One of the fundamental distinctions between public health and biomedicine is that the former is concerned primarily with the health of populations, whereas biomedicine is concerned with the health of individuals. There is obviously some overlap between the two fields, but it’s an established scientific fact that increases in life expectancy in the general human population over the past 100 years or so are due to advances in public health science and the acceptance of those advances by both the public and policy makers.
One of public health’s most important functions is determining the causes of diseases and illnesses that affect populations, and implementing strategies to stop or reverse the spread of widespread life- or health-threatening conditions. It goes without saying, perhaps, that public health successes have not been shared equally by all members of the US population during the ascendancy of the field of public health. While there has been a kind of “trickle down” effect (the development and administration of the polio vaccine, for example, benefited every US demographic), it is indisputable that life expectancy among Black Americans remains lower than it is for members of the dominant culture.
Given that public health in the age of coronavirus has become less about health or disease vectors than political spin, it is highly unlikely that the current epidemic of police murders of innocent Black Americans will be universally regarded as a public health issue. For context, such behavior by the police isn’t even regarded as a criminal justice issue; the most recent example of this (as of September 23, 2020) is the assassination of Breonna Taylor, for which no relevant charges have been brought against the three police officers who murdered her. Death and destruction scything through large swaths of the dominant culture’s population is regarded quite differently. (See the “opioid crisis,” for instance, which for decades was considered a law enforcement issue, until it became impossible to maintain the fiction that “dope addicts” were a problem confined to African American communities. “Dope” and “narcotics” aren’t even part of the lexicon anymore.)
Unlike a conventional public health crisis, determining the causes of and the possible solutions for this different public health crisis aren’t a mystery. And it certainly isn’t within the purview of public health officials and scientists to stop the wanton murder of so many Black people. But it’s still worthwhile to identify what matters fit the definition of a public health issue as easily as the opioid crisis does.
In the summer of 2019, I had the opportunity to engage a forensic psychologist on the subject of police brutality. It was a conversation I’d been wishing to have for years, so I leapt at the chance. I suggested to him that police departments, and the public, could benefit from having more stringent screening protocols in order to prevent sociopaths, and worse, from becoming police officers. His response, no doubt influenced by his close research associations with police departments, was that the percentage of miscreants in police departments was roughly the same as the percentage of such people in the population at large. This was hardly a satisfactory answer, but I didn’t press the point that we should demand a much lower percentage of such people in police departments than in society at large. This perspective — that it’s basically OK to have murderers in police departments because society has them too — is only one aspect of the issue, albeit a critically important one. Another, even more troubling, reality is that murdering Black people with impunity is a recurring theme that seems to have been invigorated by the currently outgoing presidential administration’s embrace of lawlessness as a political cudgel (or perhaps as a knee-jerk reaction to the nation’s having elected, and then re-elected, a Black man as president).
“History doesn’t repeat itself, but it often rhymes” is a quote attributed to Mark Twain. The truth of this statement is nowhere in greater evidence than in the current epidemic of the lynching of Black Americans, whether they’re children (see Tamir Rice) or adults (a list that seems to grow by the hour). When Michael Brown was murdered in Ferguson, Missouri, I emailed a criminologist friend, “Who says you have to use a rope to commit a lynching?” This is a certain kind of historical rhyme — instead of ropes, it’s now military assault weapons, police service weapons, or simply torturing victims to death by asphyxiation. A more fundamental historical rhyme, however, informs lynching: the Dred Scott Decision can teach us quite a lot about the state of affairs under discussion.
Nearly everyone has heard of the Dred Scott Decision, but even so it’s worthwhile to recap the main points of the case. In 1834, Scott was taken by his “owner” from a slave state (Missouri) to a free state (Illinois), and subsequently was brought back to Missouri. Scott argued that since he was taken to live in a state in which slavery was illegal, he automatically became a free man, and that his status as a free man remained in effect even though he was taken back to Missouri. His “owner” refused to accept Scott’s claim, to which Scott responded by suing for his freedom in court. He won, but the case was appealed to the US Supreme Court, which gave us the infamous Dred Scott Decision in 1856. Chief Justice Roger B. Taney spills a great deal of ink elucidating, in rather cold, clinical language, the distinction between being a citizen of a state and being a citizen of the United States; and explaining how no government, local, state or federal, has the right to tell a citizen such as Scott’s “owner,” John F. A. Sandford, what to do with his property.
The Court’s essential argument, however, is that Scott has no right to sue Sandford because he has no rights as a citizen, and even more important, given that he is “property,” he doesn’t even have rights as a human being. The quote from Dred Scott that is most telling concerning this perspective is that Black persons had long been regarded as “so far inferior, that they had no rights which the white man was bound to respect.” It takes no great leap of the imagination to realize that this denial of rights by definition includes the right to life (which, despite the fact that the concept has been commandeered by the political right to deny women the right of reproductive self-determination, applies at least as well to lynchings). To watch the video of Derek Chauvin, in effect mugging for the cameras of people who are filming him, torture George Floyd to death by kneeling on his neck — in broad daylight on a busy city street — one is forced to acknowledge that Chauvin’s views on a Black person’s right to life are in lockstep with Chief Justice Taney’s.
As already mentioned, unlike many public health crises, the causes of this one are not the least bit obscure. We find ourselves in a society in which it is “controversial” for Black people to insist that it is wrong — legally, ethically and morally — not only for members of their community to be gunned down (or choked to death) in cold blood, but also that those responsible are either not charged or are acquitted. In the same conversation with the above-mentioned forensic psychologist, I suggested to him that when a police officer gets charged for an act such as an “extra-judicial” killing, what it indicates above all else is that the responsible police officer has no friends or allies on the police force, or at least not enough. Otherwise, the officer’s co-workers would close ranks, and trot out one or more of the standard excuses for why this particular killing is justified. This time, the psychologist said, “You’re absolutely right.” In this same context, it’s worth noting that after the Floyd killing, as municipalities began to at least pay lip service to the Black Lives Matter (BLM) movement, police unions across the country aggressively presented the police as the ones being treated unfairly.
The fact that the causes are easily identified of course doesn’t mean that the solutions are easy. But solutions must begin with an unflinching look at the causes.
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