What Has Place Got to Do With It? Hot Spots Policing to Address Physical and Mental Health

Abstract

In the last few decades of criminological research, the contextual concept of place has become a widely discussed and studied topic. Currently, one of the most studied and discussed place-based strategies is hot spots policing, the study of crime patterns at micro-geographic places. Since the 1980s, hot spots policing has become an important and empirically validated law enforcement intervention. One of the most novel questions about hot spots policing is whether it can be used to address other issues such as the intersection of crime, place, and health. Do concentrated patterns of physical and mental health issues mirror the patterns of crime at places? If so, can hot spots policing guide police interventions? This article reviews the current state of public health and place-based crime patterns to synthesize the concept of place-based interventions for health and crime. The article concludes with implications for the scholars and practitioners.

Keywords

hot spots policing mental health physical health place-based interventions

Criminologists, sociologists and other social scientists have always maintained that context matters (Cummins, Curtis, Diez-Roux, & Macintyre, 2007). In recent decades, the concept of place has become an important contextual factor for various social science interests such as crime and health. Places can be either health damaging (pathogenic; see Weisburd et al., 2018) or health promoting (salutogenic; see Pearce, Cherrie, Shortt, Deary, & Ward Thompson, 2018). Places can also be criminogenic (Sherman, Gartin, & Buerger, 1989; Weisburd, Groff, & Yang, 2012). Health is also a factor that many criminologists take into account when studying communities and how it connects to criminal incidents or victimization. Only recently have criminologists focused on place-based approaches for studying the direct connection between crime and health. In other disciplines, such as public health, for over a decade, there has been a focus on how health and mental health relate to geography (Latkin & Curry, 2003; Mair, Roux, & Galea, 2008; World Health Organization [WHO], 2002). The general question examined in this review is whether health issues follow a similar pattern to crime and concentrates in micro-geographic places, and whether these health concentrations overlap with crime. If so, why? How can criminologists and criminal justice policies work hand-in-hand with public health research to intervene at places where health and crime concentrate?

Hot Spots

Within the last few decades, a place-based approach to crime solving has moved to the forefront of criminological theory and testing. This approach goes beyond the theoretical notion that crime clusters in specific geographic patterns, but these patterns can be micro-geographic places in nature such as household addresses, street segments, and small neighborhoods (Weisburd, Eck, Braga, & Cave, 2016). Although the modern roots of crime and place theory can be traced to the early 19th century (Weisburd, Bernasco, & Bruinsma, 2008), interest again emerged in the 1980s and has grown to be a key criminological perspective in recent years (Eck &Weisburd, 1995; White & Goldberg, 2018). In the seminal 1989 publication in Criminology, Sherman, Gartin, and Buerger coined the term criminology of place to capture the concept of studying crime at micro-geographical units. “Criminology of place” or “crime and place” studies (Eck &Weisburd, 1995) focus on small geographical areas, typically conceptualized as addresses or street segments (Weisburd et al., 2012).

Other criminological theorists support the notion of using place characteristics as references for studying behavior. Sampson (2013)—a pioneer of using the concept of collective efficacy to address community crime issues—argues that neighborhood contexts are invaluable metrics to measure the quantity and quality of human behavior. Criminology of place challenges scholars to study why crime occurs at places rather than what causes people to commit offenses. As the collaboration between police agencies and researchers has grown, advancements in evidence-based place policies and practices have made leaps and bounds over the last few decades. One of the most widely adopted techniques for studying crime locations is geospatial technology that allows law enforcement agencies to map various data points, such as calls for service. Gathering and mapping these data has allowed both practitioners and researchers to identify concentrations of crime in locations. Typically, most of these areas are micro-geographic places (Weisburd, 2015; Weisburd et al., 2012). The application of this knowledge to police practices is commonly known as hot spot policing (Sherman & Weisburd, 1995). Hot spots policing, however, is not limited to identifying concentrations of crime; it can be adopted into a variety of strategies in police agencies (for meta-analysis of hot spot policing interventions, see Braga, Papachristos, & Hureau, 2012).

