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<h1 class="article-header__title">Fatal police violence in the
USA: a public health issue</h1>
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<div class="inline-it"><span class="article-header__publish-date
bulleted"><span class="article-header__publish-date__label">Published:</span><span
class="article-header__publish-date__value">October 02, 2021</span></span><span
class="article-header__doi bulleted"><span
class="article-header__doi__label">DOI:</span><a
class="article-header__doi__value"
href="https://doi.org/10.1016/S0140-6736(21)02145-0">https://doi.org/10.1016/S0140-6736(21)02145-0</a></span></div>
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<div class="section-paragraph">Preventable violent deaths of
people of colour at the hands of police in the USA have been
overlooked as a public health issue. Many victims of police
violence have become household names, like George Floyd,
whose death made headlines worldwide and raised awareness of
the Black Lives Matter movement, which targets structural
racism and violence against Black people in the USA and
abroad. Yet, for every George Floyd, hundreds of other
Americans' deaths after violent exchanges with police go
unheeded, unacknowledged, and uncounted.</div>
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<div class="section-paragraph">Although the US federal
government has tracked deaths from law enforcement since
1949 using the National Vital Statistics System (NVSS),
questions around undercounting of police violence fatalities
and the underlying quality of death certificate data have
arisen only in recent years. Journalists have not only
documented narratives of police brutality but also
identified disparities in the total number of deaths
reported in the NVSS, especially when non-firearm injuries
were involved or when information about the individual's
race or ethnicity was missing or misclassified. Open-source
databases composed of news coverage and public records of
police violence fatalities maintained by journalists and
independent research teams, including Fatal Encounters,
Mapping Police Violence, and The Counted, have provided rich
alternatives to NVSS data, but are limited by short periods
of coverage and differences in case definitions.</div>
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<p id="related-message-text" style="padding: 0px; margin:
0px;"><span>• </span><a id="related-message-link"
href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02145-0/fulltext#gbd-linkback-header">View
related content for this article</a></p>
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<div class="section-paragraph">A lack of accurate data has
arguably been one of the major impediments to adopting a
public health approach to deaths caused by police violence.
Today in <em>The Lancet</em>, a group led by researchers at
the Institute for Health Metrics and Evaluation (IHME)
publish the most accurate and comprehensive assessment of
deaths attributable to police violence in the USA to date.
The study is a potential turning point for improving
national estimates of fatalities from police violence by
incorporating non-governmental open-source data to correct
NVSS data. The findings are staggering: around 30 000 people
died from police violence between 1980 and 2018. The NVSS
omitted approximately 17 100 deaths, leading to an
under-reporting of deaths attributable to police violence by
more than 55%. Age-standardised mortality was higher in
Black people (0·69 of 100 000) and non-Hispanic Black people
(0·35 of 100 000) than White people (0·20 of 100 000).</div>
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<div class="section-paragraph">These figures show a system of
violent and fatal policing in the USA that is unfairly and
unevenly applied across race and ethnicity. Arguing that
police brutality exists because of a context of structural
racism is not new, but there is novelty and power in
leveraging the IHME methodology for reform. Ensuring the
veracity of data collection requires moving it out of the
remit of law enforcement, which has been self-interested,
voluntary, and incomplete. Data collection across states,
especially those where reporting is low and
misclassification is high, should be supported through
public health infrastructure, funding for collaborations
between journalists and researchers, and the mandating of
consistent standards to ensure that death certificates are
completed by medical examiners or physicians with
appropriate forensic training. Accuracy is crucial, but how
cause of death is reported is itself an issue of complicity
in racist policing, as underscored in a recent
Correspondence on the designation of sickle cell trait as a
cause of in-custody death: “Physicians deny justice to
communities by providing medical cover for death at the
hands of law enforcement officers and by perpetuating
medical falsehoods to justify this practice.”</div>
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<div class="section-paragraph">Better data are one aspect of a
public health approach; introducing harm-reduction policies
is another. Policing in the USA follows models of hostile,
racialised interactions between civilians and armed agents
of the state. Marginalised groups are more likely to be
criminalised through the war on drugs or homelessness.
Reducing hostile or violent interactions between police and
civilians, particularly those who are most vulnerable
overall, is a forceful case for investment in other areas of
community-based health and support systems, including
housing, food access, substance use treatment, and emergency
medical services. Strategies to lower fatalities from police
violence must include demilitarisation of police forces, but
with the broader call to demilitarise society by, for
example, restricting access to firearms. Drawing on the
experience of the public health community in countries with
unarmed police forces, such as Norway and the UK, could also
improve policy. Police forces too must take greater
responsibility for police-involved injuries and deaths. Such
changes are long overdue. As the Article in this week's
issue so starkly shows, the status quo has been hugely
harmful to the health and wellbeing of people in the USA.</div>
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