It Takes A Toll

June 2, 2020

Photo by Daniel Arauz / CC BY 2.0 

As the nation responds to the police killing of George Floyd, we explore the public health impacts of police violence and what a public health response could look like.

Listen to the full episode below or scroll down for the transcript and more information.

This story contains discussions of police violence.

Dan Gorenstein: Dr. Rhea Boyd thinks a lot about Erica Garner. 

Rhea Boyd: Erica Garner was Eric Garner’s daughter.

News clip: Erica Garner turned personal tragedy into a public mission. She became a national advocate following the death of her father, Eric Garner, at the hands of a New York City police officer in 2014.

RB: Erica Garner died of a heart attack after having an asthma attack within months of having a child, and she was 27 years old. Obviously, it’s exceedingly rare to die at age 27. I bring up Erica Garner because she poses a challenge to us in health care to ask what killed Erica Garner.

Theme music

RB: The next question is not who’s more likely to die of police violence. We know that question. We know who’s affected. We know what it looks like. Now we have to start connecting the dots.

DG: Six years after Eric Garner’s death, cries of “I can’t breathe” are back. 

This time they’re in response to the police killing of George Floyd in Minnesota. 

Today, from the Annenberg Studio at the University of Pennsylvania, we explore the public health impacts of police violence and what a public health response could look like.

I’m Dan Gorenstein, and this is Tradeoffs.

Dr. Rhea Boyd is a pediatrician at the Palo Alto Medical Foundation in the San Francisco Bay Area.

She’s also a researcher and advocate on the population health impacts of police violence.

Dr. Rhea Boyd, pediatrician and police violence researcher

RB: Police kill people. As soon as you know that people die in police encounters and at the hands of police, we know it’s a form or a source of premature death. That alone is enough for us to be studying and doing something about it. But we know more, right? We know these encounters result in injuries. We know they result in disabilities. We know they result in mental health impairments.

DG: You said that we know more, and one of the things we know more about is that there’s a physiological and psychological impact of toxic stress, which one researcher defined as, “the prolonged experience of significant adversity.” How does toxic stress actually impact people’s physiological and psychological health, Dr. Boyd?

RB: It can disrupt the actual process by which stress hormones like cortisol keep you healthy and shift it to one where it makes you more likely to be sick. Toxic stress has been related to increased risk of heart disease, lung disease, cancer and mental health impairments like depression.

DG: Dr. Boyd points to a particularly powerful study on the mental health impacts of police violence that was published in 2018 in the British medical journal The Lancet.

RB: It basically showed that police killing one unarmed Black American in your state impacted the mental health of every other African-American in that state, and that the size of that burden of mental health impairments was analogous to the size of the burden of mental health impairments associated with diabetes. Just living in a state where police killed an unarmed Black American causes a mental health impairment similar to if you actually had diabetes. I mean, it’s profound. And so the other thing that clinicians have to think about is how are we responding to the population level mental health impact of police violence? Because now the person who needs an intervention is not just that one individual who is injured. It’s everyone in the state.

DG: If we accept that police violence and the threat of police violence is a public health problem, what are two or three steps that could be taken that represent a helpful public health response?

RB: I think, number one, we have to collect more data. We have to prioritize the study of policing and police violence and its impacts on health so that we can enumerate interventions. Two, I think at a local and state level, we have to shift how we fund public health, and some of those dollars should absolutely come from how we currently fund policing. Three, we have to be a part of creating sanctuaries from the violence that occurs as a result of being exposed to policing. Many hospitals, many clinics employ security officers and sometimes local police to police patients in the hospital during their medical stay. That can contribute to further harmful exposures to police.

DG: As a researcher, you say that we need to gather more data, more evidence. What are questions that you want to study? What are questions that you think must be asked, that this past week is a reflection that need to be asked?

RB: I think I’m now asking questions about the intersections between chronic illness, toxic stress and police violence, and how that can contribute to disease. How we can better understand when the onset of those diseases might occur, so that if we’re able, especially for children, we could start employing early screening and prevention interventions so that they don’t have negative outcomes.

DG: Dr. Rhea Boyd says for the health care system to effectively respond to police violence, it needs to undergo a paradigm shift.

