Beyond the Badge:
Policing as a Social Determinant of Health
Ashley J. Hodo, MPP, John R. Lewis Social Justice Fellow
June 2025
Introduction
Policing in the United States has been a persistent mechanism of state-sanctioned racialized violence and surveillance with deep-rooted public health consequences for Black communities. From 19 th century slave patrols to today’s militarized policing, the criminal legal system perpetuates cycles of discriminatory violence that undermine the health and well-being of Black citizens through physical abuse and significant trauma. The physical and psychological abuse of discriminatory policing exacerbate racial health disparities across multiple indicators, such as cardiovascular disease, diabetes, and mental health. Adverse health outcomes underscore how structural racism reinforces socioeconomic inequalities by creating chronic stress, disrupting community stability, and reducing access to vital resources necessary to promoting a higher quality of life.
The deaths of unarmed Black Americans murdered by white police officers, like Breonna Taylor and George Floyd in 2020, emphasize a critical need to examine the balance of power between law enforcement and Black America and rectify the harms of statesanctioned violence through structural reforms to the criminal legal system. State and local officials have made incremental progress in addressing physical abuse from excessive police force. However, policies have yet to provide substantive relief that addresses the chronic stress inflicted by the criminal legal system. This brief will conduct a difference-in-difference analysis comparing health outcomes in Minneapolis, MN and St. Louis, MO before and after the passage of the Minnesota Police Accountability Act and other city-level ordinances in Minneapolis, where George Floyd’s death brought renewed urgency to demands for police accountability. The findings suggest that incremental reforms fall short in addressing the profound health consequences of systemic police violence. Until policymakers transform the criminal legal system by dismantling the legacy of white supremacy and advancing structural reforms that deliver justice for Black communities, the cycle of police violence and its harmful effect on the health of Black citizens will continue to threaten Black lives.
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
A Brief History of the Health Impacts of the U.S. Criminal Legal System
The history of the U.S. criminal legal system shows how state-sanctioned violence has negatively shaped the health outcomes of Black Americans. During this nation’s founding, white settlers created systems that inflicted physical and psychological trauma on enslaved Africans. In the 17 th and 18 th centuries, slave patrols were enacted by state legislators to capture escaped enslaved people and suppress uprisings, setting a precedent for state-sponsored surveillance of and violence against Black communities. 1 Enslaved Africans endured brutal physical punishment, malnutrition, medical neglect, and forced medical experimentation. 2 These conditions contributed to intergenerational trauma and laid the foundation for longstanding racial health disparities. Following the emancipation of formerly enslaved Africans, Black Codes and Jim Crow laws reinforced white supremacy and legalized violence against Black communities. The criminal legal system permitted physical and psychological violence, including lynching and police complicity in racial terror. 3 Furthermore, the toll of such violence contributed to the health phenomenon known as “weathering,” accelerated aging and health deterioration due to stress. 4 Racial segregation also restricted access to quality healthcare, further exacerbating health disparities.
As Black Americans migrated to the North to escape racial terror in the Jim Crow South during the Great Migration, many were subject the brutality of organized policing in Northern cities. Upon migrating to major urban cities like Harlem, NY, Detroit, MI, and Newark, NJ. Black citizens faced police violence, often resulting in racial uprisings for increased civil rights. In the 1960s, activists made police brutality a defining issue of the civil rights movement, particularly as law enforcement confronted peaceful protesters with militarized force. Images of police officers releasing dogs and fire hoses on demonstrators showed the nation the physical abuse law enforcement inflicted upon Black communities and exposed the depth of white supremacy in the criminal legal system.
1 “The Origins of Modern Day Policing,” NAACP, December 3, 2021, https://naacp.org/find-resources/history-explained/ origins-modern-day-policing
2 Robert L. Reece, “Slave Past, Modern Lives: An Analysis of the Legacy of Slavery and Contemporary Life Expectancy in the American South,” Journal of Black Studies 53, no. 7 (2022): 677–702.
3 Nathaniel J. Glasser, Elizabeth L. Tung, and Monica E. Peek, “Policing, Health Care, and Institutional Racism: Connecting History and Heuristics,” Health Services Research 56, no. 6 (2021): 1100.
4 Chantelle Miller, Too Much for a Heart to Bear: A Systematic Review and Mini Meta-Analysis on The Role of Skin-Deep Resilience in the Weathering of Black People in America (2022).
