‘To be safe means to be healthy’ — Expert on racial health disparities

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The Black Lives Matter (BLM) protests raised concerns, at the time, that they would cause COVID-19 cases to spike. Some people used these concerns to discredit the protests and the public health experts that supported them. 

However, the protests did not raise COVID-19 rates and called the notion of public health into question. It is becoming increasingly apparent that we can no longer ignore social determinants of health, such as poverty or racial discrimination. Police brutality is a public health issue, and so is racism. 

Furthermore, in some communities, a police presence makes the members of those communities feel anything but safe. This begs the question — what does public safety mean? What is the relationship between public safety and public health?

For answers, we turned to Hedwig Lee, a professor of sociology at Washington University in St. Louis (WUSTL). Prof. Lee’s research interests include health disparities, race, and policing and social control. She is also the associate director of the Center for the Study of Race, Ethnicity, and Equity at WUSTL.

We started by inquiring about public safety and public health as if they were two separate notions, but Prof. Lee challenged us to “flip the script.” It is time to understand that “Being safe is a key dimension of being healthy,” she said. 

Also, in the context of “over-policing” and how it affects Black communities, in particular, it is worth bearing in mind that ‘safety’ may mean different things for different people, and this may depend on where people live.

We talked to Prof. Lee about the legacy of racial violence in the United States, policing, COVID-19, wealth inequality, and how all of these aspects are interconnected into a broader picture of health. We have lightly edited the interview for clarity.

MNT: In the context of the BLM protests and COVID-19, it seems like a good time to rethink the concept of public health and what it means for different communities. Is there a tension between public safety and public health? Can the former be detrimental to the latter?

Prof. Lee: I’ve been thinking a lot about your questions, and I think, coming from my perspective as a person who studies the social determinants of health, it’s hard for me sometimes to disentangle public safety from public health. 

[C]OVID has changed the entire world, and in the U.S., I think it really helped to amplify what racial inequalities actually mean. I think one of the reasons it did that is because it shows that all health outcomes are related. It shows that there’s no such thing as a public health policy or a criminal justice policy or an education policy, but that economic policy impacts health outcomes, that education policy impacts health outcomes, etc. 

And so, when we try to create divisions or try to think about public health and public safety in a zero-sum game, I think we forget or lose sight of the larger picture, which is that all of these things are connected. 

So, issues of structural racism impact policing just in the same way that they impact people’s disproportionate risk to health hazards. 

And so, if we used that framework, we would be asking different kinds of questions. I think the questions you’re asking are still really important and we have to think about them. But, if we’re thinking more upstream, [we see that] if we were doing a better job at, for example, ensuring that neighborhoods weren’t segregated, [if] we were ensuring that we didn’t have policies that led to racial residential segregation, we’d have less police violence and we’d have fewer people exposed to COVID. 

Those are the kinds of things [that we should be looking at,] and that’s how I think about it — big picture.

MNT: Along the same lines, I was wondering if there are similar factors at play in the BLM protests. Are there any social determinants of health that we need to look at there before we think [in rather simplistic terms] just about the risk of spreading the virus? What are some of the underlying factors that created the protests in the first place?

Prof. Lee: People are protesting because of many reasons, and I can’t list them all. I think Black Lives Matter does a good job of talking [about that,] but individual groups of people are protesting because of inequalities that exist across all sectors of society — in health and education, in the job market, etc. 

And [people are protesting] because at some level, we understand that if we actually want to improve outcomes for individuals — and that includes protecting people from being at risk of COVID, ensuring people have adequate healthcare when they feel sick, ensuring that people have enough job security not to have to come to work if they’re sick, ensuring that they live in homes that are safe and [that] allow for the ability to self-quarantine, etc. — we have to address larger-scale policies. I think protesting is trying to address these larger-scale issues.

