Our Police, Ourselves

Last week, the National Bureau of Economic Research (NBER) published a working paper by economist Roland Fryer on how police use violent force on civilians based on the race of those civilians.

Because police departments are not obliged to provide detailed encounter summaries in response to Freedom of Information Act requests and there is no standardized reporting of police use of force, Fryer’s team used a non-random sample of urban police departments with whom they were able to make contacts. Most of these departments were voluntarily a part of President Obama’s Police Data Initiative, a reform initiative focused on police accountability. In the methods section, Fryer is explicit about the bias that this selection introduces to the study and the limits it places upon its generalizability.

From these data sets, Fryer makes some interesting observations:

New York City Stop-And-Frisk Data

  • In New York, Black people are 17% more likely to experience police violence during a police stop compared to Whites. Hispanic people are 12% more likely.
  • This disparity was present across all use of force categories [(1) hands, (2) force to a wall, (3) handcuffs, (4) draw weapon, (5) push to the ground, (6) point a weapon, (7) pepper spray or (8) strike with a baton].

Police-Public Contact Survey (PCPS)

  • The PCPS is a nationally representative survey of civilians on their encounters with the police.
  • In the PCPS data set, Black people were 2.7 times more likely to report use of force by police and Hispanic people were 1.7 times more likely after accounting for demographic and encounter characteristics.
  • “Strikingly, both the black and Hispanic coefficients are statistically similar across these income levels suggesting that higher income minorities do not price themselves out of police use of force”

Houston Officer-Involved Shooting (OIS) Data

  • This was the result that has made the headlines. In Houston, police were no more likely to shoot a Black person during a police encounter than a White person.
  • Unlike in much of the press surrounding this research, in the paper itself Fryer is explicit about the limited scope of its conclusion: “To be clear, the empirical thought experiment here is that a police officer arrives at a scene and decides whether or not to use lethal force. Our estimates suggest that this decision is not correlated with the race of the suspect. This does not, however, rule out the possibility that there are important racial differences in whether or not these police-civilian interactions occur at all.”

This study joins a growing body of literature focused on racial bias in policing. These studies are reliant on the lay press for data which introduces its own set of biases, but unfortunately such weak data is what we’re stuck with until we get mandatory reporting of all police shootings.

These results do no necessarily conflict with Fryer’s result when you consider that Black people are more likely to be stopped by police than white people.

In other words, even if there is an equal chance of a police officer pulling the trigger during an encounter with a Black or White person, because Black people are stopped by police more often, they are shot by police more often.

I think this is an important conclusion to think about because it moves the narrative away from focusing solely on police shootings to a bigger picture view of how policing reflects broader social perceptions of Black criminality and suspiciousness.

Better de-escalation training can reduce the overall number of people killed by the police and by extension the number of Black people killed by police. Implicit bias training can reduce the excess targeting of Black communities which leads to excess Black deaths at the hands of police. These are great harm-reduction steps that we can take right now that will literally save lives.

However, affirming that Black Lives Matter means taking a step beyond reactive politics toward an understanding that police attitudes and behaviors are not anomalous, but a reflection of the society in which they operate. Police reforms are important, but so is rooting out and addressing the racial biases present in my own life and in my immediate community.

If this is something that you’re interested in as well, check out this curriculum on race and racism or this guide to developing a positive White identity through anti-racist action. And of course, feel free to chat with me about it. I’m @hkalodimos on Twitter.

 

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Affirming the Value of Black Lives

In the wake of Alton Sterling and Philandro Castile’s untimely deaths at the hands of police, there is renewed focus on how we might remake our society into one which upholds and affirms the value of Black Lives. As healthcare providers, life’s value is not an abstraction, but a concrete goal toward which we strive every day. Every therapy we prescribe or perform is rooted in the value of life and our mission to preserve and prolong it.

Because of this, there is currently a lively discourse amongst physicians and other healthcare professionals about how we might respond to this epidemic of violence. I’m collecting some of these approaches in this post mostly in order to organize my thoughts, but I also want them to be available to anyone who is looking for a way to take action against the systemic racism which leads those who are labeled Black in this country to have a greater burden of illness.

If you have anything that you think I should add to this list, please let me know! Specifically, I want to know of any groups or individuals which are helping organize people around specific interventions.

Personal Interventions

Educate yourself

Change begins with you, right? A Letter to Our Patients on Racism is a great statement on how medical providers can meaningfully commit to anti-racism. While you’re at it, here are some great reading lists to better inform yourself of the causes and consequences of racism in American society:

If you have privilege, be an ally to those without it

At some point, I will pick and choose from these lists to make a shorter more manageable doc, but for now here are some resources that I frequently draw upon.

Speak to your friends, family, and coworkers

Discussing race is difficult, but important. Here are some tips to make the conversation productive.

  • Connect before you correct. Always start the conversation by centering on your connection with the person and acknowledgement of their good qualities. At the very least, most people have good intentions.
  • Spend more time listening than speaking. Monologues do not change minds. Spend time early in the conversation coming to understand not only what a person’s beliefs are, but what experiences they’ve had that have informed those beliefs.
  • Respond to the person, not to the straw man. When listening to someone, consider the most generous interpretation of their words and respond to that.
  • Do not try to “win” the conversation. The purpose of this conversation is not to embarrass the other person or force them to admit they are racist. It’s to come to a better understanding of each other’s points of view. If you are approaching the conversation with malice, you better believe that the other person is going to shut down.

Law Enforcement Interventions

Advocate for comprehensive police reform

  • Summary: No single intervention is going to fix all the problems with our current law enforcement system, however, Campaign Zero has put together a thoughtful list of reforms which when taken together promote and more just and peaceful society.
  • What you can do: Read over their reform proposals and then use the Take Action Tool on their website to speak with your local representatives about the laws being considered in your state or to advocate for the reforms you feel most passionate about. If you’re feeling generous, you should donate here!

Promote police implicit bias training

Promote Crisis Intervention Teams

  • Summary: Crisis Intervention Teams are focused on safely and appropriately responding to people experiencing a mental health crisis without resorting to violence. While not directly addressing the issue of racism in policing, it is a reform effort to making law enforcement more humane and community-oriented.
  • What you can do: The National Alliance on Mental Illness has a page dedicated to how you can help establish a Crisis Intervention Team in your city. As before you can also contact your city council person and advocate for this intervention.

Make law enforcement-related deaths a notifiable condition 

  • Summary: By mandating reporting of these deaths, researchers will be able to gather more accurate public health data about patterns in this type of violence. Dr. Nancy Krieger has been the most vocal advocate of this approach and you can read her full argument in PLoS Medicine (Open Access).
  • What you can do: I’m not aware of any formal organizing around this issue, but you can contact the APHA or your medical society and advocate for this approach.

Healthcare Interventions

Commit to and promote the practice of trauma-informed care

  • Summary: Patients that have been traumatized by police violence, repeated racist encounters, or other events are often at higher risk of illness. Trauma-informed care is a practice of acknowledging past traumas and helping patients heal while avoiding re-traumatizing them.
  • What you can do: The Substance Abuse and Mental Health Services Administration has some great resources here, but to really engage you will likely have to seek out local training for your physician group.

Ensure hospital staff is trained in de-escalation strategies

  • Summary: The recent shooting of Alan Pean while he was hospitalized for a manic episode brought national attention to hospital security staff that is often unprepared to safely manage agitated patients.
  • What you can do: Find out what policies your hospital has for managing agitated patients and if they haven’t instituted de-escalation training for security personnel, advocate for it.

Physician-Activist Groups To Join or Follow

BLM