In the second half of the 20 th century, the federal government accelerated the militarization of law enforcement. The 1965 Law Enforcement Assistance Act and the Safe Streets Act of 1968 expanded the carceral state by increasing the federal government’s role in local policing through militarized police trainings and funding for increased street patrols in majority-minority, low-income communities. 5 The emergence of SWAT teams furthered aggressive policing practices in Black communities, as evidenced by the late 1960s raids of the Black Panther Party in cities like Los Angeles and the police bombing of the Black liberation group MOVE’s headquarters in Philadelphia. This period also marked the rise of broken windows policing, a theory that helped police criminalize poverty by framing minor offenses as pathways to more serious crimes. 6 During the 1980s, the War on Drugs escalated drug enforcement policies that disproportionately targeted Black communities. These policies resulted in the mass incarceration of Black Americans in overcrowded prisons, where infectious disease, inadequate diagnosis and treatment of chronic disease, and mental health illnesses negatively impacted incarcerated Black people. 7 At the same time, the widespread adoption of stop-and-frisk policies in cities like New York subjected Black communities to invasive, unlawful searches. These practices reflect the evolution of the criminal legal system as a historical tool to surveil and control Black people under the guise of public safety. The chronic stress of overpolicing and mass incarceration increased rates of anxiety, depression, hypertension, and cardiovascular disease in both incarcerated and non-incarcerated Black Americans, highlighting the public health implications of a racialized criminal legal system. 8
Policing as a Social Determinant of Health
Within the last decade, public health scholars have adopted more interdisciplinary approaches to understanding the links between excessive policing and health outcomes
5 Law Enforcement Assistance Act of 1965, Pub. L. No. 89-97, 79 Stat. 279 (1965). Safe Streets Act of 1968, Pub. L. No. 90351, 82 Stat. 197 (1968).
6 C. C. Lanfear, R. L. Matsueda, and L. R. Beach, “Broken Windows, Informal Social Control, and Crime: Assessing Causality in Empirical Studies,” Annual Review of Criminology 3 (2020): 97–120, https://doi.org/10.1146/annurevcriminol-011419-041541
7 G. G. Grecco and R. Andrew Chambers, “The Penrose Effect and Its Acceleration by the War on Drugs: A Crisis of Untranslated Neuroscience and Untreated Addiction and Mental Illness,” Translational Psychiatry 9, no. 1 (2019): 320, https://doi.org/10.1038/s41398-019-0661-9
8 Hannah LF Cooper and Mindy Fullilove, “Excessive Police Violence as a Public Health Issue,” Journal of Urban Health 93 (2016): 2.
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
in Black communities. The analysis of policing as a social determinant of health recognizes that discriminatory policing practices can contribute to racial disparities in mental health, chronic disease, and premature mortality. This framework expands public health discourse surrounding health inequities by accounting for the growing effects of systemic police violence and surveillance on health outcomes.
One key pathway in public health literature linking police brutality to poor health outcomes is that such brutality triggers “adverse physiological responses [that] increase morbidity.” 9 Constant surveillance and harassment through practices like pretextual traffic stops and stop-and-frisk policies can generate chronic physiological and mental stress known as surveillance stress. 10 Black people are already over-policed. Young Black men are nine times more likely than white men to be killed by police. 11 Black people are nearly five times more likely than other Americans to sustain police interventionrelated injuries and are more likely to report use of force or threats by police. 12 There are consistent findings showing that constant harassment from over-policing can negatively impact mental health. For example, data shows that increases in police stops by the New York Police Department resulted in a 2.7% increase in psychiatric emergency room visits among Black residents. 13 These patterns of discriminatory police contact, which often start at an early age, demonstrate the intense exposure and health risks Black communities face through routine interactions with law enforcement.
Direct individual interactions with police also result in physiological stress, contributing to weathering and other premature declines in health for those under constant police surveillance. 14 The trauma responses from over-policing increase the probability of
9 Selamawit Alang, Donna McAlpine, Ellen McCreedy, and Rachel Hardeman, “Police Brutality and Black Health: Setting the Agenda for Public Health Scholars,” American Journal of Public Health 107, no. 5 (2017): 662–665, https://doi.org/10.2105/AJPH.2017.303691
10 Elizabeth Pittenger, Policing as a Social Determinant of Health: How Death by Law Enforcement Impacts Community Health in the Time of COVID-19 (Honors thesis, Emory University, May 5, 2022).
