Dismantling Public Health’s Complicity in State Violence
By Abby Cartus
March 1, 2021
Recent waves of Black Lives Matter uprisings amid the COVID-19 pandemic have again touched off a broad cultural reckoning with racism and white supremacy. The uprisings have also trained a spotlight on police practices and the social functions of policing. Scientific disciplines are no exception. A consensus is forming in public health that state violence, including police violence, is an important determinant of population health. Some groups and professional organizations, like the End Police Violence Collective affiliated with the American Public Health Association (APHA), insist that treating police violence as a public health issue requires broad-based, radical approaches to shrink the power and influence of police. Others argue that public health and policing are complementary endeavors and recommend closer cooperation between police forces and health authorities. Widespread but inaccurate cultural assumptions about police dominate the public health conversation — for example, that policing is a high-risk profession, or that incidents of police violence can be attributed to individual “bad apples” acting independently. In this environment, it is clear that empirical studies demonstrating causal relationships between state violence and health are needed; no less important is explicit theorizing about why and how state violence influences population health.
Examples of this contradictory understanding of police and state violence in the health disciplines are easy to find. In 2018, the End Police Violence Collective succeeded in passing a policy position declaring police violence to be a public health issue.1 This statement, now the official position of the APHA, provides concrete objectives for public health practitioners looking to work towards ending police violence. More recently, the collective has released a police non-collaboration pledge for public health researchers. In contrast, Dr. Leana Wen advanced an opposing view in an op-ed in the Washington Post.2 Calling proposals to defund police “inflammatory,” Wen instead recommends “reimagining public safety through public health partnerships” with police forces. Wen claims that the kinds of health programs she has experience running “can never replace police,” demonstrating a clear belief that police are a necessary component of community health interventions, in part because the public is regarded as a potential danger to health workers. Wen’s argument echoes a 2018 Lancet article advocating collaborative efforts between public health and police.3 The authors of the Lancet article and Wen assert that collaboration between police and public health is a natural step, as both fields have essentially the same goals.
What are these goals? Both Wen and the Lancet article emphasize the shared mandate to “protect the public.” Interestingly, the Lancet article also identifies “enforcing social norms” as a key area of overlap between public health and policing. This is superficially true; this overlap belies the troubled history of both disciplines and the dimensions of how both operate in the present. Insistence that the police be recruited to do public health work misses the many problematic ways in which public health already does the work of the police. This is most evident in the conflation between unhealthy, or “risky,” behavior and criminal behavior that is commonplace in the United States; this conflation that disproportionately targets Black and brown people, poor people, and other marginalized groups. Examples of this conflation from my own field (perinatal epidemiology) include the criminal prosecution of Black mothers for (known or suspected) drug use in pregnancy and for incomplete abortion or miscarriage.4 It is also evident in statutes criminalizing infectious disease transmission and in the disproportionate issuance of citations for social distancing violations to Black New Yorkers during the recent pandemic.5
Police don’t create public health, but public health helps create targets for policing. In the profiles of those who are disproportionately targeted by police and overrepresented in jails and prisons, we can begin to understand the police-prison axis as a terminal node in a much larger network of state violence. Scholar, professor, and activist Dr. Angela Davis has written extensively on how the interrelation between structural racism and disinvestment in social welfare produces “candidates for prison.”6 State violence both “disappears” individuals as stand-ins for larger social problems and perpetuates the unequal and unjust social and economic arrangements that produce those problems.7 People frequently end up in encounters with police, in jail, or in prison for the same structural reasons that they are, for example, systematically excluded from access to appropriate health care. Public health thus doubly does the work of police: first by identification of candidates for policing, and second through deliberate inattention (in both scholarship and practice) to the forces that both produce ill health at the population level and require state violence to manage the consequences of a sick population.8
While Wen does lament that money funneled into police departments, prison administration, and contracts with ICE is money that can’t be directed towards health and welfare programs, she fails to consider alternative modes of social organization that would negate the need for policing. Her argument that police and public health should work together relies on the possibility of “culture change” in police departments; by way of an example, she describes her participation in a successful intervention to require police to carry the overdose-reversing drug naloxone. However, this argument addresses the problem at the wrong level of analysis. Success in convincing individual officers or even whole departments to administer naloxone leaves intact the vast inequities in power, wealth, and health in our society — inequities that are both managed and perpetuated by the carceral apparatus of the state. Against such a structure, abolitionist perspectives, including the call to “defund the police,” emphasize transformation, imagination, and most of all, in the words of geographer and abolitionist Dr. Ruth Wilson Gilmore, presence: “Abolition is building the future from the present, in all of the ways we can.”9 Rather than making marginal tweaks to the administration of a violent system and calling it harm reduction, abolitionist perspectives envision the kinds of robust, democratic systems and structures that can create collective safety (and collective health) without police.10
Public health practitioners and researchers must resist calls to collaborate with police, and must also confront the ways in which our discipline does the work of the police directly and indirectly. We can think and do bigger, smarter, and better if we have the courage to imagine a world that can deliver safety and health for all people without violence.
