Race, Policing, Health, and Increasing Trust not Trauma
This report explores the relationship between police-community relations and health, and identifies specific actions state and local-level decision makers can take to improve public health and public safety. Click each heading of the Executive Summary below to collapse or expand the summary sections and read more. Use the navigation bar at the top to download PDFs of the executive summary, full report, and appendices, or to contact us.
The tension and distrust between people of color and police in the United States is an underestimated public health crisis. Shocking cases of mistreatment, injury, and death grab headlines and go viral on social media, but the mental, emotional, and behavioral impacts of this fraught relationship affect communities of color and police officers in ways less often discussed.
This report shows that for many black people in the United States the perceived color of their skin means more uneasy interactions with police than others in our society, and stress and anxiety that in turn result in poorer physical and mental health. The report also shows that for police, heightened stress and anxiety put officers at greater risk of cardiovascular disease, substance abuse, depression, and suicide. The good news is the report finds that changes in policing models and practices can build trust between police and black communities, improving public health and public safety.
The anxiety and stress from interactions with police shape the daily experiences of black people – where they go, how they get there, and their sense of safety and security in their communities and the wider society. One study referred to black peoples’ experiences of police interaction as “mundane extreme environmental stressors.” Constant background stress can profoundly influence the emotional and physical development of youth, changing how youth interact with each other, adults, and institutions like schools. Prolonged and deep stress can change a child’s brain structure, and affect how well they do in school or work.
Anxiety and stress are also constants in police work. They stem not only from the inherent dangers of the job but from workplace factors such as long hours, excessive paperwork, court appearances, inadequate administrative support, and disciplinary procedures. Today’s police are called on for public service duties they may have little or no training for, such as dealing with people who have mental health conditions. These factors lead not only to increased risk of disease, but alcohol abuse, marital and family problems, and emotional withdrawal – what one Cincinnati officer described in a focus group as building “a wall around your skull to handle what you’re going to see.”
Beyond mental health and well-being, interactions between police and the public, especially people of color, carry the risk of injury or death. Compared to other people in the United States, black people are disproportionately injured from what are called “legal interventions”. Differing sets of data indicate that in Ohio in 2015 (as of November 1), 40 to 45 percent of people shot and killed by police were black – in a state where the total black population is about 12 percent. Nationwide in 2014, an estimated 13,400 police officers were injured by assaults in the line of duty, and 51 were killed.1,2
The evidence is clear: by failing to also understand mental and emotional health harms, the nation’s current approach to policing is failing black people and police officers. Change will not come easily or quickly, and will require a continuing commitment to building mutual trust.
Stark Disparities in Trust
This report focuses on the state of Ohio and its third- and fifth-largest cities, Cincinnati and Akron. (The Cincinnati Police Department participated in the report; the Akron Police Department declined.) The report shines a light on how current policing practices affect health and well-being, and points toward better practices that will help restore trust and respect, improve public health, and build safer environments for all. It is particularly aimed at helping shape the standards and practices under development by the Ohio Collaborative Community-Police Advisory Board, and practices in Cincinnati and Akron; the report can also inform other cities nationwide that are working to reform policing practices.
For this report, researchers reviewed a large body of literature about policing models and practices. We led eight focus groups of community members and police and interviewed people with a variety of perspectives. We also coordinated an in-person survey of 470 residents in select neighborhoods of Cincinnati and Akron. The survey results show stark disparities between how samples of black and white people in these cities experience and feel about police and policing practices (note: total survey responses varied for each question):
- Among white respondents, almost 70 percent (n=67) said they trust the police in their community either “somewhat” or “a lot” compared to about 40 percent (n=135) of black respondents.
- About one in seven black respondents (n=45) reported being stopped by police one or two times a day, and almost one in five (n=58) reported being stopped one or two times a week. Only three percent (n=3) of white respondents being stopped once or twice daily, and just another two percent (n=2) said they were stopped once or twice weekly.
- More than 40 percent of black respondents (n=131) said they were “very afraid” or “somewhat afraid” of police in their community, compared to only 15 percent of white respondents (n=14).
- Nearly two-thirds of black respondents (n=209) said they had feared police would injure or kill them, or had those fears for someone else in an incident they witnessed. The response from white respondents was almost the exact opposite – nearly two-thirds (n=62) said they never had those fears.
These disparities demonstrate that many black people live daily with the belief that the police are not there to serve and protect them. One black focus group participant in Cincinnati said:
I get a little queasy when a cop pulls up behind me.
In Akron, another said:
How can I feel safe in my own body if I don’t feel protected [by the police]?
Little research exists on police trust of the public in the United States. However, some studies find that police culture leads to social isolation, cynicism toward their own agency or the public, and an us versus them mentality of “warriors” and “civilians.” In one focus group, a Cincinnati officer said:
Everyone else is normal because they trust easier than we do. But the majority of people lie to us, so we have to believe that everyone is lying. And they lie really well to us.
Effectiveness of Policing Models and Activities
Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust not Trauma looked at four widely accepted models of policing:
- Community-oriented policing described by a White House task force as police working “with neighborhood residents to coproduce public safety.”
- Problem-solving policing, in which police seek to proactively identify and address the root causes of crime.
- Focused policing, including cracking down on a specific crime or offense, stepping up police presence in hot spots, and focusing on repeat offenders.