11 Selamawit Alang, Donna McAlpine, Ellen McCreedy, and Rachel Hardeman, “Police Brutality and Black Health: Setting the Agenda for Public Health Scholars,” American Journal of Public Health 107, no. 5 (2017): 662–665 https://doi.org/10.2105/AJPH.2017.303691
12 Katherine P. Theall et al., “Neighborhood Police Encounters, Health, and Violence in a Southern City,” Health Affairs 41, no. 2 (2022): 228–36, https://doi.org/10.1377/hlthaff.2021.01428
13 This study evaluates interaction involving police stops, stops with frisk, and stops involving excessive force. Aniruddha Das and Timothy A. Bruckner, “New York City’s Stop, Question, and Frisk Policy and Psychiatric Emergencies among Black Americans,” Journal of Urban Health 100 (2023): 255–268, https://doi.org/10.1007/s11524-022-00710-x
14 David H. Chae et al., “Racial Discrimination and Telomere Shortening among African Americans: The Coronary Artery Risk Development in Young Adults (CARDIA) Study,” Health Psychology 39, no. 3 (2020): 209–19, https://doi.org/10.1037/hea0000832
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
diabetes, high blood pressure, and other chronic illnesses due to the overuse of allostatic load.15 Allostatic mechanisms help manage individual responses to a stressor, such as discriminatory policing practices. When stressors become chronic, they strain processing systems and eventually prevent the body from appropriately responding. Adrenal hormones, which are responsible for mediating threats from perceived discrimination, will increase blood sugar, heart rate, and blood circulation. The overuse of these hormones can result in hypertension, elevated glucose levels, and plaque build-up around the heart, which increases the risk of chronic illnesses such as diabetes and cardiovascular disease.16
The physiological impact of police presence emphasizes how structural inequities that normalize racialized surveillance and violence have resulted in a public health crisis. Understanding the health consequences of discriminatory policing underscores the critical need for systemic criminal legal system reform that alleviates chronic stressors and promotes an environment of safety, not surveillance, for Black communities.
Policing and Public Health: A Comparative Study of Minneapolis and St. Louis
Criminal legal reform has the potential to address adverse physiological and mental health responses. Banning excessive force can reduce incidences of bodily injury and death of Black communities, while other accountability methods such as ending stopand-frisk policies can reduce chronic illnesses associated with surveillance stress. To analyze the impact of these reforms on health outcomes in Black communities, this brief uses a Difference-in-Differences (DiD) approach to compare health outcomes across Black populations in Minneapolis, MN and St. Louis, MO. These cities offer a compelling case study to help understand the extent to which criminal legal reform improved the well-being of Black citizens. Minneapolis and St. Louis grappled with the deaths of two unarmed Black men by police brutality and endured subsequent protests and calls for
15 Alyasah Ali Sewell et al., “Illness Spillovers of Lethal Police Violence: The Significance of Gendered Marginalization,” Ethnic and Racial Studies 44, no. 7 (2020): 1089–1114, https://doi.org/10.1080/01419870.2020.1781913
16 Bridget J. Goosby, Jacob E. Cheadle, and Christy L. Mitchell, “Stress-Related Biosocial Mechanisms of Discrimination and African American Health Inequities,” Annual Review of Sociology 44 (2018): 319–340, https://doi.org/10.1146/annurevsoc-060116-053403
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
reform. Lawmakers were presented with an opportunity to explore how city and state policy efforts could address the public health impacts of systemic police violence on Black communities. However, while Minneapolis enacted numerous police reforms in the aftermath of George Floyd’s death, St. Louis did not implement any comparable policy changes following the killing of Michael Brown. This contrast allows for a comparative analysis of how reform, or the lack thereof, affects the well-being of Black residents.
ST. LOUIS, MISSOURI
On August 9, 2014, Ferguson Police stopped Michael Brown while he was walking down the middle of the street. Prior to this stop, Ferguson Police had been searching for two Black males reported to have stolen a box of Swisher Sweet cigars. Brown and Officer Darren Wilson engaged in a physical struggle, during which Wilson discharged his gun, striking Brown in the hand. As Brown fled and then turned back, Wilson fired additional shots, ultimately killing him. Eyewitness accounts varied, as some stated that Brown raised his hands in surrender, while others claimed he moved toward Wilson. These conflicting reports, combined with the delayed response and lack of transparency in the investigation, ignited collective outrage among Black communities.
