The Intersection of Policing and Public Health: Challenges and Opportunities

1. Scottish International Policing Conference 2018Policing and public health: Challenges and Opportunities 46th James Smart Memorial Lecture The multiple intersections of law enforcement and public health Professor Nick Crofts, AM Director, Centre for Law Enforcement and Public Health Melbourne, Australia and Amsterdam, Netherlands

2. LEPH: Law enforcement and public health • Introduction and background • Police, drugs and harm reduction • “The mysterious case of the missing cop” • Law enforcement and public health collaborations - themes • Partnerships • The International LEPH Conferences • LEAHN Consultations • Global LEPH Association

3. Fundamental challenge E.g. the Dutch model – the Top 600 … • Top 600 users of police resources • Top 600 users of public health services – A&E, mental health etc => strong overlap • Indicates common roots – inequality, ACEs etc • Health states increase involvement with CJS • Involvement with CJS is bad for your health • Therefore why deal sectorally …? “So we beat on, boats against the stream, borne ceaselessly back into the past.”

4. Disambiguation … • Public health approach to policing • Public health role and contribution of police • Police and public health partnerships • Public health as crime prevention

5. Introduction and background • GP in Community health and community development • HIV/HCV epidemiology, esp among and from PWID • Harm reduction – globally especially Asia • Law enforcement and public health

6. Introduction and background • 1986: CDSC, Colindale • 1987-8: CDC Atlanta, AIDS Branch • HIV among and from people who inject drugs • AIDS from IDU > AIDS from MSM • No-one researching • 1988: Seattle Health Department: • First NSP in North America • With support of police

7. An early harm reductionist … ‘Fair play, St Trinian’s – use a clean needle!’

8. HIV in Asia • Epidemics driven by injecting drug use • Drug users universally criminalised, demonised • Incarcerated, brutalised … by police • No human rights • No drug treatment • No harm reduction … • → Massive HIV epidemics

9. The mysterious case of the missing cop • International AIDS and Harm Reduction Conferences 1984-2018: • Many presentations: adverse impact of police on risk environment • No presentations: working with police to change their behaviour • How to increase police engagement in the HIV response?

10. Background Introducing harm reduction to Asia: • 1991: Kathmandu - first NSP and harm reduction workshop in Asia • Again, with support of Narcotics Police • 1995 Guiyang, Guizhou: WHO workshop for public health and public security – lessons learned! • 2000-2004: ARHP – Myanmar, Yunnan, Guangxi, Viet Nam • Working with police/public security and Health • 2004: LEAHN: the Law Enforcement and HIV Network

11. Law Enforcement and HIV Network • Founded 2004 • Website and newsletter – resources: • http://www.leahn.org/ • 2014: UNODC manuals for police working with civil society and for CS working with police • 2016: J Int AIDS Socon Police and HIV, Durban AIDS Conference • LEAHN Country Focal Points

12. LEAHN Country Focal Points • 25 serving and retired police in 22 low and middle income countries in Asia, Africa and EECA regions • Advocacy to and education of police colleagues • Formation of partnerships with civil society organisations Assistant Commissioner Jones Blantari, Ghana P. Mulyatno, Police Grand Commissary Adjunct, Drugs Law Enforcement Directorate, Criminal Investigation Board, Indonesia AleksandrZelichenko, PhD, recently retired Police Colonel, Director of Central Asian Drug Policy Center, Kyrgyzstan Roli Bode-George, Director-General, National Drug Law Enforcement Agency, Nigeria

14. LEAHN Consultations: outputs • 2012: Statement of support by police for harm reduction • 10,000+ serving and retired police from 42 countries, 10 police agencies • 2013, Vienna: Launch at UN Commission on Criminal Justice and Crime Prevention • 2014: Amsterdam Declaration on Police Partnerships for Harm Reduction • CFP advocacy video: https://www.youtube.com/watch?v=KzeBlYVRlYw • 2016: Principles of Policing, Public Health and Vulnerable Populations • 2018: Statement of support by police for drug policy reform • To be launched at the Commission on Narcotic Drugs, 2019

15. Police and HIV Lessons learned: • Those countries which have dealt well with HIV/AIDS among and from PWID have involved police as key stakeholders – early, fully and really • Don’t expect police to do your job – they have enough to do: ‘what’s in it for them?’ e.g. methadone in Ha Noi • Police listen to police: peer education and advocacy paramount • Partnerships critical • Conflict resolution: re-humanisation e.g. Tanzania

17. Police wellness as aprerequisite … Because of work with police on harm reduction: • Assessment of drug and alcohol use among the Kenya National Police Service (with UNODC) 2018 • Led to development of wellness awareness for NPS