And then, the conversations will turn to more proximate issues, like okay, can people protest safely? Is this going to increase COVID-19 risk, are we going to create new hotspots? But, I think for most of the people protesting, they believe that they are advocating for larger-scale issues that won’t just impact COVID risk now and racial disparities but will prevent something like COVID from happening again in the future.

COVID is just one of many examples that we can turn to [in order] to understand racial disparities in the U.S. And while COVID is monumental and exceptional in so many ways, we, as African Americans, have a higher mortality risk and are at higher risk for other kinds of chronic diseases — the list continues. COVID is what we’re thinking about right now, but something else might replace COVID.

Once COVID is gone, we will see racial disparities in other health and social outcomes, and protesting is about doing the work so that we can fix today and tomorrow. So I think it’s a longer-term investment. 

So, I think if you see it that way, you realize that individuals are thinking about saving lives today and tomorrow, and it might make you sort of reconsider the costs and benefits of protesting right now, given the goals of the protests.

MNT: With regards to this, and in connection with your earlier point that criminal justice, economy, education, and health policies are interconnected, and we should be asking different questions, can I ask you to expand a little more on these topics for our readers?

Prof. Lee: Yeah, I think there are some writers who are doing a good job of this, so people such as Nikole Hannah-Jones, Eddie Glaude, Khalil Gibran Muhammad, Ta-Nehisi Coates, Michelle Alexander. There are some leading public thinkers who have been talking about this, but one [question], at least in the U.S., is to think about our racial history. 

I think it’s no coincidence that as our country is contending with COVID and understanding its racial and economic disparities — these extend beyond black and white because COVID is also disproportionately impacting the Latinx population, the Native American population, and other marginalized groups, so I just want to make that clear — we’re also thinking about how we are going to address racial and ethnic disparities in COVID risk and death. And, as we’re also talking about racial disparities and policing, [it’s no coincidence that] this is also a moment where people want to do some reckoning with our history. 

So, there’s lots of discussions in the news around removing monuments that represent racial violence, removing names of leaders that adorn many universities, entryways, etc., and I think it’s because it’s clear, at least for many people, that if we did a better job at understanding legacies of racial violence and how those legacies are impacting present-day outcomes, we could understand that we have systems of racial hierarchy or racism (however you want to describe it) that are impacting communities of color across a variety of domains. 

[F]or example, there have been […] disparities [in racial violence] [f]rom legal and non-legal actors since slavery. So, […] some would argue that the racial disparities that we see in policing are just an extension of the kinds of practices that have been happening throughout history from slave times — from the slave courts, moving on to the policing of individuals during times of sharecropping and Jim Crow, through the work of non-legal actors, such as the KKK, sometimes working alongside the police in certain parts of the country — and that this is just sort of a continuation of those kinds of patterns.

And we can say the same thing for health disparities. [W]e’ve seen disparities in health for a long time — W.E.B. Du Bois talked about these in the late 1800s. A lot of these [disparities] are the result of policies and practices that have disallowed African Americans from fully entering the labor market and denied them opportunities to live in and own places that could improve economic outcomes.

And we are seeing the generational results — of that lack of opportunity to accumulate wealth — in where African Americans can live, along with policies that place certain racial groups in non-resource areas that also tend to be over-policed. 

So, I think, if you think more historically, if you take that long view, you realize that all of these things are connected — [this] doesn’t mean that there’s nothing we can do right now. It doesn’t mean we shouldn’t be asking the questions that you’re asking. We still have to ask them because we are in ‘today,’ and we have to [figure out] how to intervene now. But, I think if you think about those things in that way, connections become a lot clearer.

MNT: You mentioned the over-policing of African American communities and the lack of wealth and resources in these communities. In light of the BLM protests, more and more people are thinking of police violence as a public health issue, and some are calling for defunding the police — what are your thoughts on this issue?

Prof. Lee: [I] think we can think about policing, and we should always think about inequalities in policing as a public health issue, and that’s because there are many ways in which policing impacts the health of communities. 