Brown’s death ignited protests across Ferguson calling for accountability as Black communities grieved yet another death at the hands of police brutality. Former President Barack Obama attempted to implement criminal legal reform through an executive order curtailing the use of military-grade equipment by local law enforcement. Obama also commissioned the President’s Task Force on 21st Century Policing, a multidisciplinary expert panel that developed comprehensive recommendations on crime reduction strategies and
CPAR | Beyond the Badge: Policing as a Social Determinant of Health community-based policing initiatives.17 In addition, the Department of Justice launched an investigation into the Ferguson Police Department, which concluded that the department conducted routine patterns of discriminatory policing that violated the constitutional rights of Black residents in Ferguson.18 Despite attempts to enact reform, officials from the City of Ferguson and the Ferguson Police Department have only fulfilled 45% to 60% of the requirements outlined in its 2015 consent decree with the Department of Justice.19 Leadership across state and city offices remained in place, making it increasingly difficult for activists to achieve sustainable, long-term reforms. Additionally, former St. Louis County Prosecutor Wesley Bell declined to bring charges against Officer Wilson for Brown’s death. The lack of comprehensive reform measures signaled the continued struggle of implementing meaningful policies that promote accountability for Black communities.
MINNEAPOLIS, MINNESOTA
On May 25, 2020, former Minneapolis Police Officer Derek Chauvin knelt on the neck of George Floyd, an unarmed Black man, for 9 minutes and 29 seconds, resulting in Floyd’s death. An independent autopsy concluded that Floyd died from “asphyxia due to sustained forceful pressure.”20 This blatant use of deadly excessive force renewed calls for police accountability across the country, compelling state and local lawmakers to reevaluate police forces and implement policies addressing abuses of power from law enforcement experienced by Black communities over a century.
17 President’s Task Force on 21st Century Policing, Final Report of the President’s Task Force on 21st Century Policing (Washington, DC: Office of Community Oriented Policing Services, U.S. Department of Justice, 2015).
18 City of Ferguson, Amended and Restated Consent Decree No. 97-1 (Ferguson, MO: City of Ferguson, 2018), accessed June 16, 2025, https://www.fergusoncity.com/DocumentCenter/View/3854/97-1-Amended-and-Restated-ConsentDecree?bidId=
19 City of Ferguson, Amended and Restated Consent Decree No. 97-1 (Ferguson, MO: City of Ferguson, 2018), accessed June 16, 2025, https://www.fergusoncity.com/DocumentCenter/View/3854/97-1-Amended-and-Restated-ConsentDecree?bidId=
20 Amy Forliti and Steve Karnowski (Associated Press), “Independent Autopsy for George Floyd Contradicts Prosecutors’ Findings,” PBS NewsHour, June 1, 2020, https://www.pbs.org/newshour/nation/independent-autopsy-for-george-floydskilling-policing-defined-tim-walzs-tenure/
Two months after Floyd’s death, the Minnesota Legislature passed the Minnesota Police Accountability Act. According to State Representative Carlos Mariana, this bill would create “a modern accountability framework of laws that will help end the type of police brutality that killed George Floyd.” 21 This legislation introduced several reforms, including a statewide ban on chokeholds, the end of warrior-style training for officers, data collection on deadly force incidents, duty-to-intervene requirements, and the establishment of a new state unit for police oversight. It also addressed broader socioeconomic impacts of the criminal legal system through cash bail reform, community-centered public safety initiatives, and mandatory mental health and autism training. 22
Although Minnesota lawmakers acknowledged the legislation as a significant step toward a more equitable criminal legal system, activists continued to call for deeper reforms. In response, Governor Tim Walz and the Minnesota Legislature appointed new board members to the Police Officer Standards Training Board, which oversees police licensing and rulemaking over Minnesota’s 11,000 law enforcement officials. Other reforms include entering a state-level consent decree with Minneapolis over discriminatory policing and investing $70 million in community violence prevention grants. 23
Reform also occurred on the local level, including $2.5 million in investments for comprehensive reviews of restraint methods and other discriminatory policing practices. Since March 2024, city officials and the Minneapolis Police Department, under the guidance of the Minnesota Department of Human Rights, have also significantly reduced backlogs of police misconduct investigations, implemented crisis response teams to answer behavioral health dispatches, and increased meaningful community and nonprofit engagement.24
DEMOGRAPHICS
Despite comprising only 18.3% of the population, Black individuals in Minneapolis are more than 28 times more likely to be killed by police than their white counterparts. 25 They also account for 61% of all arrests by the Minneapolis Police Department and are 8.1 times
21 Mike Cook, “House, Senate Agree to Compromise Police Reform Package,” Session Daily, Minnesota House of Representatives, July 21, 2020, https://www.house.mn.gov/sessiondaily/Story/15394
22 Minnesota Legislature, Police Accountability Act of 2020, 91st Legislature, 1st Special Session, Chapter 1–H.F.No. 1 (July 2020), https://www.revisor.mn.gov/laws/2020/1/Session+Law/Chapter/1/
23 Deena Winter, “After George Floyd’s Killing, Policing Defined Tim Walz’s Tenure,” Minnesota Reformer, August 15, 2024, https://minnesotareformer.com/2024/08/15/after-george-floyds-killing-policing-defined-tim-walzs-tenure/
24 City of Minneapolis, “Second Independent Evaluator Report Shows ‘Significant Strides’ in Minneapolis Police Reform,” City of Minneapolis, May 20, 2025, https://www.minneapolismn.gov/news/2025/may/year-report/
25 Police Scorecard, “Minneapolis Police Department,” Police Scorecard, accessed June 16, 2025, https://policescorecard.org/mn/police-department/minneapolis
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
more likely to be arrested for low-level, nonviolent offenses. 26 In St. Louis, which serves as the control group in this analysis, Black residents comprise 23% of the population in St. Louis County but account for 50% of those killed by police. Additionally, 62% of all arrests by the St. Louis Police Department involve Black individuals, who are 3.6 times more likely than whites to be arrested for low-level, nonviolent offenses.
