Time to consider police brutality as a global health problem?
Adrienne Milner is lecturer in social determinants of health and Giuliano Russo is lecturer in global health at the Centre for Primary Care and Public Health, Queen Mary University of London, UK.
Police brutality has been framed in the past as a civil and human rights issue, and explained in terms of its sociological roots and legal implications. However, similarly to other human rights (eg, reproductive rights), substantial health repercussions arise from its perpetration for individuals as well as for the general public, and recent research in the USA has firmly established police brutality as a public health concern. In addition to the obvious link between police violence with fatality and injury (see panel), empirical evidence has shown harmful mental health consequences that are not limited to victims, but also shared by witnesses to negative police encounters. Apart from premature death and bodily harm, documented health consequences in the USA of negative police interactions include high blood pressure, diabetes, asthma, HIV and sexually transmitted infections, as well as anxiety and post-traumatic stress disorder.
- In 2016-17, people were killed by the police or the army for peacefully standing up for human rights in 22 countries;
- In 2017 in the USA, the Washington Post reported that 748 people lost their life at the hands of the police, 309 of them of African American ethnic background; the economic costs of police brutality estimated to round £1.8 billion per year;
- South-Africa’s Independent Police Investigative Directorate in 2016 reported 366 civilian deaths as a result of police action, 216 in police custody, 145 cases of torture, and 31 cases of rape;
- In the run-up to the 2016 Olympics, there were 920 killings by the police in Rio de Janeiro, Brazil–an increase of 103% from the previous year;
- In the Philippines, hundreds of children have been killed in 2016-17, and over 200,000 civilians displaced as a result of the government’s ‘war on drugs’;
- Médecins Sans Frontières reported that following the Boko Haram conflict the north of Nigeria, tens of thousands of internally displaced people were held in camps by the Nigerian military; thousands of people have died there due to severe malnutrition.
Despite the broad-reaching health implications, the global public health community has yet to recognise police brutality as a global health issue; both public commentary and academic research on police brutality has been country-specific and framed as a localised rather than global phenomenon. This previous lack of global focus may be attributed to the complex causes of police brutality which very often are linked to geographic location as well as specific nations’ divergent social, economic, and legal and criminal justice systems. However, it must be acknowledged that, even though police brutality is caused by a number of circumstantial factors, this in reality is rooted in power differences relative to socially constructed hierarchies such as socioeconomic status, race, ethnicity, gender, sexual orientation, political party, and religion, with the most vulnerable populations in a given society at the greatest risk. Such disparities are observed in each and every country, with no exceptions. There are common ways in which police brutality is experienced globally, and these commonalities can be utilised to both frame and combat police brutality as a global phenomenon. Violence perpetrated by the police in any context is linked to negative physical and mental health consequences as well as societal fear and mistrust.
What would be the benefits of considering police brutality as a global health issue? There is precedent showing that framing an issue in terms of its global health relevance has facilitated its conceptualisation and identified paths towards solutions. Recognising the right to health as a basic human right enabled governments worldwide to adopt the universal health coverage paradigm. Framing illegal drugs as a global health problem helped define a comprehensive international approach and policy agenda, moving forward the debate from prohibition to regulation. As argued elsewhere, better theories and data can help bring to the forefront an issue too often dismissed and driven underground as a matter of individual national governance.
If police brutality were recognised as a global health issue, it would be possible to go beyond the narrow circumstances of each specific case to address its global determinants and outcomes. International-level data could be collected that enables both a better conceptualisation and measurement of the problem. This would result in the ability to define worldwide policies to combat the public health consequences of police brutality, and to establish health programmes to support its victims. Recognising police brutality as a global health issue would enable the development of international standards to which offending governments would be accountable, upheld by supranational organisations in the interest of the global, common health interest. The health consequences of police brutality are too serious and too common worldwide to hang the potential solutions in the balance, in essence relying on the good will of its very perpetrators to deal with them.