Hello everyone. My name is Dr. William Lopez and I'm a clinical assistant professor at the University of Michigan School of Public Health and the Department of Health behavior and health education. In this session, we'll be talking about how law enforcement makes its way into your body. That is how does law enforcement harm our health? What are some of the pathways through which this occurs? Will be a little less concerned with laws themselves and more about law enforcement in our communities. How this shapes where we go, who we see in which resources we access. By the end of this lesson, you'll be able to describe three pathways through which law enforcement may impact your health and consider how these harms may have spillover effects on the rest of our community. So let's begin by thinking about who enforces law in the US. Generally speaking, there's dozens upon dozens of departments throughout the country, enforcing law at international borders, North and South and everywhere in between. For the purposes of this lesson, we want to consider the agents and employees of these institutions who are policing and enforcing the law that shape our everyday lives. Generally speaking, this means we consider uniform police officers, Sheriff's deputies and ICE and CBP officers who may be in our communities every day of the year. So let's think about three pathways through which law enforcement may impact their health. First, law enforcement can result in direct physical harm, death or injury morbidity and mortality. Second law enforcement can result in psychological harm. This often extends from fear or worry about the possibility of physical violence or deportation. And lastly, our health can be impacted due to the avoidance of social service and health resources. When we're worried about possible arrests, violence or deportation when we interact with these institutions. Let's look at the first pathway physical harm. At its most egregious law enforcement violence can result in death. As we've seen in cases such as that of George Floyd, Adam Toledo, Laquan McDonald's or Rosser, Philando Castile, Brianna Taylor and many others. But even in the absence of death, serious injury can result which sometimes impacts mobility or cognitive function. To get a sense of the scale of this injury, we can look at data from 2016. These data show that over 1000 people were killed by the police in the US. And that over 76,000 nonfatal injuries took place. Now there's two important caveats here. First, data and law enforcement violence are notoriously difficult to collect and often under reported. Unlike death and injury and other industries, there's no regulated way to collect these data. Secondly, law enforcement violence shows large disparities by race and gender, making it challenging to represent the harm of law enforcement in one graph or statistic, we'll talk about this shortly. Now, there are many spillover effects from these death and injuries. Those 1000 deaths in 2016 resulted in 54,000 years of life lost.. And nearly $2 billion dollars to address the cost of these deaths and the related injuries. Career and educational trajectories, changes communities and family members often have to take care of their injured loved ones becoming legal advocates in many cases. Perhaps having to leave school or leaving work to do so. And research shows that simply living in a neighborhood with more police killing can result in increased blood pressure for other residents of that neighborhood. Let's consider the second pathway through which law enforcement violence can harm health. Studies show that perceived victimization by police can result in psychological distress or depression and that more contact with police can predict trauma and anxiety. For those who fear deportation, worry about deportation has been linked to cardiovascular risk or negative emotional states like anger. And of course, as human beings connected in myriad ways to other human beings are worried and physical harm as often about others. Studies show that worry and deportation can result in emotional distress, especially among children of undocumented parents. Now, let's consider a few ways in which these pathways may interact. It's critically important to understand that the fear of physical violence and deportation may result in psychological stress. This afterwards goes on possibly to harm your body again. For example, Garcia shows that fear of deportation can be a chronic stressor that gets under the skin, resulting in more physical harm and exacerbating pre-existing conditions and other chronic illnesses. Now, let's look at a third pathway through which fear of law enforcement may impact our health. Now, studies show that fear of deportation can lead to the avoidance of social services, including the emergency room, maternal healthcare and Medicaid. We see similar impacts among folks who are worried about interacting with the criminal justice system. Who may avoid interactions with the medical, financial, labor or educational sectors in order to avoid possibly crossing paths with police. Now there's spillover effects from this pathway as well. Parents who fear their own deportation may avoid resources to which their children, perhaps citizens are entitled. Other studies show that formerly incarcerated parents may avoid contact with their children's schools. And let's again think about how these pathways interact. As you see in pathway A, in ideal conditions when your health declines, you access resources to improve your health. Said another way, when you're sick, you see a doctor to feel well again. When you're depressed, perhaps you see a counselo,r when you're hungry, perhaps you go to a food bank when you're unemployed, maybe you go to the unemployment office. These resources allow your health to improve, they allow you to feel better. Now in pathway B, when your health declines, if you fear law enforcement, you may avoid seeking the resources that you need to improve your health, resulting in once again decreased or poor health. You may feel sicker, you may be hungrier when you aren't able to access the resources, you need to improve your health. To summarize law enforcement can shape our day to day lives and impact our health via at least three pathways described here. The first is physical violence, including death and injury. The second, psychological harm often worry about that death injury or possible arrest and deportation, and the third is avoidance of health and social services. In our next session, we'll discuss how these harms to health may differ depending on your race and ethnicity.