Health disparities between Black and white residents are also significant in both states. In Minneapolis, 12.5% of Black residents are diagnosed with diabetes, 1.4 times higher than the rate for white residents. 27 In Missouri, Black residents have higher rates of emergency room visits, in-patient hospitalizations, and mortality due to diabetes than their white counterparts. Cardiovascular mortality in St. Louis is also higher among Black residents (265 per 100,000) compared to white residents (194 per 100,000). 28 While Black residents in Minnesota have lower cardiovascular death rates overall, this may be attributed to a large African-born population, which tends to have different health outcomes than U.S.born Black Americans. Lastly, Black residents in St. Louis also experience higher rates of anxiety and mood disorders, with nearly 40 per 1,000 individuals receiving mental health services, exceeding rates among their white counterparts. 29
DIFFERENCE-IN-DIFFERENCE ANALYSIS
Using 2017-2023 health data from the Behavioral Risk Factor Surveillance System (BRFSS), this analysis compares health outcomes before and after the implementation of the Minnesota Police Accountability Act and other reform efforts. BRFSS is a healthrelated telephone survey conducted by the Centers for Disease Control and Prevention that collects state and local data on chronic health conditions, health-care access, and risk behaviors. 30 The DiD analysis utilizes survey data from the Minneapolis-St. Paul-
26 Police Scorecard, “St. Louis City Police Department,” Police Scorecard, accessed June 16, 2025, https://policescorecard.org/mo/police-department/st-louis-city
27 City of Minneapolis, “Why We Do This Work,” City of Minneapolis, last modified June 13, 2025, https://www. minneapolismn.gov/government/programs-initiatives/healthy-living/why/
28 City of St. Louis Department of Health, “Cardiovascular Disease Data Brief (2021),” City of St. Louis, accessed June 16, 2025, https://www.stlouis-mo.gov/government/departments/health/documents/briefs/cardiovascular-diseasejanuary-2021.cfm
29 City of St. Louis Department of Health, “Mental Health Data Brief (2021),” City of St. Louis, accessed June 16, 2025, https://www.stlouis-mo.gov/government/departments/health/documents/briefs/mental-health-september-2021.cfm
30 Centers for Disease Control and Prevention, “Behavioral Risk Factor Surveillance System,” Centers for Disease Control and Prevention, June 4, 2025, https://www.cdc.gov/brfss/index.html
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
Bloomington Metropolitan and St. Louis Metropolitan Statistical Areas and includes responses on general health, mental health, and chronic disease (i.e., reports of high blood pressure and heart disease diagnoses). Data from 2020 was excluded due to potential shocks from the COVID-19 pandemic and the civil unrest following Floyd’s murder. This analysis was also adjusted for demographic factors—including education, sex, and age— to account for potential confounding variables and increases the internal validity. 31
Intercept -0.03252 Not Significant
Treatment -0.53499 p < 0.001
Post-Policy 0.18515 Not Significant
DiD 0.097981 Not Significant
Baseline prediction of reporting poor health in St. Louis (control group) before the policy.
Black respondents in Minneapolis had significantly lower odds of poor health than Black respondents in St. Louis before the policy change.
After the policy, Black respondents in Minneapolis and St. Louis had a small increase in poor health.
After the policy, Black respondents in Minneapolis did not have a statistically significant difference in poor health compared to Black respondents in St. Louis.
