In Philadelphia, PA, neighborhoods confronted with chronic and intrusive policing contact (e.g., "stop-question-and-frisk"), residents are less likely to utilize local emergency department (ED) resources. There are two notable contributions from this article: (1) Black underserved and over-policed neighborhood residents rely heavily on public hospital care. Thus, decreased ED use means that the sickest among us are not accessing the care they need and could otherwise secure. (2) The analyses lay bare that despite the shared human service and public safety aims of both municipal policing and public healthcare, their functioning in parallel “success” is impossible.
Abstract
Objective
This paper demonstrates that localized and chronic stop-question-and-frisk (SQF) practices are associated with community members’ utilization of emergency department (ED) resources. To explain this relationship, we explore the empirical applicability of a legal epidemiological framework, or the study of legal institutional influences on the distribution of disease and injury.
Data and Study Design
Analyses are derived from merging data from the Philadelphia Vehicle and Pedestrians Investigation, the National Historical Geographic Information System, and the Southeastern Philadelphia Community Health database to zip code identifiers common to all datasets. Weighted multilevel negative binomial regressions measure the influence that local SQF practices have on ED use for this population. Analytic methods incorporate patient demographic covariates including household size, health insurance status, and having a doctor as a usual source of care.
Principal Findings
Findings reveal that both tract-level frisking and poor health are linked to more frequent use of hospital EDs, per respondent report. Despite their health care needs, however, reporting poor/fair health status is associated with a substantial decrease in the rate of emergency department visits as neighborhood frisk concentration increases (IRR = 0.923; 95% CI: 0.891, 0.957). Moreover, more sickly people in high-frisk neighborhoods live in tracts that have greater racial disparities in frisking—a pattern that accounts for the moderating role of neighborhood frisking in sick people's usage of the emergency room.
Conclusions
Findings indicating the robust association reported above interrogate the chronic incompatibility of local health and human service system aims. The study also provides an interdisciplinary theoretical lens through which stakeholders can make sense of these challenges and their implications.
