But he deserved it! Why all these forms?

But he deserved it! Why all these forms?

This week’s issue of PLOS Medicine has an excellent, simple article about the problem of police killings in America. It hinges around the simple fact that the Guardian’s website The Counted appears to have more accurate and up to date information on police killings than the American government, even though the US government has a real-time update of deaths in the largest 122 cities, and an ongoing FBI database of police killings that seems to significantly undercount the true numbers. The article makes the reasonable point that governments should be able to keep track of how many people their police kill, and that killings of police are tracked in great detail.

The article argues for the public health relevance of counting police killings on two grounds. First of all, based on just the data from the website, it compares the toll from police killings to other diseases, and the results are kind of shocking:

As of September 19, 2015, the cumulative 2015 total of 842 US persons killed by the police notably exceeded the corresponding totals reported for the 122 cities’ 442 deaths under age 25 (all causes) and also 585 deaths (all ages) due to pneumonia and influenza, and likewise exceeded the national totals for several diseases of considerable concern: measles (188 cases), malaria (786 cases), and mumps (436 cases), and was on par with the national number of cases of Hepatitis A (890 cases)

Putting aside the rather alarmingly large number of mumps and measles deaths, it’s quite shocking that police have killed more people in America this year than the total number of people aged under 25 who died in the 122 largest cities. The authors don’t spend much time on the fact, but a remarkably large number are black: at the time I am writing this post the website counts 1061 deaths and gives a population rate of 6.34 per million for blacks and 2.67 for whites. The death rate is highest in Oklahoma, at nearly 9.3 per million. The total death rate for violence in the USA in 2010 was 56.6 per million, which suggests that police killings are approximately 10% of all deaths due to interpersonal violence in the USA.

By way of comparison, the death rate due to interpersonal violence in Japan was 7.4 per million in 2010; in the UK it was 5.6 per million. The police in the USA have a higher death rate than everyone in the UK.

The article also makes a strong argument for the public health importance of police killings. The authors say that

Police are one of the most visible “faces” of government, whose work daily puts them in view of the public they are sworn to protect. Combine excess police violence with inadequate prosecution of such violence, and the ties that bind citizens and their democratically elected governments become deeply frayed, with vicious cycles of distrust and violence fueling dysfunctional policing and dysfunctional governance more generally. The direct effects and spill-over effects matter for public health and medicine alike, as reflected in the impact on emergency medical services, trauma units, mental health, and the trust required to deliver and implement any government-sponsored program, public health or otherwise.

They also mention in the previous paragraph the challenge of police deaths, which appear to be quite high in the USA and, I suspect, as a rate are quite horrifyingly high (I don’t know how many police there are in the USA). Police in the USA have to contend with an environment of uncontrolled gun use, and I’ve no doubt that some portion of the killings listed in the Guardian website would almost certainly have been averted if the police could have some confidence that the men and women they are dealing with are unlikely to be armed. Nonetheless, police are functionaries of the government, the primary means by which the state exerts its monopoly of force, and a huge amount of our social behavior is dependent on how restrained they are in the exercise of that monopoly. I think the authors of this article are right to observe that the behavior of the police is relevant to public health, and certainly when I worked in clinics for people who inject drugs in Australia, good relations with the police were a hugely important part of our public health work – senior medical staff in the clinics I worked at spent a lot of time negotiating with police and making sure that they understood their public health role, and having the police onside paid huge dividends in our public health work.

The article finishes by recommending that deaths involving police – either of police or by police – be publicly notifiable, like AIDS mortality or measles. This would enable the state to track the behavior of police, and to give real-time information about how police are behaving to public health authorities. I think this is a good idea, though I don’t think it’s necessary in every country. In Australia police deaths and deaths in custody are already notifiable [that link is from Queensland but I think every state is the same], and I think it’s safe to say that Australian police activities are not hampered by this requirement. Australia went through this discussion in the 1980s and 1990s, when there was a major government inquiry into Aboriginal deaths in custody that turned up some remarkable and counter-intuitive findings[1], and made important reforms to the way police behave. It’s really not difficult to enact these reforms if a government wants to, and although reforming police forces can be tough and requires political leadership, and police forces are often very racist, they are also bound together by a calling to civic duty that can be used to force powerful changes. Requiring that police deaths be counted is the first step to holding police accountable for those they kill. It’s always worth remembering this simple principle: if you aren’t counted, you don’t count.

Police violence in America seems to be something that happens in Republican and Democrat jurisdictions (Chicago seems to have developed its very own police torture centre, and yet Chicago is a Democrat stronghold). I suspect that problem is not one of simply political will, but also requires gun control and other anti-corruption measures at the political level that would seem natural in the rest of the world but seem to be anathema in the USA. It might also require removing appointment of police commissioners and deputies from public vote to political appointment. I don’t know what the correct changes would be. But actually forcing the police to register the people they kill – to count the dead – would be a big first step towards the changes that need to be made.

Let’s hope President Trump agrees with me …

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fn1: In brief, Aboriginal people were no more likely to die in custody than white people, but were much, much more likely to be charged and taken into custody than white people, which produced a perception in Aboriginal communities of slaughter in prison. The reason for the charges was identified, primarily as the “trifecta”: a police officer approaches an Aboriginal person over the charge of offensive language, which rapidly escalates to abuse of an officer, and then becomes resisting arrest. The first of these three charges was almost exclusively applied only to Aborigines, and no one even really understood that this thing was happening until the government inquiry uncovered it and introduced a range of recommendations to reduce the rate at which Aboriginal people entered custody. Result: less black deaths in custody. It occasionally still enters the news, but mostly has become an irrelevant part of Australian history. My guess is that the same straightforward approach to discrimination won’t happen in America …