The results of this DiD model indicate that prior to the implementation of the state’s excessive force policy, Black respondents in Minneapolis and St. Louis had no significant baseline difference in health outcomes. This suggests that these metropolitan areas were comparable and further supports the reliability of this analysis. 32 The DiD interaction term, which captures the relative effect of the policy on Black respondents in Minneapolis compared to Black respondents in St. Louis, is positive but not statistically significant. 33 The positive coefficient suggests a small increase in reported poor health; however, because the effect is not statistically distinguishable from zero, we cannot conclude that the reform measures caused this change.
31 Limitations to this research include the assumption that treatment and control groups would have followed similar health trends without reform. Additionally, BRFSS data reveals population-level trends between policing and health outcomes rather than individual exposure, which could limit the specification of health outcome associations.
32 Estimate = -0.033, p = 0.8452
33 Estimate = 0.098, p = 0.464
DiD models were also analyzed for reported diagnoses of cardiovascular disease and high blood pressure. The DiD interaction terms were both positive; in this case, the positive interaction terms suggest that there were slight decreases in reported diagnoses of cardiovascular disease and hypertension. 34 The implementation of police reforms in Minneapolis did not have a statistically significant effect on cardiovascular disease or hypertension diagnoses, indicating that reforms were weakly beneficial. Therefore, it is reasonable to conclude that the policy did not significantly improve or worsen selfreported health outcomes for Black residents in Minneapolis following the passage of criminal legal reform.
These findings imply that while Black respondents in Minneapolis may have experienced better health prior to the policy’s implementation, the Minnesota Police Accountability Act and other reform measures were insufficient in improving population-level health outcomes, highlighting the limitations of these reforms in addressing structural health inequities. Several factors could account for these outcomes. In particular, these reforms did not have a direct impact on self-reported health. Consistent surveillance and systemic racial biases, coupled with the disproportionate use of excessive force, contribute to the overall adverse health outcomes in Black communities. Reforms, often developed in response to an event of police brutality, attempt to mitigate harmful physical contact with police and fail to adopt long-term approaches to systemically changing interactions between Black communities and law enforcement. For example, the use of body cameras is recognized as a potential tool for transparency and a deterrent for negative police behavior. However, a 2017 study of the Metropolitan Police Department in Washington, D.C. concluded that there were no meaningful decreases in use of force or complaints after the implementation of body camera requirements. 35 Furthermore, some evidence suggests that police departments with restrictive use of force continuums may reduce the use of lethal force (i.e. the use of guns during police interactions) but increase the uses of chokeholds and other restraint methods that may be lower in the continuum. 36
The Minnesota Police Accountability Act, as with similar reform attempts across the country, failed to comprehensively deconstruct norms and structures that incentivize
34 Estimate = 0.374, p-value = 0.197 (cardiovascular disease model); Estimate = 0.107, p-value = 0.441 (high blood pressure model)
35 David Yokum, Anita Ravishankar, and Alexander Coppock, Evaluating the Effects of Police Body-Worn Cameras: A Randomized Controlled Trial (Washington, DC: LAB @ DC, 2017).
36 Trevor Bechtel, Mara C. Ostfeld, and H. Luke Shaefer, Evidence on Measures to Reduce Excessive Use of Force by the Police (Ann Arbor, MI: Poverty Solutions at the University of Michigan, 2023).
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
police interactions and criminalize Black people. Therefore, when considering police reforms, it is important to recognize that reforms cannot be solely focused on deterring flagrant acts of violence from law enforcement; they must address systemic practices that perpetuate racial bias and chronic stress in Black communities.
Policy Recommendations
Since 2020, state and local governments have implemented incremental policing reforms. But a recent Congressional Black Caucus Foundation poll reveals that 80% of Black Americans feel the criminal legal system has stayed the same or worsened since 2020, underscoring the limitation of incremental reform. 37 Although 25 states have enacted useof-force policies between 2020 and 2024, including bans on chokeholds, requirements for de-escalation and duty to intervene, restrictions on deadly force, and comprehensive reporting protocols, these measures have done little to significantly curtail police violence in Black communities. 38 According to the Brennan Center, these reforms address only a small fraction of police killings and fail to meaningfully address systemic issues within the criminal legal system. 39 In many jurisdictions where discriminatory police violence happened, policies such as duty-to-intervene and body camera measures were already in place; however, there was a lack of proper accountability measures that allowed for the continuation of police misconduct. For example, Black residents of Northern Minneapolis reported that while body cameras are a promising example of police accountability, their inconsistent enforcement and use have not delivered justice when Black citizens are killed by police. 40 Furthermore, researchers often find difficulty demonstrating strong causal relationships between these policies and a reduction in police violence, suggesting the need for more robust structural interventions for criminal legal reform. 41 Research shows that to effect change, policy interventions must address the underlying structures that drive racial bias in the criminal legal system.