There is a growing body of research that supports hot spots policing as an evidence-based policing practice by departments to target their preventive efforts at micro-geographic places (Braga et al., 2012; Sherman & Weisburd, 1995; Skogan & Frydl, 2004; Weisburd & Eck, 2004; Weisburd & Majmundar, 2018; Weisburd & Telep, 2014). The growing use of evidence-based data to inform policing policy is notably similar to how public health research on violence informs policy (Krug, Mercy, Dahlberg, & Zwi, 2002). Despite the similarities of methodologies across these two disciplines, there has been little empirical focus on using place-based techniques to address issues such as mental health calls or other matters of public health.

It should be noted that public health research quantifies places differently than criminology. The conceptualization of places in public health research is quite varied. Studies can focus on one single neighborhood, communities, cities, or countries. The study of crime and place trends, however, is much more focused, similar to the translation to hot spots policing. Place in criminological discourse describes these micro-geographic places, such as street segments or small clusters of streets. Understanding these differences in conceptualization is critical when merging the disciplines of public health and criminology to study place and health. The processes at the crux of these interactions are quite different at a street level compared with a city level.

Physical Health

Since the 1990s, there has been empirical interest how place affects people’s health (Macintyre, Ellaway, & Cummins, 2002). Based on a nationwide study, Haan, Kaplan, and Camacho (1987) found that compared with their wealthier counterparts, residents in poverty areas had higher mortality rates even after multivariate adjustments were made. The authors concluded that factors of sociophysical environment may significantly contribute to the correlation between low socioeconomic status (SES) and high mortality (Haan et al., 1987). Diez-Roux et al. (1997) found that neighborhood characteristics were related to coronary heart disease. These early studies were instrumental in shifting the empirical focus onto how the characteristics of geographically larger places, such as poverty (Phelan, Link, & Tehranifar, 2010), can affect health. However, as many scholars have learned over the centuries, linking cause and effect is rarely so simple and direct.

Following the 1980s and 1990s, researchers began looking at how health, place, and poverty interact with not only one another, but also with other macro-social factors. Some scholars used place as the contextual map for where characteristics like poverty and other relevant factors interact. Morello-Frosch and Lopez (2006), for example, studied the relationship between outdoor air pollution exposure, segregation, and environmental health outcomes. Their results indicated that racial segregation was associated with larger city wide levels of sulfur dioxide and ozone. Segregation by Blacks–Whites was concluded to be associated with a variety of health risks such as higher levels of hazardous air pollutants, cancer risks, and noncancer risks. This study is one example of how intersecting variables like poverty and racial disparity can concentrate in certain neighborhoods to create significant health consequences at the public level. The noncancer risks for children, in particular, could affect their development or could affect the health of their parents or caregivers. Researchers have found that lack of community social support, ability to access preventive health care services (Wright, Cohen, Carey, Weiss, & Gold, 2002; Wright, Rodriguez, & Cohen, 1998), and exposure to community violence (Wright et al., 2004) can lead to higher levels of caregiver stress.

Place and racial segregation can affect health in various ways. Individual health can be affected by food security (availability of nutritionally valuable food such as fresh fruits and vegetables), which can be low in disadvantaged neighborhoods, as well as access to health-promoting services such as health care and open spaces like parks (Center for Third World Organizing, 2002; Diez-Roux et al., 1997; Morland, Wing, Roux, & Poole, 2002). The characteristics of a place can also affect health, such as the social environment (social capital, cohesion, and crime rates; Conley, 2010; Kawachi & Berkman, 2003; Keister, 2000; Sampson, 1987) and the physical characteristics of the place (traffic density, abandoned properties, housing quality; Reynolds et al., 2002; Shenassa, Stubbendick, & Brown, 2004; R. Wallace, 1990). Although not always direct, factors that can be health promoting or damaging—such as access to nutritionally valuable food or areas for physical activity—can be salient in what accounts for disadvantages and how they interact with place and health.

This is particularly true for disadvantaged neighborhoods that may not have the resources to address these issues. Households in these neighborhoods have a more difficult time accessing medical and health care, the ability to recover away from work, and the ability to physically leave the community where the health and other risks, like crime, occur (Morgan & Kena, 2017). Therefore, the limited financial means connected to these particular places not only affect residents’ mobility options, but also increase their possibility suffering from the same conditions repeatedly and long-term exposure. This is but one way the interaction between disadvantages, place, and health can perpetuate difficulties for residents.