18. Police engagement in the HIV response • But generally it is not working – police are not engaged in the HIV response in LMICs There is no funding for such projects • Barriers are twofold: • AIDS sector and affected communities see them as the enemy • ‘my police are not social workers’ – role in PH not seen by police • Ha Noi • Swaziland

19. Law enforcement and public health So - need for a new strategy: Not just about harm reduction or HIV/PWID – it’s about all Public Health Better platform for advocacy … • 2012: Melbourne - 1st International Conference on Law Enforcement and Public Health

20. The public health mission Centers for Disease Control and Prevention (CDC): ‘Public health connects us all’ • PH concerned with protecting the health of entire populations: • as small as a local neighborhood, or • as big as an entire country or region of the world. • PH professionals prevent problems from happening or recurring by: • implementing educational programs, • removing structural barriers, • recommending policies, • administering services and • conducting research • Public health also works to limit health disparities. A large part of public health is promoting healthcare equity, quality and accessibility.

21. The Public Health Team • Public health is multisectoral: • … therefore the practice of public health involves multidisciplinary teams: • Typical listings: The Mysterious Case of the Missing Cop: It will be noted that police are not mentioned as key members of the public health team: The Public Health Agency of Canada: • Specialist public health physicians • Epidemiologists and Biostatisticians • Public Health nurses • Medical microbiologists • Environmental Health Officers • Dental hygienists • Dietitians and Nutritionists • Health inspectors • Veterinarians • Public health engineers • Public health lawyers • Sociologists • Community development workers • Communications officers

22. The mysterious case of the missing cop … • Modern public health practice requires multidisciplinary teams of public health workers and professionals: • epidemiologists • biostatisticians • medical assistants • public health nurses • midwives • medical microbiologists • economists • sociologists • geneticists • data managers • environmental health officers • public health inspectors • bioethicists • veterinarians Wikipedia: Public health is interdisciplinary: • epidemiology • biostatistics • health services • environmental health • community health • behavioural health • health economics • public policy • mental health • occupational safety • gender issues in health • sexual and reproductive health

23. The mysterious case of the missing cop … University of Pittsburgh Public Health Public health involves the application of many different disciplines: • Biology • Anthropology • Public policy • Mathematics • Engineering • Education • Psychology • Computer science • Sociology • Law • Medicine • Business

24. The mysterious case of the missing cop … Johns Hopkins University, Bloomberg School of Public Health The largest institution of its kind in the world, the Bloomberg School is home to 10 departments that offer faculty and students the flexibility to focus on a variety of public health disciplines. • Department of Biochemistry and Molecular Biology • Department of Biostatistics • Department of Environmental Health and Engineering • Department of Epidemiology • Department of Health, Behavior and Society • Department of Health Policy and Management • Department of International Health • Department of Mental Health • Department of Molecular Microbiology and Immunology • Department of Population, Family and Reproductive Health

25. The mysterious case of the missing cop … International Domestic Violence and Health Conference:  Sustainable Change in the Health Sector • “Whether you are a practitioner, survivor, carer, researcher, student, policy maker, community leader, manager or advocate: • “join others from all over the world to participate in the first international conference to headline early intervention for domestic violence in health settings.” • If I were a police officer, I’d be starting to feel neglected …

26. Law enforcement roles in public health • Regulatory role of public health authorities well recognized and studied • The police role in public health is under-recognised • as a result, under-studied and often undervalued Why bother? • Increased role definition and clarity for both sectors • more effective collaboration. • Clarity of roles and of motives - basis for better partnerships • Realisation from both sectors of need for partnership. • An explicit conceptual frame • defining the boundaries of organizational responsibility for police and public health • bringing both support and pressure to tackle difficult social problems together.

27. LE & PH Partnerships Bringing the sectors together: • Law enforcement – police, prosecutors, magistrates and judges, prisons and jails … but also PH law and regulation enforcers • Police: policy, management and operational • Public Health – across the widest range of issues • Academic/research and practitioners • Local government – where it comes together • Observations: • more interest from police – but very varied: why? • little interest from academic public health: why not?