37 Congressional Black Caucus Foundation. “#1: Fifth Anniversary of George Floyd’s Murder.” Congressional Black Caucus Foundation. Accessed June 16, 2025. https://www.cbcfinc.org/policy-research/the-pulse/#1747154015348bbb50041-8072
38 De-escalation tactics include active listening, nonverbal communications, building rapport and using empathy in interactions. Campaign Zero, “8 Can’t Wait,” Campaign Zero, accessed June 16, 2025, https://8cantwait.org/
39 Brennan Center for Justice, “State Policing Reforms Since George Floyd’s Murder,” Brennan Center for Justice, accessed June 16, 2025, https://www.brennancenter.org/our-work/research-reports/state-policing-reforms-george-floyds-murder
40 Michelle S. Phelps, Christopher E. Robertson, and Amber Joy Powell, “‘We’re Still Dying Quicker Than We Can Effect Change’: #BlackLivesMatter and the Limits of 21st-Century Policing Reform,” American Journal of Sociology 127, no. 3 (2021): 867–903.
41 Trevor Bechtel, Mara C. Ostfeld, and H. Luke Shaefer, Evidence on Measures to Reduce Excessive Use of Force by the Police (Ann Arbor, MI: Poverty Solutions at the University of Michigan, 2023).
Substantive criminal legal reform must demand that institutions acknowledge their racist origins and implement structural interventions that dismantle the systems of oppression within policing. Historically, law enforcement has exerted control over Black communities, reinforcing generational trauma and socioeconomic hierarchies that unjustly abuse Black citizens. The initial gains of reform are often undone, leading to the gradual reversal of progress. Recently, state legislators across the country have crafted new “tough-on-crime” legislation that jeopardizes progressive criminal legal reform, including requiring cash bail for non-violence misdemeanor crimes and prohibiting local bans on pretextual traffic stops 42 Since taking office in January, President Trump has revoked a President Joe Biden-era executive order setting federal use-of-force standards , resumed federal executions , and halted DOJ investigations into discriminatory policing 43 The pattern of reform followed by subsequent reversals reveals the inefficiencies of incremental approaches and underscores their inability to produce sustained, systemic change.
Policymakers should consider the following recommendations to get to the root of structural racism at the heart of the criminal legal system and address its impact on health outcomes for Black Americans. These reforms reimagine policing in ways that promote community wellbeing, reduce chronic stress, and reduce the disproportionate impact of police violence on Black communities.
POLICY RECOMMENDATION: REALLOCATE POLICE FUNDING
Reallocating police budgets toward other social services such as housing, health care, and employment programs can reduce the root causes of health disparities while decreasing the need for police interventions. By shifting funding away from traditional policing, city officials can foster environments that improve community safety and overall well-being for residents. For example, city councils in Austin, Texas and Seattle,Washington significantly reduced their police budgets to redirect funding towards resources to support unhoused residents, increase food access, and scale alternative response programs. 44
42 Jonathan Mattise, “Tennessee Gov. Lee Signs Bill to Undo Memphis Traffic Stop Reforms after Tyre Nichols Death,” PBS NewsHour, March 28, 2024, https://www.pbs.org/newshour/politics/tennessee-gov-lee-signs-bill-to-undo-memphistraffic-stop-reforms-after-tyre-nichols-death
43 Hernandez D. Stroud, “Trump Reverses Biden Directive on Policing Reforms,” Brennan Center for Justice, January 22, 2025, https://www.brennancenter.org/our-work/analysis-opinion/trump-reverses-biden-directive-policing-reforms; Congressional Black Caucus Foundation, Restoring the Death Penalty and Protecting Public Safety, March 2025, https://www.cbcfinc.org/wp-content/uploads/2025/03/Restoring-the-Death-Penalty-and-Protecting-Public-Safety.pdf; Associated Press, “Trump Could Reshape Justice Department’s Civil Rights Focus,” AP News, accessed June 25, 2025, https://apnews.com/united-states-government-accd3043078e4a95a21aac41a89c0213
44 Libby Doyle and Leah Sakala, Shifting Police Budgets: Lessons Learned from Three Communities (Washington, DC: Urban Institute, July 26, 2021), https://www.urban.org/sites/default/files/publication/104562/shifting-police-budgets-lessonslearned-from-three-communities_0.pdf
These investments highlight the critical role social determinants of health play in shaping individual and community well-being. By improving factors such as stable housing, economic opportunity, and access to healthcare, reallocating police funding can not only enhance health outcomes but also help decriminalize poverty and reduce law enforcement interactions with marginalized communities. Additionally, participatory budgeting empowers communities to determine how earmarked public funds are allocated, ensuring investments reflect the priorities and needs of those most impacted by discriminatory policing. For example, the City of Boston established its Office of Participatory Budgeting in 2023, which has since funded several community-led projects advancing racial and social justice, including initiatives that increase access to fresh food and programs supporting incarcerated and formerly incarcerated youth. 45
Reallocating police funds and making strategic investments promotes equitable health outcomes while enhancing individual and community autonomy and resilience within communities impacted by discriminatory policing practices.
