The death of Tyre Nichols at the hands of Memphis police earlier this year has set off new questions about what public safety really means in America. While the five former officers are being charged for Nichol’s murder, there’s been scrutiny over how EMS responders handled the victim’s injuries after arriving on the scene.
On the night of January 7, paramedics responded to a call of a person being pepper sprayed. Despite the man laying bloody and in distress against a police vehicle, they failed to make their own assessment of the patient beyond what the officers told them. It took another 19 minutes for the EMTs to bring a stretcher out for him.
The mistreatment Nichols endured from people trained to save lives is a grave reminder that America is built on a system designed to treat minority communities differently. One in every 1,000 Black men in the US will be killed by law enforcement, estimates a 2019 criminal justice study. Among young Black men between 25 and 29, police brutality ranks as the sixth leading cause of death. And more than half of police brutality cases go unreported, especially when they involve Black people.
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In the wake of Nichols’s murder, medical organizations like the Association of American Medical Colleges released statements condemning the violence. But they didn’t address the fact that fear of being harmed by figures of authority can also carry over to medical institutions and personnel. Sirry Alang, an associate professor of Black Communities & the Social Determinants of Health at the University of Pittsburgh School of Education, says police brutality must be considered a public health crisis. “Police brutality literally kills people. It causes death and disability and it shifts relationships with healthcare providers that make people less likely to seek care.”
The roots of medical mistrust
Medical mistrust is the belief that people working in the medical field want to harm you or don’t have your best interests at heart. Alang says it tends to come from the concern of being treated differently because you are affiliated with a specific racial or gender group.
Medical mistrust has been justified through American history. From the 1930s to the 1970s, public health researchers with the Tuskegee syphilis study infected hundreds of healthy Black men and intentionally withheld treatment when penicillin became available. What’s more, the bogus science of eugenics promoted the forced sterilization of thousands of people of color in the 20th century.
Mistrust has also arisen, in part, because of the prejudices workers at medical institutions hold against certain groups of people. For example, Black patients are less likely to be prescribed pain medication than white patients, even if they are experiencing the same level of pain, because of a deep-rooted stereotype that they have “thicker skin.” The US mortality rate among Black mothers from complications during pregnancy is also three times higher than that of white mothers, in part because of the failure of doctors to understand the pain of Black women.
“People don’t seek healthcare as individuals,” explains Alang—their choices are shaped by personal experience and the experiences of others in their community. “One bad experience can influence the expectations of others in that network and make it easy for medical distrust to spread.”
Cycles of violence, trauma, and more mistrust
Experiencing police brutality creates traumatic racial experiences that can subvert a person’s belief on what to expect when dealing with a figure of authority. Think about the end of an abusive romantic relationship. Even if you moved on, you might always be wary of your new partner and whether they’ll behave just as badly. Similarly, a traumatic experience with the police keeps you on edge of being mistreated in other areas.
“If people in authoritative roles have showed they don’t respect you, you’ll be more suspicious of other authority figures like healthcare providers,” says Georges Benjamin, the executive director for the American Public Health Association. What’s more, exposure to police violence can force survivors to develop feelings of hopelessness and worthlessness and further convince them to avoid care—even when they need it.
Another issue is that healthcare institutions support a broken public-safety system that often works against those who need it. Take emergency medical dispatches, for example. First responders tend to talk to the officer at the scene first instead of speaking with the harmed individual to figure out what happened. “They then come to you like an object it has to fix instead of a person,” says Alang.
Crumbling police-community relations
The stress and trauma that comes from the threat of police brutality can cause long-term stress that wears down the body over time. For example, a 2016 study of Black residents living in highly policed areas of New York City found they were more likely to have poor health outcomes such as high blood pressure, regardless of whether or not officers stopped them. Benjamin says that the perception that law enforcement is not actually there to protect you can create community stress that keeps your body in a constant fight-or-flight mode.
Constant stress contributes to a higher risk of heart disease, stroke, and diabetes, along with a number of mental health conditions. But when people are apprehensive about how they will be treated for “overreacting” to the constant threat of police brutality, Alang says they are more likely to skip out on seeing or talking to their doctor about the source of their stress and trauma. They might also be less likely to adhere to medication or treatment plan. “The relationship between a healthcare provider and a patient is one of fundamental trust,” Benjamin explains. “If you don’t trust that individual, you might have some suspicions on their advice or you may not believe what they told you.”
Building a safer public health system
Reducing police violence is just one part of fixing medical mistrust; hospital, EMS groups, and public health organizations need to actively build rapport with communities grieving the loss of their members. Alang says putting out anti-racist press statements after a violent incident does little to reassure the public. Instead, both she and Benjamin advise medical institutions to take action in ways that make people feel heard or supported.
This can come from changes like hiring a healthcare workforce that represents the patient population it’s treating, and setting up accessible mental health programs focused on addressing trauma and stress. Benjamin adds that medical institutions can work with law enforcement to build out community-based policing, including teaching them how to interact with people under stress. “Public health is not going to [completely] solve this police violence problem,” he says. “But we are part of the solution.”