28. Barriers: culture … • LE sees PH as naïve: “people are inherently good” • Stockholm syndrome • “There’s bad people/a war out there” • Experience • PH sees LE as ‘public health enemy number one’ Two sectors divided by a common language e.g. ‘case’, ‘surveillance’, ‘early intervention’ … The Dialogue of the Deaf Snobbishness

29. The need for information sharing Major problem for collaboration: • Information is not systematically shared between problem-solving courts/diversion list databases and police Problematic on several levels: • Possible negative impact of police intervention when not fully informed • Budget cuts make agencies fall back on their own siloed approach to their core-businesses, in a reactive manner • Good modes of governance are waved aside, as individual core businesses are becoming more pressing

30. LEPH Themes

31. LEPH2018 Conference themes Overarching theme: • Disparities in access to health and involvement with criminal justice Major themes: • Mental health • Violence – domestic, gender-based, gun, family violence, the Unsafe City and other violence prevention – sexual harassment, hate crimes • Racial/ethnic disparities in access to health and involvement with CJS • Indigenous communities • Marginalisedand vulnerable populations • Alcohol regulation and public order • Illicit drugs and harm reduction • Infectious/epidemic disease • Trauma – especially road/rail • Crises & Catastrophes, major events • ‘Hidden in Plain Sight’ • Corrections – prisons as public health institutions • Wellness & resilience

32. Adverse Childhood Experiences

33. ACEs: key indicators of childhood trauma that fundamentally affects behavior, wellbeing and prospects • ACE assessment guides trauma-informed policing Adverse Childhood Experiences

34. Adverse Childhood Experiences Deputy First Minister @JohnSwinney ."Tackling the implications of ACEs will never ever be achieved in a compartment of education or health or police. We will succeed if absolutely all disciplines play a part."

35. Adverse Childhood Experiences

36. Adverse Community Environment:Income inequality

37. ACEs: Initiation into injecting • Initiation into injecting is a crucial event for continued reproduction of an injecting drug using (IDU) population and for exposure to blood‐borne viruses, but little is known about how this happens. • Three hundred young injectors were interviewed in Melbourne by peer workers within the first few years of beginning to inject, about the circumstances surrounding their initiation. • Over 95% had multiple indications of social disruption, including having left school early, unemployment, family disruption, homelessness and incarceration. • Injecting was much less about drugs than about social acceptance

38. Injecting as a communicable phenomenon • All were initiated by an older, more experienced injector • Some few injectors initiate many others … Ro>>1 • U.S. LE response: identify and incarcerate (remove from circulation) • PH response: immunise

39. Drugs and boredom and meaninglessness • Drug use in Collingwood/Footscray • Opium in soldiers in Viet Nam • Drugs in prisons • Why on earth criminalise and incarcerate?

40. Violence

41. Gun violence: a case study Per capita deaths from firearms: • 12 of the top 15 are in the Americas • U.S. ranks 13th – 40,000+ per year • 37% homicide • suicide and OD (quasi-suicide) lowering US life expectancy • Traditional response: arrest, punish and incarcerate • Reliance on deterrence and incapacitation • Not working – argument is because only 5% arrested, 17% if fatal

42. Gun violence: a case study • Public health approach: ‘comprehensive, non-judgemental, pragmatic, evidence-based approach to saving lives, with the emphasis on prevention” • Obama after Sandy Hook, 2013: CDC ‘Priorities for research to reduce the threat of firearm related violence’ • Gun regulation, conflict mediation, preventive patrols • Does not mention increased arrests • PH approach: break chain of transmission/causation • = no guns

43. Alienation, drugs and guns

45. U.S.: Officer involved shootings Does Military Veteran Status and Deployment History Impact Officer Involved Shootings? Background: • Since 2001, roughly 2.7 million U.S. military services members have been deployed to Iraq or Afghanistan in Operations Iraqi Freedom and Enduring Freedom. • Law enforcement agencies view prior military history as an asset, citing veterans’ experience handling firearms, physical conditioning, discipline, critical incident response, and other skills (IACP 2009). Aim: To examine the effect of military veteran status and deployment history on LEO-involved shootings. Results: suggest that deployments, rather than military experience alone, are associated with increased odds of shootings among LEOs.

46. Institute for the Study of the Blindingly Obvious ISBO Motto: ‘Blind Freddie knew that’ Militarised police alienated from their communities …

47. American Public Health Association • On Tuesday, November 13, 2018 the American Public Health Association (APHA) adopted a policy statement that explicitly names law enforcement violence as a public health issue. • “It is a statement rooted in an understanding of how structural racism and institutional oppression shape population patterns of law enforcement violence and it is a statement firmly committed to a public health alternative, recommending upstream, community-based and community-led solutions.”

48. APHA: law enforcement violence as a public health issue • eliminate policies and practices that facilitate disproportionate violence against specific populations (including laws criminalizing these populations); • institute robust law enforcement accountability measures; • increase investment in promoting racial and economic equity to address social determinants of health; • implement community-based alternatives to addressing harms and preventing trauma; and • work with public health officials to comprehensively document law enforcement contact, violence, and injuries. Police are to be surveilled and controlled – not partnered with

49. Sexual harassment • The violence in sexual harassment – public health implications

50. Illicit drugs