Cops, docs, and systemic racism

REFORM COMMISSIONS AT the state and national level have been charged with exploring ways to improve law enforcement, with a particular focus on addressing the issues of racism and racial bias in policing. As they look to understand biases in policing and recommend steps to eliminate it, the groups might draw valuable insights from an unlikely source: a recent study of infant mortality in US hospitals.

In September of last year, researchers reported findings of a study that reviewed records from 1.8 million births in Florida hospitals from 1992 to 2015. While black babies born in the US are known to suffer from higher infant mortality rates, the study found that when black newborns were cared for by black physicians, the “mortality penalty” they suffered, compared with white newborns, was cut in half. “Strikingly,” the researchers wrote in the Proceedings of the National Academy of Sciences, “these effects appear to manifest more strongly in more complicated cases, and when hospitals deliver more Black newborns.”

How could this study inform efforts to address racial bias in policing? Research shows that “blind spots” distort perception. We seem to be able to see in others’ behavior what we cannot recognize in ourselves. That’s why the study of infant mortality rates might help police see the need for inquiry into systemic racism in their profession.

As disconnected as law enforcement and labor and delivery might seem, the work of policing and medicine are remarkably similar in important ways. Chief among their similarities is the consequential nature of the decisions their practitioners make about the lives of those they help.

In both professions the effects of stress and cognitive bias on practitioners’ judgments are more profound because of the consequentiality of their choices. Both are life-and-death vocations. The intensity of the experience has caused people in both professions to see themselves, intentionally or otherwise, as a high priesthood of sorts. The views of the “outsider,” those uninitiated in the physical trauma they treat and the emotional trauma they experience, are viewed warily.

So, when a study of a major area of medicine discovers systemic racism lurking in judgments in the treatment room, reform-minded police practitioners and community reformers should take note. Where, for instance, does research show systemic racism manifesting in the police workplace? The disproportionate deaths of unarmed black suspects during police responses are the most pressing example. The searches of stopped automobiles are another, if less publicized, example. For years, research has shown that police search the cars of black motorists at a higher rate than those of whites. Yet they find contraband – weapons, drugs, alcohol, stolen goods – more frequently in the cars of whites.

I have no doubt that white obstetricians in general believe in racial equality. Such beliefs are probably among their professed core values. They would object strenuously to any suggestion that they treat black patients differently from whites. Police professionals are similar in their core values and beliefs. Docs and cops might also object to the fact that none of the researchers in the recent infant mortality study is a physician. To do so, however, would be to miss the big and consequential lesson and to miss the point.

Judgments are an accumulation of many smaller decisions. These decisions begin beneath consciousness. Nobel Prize winner Daniel Kahneman and Amos Tversky found decades ago that our brains begin deciding before we are aware that we are making a decision. The brain uses cognitive biases built into it through our formation and education in society.

Boston-based physician and writer Jerome Groopman, author of How Doctors Think, describes an “18 second rule” in primary care. “That’s the average time it takes a doctor to interrupt you as you’re describing your symptoms. By that point, he/she has in mind what the answer is, and that answer is probably right about 80 percent of the time,” he writes.

In showing that physicians’ snap conclusions are wrong 20 percent of the time, Groopman wants to prompt patients and doctors alike to get past the fallacy of the doctor as all-knowing expert.  His evidence argues for a slowed-down diagnostic process that includes patients as sources of important information.

Because they are human, cops and docs’ brains use what medicine calls “heuristics,” mental shortcuts that rely on prior knowledge and experience. Police have adopted the term “implicit bias.” The heuristic or bias can be good or bad, depending on how well a human manages and uses it. That’s a main point of Malcolm Gladwell’s 2005 primer on managing bias, Blink: The Power of Thinking Without Thinking. However, biases can also produce systematic error when understood poorly or not at all. This fact probably hides in the weeds of the Florida study that found disparate outcomes in infant mortality based on physician race.

The Annie E. Casey Foundation offered a definition that also would be useful to the state and federal reformers trying to identify and eliminate systemic errors in police thinking. In August 2020 foundation staff wrote, “Since the word ‘racism’ often is understood as a conscious belief, ‘racialization’ may be a better way to describe a process that does not require intentionality. Race equity expert John A. Powell writes, “‘Racialization’ connotes a process rather than a static event. It underscores the fluid and dynamic nature of race… Structural racialization is a set of processes that may generate disparities or depress life outcomes without any racist actors. Systemic racialization describes a dynamic system that produces and replicates racial ideologies, identities and inequities. Systemic racialization is the well-institutionalized pattern of discrimination that cuts across major political, economic and social organizations in a society.”

Every day, it seems, we learn something new about how the malignancy of racism biases our institutions. No two institutions have a greater immediate impact on individual and collective life than do medicine and policing. The recent findings on birth outcomes do not mean that white obstetricians don’t care about black newborns. Similarly, research findings on disparate outcomes in policing decisions do not mean that most police are practicing racists.

For policing, the accumulated research and the many decades of experiences of black people make the moral case for the profession to probe its thinking and practices much more deeply. Systemic racialization has been calling the shots for too long.

Many communities and individuals in Massachusetts are making good faith efforts in the policing arena. In Worcester, according to the Telegram & Gazette, City Manager Ed Augustus signed an executive order in February “acknowledging the role structural and institutional racism has played and continues to play in the city, and he laid out a broad-based plan seeking to address those issues.”

Edward Denmark, police chief in the small central Massachusetts town of Harvard, is a notable individual voice calling for a candid and fearless appraisal of how embedded, systemic racism affects policy, practice, and behavior. The City of Newton recently empaneled a reform task force to look at these issues with its police department.

The new state and federal reform commissions on policing should question the old assumptions. They should look at what Mayor Svante Myrick is proposing in Ithaca, New York. GQ reports that the 33-year-old Cornell grad, who caught the political bug and stayed on in Ithaca after college, is calling for “replacing the city’s current 63-officer, $12.5 million a year department with a ‘Department of Community Solutions and Public Safety’ which would include armed ‘public safety workers’ and unarmed ‘community solution workers,’ all of whom will report to a civilian director of public safety instead of a police chief.”

Myrick’s proposal to require current officers to reapply for positions with the new department seems unjust and shortsighted. But the overall concept bears a long look.

It’s time in our history to look all the elements of the criminal justice process. We need to look at the inherent, structural racialization embedded in places such as our drug laws. We need to look at how it affects judgment and decision-making at the crime scene and in the detectives’ room.

The first step in solving this most American of problems is to look at it honestly. That’s where the new policing commissions could make a historic contribution.

Jim Jordan is the former director of strategic planning for the Boston Police Department and co-principal of Public Safety Leadership. He has taught policing courses at Northeastern University and the University of Massachusetts Lowell.