Health and poverty, based on these empirical results, can be connected. However, how does crime and place interact with both of those factors? The Bureau of Justice Statistics found that in 2014, persons in households below the federal poverty level had more than double the rate of violet victimizations than those in high-income households (Harrell, Langton, Berzofsky, Couzens, & Smiley-McDonald, 2014). Higher rates of violent victimization are also connected to households annually making less than 25,000 dollars (Morgan & Kena, 2017; Tseloni & Pease, 2004). Poverty, however, is a contextual factor within itself as it can be affected by other individual- and macro-level factors. Researchers must also address racial disparities as in relation to crime and poverty of place (Morgan & Kena, 2017; Sharkey, 2008; Truman & Morgan, 2016). Williams and Collins (2001) argue that racial residence segregation is the leading cause of health disparity for African Americans. Racial residence segregation can negatively impact SES; SES impacts health such as chronic issues affecting activity. African Americans are also more likely to report being in fair or poor health than Caucasians (Williams & Collins, 2001). Taking into account all of these individual and neighborhood factors, concentrations of health hazards and poverty can be shown to overlap with increased crime risks.

Do neighborhoods or communities, as a contextual place factor, have a reliable effect on health across the discipline? In a meta-analysis of the literature, Pickett and Pearl (2001) found that neighborhood had a modest effect on health. In addition, this effect was stable despite variations in methodology design, measures, and probable error. Another study found that neighborhood problems were not related to typical risky behavior (e.g., drinking, smoking) or even physical activity (Steptoe & Feldman, 2001). Rather, they are associated with self-rated poor health, psychological distress, and individual deprivation. Neighborhood problems can contribute to long-term stress that can lead to poor health.

However many of the studies in Picket and Pearl’s (2001) model did not include factors that represent the social structure of a neighborhood like social support, despite their conclusions that public health interventions need to take into account community structure. Neighborhood disorder—physical characteristics of a neighborhood that indicate a threatening or toxic environment (Sampson & Raudenbush, 1999)—has been suggested to have some mediating effect on the relationships between fear of crime and self-rated health (D. Wallace, 2012); however, the strength of those mediating effects vary. Collective efficacy has also been found to be a protective factor of physical health (Browning & Cagney, 2002). Other studies have supported this notion of neighborhood crime and social aspects as affecting residents’ health. A. Curry, Latkin, and Davey-Rothwell (2008) found two indirect pathways between neighborhood crime levels and depressive symptoms: residents’ perceptions of the level of disorder in their neighborhood and experiences of violence in their neighborhood increased depressive symptoms (A. Curry et al., 2008). In essence, the research—directly or indirectly—supports the theory that place affects health (Macintyre et al., 2002; Yen & Syme, 1999).

Law Enforcement and Physical Health

On a superficial level, law enforcement and other criminal justice system (CJS) actors mediating risky health factors and environments may seem nonstandard (Burris et al., 2010). However, police, in particular, frequently encounter citizens who struggle with health issues such as addiction, homelessness, and mental health concerns along with the ecological contexts of those risky positions (Wood, Taylor, Groff, & Ratcliffe, 2015). Another connection between law enforcement and health is that there have been some empirical findings that suggest negative health outcomes occur in places where police intervene. For instance, police interventions on sex work results in sex workers being displaced to riskier environments (Blankenship & Koester, 2002). Other studies have noted that police interventions are related to discouragement of harm reduction practices (Beletsky, Macalino, & Burris, 2005; Burris et al., 2004; Cooper, Moore, Gruskin, & Krieger, 2005; Davis, Burris, Kraut-Becher, Lynch, & Metzger, 2005).

