By Keon Gilbert
About 1.5 million Black men are missing from daily life because of health challenges, economic instability, and over-policing. There are several complex determinants that explain these disproportionate patterns of incarceration and premature mortality, which are fundamentally interlinked.
Black men suffer devastating health consequences because they are rendered invisible by racism in health care, and because of the socio-economic stress they experience.
Cardiovascular disease (CVD) becomes the leading cause of death for Black males in their forties. Stressful social and economic living conditions, and restricted access to health-promoting resources to manage those conditions, such as grocery stores to access healthy foods, health care facilities, jobs, and education, may contribute to behavioral responses to these stressors, which in turn have adverse health outcomes, such as cardiovascular diseases and diabetes. These health outcomes and their social determinants are also contributing to the three-fold higher risk of mortality from COVID-19 Black communities are experiencing.
The poverty and health concerns in Black communities are fundamentally linked in a feedback loop to the policing they experience. One in twelve Black men between the ages of 25-54 are incarcerated, compared to one in sixty non-Black men of the same age group. About 900,000 Black men within the same age group die prematurely. A disproportionate number of poor Black men are arrested for crimes such as theft, forgery, and buying or selling stolen property.
The policing in these communities is part of a general form of hyper-surveillance that may be linked to the resurrection of de facto debtor’s prisons to close deficits in many counties and municipalities. Municipalities have relied on police officers to collect fines and fees from criminal convictions, traffic fines, child support payments, and engage in disproportionate vehicle stops, thereby entrapping poor Black communities in a cycle of imprisonment and poverty.
In recent reviews of policing, some estimates suggest that forty-six to eighty-one percent of an officer’s time is spent on unassigned activities, such as patrolling neighborhoods, completing paperwork, and responding to non-criminal calls. Officer and community interactions emerge from calls about truancy, dead animals, checking on elderly residents, and many other incidents that may be better handled by other institutions or agencies, but that are instead handled by the police, who fill the gaps these other agencies sparsely support, to sometimes lethal effect.
Lethal policing increases these negative health consequences and contributes to neighborhood level rates of chronic illness-spillovers. Policing as a systemic form of racial bias adds to the cumulative stress many Black men experience in these neighborhoods and restricts social and economic mobility.
The removal of Black males from communities by incarceration disempowers Black communities and marginalizes Black men’s participation in opportunities to make decisions to improve those communities, such as voting, and engaging in advocacy work. Fears of retaliation while on parole or probation lead to a civil death, further driving Black men into the margins of invisibility. Recent studies also point to the challenges Black families have in becoming upwardly mobile as a result of intergenerational downward movement of Black men’s earnings. The current and future health of Black families is tied to their ability to be upwardly mobile.
One factor that constrains Black families’ economic growth is racial capital. Racial capital is one mechanism that concentrates power and resources in white communities while disinvesting in Black communities through segregation, low-performing schools, low-earning jobs, imprisonment, and health care infrastructure. Racism operates within each of these structures and raises the risk for Black men being incarcerated, which prevents them from taking advantage of the limited resources available in their communities.
Municipal use of policing to generate revenue by court fees, fines, and arrests threatens the viability of Black families. This disinvestment has made access to health care unattainable for some Black communities. The lack of access to health care to identify and treat preventable health conditions contributes to the $447.6 billion in medical care expenditures for Black men, of which $24.2 billion constituted “excess medical expenditures,” in other words, expenditures directly attributable to health disparities.
Recent calls to #defundthepolice can serve three functions: 1) address systemic racism that leads to police killings, 2) re-direct resources towards public health prevention strategies, and 3) reduce the burden of officers’ involvement in collecting revenue for municipalities’ general funds.
This movement to enact anti-racist policies and re-structure resources within Black communities can help improve Black family and community dynamics, remove structural barriers to health and well-being, and prevent the policing of what are fundamentally social and health issues. Without an anti-racist public health infrastructure, the death of Black men will persist as an inequitable health outcome.
Keon L. Gilbert, DrPH is an Associate Professor of Behavioral Science and Health Education at the College for Public Health and Social Justice at Saint Louis University. He is also Co-Founder of the Institute for Healing Justice and Equity.