Violence, Policing, and Incarceration are Public Health Crises

Structural violence, as understood by scholars like medical anthropologist Paul Farmer, refers to the systematic deprivation of the social, economic, and environmental resources necessary for life, alongside systematic hyper-exposure to that which annihilates life. Poverty, for example, is a predictor of exposure to the carceral system and to illness and shortened life expectancy; access to quality food options, or lack thereof, can be another form of structural violence. 

Black New Yorkers are among those most likely to be exposed to structural violence, and also among the most likely to be systematically deprived of the resources required to be healthy, including quality and stable housing, quality education and food, and living wage jobs. We see how social determinants of health affect New Yorkers differently depending on racialization and geography—as in the majority Black and Latinx Brownsville neighborhood where 47% of children live in poverty and where 20% of children in Brownsville’s Community School District 23 are unhoused; or in the ratio of supermarkets to bodegas, which is five times higher in majority white Upper East Side, as compared to Brownsville. 

This systematic deprivation is the product of budget and policy decisions that treat Black life as without value. Budget decisions like the decades-long evisceration of the social safety net, and more specifically anti-Black policies and practices like redlining, segregation, and the wars on drugs and crime targeted Black New York City communities for violent disinvestment and criminalization. Meanwhile, formerly racialized white ethnic groups (like Irish or Italian Americans) were able to accumulate wealth for their families and descendants because they were the beneficiaries of sweeping government programs like the New Deal—from which Black people were largely excluded—that enabled access to high quality housing, education, and wealth-building opportunities. Working-class Black New Yorkers, in contrast, have been waiting for their New Deal for over a century. These policy choices and their effects are often framed as economic issues; while this is true, as long as Black New Yorkers continue to be targeted with systematic deprivation of the resources that would allow them to enjoy health and long lives, then that deprivation qualifies as a public health crisis as well. 

Policing and the Carceral State as Structural Violence 

Policing and incarceration are powerful manifestations of structural violence that significantly influence health outcomes. Those exposed to incarceration in the United States—disproportionately Black—have elevated rates of mortality and of chronic and infectious diseases. These harms, in turn, tear through communities and families. The loved ones of incarcerated people—also disproportionately Black—have elevated levels of depression, anxiety, sexually transmitted infections, and heart disease. 

Nearly a third of New Yorkers with mental illness and nearly a quarter of Black New Yorkers experience direct exposure to police violence, which puts them at risk of depression, anxiety, and suicide. People residing in areas with high levels of police violence have elevated levels of high blood pressure, diabetes, and preterm birth. Additionally, those whose experiences and observations have taught them to fear police violence have elevated levels of depression and anxiety. Similar to families of incarcerated people, family members of those directly harmed by police describe symptoms consistent with post-traumatic stress disorder. Nearly a fifth of Black New York City residents report having been abused or threatened by the police; these data reflect a stable pattern of routinely disrespectful and violent interaction with Black communities. 

Brownsville and The Upper East Side: A Tale of Two Neighborhoods

These patterns can be observed at the neighborhood level by comparing two specific communities: the majority Black and Latinx Brownsville and the majority white Upper East Side. Although children in each of these neighborhoods are born with the same potential for brilliance, creativity, and joy, the circumstances of life on the Upper East Side nourish these possibilities, whereas the longstanding forms of structural violence in Brownsville—a formerly redlined community—do not. 

Whereas a child born in census tract 144.1 of the Upper East Side can expect to live until about age 90, a child born in census tract 906 in Brownsville can expect to live twenty fewer years, only to age 70. In other words, children in this part of Brownsville live three years less than children born in El Salvador, and three years less than children born in the West Bank and Gaza. As research from the NYC Department of Health and Mental Hygiene makes clear, 54% of deaths in Brownsville would have been avoided if Brownsville residents died at the same death rate as those in wealthy neighborhoods like the Upper East Side. 

Examining the conditions of life in these two NYC areas clarifies how structural violence has created these inequities. People in Brownsville are hyper-exposed to policing: the rate of incarceration is 24 times higher there than in the Upper East Side, and a shocking 30% of Brownsville residents have a family member who has spent time in a correctional facility. 

Notably, some of the New York City neighborhoods with the highest proportions of Black and Latinx residents and the lowest levels of income are those targeted by the current administration’s plans for heightened criminalization and policing.

A Preventable Crisis

The American Public Health Association asserts that violence is a largely preventable crisis. Rigorously sourced evidence can help our legislators choose which policy interventions are truly preventative. The research is already clear: Policing “solutions,” are ineffective at reducing violence in the long-term. Increasing police activity in communities in an effort to quell violence causes harm through exposing more community members to the ill effects of incarceration and magnifying poor physical and mental health outcomes among Black New Yorkers. As legendary New York poet Langston Hughes pointed out, “we too are America” and we too require the resources and investments that enable safety, thriving, and well-being.