Although the need for law enforcement and health collaboration is clear based on these studies (Abad Gomez, 1962), it is not so easy to shift the notion that law enforcement and CJS agencies can operate with public health–oriented goals. For instance, a drug crackdown tactic used by police leads to increased searches of users’ bodies. Users, to combat that traditional police response, change their behavior and stop carrying sterile injection kits to avoid being caught with paraphernalia, increasing their health risks for HIV and other intravenous illnesses (Cooper et al., 2005). Law enforcement approaches and interventions, therefore, have to shift from an apprehensive, punitive viewpoint to proactive and health risk reduction. Current research on departmental organization and culture indicate that officer attitudes and knowledge make it difficult for police to view social problems from a public health standpoint rather than a criminal justice one (Beletsky et al., 2005; Small, 2005). Due to the intertwined relationship between place, crime, and health (Fitzpatrick & LaGory, 2013), it is becoming more and more imperative for law enforcement to begin using place-based strategies to address concentrated crime and health issues.

Hot Spots and Health

By nature of patrol—either by foot or by vehicle—law enforcement’s exposure to crime and health issues are “particularized” (Bittner, 1967) in that patrol areas are assigned in small units (Wood, Sorg, Groff, Ratcliffe, & Taylor, 2014). Arguably, aligning police culture to a health standpoint can encourage officers to affect behaviors and places within hot spots to further public health goals (Wood et al., 2015). For example, Groff and Lockwood (2014) found that street proximity to bars in Philadelphia was related to increases in violent, property, and disorder crimes. A possible intervention for these places could be increased police presence around bars. The increased police presence could affect the behavior of patrons (e.g., reducing aggressive behavior) and places (e.g., bars change protocols to decrease police attention). Using hot spots as a strategy to identify areas of crime and health concentrations would give police departments and city public health officials the ability to focus interventions in the micro-geographic places that are in most need of intervention and services (Weisburd, Groff, & Yang, 2014).

Given the focus of law enforcement among police officers, it is not clear whether individual officers are aware of the health needs of residents in places they patrol, nor of their ability to affect health factors in places and with people in these places. In their study of foot patrols, Wood et al. (2015) used both routine activities (Felson, 1986) and broken windows (Wilson & Kelling, 1982) theory to explain how officers on foot patrols function as capable guardians. Officers’ presence affords them the ability to alter the social and physical factors of their beats. Using data from a larger randomized control trial study that looked at the effectiveness of targeted hot spots patrols on urban violence, Wood et al. (2015) interviewed new police graduates in sixty of Philadelphia’s violent hot spots. The officers’ foot patrols averaged 1.3 mile²—about 15 intersections—and the officers spent considerable time in their areas for the reliability of the study dosages. Only two of the conclusions from the study were related to health.

The first health conclusion was drug use. Wood et al. (2015) found that officers focused on deterring users and dealers to affect drug use and sales. The results indicated that officers were given discretion to address these concerns. For example, one officer stated they and their partner were very aggressive while others gave out warnings before making arrests. Similar to the results from the drug crackdown study (Cooper et al., 2005), the Philadelphia patrol officers addressed a public health concern (drug use) by using traditionally punitive and apprehension-based tactics. Consequently, deterrent responses by police may alter the users and dealers behavior in a way that avoids apprehension, but increases health risks (Cooper et al., 2005).

The second conclusion and concern was risky behaviors, such as prostitution and public drinking. For these types of health risks, a particular technique officers used was spatial sorting, where officers shift people from one place to another to decrease social disorder and minimize negative behavior in places (Kempa, Carrier, Wood, & Shearing, 1999). One officer’s use of spatial sorting was an unofficial arrangement with a sex worker where he would only arrest her if he witnessed her engaging in that illegal behavior, despite knowing that was her main source of income.

Overall, Wood et al. (2015) found that the officers were more focused on order maintenance aspects of these health issues rather than from a public health perspective (see also Beletsky et al., 2005; Small, 2005). This organizational culture promoted contradictory health-based goals such as “generating numbers” and the ineffectiveness of incarceration as deterrence for repeat offenders. In addition, the officers had difficulty viewing addicts as vulnerable people: “in public health terms, the public protection mandate of the police would override the principles of overall harm reduction” (Wood et al., 2015, p. 215). As Weisburd et al. (2014) note, addressing health concerns via hot spots strategies may require the participation of community leaders as well, rather than strictly the domain of police. Mobilized local community leaders could also address local department culture, urging middle management to focus more on proactive and interagency strategies rather than order maintenance. However, the role of police in micro-geographic places of crime and health cannot be understated.