POLICY RECOMMENDATION: STRENGTHEN OPPORTUNITIES FOR REDRESS
Policymakers should expand avenues for accountability by reforming qualified immunity and establishing reparative measures such as state-level compensation funds. Qualified immunity is a legal doctrine that shields officers from civil liability when they violate constitutional or statutory rights. The Civil Rights Act of 1871 granted emancipated Black Americans the right to seek redress for violations by law enforcement. However, in 1967, the Supreme Court severely weakened this protection through its ruling in Pierson v. Ray, laying the foundation for modern qualified immunity. This lack of accountability for officers that inflict harm on Black communities continues the cycle of trauma and chronic stressors arising from over-policing and violence.
In June 2020, following the murder of George Floyd, members of the Congressional Black Caucus introduced revisions to qualified immunity through the George Floyd Justice in Policing Act, aiming to eliminate the doctrine for both local and federal officers. 46 Addressing the trauma caused by policing must include meaningful pathways for
45 City of Boston, “Mayor Wu Files Ordinance to Establish Office of Participatory Budgeting,” Boston.gov, December 13, 2022, https://www.boston.gov/news/mayor-wu-files-ordinance-establish-office-participatory-budgeting
46 George Floyd Justice in Policing Act of 2021, H.R. 1280, 117th Cong. (2021), introduced February 24, 2021; passed House, March 3, 2021
CPAR | Beyond the Badge: Policing as a Social Determinant of Health
accountability that promote justice and support mental health and healing within Black communities. When accountability mechanisms are in place, they help alleviate chronic stress by signaling that harms are acknowledged and addressed, which can break the cycle of trauma. These measures affirm that the criminal legal system values Black lives by recognizing systemic harm and providing tangible avenues for redress.
POLICY RECOMMENDATION: INSTALL CIVILIAN OVERSIGHT BOARDS
Civilian oversight boards can play a critical role in promoting police accountability and empowering communities to influence public safety strategies, department polices, and resource allocation. These independent bodies investigate misconduct, make disciplinary recommendations, and bring community insight into departmental policies. For example, the Washington D.C.’s Police Complaints Board oversees the Office of Police Complaints and is comprised of civilians with no connection to law enforcement. It reviews complaints of police misconduct, issues policy recommendations to the Mayor, City, Council, and other officials, and hosts community meetings to raise awareness of its mission. 47
Although flaws of D.C.’s model include mild reprimands for most police misconduct cases, it serves as a foundational model that demonstrates how community-driven oversight, when given adequate power and resources, can increase transparency and reshape community safety. By improving accountability and shifting power back to those most impacted, these democratic structures help bridge the gap between law enforcement and the communities they serve. They can also reduce the chronic stress that results from discriminatory policing. Historically, many police departments have protected officers from consequences to preserve internal loyalty, resulting in a cycle of discriminatory policing that contributes to anxiety, depression, and other adverse health impacts. In contrast, civilian oversight boards offer impartial accountability measures that prioritize community needs and help deter harmful behavior. Civilian oversight boards, by addressing misconduct and giving communities a voice in how they are policed, can help reduce this psychological burden and foster a sense of agency and safety for impacted communities.
To develop meaningful change that addresses systemic racism in the criminal legal system, policymakers must not only remedy the immediate harms of policing—like excessive force and de-escalation tactics—but also address the power imbalances that continue to perpetuate bias against Black communities.
47 The D.C. Office of Police Complaints reviews complaints involving harassment, inappropriate language or conduct, retaliation, unnecessary or excessive force, discrimination, failure to identify, and failure to intervene.
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