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Title: The Harmful Effects of Policing—From the Neighborhood to the Hospital

Citation Type: Journal Article

Publication Year: 2021

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DOI: 10.1001/JAMAPEDIATRICS.2021.2936

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Abstract: From historical slave patrols and the enforcement of Black Codes and Jim Crow laws to the more recent War on Drugs and "stop and frisk," police violence is one of the oldest forms of structural racism in the US. 1 Policing tactics have relied heavily on the use of force to sub-jugate Black and Hispanic and Latinx communities and uphold white supremacy by enforcing race, class, and other visible and invisible boundaries. 1 To maintain these boundaries, police officers are trained to use strategies that include violence and harm, forcing their subjects to acquiesce. While not a new phenomenon, police violence among racial and ethnic minority groups has been catapulted to a subject of considerable attention within the national public discourse, capturing the interest of individuals, communities, and policy makers across the US over the past year. Following the murders of Breonna Taylor and George Floyd, there has been a sustained public outcry against police training and tactics, brutality, and the allocation of police funding in cities across the US. However, structural racism is embedded in policing like other US systems. Thus, instances of police brutality and violence toward Black and Hispanic and Latinx youth are not isolated instances at all. In the year since George Floyd's death on May 25, 2020, at least 229 more Black people have lost their lives at the hands of police. 2 Indeed, the system of policing in the US must be understood as a chronic and continuous injury to the body, mind, soul, and overall well-being of Black and Hispanica and Latinx bodies. 3 Policing has clear associations with health and well-being, for even the youngest members of society. And though, in the past year, many health care professionals have proclaimed "Black Lives Matter," we have been reticent to discuss the role of policing in health and health care. Connection Between Police and Health In this issue of JAMA Pediatrics, Jindal et al 4 analyze the current literature on policing and youth health. This systematic review used a convergent segregated approach, which includes separately examining both qualitative and quantitative studies but integrating all the findings to create a wholis-tic picture of the state of the science. Jindal et al found an association between police presence and the health of Black youth. Specifically, this review highlights the toll on mental and emotional health (eg, sadness, anger, fear, externalizing behaviors, and feelings of safety), risky behaviors (eg, intentions to have sex and number of sexual partners), and substance use (eg, smoking) associated with police presence. The small number of studies (N = 3) examining physical health outcomes and policing constrained this systematic review. While there is less research demonstrating the impact of police presence on physical health, it is critical to understand the evidence that exists. These studies associate police exposure with overall health and sleep. For example, adolescents with direct or vicarious exposures to police stops report worse health than their peers, especially among Black and Hispanic and Latinx youth. Procedural injustice, or the perception that appropriate procedures were not applied fairly or consistently, exacerbated this association between both direct and vicarious contact and self-reported health. 5 Further, adolescents stopped by the police may report more intrusive stops (eg, frisking , harsh language, and threat of force), which may be associated with higher levels of sleep deprivation and lower sleep quality. These associations were attenuated by social stigma and posttraumatic stress. 6 In this same issue, Farkas et al 7 examined physical health by using California state-level emergency department and hospitalization administrative data (ie, International Classification of Diseases, Tenth Revision coding) to characterize law enforcement-induced injuries by demographic characteristic of youth. The authors reference a new pediatric framework that includes well-child questions about police interactions after finding that beginning at ages 10 to 14 years, Black youth had higher rates of sustaining injuries from law enforcement as compared with their White peers, ranging from rate ratios of 3.5 (95% CI, 3.3-3.7) for Black male youth aged 15 to 19 years to 6.7 (95% CI, 4.8-9.5) for Black female youth aged 10 to 14 years. Though limited by state-level data and the reliance on administrative coding, this study further elucidates the disproportionate experience of police violence on Black youth, especially for Black girls, who have higher relative rates of policing injuries as compared with White girls. Further inquiry is needed to understand the incidence of police violence for gender nonconforming youth, and other demographic features , such as sexual orientation, socioeconomic status, or community characteristics. Both Jindal et al and Farkas et al offer compelling evidence of the impact of police violence among racial and ethnic minority groups on the health and well-being of Black and Hispanic and Latinx youth when they are exposed to police. While policing has come under considerable scrutiny and criticism recently, health care professionals and leaders have been less vocal about their role in public safety. This, despite recent findings that demonstrate experiencing police brutality affects relationships with the medical system. Individuals with negative police encounters have higher levels of medical mistrust compared with those without these encounters. 3 Fur

Url: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2783642

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Authors: Heard-Garris, Nia; Johnson, Tiffani J.; Hardeman, Rachel

Periodical (Full): JAMA Pediatrics

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