The role of health care equity in improving public safety | Opinion

Photo by Joe Raedle/Getty Images.

Health and access to affordable, high-quality health care play key roles in creating the conditions necessary for true public safety — and they are too often left out of the conversation altogether.

As caregivers and health educators with frontline experience partnering with marginalized communities, we recognize that mental health services both prevent and address mental health crises that create unsafe situations. Timely and readily accessible addiction treatment services were shown in one study to reduce the likelihood of repeat crime activity by 75%. Physical well-being and social cohesion mutually reinforce each other, creating safer neighborhoods. Models show that levels of social cohesion — whether or not people know and trust their neighbors — explains more than 75% of variation in levels of violence between neighborhoods.  

Health care built on trusting relationships also offers a distinct opportunity to compassionately identify and interrupt social circumstances that increase the risk of harm amongst communities. For example, health workers are sometimes the first to learn about domestic violence, housing and food insecurity, substance use, and threats of gun violence that patients and their families face. In such situations, health workers can collaborate with community organizations focused on addressing such concerns, thereby playing a fundamental role in promoting public safety.

Resourcing social programs that enable healthy living — food security, clean water, housing, economic stability, and accessible healthcare and green space — aligns with our framework as social medicine practitioners and educators. Our lived experience with patients and empirical public health evidence continually reinforce that social and economic forces constitute health far more than biology, behavior, or medical care. 

Further, it is oppressive social forces such as racial capitalism that explain health inequities. For example, substance use disproportionately arises amongst those who have suffered the trauma of oppressive histories. Likewise, structural racism, as systematically implemented through historical redlining and its resultant ongoing residential segregation, contributes to the creation of modern day differences in preterm birth

Achieving the individual and community health needed for public safety requires addressing these historical and on-going injustices through a radical redistribution of power, money and resources.  Health equity champion Dr. Camara Jones teaches a valuable lesson with applicability for reimagining public safety: We must be “valuing all individuals and populations equally; recognizing and rectifying historical injustices; providing resources according to need.”  

Given the interlinkages between health and public safety, budgetary choices now facing us must prioritize community services related to health. Police currently devote up to 10% of their time responding to crises amongst those with serious mental illness, with limited success. Policing is designed to control, and not heal. So, cultivating resources for mental health crisis response teams that are completely separate from police would be more effective, while also decriminalizing mental illness.

In Minneapolis, we support the creation of city-wide 24/7 rapid-response mobile mental health response teams equipped with tools to de-escalate mental health crises. More importantly, we recommend interventions that heal mental illness and prevent escalation from ever happening in the first place. 

Similarly, meaningful intervention for substance use requires a paradigmatic shift away from prosecution and toward treatment. Responding to substance use not as an issue of law and order but as a public health issue calls for putting in place harm reduction policies and practices. Minneapolis boasts skilled community outreach programs through Southside Harm Reduction and SWOP Minneapolis. Money divested from the Minneapolis Police Department can be invested in outreach teams and safe places to use drugs to meet the needs of people where they live. Centering harm reduction in the approach to substance use will ultimately lead to violence prevention in the community. 

We envision a path forward that shifts public resources away from policing and into community and social services prioritizing Black, Indigenous and other people of color, transgender, immigrant, differently abled, and working class communities that have faced disproportionate hardship. The efforts of the Yes4Minneapolis coalition are laying a concrete foundation for such a path. 

Health care access that supports mental and physical wellbeing while cultivating structural determinants of health such as living wage income and dignified housing ultimately fosters life-affirming institutions for public safety that no amount of policing or criminal justice reform can achieve. The visions of social medicine and abolition of police coalesce, with both imploring us to invest public resources in community social services. If more of us have our needs met, ultimately, we are both healthier and safer.  

Amy Finnegan
Amy Finnegan is an associate professor in justice and peace studies at University of St. Thomas and organizes with the Twin Cities Chapter of EqualHealth's Campaign Against Racism.
Nasreen Quadri
Nasreen Quadri is an internal medicine/pediatrics physician, assistant professor in the department of medicine at the University of Minnesota and organizes with the Twin Cities Chapter of EqualHealth's Campaign Against Racism.
Michael Westerhaus
Michael Westerhaus is a primary care provider at the Center for International Health and organizes with the Twin Cities Chapter of EqualHealth's Campaign Against Racism.