About the Author
Abby Cartus is a perinatal epidemiologist. She received her PhD in 2020 from the University of Pittsburgh Graduate School of Public Health. Abby is a member of Science for the People.
Grace Mackson (Lead Editor)
Emma Harnisch (Co-Editor)
Mike Friedman (Editor at Large)
Ashley Bennett (Copy Editor)
Gary Gerald & Matt Moss (Technical Editors)
Søren Hough & Matt Moss (SftP Online Editors)
- “Addressing Law Enforcement Violence as a Public Health Issue,” American Public Health Association, November 13, 2018, https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violence.
- Leana Wen, “Instead of ‘defund the police,’ imagine a broader role for them with public health,” The Washington Post. June 6, 2020, https://www.washingtonpost.com/opinions/2020/06/12/instead-defund-police-imagine-broader-role-them-public-health/.
- Auke J. Van Dijk et al., “Law enforcement and public health: recognition and enhancement of joined-up solutions,” The Lancet 393, no. 10168 (2019): 287-294, https://doi.org/10.1016/S0140-6736(18)32839-3.
- Dorothy E. Roberts, Killing the black body: Race, reproduction, and the meaning of liberty (United States: Vintage Books, 1999); Lynn M. Paltrow, “Roe v Wade and the new Jane Crow: Reproductive rights in the age of mass incarceration,” American Journal of Public Health 103, no. 1 (October 2012): 17-21; The Editorial Board, “How My Stillbirth Became a Crime,” The New York Times, December 28, 2018, https://www.nytimes.com/interactive/2018/12/28/opinion/stillborn-murder-charge.html; Darran Simon and Susan Scutti, “DA drops all charges against a pregnant woman indicted in her baby’s death after shooting in Alabama,” CNN, July 3, 2019, https://www.cnn.com/2019/07/03/us/pregnant-alabama-woman-manslaughter-indictment/index.html.
- Zita Lazzarini et al., “Criminalization of HIV transmission and exposure: research and policy agenda,” American Journal of Public Health, 103, no. 8 (July 2013): 1350-1353, https://doi.org/10.2105/AJPH.2013.301267; Elliot Hannon, “Nearly Every Social Distancing Arrest in New York City Has Been a Person of Color,” Slate, May 8, 2020, https://slate.com/news-and-politics/2020/05/new-york-social-distancing-enforcement-data-disproportionate-arrests-black-minority-communities.html.
- Angela Y. Davis, Are prisons obsolete? (United States: Seven Stories Press, 2011) 16.
- Davis, Are prisons obsolete?
- Zinzi Bailey et al. “Policy-relevant epidemiology and state violence: policing, mass incarceration, and immigration detention,” presented at the Society for Epidemiologic Research, December 18, 2020, https://epiresearch.org/event/policy-relevant-epidemiology-and-state-violence-policing-mass-incarceration-and-immigration-detention/; A. J. McMichael, “Prisoners of the Proximate: Loosening the Constraints on Epidemiology in an Age of Change,” American Journal of Epidemiology, 149, no. 10 (May 1999): 887-897, https://doi.org/10.1093/oxfordjournals.aje.a009732.
- Ruth Wilson Gilmore and Léopold Lambert, “Making Abolition Geography in California’s Central Valley with Ruth Wilson Gilmore,” The Funambulist, November 30, 2018, https://thefunambulist.net/making-abolition-geography-in-californias-central-valley-with-ruth-wilson-gilmore.
- Angela Y. Davis, Abolition democracy: Beyond empire, prisons, and torture (United States: Seven Stories Press, 2011).