Policing as a social determinant of health in three decades of public health research: A systematic review

Background

This study explores how policing and police violence are analyzed in critical theoretical frameworks used in public health research literature such as the Social Determinants of Health (SDOH) in the United States.

Methods

We reviewed articles published from 1990 to 2021 that studied U.S. populations and/or those residing at the U.S. southern border and appeared in public health journals to analyze the relationship between policing and the SDOH. After searching key academic databases and screening the results, 25 articles met the criteria for inclusion in the review.

Results

The key themes identified in the papers include ecosocial theory and stress; research that characterizes police violence as a form of racism; the role of policing in enforcing harsh immigration policies; research that focuses on how police harassment and fear limit access to health care resources; and research that uses the SDOH to predict police fatalities.

Conclusions

The studies reviewed provide persuasive evidence that policing has significant and harmful effects on health and critical social determinants of health. However, none of the research focused on determinants of health such as the social gradient, unemployment or neighborhood features like food or transportation. The impact of policing on other critical determinants such as work, social support, and social inclusion were only described in studies of criminalized populations such as street sex workers and injection drug users. Other limitations include the lack of research confirming hypothesized biological or social pathways showing the links between police behavior and adverse health outcomes.