Racial Profiling is a Public Health and Health Disparities Issue

Abstract

Racial profiling is a public health and health disparities issue through its disparate and adverse health impact on those targeted by this practice, as well as members of their communities. We discuss six ways police profiling and racial discrimination adversely impact Black American health. We identify four direct and two indirect ways. Four direct ways are (1) violent confrontation with police that causes injury or death; (2) police language that escalates a confrontation through micro-aggressions or macroaggressions; (3) sub-lethal confrontations with police; (4) adverse health consequences of perceived or vicarious threat, i.e., the mere belief in potential harm by police injures health. There are two indirect ways: (5) through knowledge of or personal relationship with someone who directly experienced racial profiling; (6) through public events without a personal knowledge of the unarmed person threatened or killed by police as a result of racial profiling, but where such events cause both individuals and the community at large to perceive a threat. We support recognition of racial profiling as a public health and health disparities issue. We recommend support for community programs that address the clinical health effects of racial profiling. We also recommend widespread engagement of trauma-informed policing (TIP) that acknowledges the clinical effects of racial profiling.

1. Introduction

Racial profiling is the act of suspecting or targeting a person of a certain race on the basis of observed or assumed characteristics or behavior of a racial or ethnic group, rather than on individual suspicion [1]. Black Americans comprise 13% of the population and compared with White Americans are three times more likely to be shot and killed and five times more likely to be killed unarmed by police [2, 3]. Black teens are 21 times more likely to be shot and killed by police than White teens [3]. In Black American boys between ages 15 and 19 and men between ages 20 and 39, the leading cause of death is homicide. Homicide is also the second leading cause of death in Black American young boys between ages 1 and 4 [4].

Excessive police violence can affect an individual personally and vicariously as well as the community which in turn adversely affects health. The most influential case that launched the “Black Lives Matters” movement was the case of Trayvon Martin, a 17-year-old boy who was unlawfully shot and killed walking home from a convenience store in 2012 [5]. In 2015, while in police custody, Freddie Grey, falsely accused of carrying an illegal switchblade, was refused medical attention upon his request which resulted in fatal injury and death [6]. The refusal of medical attention and the mistreatment while in police custody of this unarmed Black young man caused public health harms that included medication crises linked to the destruction of dozens of pharmacies, opioids from the pharmacies entering the illicit drug street market, mental health trauma, and damage to the economies of neighborhoods already burdened by high rates of unemployment and premature mortality [6]. Another influential case was that of Sandra Bland, a 28-year-old woman who was pulled over by a police officer for not using a turn signal. Sandra Bland was arrested for allegedly assaulting an officer during the traffic stop and later found dead in her jail cell. Her death was ruled a suicide [5]. The officer involved was later indicted on perjury charges and fired [5]. The arrest of Sandra Bland and many others like her shows bias excessive force by police against African Americans. Have the police become unconsciously biased towards minorities through social conditioning or professional training that results in excessive suspicion of Black Americas? Violence as well as excessive police violence can greatly affect the health of an individual as well as a community causing public health and health disparity issues [7].

The senior one of us (C.T.L.) has served as a member of the Connecticut Racial Profiling Prohibition CTRP3 Task Force Advisory Board. The mission statement of the task force begins with the unambiguous statement of fact, “Racial Profiling has historically occurred, and continues to occur throughout America,” [8]. In this paper, we discuss several ways racial profiling causes’ adverse health effects in Black Americans (Table 1).

Table 1.

Ways by which racial profiling results in health effects in Black Americans.

Six Ways of Racial Profiling	Effect	Health Correlation	References
1	Direct	Lethal	McLeod, M. N., et al., 2019
2	Direct	Micro and Macro Aggression	Voigt, R., et al., 2017
3	Direct	Sub-lethal	Geller, A., et al., 2014
4	Direct	Personal/vicarious	McFarland, M. J., et al., 2018
5	Indirect	Knowledge/relationship	Legewie, J., 2019
6	Indirect	No relationship	Bor, J., et al., 2018

2. Six Ways of Racial Profiling Affecting Public Health

2.1. Way 1: Direct Effect: Confrontation with Violence/Injury by Police Resulting in Death

Racial profiling is indicative of the lasting prominence of institutionalization of racism in America. Many perceive police killings of unarmed persons or suspects as a manifestation of structural racism that implicitly assigns a lower value to Black lives [9]. These behaviors alienate communities from law enforcement, hinder community-policing effects, and cause communities to lose trust in law enforcement [9]. This negative interaction undermines effective community policing for public safety. Black Americans are three times more likely than White Americans to be shot and killed by police and five times more likely than White Americans to be killed unarmed [1]. Black Americans are also five times more likely to have a police intervention–related injury to take place [3]. According to a study by Gilbert et al., in 1994, 465 felons were killed by law enforcement officers in the line of duty, the killings were all considered justifiable homicides [10]. The number of deaths began to decrease over the next 10 years and surprisingly in 2013 were back up to 465 deaths according to the Federal Bureau of Investigation, Uniform Crime Reports [10]. Throughout history, Black Americans have been portrayed as “monstrously aggressive and inhuman,” as was apparent in the testimony of the police officers in the killing of Michael Brown. The police officers involved portrayed Michael Brown as a “demonically aggressive, nonhuman monster,” and the media characterized him as a “thug” and a “gangster” [7]. Police violence and brutality can cause death which in turn affects the mental, physical, and emotional health of individuals as well as entire communities.