There’s work to show — and work that I have [done] with people such as Ali Sewell — that in communities that have disproportionate experiences with policing, especially policing that involves high use of force, the community members are also impacted, their mental and physical health is also impacted.

So, there are ways in which just being in a community that has a very high police presence, especially one that is not necessarily positive (where people are experiencing high levels of more aggressive interactions with the police), does impact the mentality of community members, their feelings of safety, their feelings of well-being.

[A]nd we can just think about, you know, what does it feel like to walk down the street and to know that there’s a potential for you to have a negative interaction [with the police], whether it’s warranted or not, or somebody that’s close to you — those [things] have negative impacts on communities.

Communities [that] are over-policed also face stigma in [other] kinds of ways. So these communities are less likely to be invested in, less people are likely to want to move into these kinds of spaces and places, which also impacts the well-being of communities at large — are grocery stores going to be there? Think about the places where the new Whole Foods are being built; they’re not in the same places where people are experiencing this kind of day-to-day interactions [with the police].

So, I think those things matter too. And for individuals who are over-policed, there’s work to show, for example, [that] some of [the young men in the city of New York] avoid even walking to corner stores, just a couple blocks away because they don’t want to be stopped by police.

Even from a practical sense, you can see how that could impact health — people can’t even engage in daily forms of moderate to vigorous physical activity that we’re told to do by our doctors to prevent poor health outcomes. 

So, we can think about policing as creating stressors that have taken a negative mental health toll. And there’s research to show that chronic stress can also impact other bodily functions related to physical health, and that includes cardiovascular health. 

And then, even just practically, people aren’t using spaces outside [b]ecause they don’t feel necessarily safe in those spaces, which is really problematic, given that police are supposed to be promoting public safety. [B]ut if the individuals in those communities aren’t feeling safe, we have to reckon with what that means. So, I think those are some of the ways we can think about police — here I’m talking about the kinds of policing where there’s excessive use of force, etc. 

Over-policing can have some really negative impacts on the people who experienced those things, but also on the community members who may never experience or have contact with police officers, but just live in those communities […].

[A]s we discussed before, the racial disparities and policing that we see today are connected to historical features of racial violence and policing of people of color, black bodies, brown bodies, etc. and so, [it is important to] understand that racial control morphs and changes over time — or not even over time, but sort of contemporaneously; racial control can also come in different forms […].

I don’t want to simplify the [movement to] defund the police because I think there are people who are really thinking about this in really sophisticated ways and have really great ideas.

[T]his is just a small example, but it is not to discount abolitionists’ work — who are really trying to think through what it means to protect the community’s safety in all the dimensions we talked about (so not just in terms of safety from, [say], something happening to your car or your personhood, but safety like your health, your mental and your physical health and your well-being) — but we do know from the work of people such as Dorothy Roberts that we see racial control happening in other spaces. For example, in the foster care system and other forms of the social welfare system. 

So, this idea that, potentially, we can replace policing with social work is really problematic for some because that’s also a space where we’ve seen huge racial disparities, and […] you can see that there are racial disparities in who enters foster care, who’s able to stay with their families, etc. 

[So,] as we think about alternatives, we have to be really vigilant about where we see racial control happening. 

Phil Goff is a psychologist who has a policing equity center. I’ve heard him speak on this topic, and I like the way [he frames] things, which is, while he thinks we should be talking about defunding the police, he’d much rather have conversations on what else can we do to invest in communities. Instead of thinking about removing funding, how can we bring more money into places and spaces, and to me, I feel like that’s another part of the conversation that needs to be had. 

And [this conversation] has been had in the [police] defunding spaces, but in terms of how we can talk about it [more broadly] — you and I and other people — it would be nice to talk about not just defunding but also investment because I think if we invested in communities and neighborhoods as David Williams has talked about […], we wouldn’t be seeing [some of the disparities that we’ve been seeing].