- Standard policing, which targets all crimes across an entire jurisdiction and aims to improve public safety by increasing the number of police, random patrolling, or responding more rapidly to calls.
The assessment found Akron’s approach is similar to the standard model, with some indication of community policing, while Cincinnati’s approach combines the community-oriented and problem-solving models. Assessing the effectiveness of the models is difficult because a model may contain a shifting set of practices governed by an overarching philosophy. Nonetheless, available evidence suggests the problem-solving approach is most effective, particularly in combination with community policing in reducing crime, building trust, and addressing inequities. By contrast, evidence suggests the standard model is least effective for these outcomes.
This report also looked at four specific activities many police departments have implemented to reduce inequities and misconduct, and to instead build trust between the public and police. We selected these four activities for analysis based on the availability of evidence to evaluate them and the frequency with which these activities have been proposed as solutions to the crisis in trust in the United States between the public and police:
Civilian review boards
These independently appointed or elected bodies oversee police practices and handle complaints from the public against police officers. About 80 percent of large US cities have civilian review boards. Studies show civilian review boards can increase public trust in police, particularly if using mediation or face-to-face discussions between the public with a complaint and the police supervisors.
Department-level performance measures
Many police departments measure and report their effectiveness using only crime statistics. Some policing experts and practitioners are developing an expanded set of measures that consider community relations, bias-free policing, and appropriate use of force. Expanding performance measures and assessing them over time through multiple methods can reduce the use of force.
Training, supervision, and evaluation
Officer training starts at the police academy and continues through on-the-job officer training; supervision includes the type, frequency, and level of supervision in the department; and evaluation involves how and when officers are evaluated. Training in communications, de-escalation and implicit bias are examples of courses found to increase trust. Using an early warning system to evaluate officer behaviors decreases use of force.
There is increased attention to use of body-worn cameras by police officers to record interactions with the public. Of the limited evidence available, it shows body cameras reduce the use of force and citizen complaints, and suggests they may decrease the number of stops. There is mixed evidence but some suggestion that body-worn cameras can increase public trust of police. More research is needed to better understand body-worn cameras.
This report makes five recommendations to improve public health and public safety, not only in Akron and Cincinnati but other cities in Ohio and that can be used nationwide. The full report details both how the recommendations overlap with those already released at the state level, federal level, and by grassroots organizations, as well as who can implement the recommendations.
We urge the Ohio Collaborative Community-Police Advisory Board, Ohio Department of Health, Ohio Attorney General’s Office, local police departments and local health departments, and researchers to consider the following recommendations. By considering the impacts on physical and psychosocial health of the public and police, high-profile bodies can produce and implement the highest priority reforms in the most effective way. (Specific actions to implement the recommendations are detailed in the full report.)
Connect current issues to historic context
Publicly recognize the historical contexts that have shaped current relationships between the public and police, using methods such as facilitated dialogues to understand each other’s experiences. This includes recognizing: police as a key factor – but only one factor among several such as poverty and unemployment – that can influence public safety; historic inequities in over-policing black people; the health impacts of policing practices; and possibility in systems thinking approaches to help resolve systemic issues. (Implementation roles for: Ohio Collaborative, public, police departments, research entities such as the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University, public health departments, and researchers in public health, criminology, and psychology.)
Implement community-oriented and problem-oriented policing according to promising practices, with primary aims of improving public safety and building trust. See table 1 in the report for promising practices. (Implementation roles for: police departments and community organizations.)
Fully implement the four specific actions described in this report – body cameras; civilian review boards or mediation; ongoing training, supervision, and evaluation of officers; and expanded department-wide performance measures. They are not the only activities available to police departments, but are the practices researched in this report and that it can comment on. (Implementation roles for: police departments, Ohio Peace Officer Training Commission)
State of Police reporting
Issue an annual statewide State of Police report that identifies, regularly collects, and publicly reports department-level measures that include and go beyond crime statistics, and report these statistics by race or ethnicity. This regular collection can enhance transparency and support the State of Police report card. (Implementation roles for: Office of the Ohio Attorney General, police departments, Ohio Department of Health, Ohio Collaborative)
Match police resources to responsibilities
Match police department resources – including staff skill sets – to the responsibilities necessary to serve all communities and create memoranda of understanding (MOUs) with community-based organizations to fill gaps beyond the skill sets of police. (Implementation roles for: police departments, Ohio Collaborative)
If these recommendations are implemented by using promising practices and including the suggested actions in the full report, we expect that outcomes in Akron would include increased public-police trust over time, and decreased fear of police, use of force incidents, and associated stress and anxiety. Key to these outcomes is full implementation as described in the report; evidence suggests that partial implementation may have the opposite effect. Through its civilian review board and improved training, supervision, and evaluation, Cincinnati has made progress in decreasing the use of force, and should continue these approaches. Full implementation of the recommendations about body cameras could further reduce use of force. Using mediation as an alternative to investigations by the civilian review board, and more complete use of department-wide performance measures as described in the report would increase community trust.
- The Guardian.com. The Counted: People killed by police in the US. http://www.theguardian.com/us-news/ng-interactive/2015/jun/01/the-counted-police-killings-us-database. Published 2015.
- The Officer Down Memorial Page, Inc. ODMP Remembers… https://www.odmp.org/officer/22273-police-officer-justin-winebrenner. Published 2015.