2.2. Way 2: Direct Effect: Confrontation Due to Police Language Micro-aggression/Macro-aggression by Police

The second direct effect of police racism is confrontation due to police language by micro- or macro-aggressions. Micro-aggressions are subtle, everyday verbal or nonverbal negative insults or messages to a person of a different race that may not be apparent or entirely understood to either party involved [11]. Macro-aggressions involve the act of racism towards every one of a certain race [11]. A number of reports have chronicled Black drivers perceiving more negative experiences in their interactions with police. An important study by Voigt, R., et al., focused on incidents captured on video involving police use of force on Black suspects. Voigt et al. completed an analysis using police body camera footage examined in the context of racial disparities. Officers were equal in formality between Black and White drivers but higher in respect with White drivers, with officers speaking with less respect to Black drivers [12]. A linguistic correlate from body camera footage data showed that White community members were 57% more likely to hear respectful utterances while Black community members were 61% more likely to hear a less respectful utterance from a police officer [12]. These factors lead to micro- and macro- aggressions that take place in the relationship between the police and the community.

2.3. Way 3: Direct Effect: Sub-lethal Confrontation with Police

The third direct effect is the sub-lethal confrontation with police that can involve anything from a police officer pulling a gun or yelling at an individual, to confrontations causing bodily injury. Several published studies have focused on exposure to police violence and the effects of that exposure on individuals. Police officers have the authority to stop individuals without any evidence of suspicion or wrong-doing [3, 13–15]. “Terry stops” or “stop and frisk” rarely end with arrests and have been associated with adverse mental health effects such as stress responses or depressive symptoms due to police aggression [16]. Data from Geller et al. reported that ethnic minorities who have been stopped by police were more likely to have higher levels of anxiety and post-traumatic stress disorder (PTSD); PTSD was higher in Black individuals [16]. Aggressive policing has major effects on the health of individuals and communities [16]. In the US population, police violence and aggression have been associated with distress, depression, anxiety, and trauma no matter the ethnicity or race of an individual [17]. Violence from racial profiling and discrimination was directly reported to cause depression in Black American boys and men, which in turn, is a mediator for cardiovascular disease, diabetes, and cancer [17]. Mental health of young Black boys was also associated with youth witnessed trauma regardless of proximity resulting in PTSD symptoms such as hyperarousal [17]. In recent studies, Oh et al. focused on the Black population and the effects of police mistreatment on individual health. The study showed police mistreatment of a Black individual was associated with worse mental health such as psychiatric, mood, and anxiety disorders, as well as PTSD and suicidal ideation, plans, and attempts [18]. Worse mental health can also be attributed to police killings of unarmed Black Americans and racial discrimination in communities not directly affected [3], causing stress, financial strain, and institutional oppressive practices [19]. African Americans (81%) who reported racial discrimination also reported having experienced PTSD [20]. Paired together, the data suggests, “law enforcement violence is a critical but nevertheless under examined public health issue” [20].

2.4. Way 4: Direct Effect: Actual and/or Perceived Threat from Police

The fourth area in which police brutality can affect mental health is the actual and/or perceived threat from police, the concept of vicarious threat. Several studies have examined the consequences of police violence and the effects it has on people who hear about the threat of violence [21, 22]. Studies have focused on the mental and physical effects of vicarious threat. McFarland et al. focused on changes in waist circumference of Black Americans in Nashville, TN, who had been treated unlawfully by police [23]. The study showed that traffic stops occurred predominantly in low-income Black or Hispanic communities and that Black drivers were five times more likely to be stopped per year and two times more likely to be searched during a traffic stop [23]. McFarland et al. determined that Black Americans were two to three times more likely to have a larger waist circumference than White Americans. Black Americans in general are faced with higher stress burdens than White Americans [23]. Unfair treatment by police is a stressor that has not yet fully been understood in terms of health disparities research and in the medical field [23]. Unfair treatment by police has a large effect on the Black community vicariously and personally. In one study, 45.8% of Black Americans experienced personal or vicarious unfair treatment versus 18.5% of Whites, with men reporting more personal unfair treatment and women reporting more vicarious unfair treatment [23]. Waist circumference was higher in Blacks who experience unfair treatment and higher (12%) in Black women who experienced it vicariously compared with White women [23]. Vicarious exposure to unfair treatment by police may be a factor of worse mental health in the Black community [23].