There’s work to show that investment in housing in disadvantaged communities, […] improving housing, and many dimensions has improved asthma outcomes for young kids — they are less likely to go to the ER with asthma attacks or events.

So, I think there are […] good models of ways that we can invest that can impact communities in many positive ways. If you have improved housing, that means you have more safe places for kids, places where they can breathe; you have communities that are being invested in. Once there’s better housing; usually, that can come with other kinds of changes to the infrastructure and businesses that will think about moving to those places and spaces. 

So, if we can think more broadly about investment — [and that’s] not to say there’s nothing that needs to be done with the police, there are huge issues there that need to be addressed — we’d be addressing some of the key drivers of why we see over-policing in the first place in certain communities […]. 

[P]olicies and practices, such as redlining, etc., create spaces that are racially segregated and also economically isolated, places that aren’t close to grocery stores, etc., places that, because they are economically isolated, have underfunded schools, which impact opportunities for kids in those neighborhoods.

This also impacts the kinds of spaces and places where people can be outside, impact people’s income so that they can live in homes, and maintain homes in ways that can protect their health. So it’s just all really connected. 

MNT: Of course, it can be hard to tackle all of these aspects in one conversation, which is why it’s important for us as journalists to commit to focusing on all of these issues in the longer run. On this note, is there anything that I haven’t asked that you would like our readers to know? 

Prof. Lee: I think for me, as a sociologist who studies health disparities, I study lots of health outcomes. So, epidemiologists often focus on a particular health outcome, [such as] cardiovascular disease [for example], but I study lots of different health outcomes, and I also study policing. 

The reason I study policing and other health outcomes is like we talked about before, I see them as being connected — policing outcomes are also public health outcomes.

And I do wonder if we should really flip the script. Why do we have to talk about public safety as something different from public health? Being safe is a key dimension of being healthy. 

[T]o be healthy, you have to feel safe in places where you live — to [quote] the Robert Wood Johnson Foundation, “where you live, learn, work, and play.” You have to feel safe in those spaces, and safety isn’t just this idea that you are protected from bad things, bad actors.

It means that you can live a full life, which is what health is about — being able to flourish and do the things you want to do.

And so it’s really hard for me to wrap my brain around differentiating them. And I think sometimes that’s also [part] of the tension communities might have, why people are voicing concern — because people want to feel safe, but safe in every dimension of themselves. 

[In other] people’s perspective, some would say, “well, if police are around, then you know that you’re safe because they will protect you from criminal actors.” But again, that’s if you have a narrow conception of what safety means, and it also means you have a healthy relationship with the police who are in your community (which is a whole other thing that we need to be thinking about). 

I really wish that we wouldn’t talk about [public safety and public health] separately because, to me, they’re just so tied together.

And we talk about [them separately] when we talk about early release [of people from prisons] or how we can promote the health of communities, while also protecting the safety of those communities. 

So, even in some of the arguments people use for why we should think about alternative sentencing practices, about keeping families together instead of having a family member going to prison for a nonviolent crime, the discussion is often “we can protect public safety but also promote the health and well being a community” […], and I think that’s a really important way [to think about these things], and we should be thinking about them, but it’s just so unfortunate that we see those as two separate things. 

Because if people really think about it, to really be safe, you have to be healthy. And I think that’s the other reason why COVID has been so influential — because people see that now.

I mean, [COVID] is different because it’s an infectious disease, it’s different from some of the other health conditions that ail the black community, such as asthma, etc., but COVID shows you that if you want to be safe, your health has to be protected too! I think it’s really expanded our mind about what safety means. 

So, I hope that future conversations can move in this direction. While we may still have to think about [public health and public safety] separately because different government and municipal actors are in charge of those things right now, it might change with the ‘defund the police’ [movement] because I think that’s some of the really exciting work that’s being done.

I really hope that we stop thinking about these as two separate things, and understand that to be healthy means to be safe and to be safe means to be healthy.