accountability offered by these devices. In 2014, with this aim in mind, Bill de Blasio, the mayor of New York, called for New York City Police Department officers to begin wearing body cameras; in addition, President Obama requested $75 million in federal funds to distribute 50,000 body cameras to police departments around the country.[75] An oft-cited example of the success of body cameras in reducing police 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%.[76] However, a national study of more than 2,000 departments revealed that the use of wearable body cameras was associated with a 3.64% increase in fatal police shootings of civilians. The authors hypothesized that police have realized camera footage can be used to support police claims of justifiable homicide.[77]

Issues of protocol, intentional sabotage, and other barriers to accountability raise serious questions about the efficacy of body- and dashboard-mounted cameras in decreasing police 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; one third of police departments using body cameras do so without written policies.[75,76] As a result of these policies (or their absence), cameras may not be activated during critical moments. In the case of the killing of 18-year-old Alan Blueford by Oakland police, the lapel camera worn by the officer who shot him was turned off.[7] Video evidence may also be deleted by police, as in the case of the Chicago police shooting of Laquan McDonald.[35] In fact, a recent examination showed that 80% of dash-camera video footage in Chicago was missing sound due to error and “intentional destruction.”[78] 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.[79] 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 lead to public safety.

Another oft-touted reform is mandatory training to reduce implicit bias of law enforcement officers against racial minorities. 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.[80] While the existence of these biases is well established, little is known about their actual effects on behavior.[80] Furthermore, no experimental studies have attempted to measure the impact of implicit bias reduction interventions on law enforcement officers.[81] One must also consider the investment of money and resources required to conduct these interventions, particularly within a context in which 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, such as anti-loitering laws.

Conclusion: Public safety is essential for public health. However, 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 on some communities, particularly communities of color. 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 underlying social and economic factors associated with crime, provides a promising way forward toward strengthening communities while reducing the harms associated with policing.

Action Steps

Therefore, APHA:

  1. Urges the U.S. Council of State and Territorial Epidemiologists to work with other public health experts to create uniform case definitions and surveillance protocols to monitor injuries and deaths caused by law enforcement officials.[15]
  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 harassment and 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 federal, state, and municipal governments to address the root causes of instability and violence in communities (also known as the social and structural determinants of health) by using resources currently devoted to law enforcement to increase economic and racial equity, including investing in employment and educational opportunities and affordable housing.
  4. Urges federal, state, and municipal governments and law enforcement agencies to engage independent organizations in a review of law enforcement agencies’ formal and informal policies and practices and eliminate those that lead to disproportionate harassment and 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. A necessary first step would be to restore the intent of the Fourth Amendment to “probable cause” from “reasonable suspicion” for searches.
  5. Urges federal, state, and municipal governments and law enforcement agencies to reverse the militarization of the police, including decreasing the acquisition and use of military equipment and reducing the number of SWAT teams and the frequency of their deployment. Restoring the division between the Armed Forces and the civilian police, as was law in the original Posse Comitatus Act of 1878, should also be pursued.
  6. Urges federal, state, and municipal governments to decriminalize and eliminate police enforcement of as many activities as possible, 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.
  7. Urges federal, state, 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 harassment and violence.
  8. Urges that all localities establish elected, independent community-based review boards with the power to write and monitor policies; subpoena, discipline, fire, and prosecute law enforcement officers; and consider all complaints of officer brutality, excessive use of force, harassment, and filing of false reports.
  9. Urges state legislative bodies to repeal the Law Enforcement Officers’ Bill of Rights and similar policies that shield police officers from investigation and accountability.
  10. Urges law enforcement agencies and oversight bodies to strictly enforce police guidelines, including codes of ethics, and international human rights standards, with strong disciplinary measures for the abusive 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.

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