2.5. Way 5: Indirect Effect: Case Where There Is Knowledge/Relationship of an Individual Who Has Been Racially Profiled by the Police

Indirect effects on mental health from police mistreatment can occur to someone who has knowledge of or a relationship with an individual that has been mistreated or racially profiled. Physiological effects can take place due to defending the character of a loved one after the police have killed them [3]. These actions can elicit negative emotions that can be damaging to mental health [24]. The mental health effect on the knowledge or relationship one may have to someone who has been racially profiled has also been evident in young Black American boys. Boys who were interviewed on police violence were all aware that they can be targeted by a police officer and killed without any legal consequence; the exposure to this violence causes trauma [17]. Young Black boys are taught to stay out of trouble, be respectful, and avoid any confrontation with the police for fear of being mistakenly targeted and racially profiled [17]. Most recently, a study published in Science Advances focused on birth records in California from 2007 to 2016 and showed that police killings of unarmed Black men were associated with a decrease in birth weight and gestational age of Black infants [25]. For a pregnant mother, the stressors of knowing someone or hearing about police racial profiling can cause stress and have negative effects on an unborn child [25]. These emotional stressors on Black women can cause physical health to decline and can be responsible for changes in birth weight and length of gestation, in an unborn child [25]. In general, studies show that stressors in an early prenatal stage can have damaging effects to an unborn child causing consequences on childhood and adulthood development [26]. The data suggests that the killings of unarmed Black Americans are linked to decreased birth weights in Black infants but not in other races, accounting for a third of the Black- White gap, indicating the effect is race specific and driven by perceptions of discrimination and structural racism [26].

2.6. Way 6: Indirect Effect: Case Where There Is No Relationship with an Unarmed Individual Who Has Been Killed by Police and the Effects on the Community

Racial profiling by police can have consequences on health even when there is no relationship to the person who has been racially profiled, but there is knowledge through the media and the community. When unarmed Black members of a community are killed, could it mediate adverse mental health issues within the community? Bor et al. focused on police killings and the effects on the mental health of Black Americans [3]. This study compared the mental health of Black Americans after a police killing of an unarmed Black American to the mental health before that event or 3 months after the event. The outcome variable that was measured was the number of days in the previous month that the respondent’s mental health was reported “not good” [3]. Killings of unarmed Black Americans were associated with worse mental health among other Black Americans, even if the Black Americans did not know the person who was killed, while no change occurred in White Americans. The killing of armed Black Americans was not associated with the mental health of Black or White Americans [3]. The effect of police brutality and mistreatment can be widespread and affect people who have only heard about the event [3]. This can trigger an individual to relive negative experiences causing stress and anxiety and can even cause the individual to worry about their safety and their families’ safety. Hearing about the event through the media or the community can also have adverse effects on an individual.

3. Discussion

Police violence experienced by racial minorities can cause adverse health consequences through stress, trauma, and anxiety [26]. Public health officials and policymakers need to treat racial profiling and adverse policing as true public health issues and recognize the scenarios in which medical effects can take place in Black Americans and minorities. There is a significant need to implement programs that mitigate the adverse mental health spillover caused by harmful police acts. The value of educating the public is important because Black Americans and other minorities are encountering clinical medical effects and many do not understand why [27]. We have two major recommendations. First, adequate public health resources need to be utilized to understand, diagnose, and address the health implications of racial profiling. Second, for police, while most traffic stops are lawful and do not involve racial profiling in our view, the 6 ways in which racial profiling produces medical effects will inform subsequent traffic stop interactions. We, therefore, need to educate law enforcement on the importance of Trauma Informed Policing (TIP) [28]. Trauma Informed Policing is defined as a framework for police officers to recognize and appropriately address the complexities of trauma experienced by survivors, to acknowledge symptoms and to use response tactics accordingly to prevent further individual trauma [28]. Several approaches have already been implemented in the use of trauma information such as the Trauma Informed Approach, referred to as Trauma Informed Care (TIC) which we can learn from and adopt in TIP [29]. The four Rs framework from the Trauma Informed Approach can be implemented for TIP. Officers can be trained to Realize the widespread impact of trauma and the different effects it may have on certain racial populations; Recognize the signs and symptoms of trauma; Respond by fully integrating experiences and knowledge about trauma into policies, procedures, and practices; and Resist retraumatization [29]. Police officers with TIP training will have the skills to approach situations with caution and care as well as awareness that many racial ethnic groups have a history of trauma and will be able to respond to agitated people in a nonjudgmental and supportive way. Relationships with police may trigger a response based on past experiences, personal or vicarious, that are not related to a current stop triggering PTSD, trauma, or stress causing an adverse reaction at the time of the police stop. Officers with TIP training will be able to recognize trauma and approach situations safely and be aware of cultural sensitivity as well as historical trauma that may impact entire communities [29]. In sum, the major focus needs to be on reducing disparities in health and promoting a culture of health. It is imperative for police and the community to understand the dynamics of racial profiling and its effects on public health.