RB: We have to invest ourselves in completely transforming what policing looks like. And then we have to place ourselves in the center of the public response that will have to be erected in the absence of that old police structure, which means what does it look like to send out health care providers, to send out social workers, to send out mental health providers when communities are in crisis? Who should people call when they need help? And the people who are trained and experienced to respond to those events and to respond to crises without violence are health care professionals. And we have to assume that role.

DG: How does your thinking and your work on this issue, Dr. Boyd, influence how you interact with your patients?  

RB: It’s actually a complicated question. It influences how I interact with my patients a lot and a little. Because health care and public health has yet to fully accept throughout our industry that police violence is a public health issue, we have few interventions that I can give out to patients at an individual level. That said, I also say a lot because as somebody who studies and writes and teaches about this, I know it matters to patients. And so I take more time. I ask more questions of parents and of our teens. Has this happened to you? How did that make you feel? Are you talking to your parents or friends about it? I ask those questions because I know it’s affecting them. I know I share some of the effects that they feel. And I want them to know that it matters to me and that it should matter to our broader health care system.

DG: Final question. It’s a personal question. What has the last week been like for you?

RB: I think one of the realities of my experience walking this world as a Black woman is that you get tried a lot. People push you on what you will take from them. And sometimes that push is physical. Sometimes that push is structural. But it feels like you are in a sieve. And I feel tried all the more. I otherwise, honestly, and this is a personal choice probably that many Black physicians, particularly at this time right now, are having to make, I actually try not, if I can, to publicly bare my emotions, although my rage tweets may say otherwise. I am an expert about the effects of racism on health and particularly the effects of police violence on health. I don’t want what I am saying to be reduced to my emotionality. It’s science. It’s what we were taught we had to bring forth to make change. And it’s the science. And I hope that this science met with this wicked unrest will finally be what it takes.

DG: Does that take a toll to have to hold that spot?

RB: It absolutely takes a toll. It absolutely takes a toll. I mean, I care about this because it’s killing people, and I care about it because it could kill me. It could kill my man. It could kill my family. Knowing that, avoiding that, doing all the tiny things we do to contort ourselves in public so that we can just make it home at night. I know the science that says all of those things that I’m doing is taking a toll, is probably shortening my own lifespan. And I think it’s why if I get the chance, every time I get the floor, I’m going to talk about this. I’m invested in building a world where Black people are free. Where they are free from the constant injustices visited upon them in this nation and in this world. And if my contribution is this science? Then I’m going to make my contribution, you know? I do it because I have to do it because I hope the kids that I hope to have in the future can live in that world. 

DG: I’m Dan Gorenstein, This is Tradeoffs.

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Episode Resources

Select Research and Analysis of Police Violence as a Public Health Threat:

Police Brutality and Mistrust in Medical Institutions (Sirry Alang, Donna D. McAlpine, Rachel Hardeman; Journal of Racial and Ethnic Health Disparities; 2020)

Why police violence needs to be treated as a public health issue (P.R. Lockhart, Vox, 8/14/2019)

Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study (Jacob Bor, Atheendar S Venkataramani, David R Williams, Alexander C Tsai; The Lancet; 2018)

Addressing Law Enforcement Violence as a Public Health Issue (American Public Health Association, 2018)

Police Brutality and Black Health: Setting the Agenda for Public Health Scholars (Sirry Alang, Donna McAlpine, Ellen McCreedy, Rachel Hardeman; American Journal of Public Health, 2017)

Dismantling Structural Racism, Supporting Black Lives and Achieving Health Equity: Our Role (Rachel Hardeman, Eduardo Medina, Katy Kozhimannil; New England Journal of Medicine; 2016)

Collateral Damage: The Health Effects of Invasive Police Encounters in New York City (Alyssah Sewell and Kevin Jefferson, Journal of Urban Health, 2016)

Episode Credits


Rhea Boyd, MD, MPH, pediatrician and police violence researcher

The Tradeoffs theme song was composed by Ty Citerman.

This episode was produced and mixed by Ryan Levi.

Additional thanks to:

Rachel Hardeman, Monica McLemore, the Tradeoffs Advisory Board…

…and our stellar staff!