The United States is consumed by two seemingly distinct tragedies.
A pandemic has killed over 100,000 Americans. Meanwhile, the murder of George Floyd, Ahmaud Arbery, Breonna Taylor, and others has crystallized the persistent threat that racism poses to the health of Black Americans, leading to countrywide protests.
However, viewing these events as unrelated is inaccurate, experts say — they're actually two sides of the same coin. During a pandemic, police violence comes at an elevated cost. In part, this is because police violence actively undermines the medical system.
Sirry Alang is an assistant professor of sociology, health, medicine, and society at Lehigh University. Alang’s January 2020 study demonstrates that police violence reshapes trust for a medical system that’s already rife with inequality.
In a sample of 4,389 people, respondents who had negative encounters with police consistently reported higher levels of mistrust of medical institutions. A negative encounter ranged from being cursed at, to threatened with arrest, or other forms of violence like use of pepper spray, stun guns, or actual guns.
“The study looks at how police brutality affects mental health — not just by increasing rates of mental illness, diabetes, heart disease, asthma, or links to injury, disability or death — but at how our relationships with the police shift our relationships with other institutions, like medical institutions,” Alang tells Inverse.
This is against a backdrop of violence: Excessive use of police force was the sixth leading cause of death for men, according to a 2019 study. Black men are 2.5 times more likely to be killed by police in their lifetime than white men are.
Inverse spoke to Alang about how policing and medicine are deeply intertwined, what that means in the context of Covid-19, and how medical institutions can begin to rebuild trust.
What prompted you to study the connection between police violence and the medical system?
I started working on police brutality shortly after 2015 and 2016. I was doing my dissertation research in a predominantly Black neighborhood, and of course, it was policed.
There were so many times I was interrogated just for nothing – for hanging out or being with people. A significant source of stress was police violence.
In your paper, you write that healthcare experiences are "increasingly intertwined with policing.” Can you walk me through how they are connected?
Racism is not limited only to the criminal justice system. The racism that we see play out in law enforcement is the same racism we see play out in our medical institutions.
The connection is that if people of color or Black communities experience racism outside of the healthcare system in the form of police brutality, then they will expect to experience racism in other institutions. People bring the social context of their lives with them to the medical encounter.
We are also increasingly seeing our healthcare institutions have security guards. Some of them have full-blown police departments in the name of patient, employee, and family security. [A 2014 survey of 340 hospitals found that 70 percent had non-sworn officers directly employed by hospitals. Of those, 52 percent were allowed to carry guns.]
What does that mean for communities that have a history with the police that’s a scary one? A deadly one? There’s the potential that every encounter with the police could lead to death. Having a police presence in hospitals ... it’s horrible.
If you are oppressed in one institution you will be oppressed in another institution because of your skin color. That’s how structural racism works.
It’s not simply a problem for police officers to fix. This is something that really irritates me. We all have to work together, medical institutions, the police, higher education, health policy and public health institutions to address police violence.
We’re in the middle of a pandemic. How does police violence influence trust in the healthcare system during Covid-19?
Even before there was Covid-19 there was medical mistrust.
[Abuse of black and brown bodies runs deep in the history of medicine, as far back as exploitative medicine during slavery and beyond. That legacy lives on in more recent history through initiatives like the 20th century Tuskegee Syphilis experiments].
But I think Covid-19 has made it worse, which is really really sad. When we talk about medical mistrust, it’s not that people don’t trust the healthcare system. It’s that people believe the healthcare system will act against their best interests.
When people mistrust the healthcare system, they don’t want to use the healthcare system. They don’t want to engage in care. That’s a big problem, and police brutality increases that.
How does public health need to change to better serve people disproportionately impacted by Covid-19 and police brutality?
With police brutality and Covid-19, it’s really important for us to focus on providing training to healthcare providers, and public policymakers in what we call structural competency. We need to train them to think about how racism shifts the interactions that they have with their patients, even before they step into the examination room.
As much as they’re able to diagnose the biological factors that cause disease and fix those, they also should be able to understand the social determinants of health. They should understand the social factors so they can advocate for broader, structural changes – anti-racism policies.
"When people mistrust the healthcare system, they don't want to use the healthcare system."
I think it’s also really important for healthcare providers to listen to the experiences of Black communities and people of color. You can be trained on how to treat cancer, and that’s fine. You can be trained on how to run a hospital. You cannot be trained on the experiences of people who are Black in the medical setting.
The only way is by listening to them and by validating those experiences. Black communities are experts in their own healthcare experiences.
We might have the knowledge to treat them, but we don’t have their day-to-day experiences with police brutality, with Covid-19, with structural racism, and with white supremacy. These shape interactions they have with healthcare providers.
We’re starting to see statements of support from scientific societies and medical groups. What else can medical institutions do right now?
I don’t see any quick actions. Over time, they have to work on building that trust. People don’t mistrust healthcare institutions because of what they’ve said. They mistrust them because of what they’ve done over and over and over again.
Medical communities need to change their actions, and the community is going to judge. We’re not just going to trust institutions, whether they’re medical institutions or law enforcement institutions, because they sent out an email saying they reject racism. It’s going to take time to heal those wounds of mistrust.
I think that speaking up is important, as is putting money into communities that are disproportionately impacted. You want to make sure those resources aren’t color blind.
The decisions about who gets what for Covid-19 resources, and who makes those decisions really should be done by people who are closest to the pain – both the pain of Covid-19 and the pain of police brutality.
When white boards of directors or white healthcare administrators make decisions or put up statements of solidarity, I always want to tweet back and say: “Put up a picture of your board.” Put up a picture of who is making those decisions. Let’s see what voices of color, what Black voices, in particular, are represented.
This interview has been edited for brevity and clarity.