Successful models exist for taking a public health approach to violence prevention. My health department oversaw a program called Safe Streets that hired individuals from the communities they serve to work as conflict mediators. Many were ex-offenders. In 2017, these outreach workers stopped more than 1,000 conflicts, 4 out of 5 of which were deemed likely or very likely to result in gun violence. More than two dozen other U.S. cities use a similar public health approach as part of a national effort called Cure Violence.
Other public health programs, across the country, have proved effective at reducing crime. Several studies have found that addiction treatment decreases robberies and thefts; for every dollar spent on drug treatment, as many as three are saved in crime reduction. Longer-term approaches include investing in early-childhood education; preventing lead poisoning; and providing food, housing and recreational outlets. All work to increase opportunity and decrease the hopelessness that later contributes to criminal activity.
Unfortunately, many of these programs suffer from lack of funding. Elected officials far and wide love to praise them, but when budgets are tight, they go on the chopping block. Despite its proven successes, Safe Streets nearly closed. Meanwhile, funding for Baltimore’s police department continued to grow.
As much as I wished that police department funding could be reallocated to public health programs, I also knew that my programs could never replace law enforcement. When one of the city’s health clinics was repeatedly broken into and vandalized, my staff wanted a police presence there to help them be safe at work. When mental health counselors went to help community members in psychiatric crisis, they often called the police for backup in case the person they sought to help had a firearm. Animal control officers, too, relied on the police when they went to investigate cruelty cases such as dogfighting operations.
Instead of using the inflammatory language of “defunding the police,” what if we consider a new approach to policing through partnering with public health efforts? Treating addiction is one area where this has already started. I worked with two reform-minded police commissioners to train officers to use naloxone, the opioid antidote, and to start Law Enforcement Assisted Diversion (LEAD), a program first piloted in Seattle that provides treatment instead of incarceration for those caught with small amounts of drugs. Cities including Denver have co-response units with police officers and mental health professionals to assist homeless individuals and those with mental illness.
These partnerships should be expanded around the country. They could spur creative thinking about what’s really needed for public safety to meet the needs of each community. If needs include certain social supports, how would this change the people recruited and their training? Might there be some public safety officers who, like Safe Streets employees, are situated within health departments — and might the police budget shift to a combined public safety budget? Could there be a renewed focus on prevention, with investment in education, health and other social supports also part of the strategy? And could a public health approach to violence prevention seek to reduce not only violence on the streets but also that perpetrated by police officers?
Critics argue that such collaborations cannot work because of the entrenched culture of police departments. Dismantling systemic racism will, as they suggest, require tremendous reform. But I’ve seen how the culture can change. The first time I conducted training for police officers to teach them how to inject naloxone into someone who is overdosing, they looked at me like I’d grown another head. “We don’t do that,” one officer said. Within a month, however, four officers used naloxone to save four lives. Soon, officers were competing with one another to see how many people they could save. I watched officers embrace LEAD when one of their own, an 18-year veteran of the force, talked about losing his brother to a heroin overdose. I was in the room when officers cried as they went through trauma-informed care trainings and saw their role in perpetuating cycles of trauma and violence.
Activists are understandably angry, and I believe that they are rightfully demanding urgent change. But calls to defund police are imprecise and raise tensions unnecessarily. It would be more constructive to recognize the vital role of police as unjust practices are reformed and as we all work to reorient public safety through a public health approach.