Even with amendments, the Police, Crime, Sentencing and Courts Act threatens healthBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2256 (Published 16 September 2022) Cite this as: BMJ 2022;378:o2256
- Jordan Wondrack Zaidi, doctoral student1,
- Kavian Kulasabanathan, member2 3,
- Hil Aked, research and policy manager2
In 2021, civil society mobilised to resist some of the most draconian measures proposed in the Police, Crime, Sentencing and Courts (PCSC) Bill, which included sweeping new police powers to curb protests and repressive measures against the already oppressed Gypsy Roma Traveller (GRT) communities. The legislation is now an act of parliament, and while the final version was successfully watered down in some places as a result of public opposition, it still threatens health in myriad ways. One of the most significant changes was that the health sector was exempted from proposed requirements to share increasing amounts of data about their patients—nominally for the “prevention of crime”—under a so called “Serious Violence Duty.”1 Yet while the sanctity of confidentiality between healthcare workers and patients was, in this instance, protected, the authoritarian and racist fundamentals of this law remain intact, making it certain to cause harm to our patients and our society.
The government used a rhetoric of “public health” in the text of the bill, alleging that a multisectoral approach to tackling violence is consistent with a public health informed approach. In fact, the key functions of the act are to expand police powers and introduce harsher sentences which will lead to higher rates of incarceration. Genuine public health initiatives are grounded in “upstream” preventive measures, which are often population based, targeting the root causes of disease. This law, in contrast, is reactive and punitive. In our report The Public Health Case Against the Policing Bill, members of Medact’s research network explained why these criminal justice measures—which merely target symptoms—will function to perpetuate a harmful cycle of criminalisation, exclusion, and poor health.2
The legislation expands discretionary police powers to stop and search through Serious Violence Reduction Orders. The problem is, “tough on crime” policies don’t work to reduce violence in society. If giving more power and money to the police resulted in less violent crime, the United States, based on its expenditure, would be the safest country on earth. But this is not the case: only some types of highly visible violence are targeted with this approach, while other forms get much less attention, notably domestic violence, or state violence.3 And this approach has led the US to incarcerate more people than any other nation, which in itself reproduces harms and violence against those imprisoned.
What, then, do such policies achieve? Primarily, they deepen inequalities—including through short and long term impacts on health. Over-policed groups, notably racially minoritised communities, are already disproportionately affected. In the case of the PCSC Act, the Home Office has explicitly acknowledged that minoritised groups, especially young black men, will be disproportionately targeted, but simultaneously sought to justify this.4
Standard policing practices such as stop and search harm the physical and mental health of targeted communities. As the American Public Health Association has noted: “Even in the absence of physical violence, several studies have shown that [police] stops perceived as unfair, discriminatory, or intrusive are associated with adverse mental health outcomes” including increased prevalence of depression, anxiety, and post-traumatic stress disorder.5 Meanwhile, direct police violence is racialised, gendered, and classed, as well as ableist—around half of those who die in police custody have a mental health condition.6
Unsurprisingly, exposure to such violence is correlated with mistrust in the clinical setting. But even when not in direct contact with the police, surveillance stress is real. Feeling like you are being watched or targeted by law enforcement (as an individual, or as part of a community) is a chronic stressor for racially minoritised people. It also erodes trust, leading to diminished use of services.
Elevated levels of psychological distress caused by racism, including discriminatory policing, also have longer term and intergenerational impacts. Correlations exist between discrimination and health outcomes, including increased blood pressure, risk of cancer, and behaviour changes affecting health including avoidance of needed care and decreased engagement in positive health behaviours.7
More broadly, the social function of policing reproduces the structural violence that lies at the root of both “crime” and health inequalities. The way the new law poses an existential threat to GRT communities epitomises this. Already marginalised and excluded, facing severe health inequalities and stereotyped as “criminal,” these groups will have their nomadic way of life criminalised by the PCSC Act, thus exacerbating this pre-existing dynamic.
Overall, more people will be incarcerated and for longer as a result of the PCSC Act’s lower criminal thresholds and harsher sentences. This comes hand in hand with significant spending for prison expansion—in contrast to real term cuts to public health services that disproportionately affect deprived areas. A huge proportion of incarcerated people enter prison with health problems and, as the American Public Health Association notes, by exposing people to multiple forms of violence such as increasing rates of self-harm and suicide, incarceration worsens health outcomes further—as well as having negative health implications for families and communities.5 Nor do prisons even reduce crime: the government’s own impact assessments for the new law concede that “the evidence of the existence and scale of deterrent and incarceration effects is weak.”8 As Angela Davis said, “Prisons do not disappear social problems, they disappear human beings.”9
So, what’s the alternative? In 2021, the American Public Health Association passed a motion advocating for a move away from carceral systems and towards building “just and equitable structures that advance the public’s health” instead. We urge the UK health community to engage seriously with this policy reframe and other similar calls for an “abolitionist public health,” looking beyond policing and prisons, instead funding primary and secondary prevention to improve the structural determinants of health.10 The PCSC Act is the antithesis of this. That’s why, although it infamously curtails our right to protest (and the new Public Order Bill seeks to further restrict this right), we must resist its enforcement—lest it and further attempts to “police away” social problems further harm our health.
Competing interests: none declared.