In terms of influencing the physical environment, the participating officers were cognizant of the broader ecological factors of their foot patrol areas (e.g., abandoned buildings, convenience stores, liquor store outlets). Officers noted that these factors were not only criminogenic, but also where health risks concentrate, such as unsanitary conditions, or attract people who collectively increase health risks (e.g., multiple intoxicated people at bars). Certain institutions, such as bars, increase both health risks and crime incidents (Groff & Lockwood, 2014). However, changing these factors is difficult as there is a limit to how police can directly manage the problem factors within their patrols.

A more recent study (Weisburd & White, 2019) compared hot spots and non-hot spots in Baltimore, Maryland, by studying social characteristics of those street segments. Utilizing a self-reported health survey and identified hot spots, the study focused on the effect of hot spots on the health of the residents. In addition, the data collected addressed a continuum of health issues such as diagnoses, impact on daily activities, impact on social/work activities, and mental health. In this manner, it is possible to analyze the effect of hot spots on acute and prolonged health impacts. Overall, the results found that residents in hot spots were more likely to report being diagnosed with chronic illnesses such as asthma. In addition, the authors (Weisburd & White, 2019) reported that residents in hot spots indicated lower quality of life and poorer overall health compared with residents in non-hot spots. In terms of mental health, the most adverse micro-geographic place effect was reported in violent and drug hot spots.

Mental Health

Since the political process of deinstitutionalization, there has been a dramatic increase of police contacts with citizens diagnosed with behavioral health issue (BHI). With available community mental health resources decreasing drastically, law enforcement has become the first line of contact when citizens experience a mental health crisis (Teplin & Pruett, 1992). Rather than fulfilling a role focused on crime prevention and offender apprehension, officers are also found in a mental health role when crisis or behavioral health complaints calls are received (Lamb, Weinberger, & DeCuir, 2002). One estimate is that 12% of people with a BHI had police involved in their pathway to mental health services (Livingston, 2016). It is difficult to approximate the exact rate of police-BHI involved contacts as notations of BHI are not connected to individuals consistently or during multiple police/CJS contacts. One of the most accepted estimates is that 7% to 10% of all police contacts involve a person with a BHI (Hails & Borum, 2003). In comparison with neurotypical persons, people with a developmental disability are 7 times more likely to attract police attention (K. Curry, Posluszny, & Kraska, 1993). A more recent analysis on mental health and police contacts found the average arrest rate of people with a BHI was 25% (Livingston, 2016). Although there are only approximations, it is empirically agreed upon that a significant portion of police contacts involve a mental or BHI.

Place and BHI

One of the first studies to look at geographical distributions and mental health was in the 1880s (Holley, 1998), focusing on suicide rates between countries. The conclusions found that mental health issues differed by population (Durkheim, 2005). Although suicide rates are not the ideal measure for population mental health, it is important to note that the earliest studies identified place as an important concept in mental health research. One of the largest particular influences place has on BHI, much like physical health, is disadvantaged areas. Residing in a disadvantaged area not only has direct effect on mental health outcomes (A. Curry et al., 2008), but residents with an existing BHI in these places may have disproportionately higher contact with police and the CJS because of crime activities in these areas (Butler, 2014; Watson et al., 2008), as well as experience stigma associated with their mental health status (Crocker et al., 2015).

The effect of place on mental health has other similar trends to physical health. Parents residing in areas with high poverty rates reported significantly greater levels of stress compared with parents of areas with low poverty rates. Living in a disadvantaged or impoverished community can cause chronic stress and poor coping skills in children, which can decrease cognitive development (Leventhal & Brooks-Gunn, 2003; Rowlingson, 2011). The effect of place not only exacerbates existing mental health issues (Butler, 2014; Crocker et al., 2015; Leventhal & Brooks-Gunn, 2003; Watson et al., 2008), but also can affect the maturation of adolescents’ brains and skills (Rowlingson, 2011). This is important to note because mental health concerns not only expand beyond a diagnostic condition such as clinical depression, but also include distress that can affect coping skills and development. For example, both the immediate and surrounding neighborhoods can have an effect on general mental health rather than just a specific diagnostic concern (Graif, Arcaya, & Roux, 2016). In a British study, Pearce et al. (2018) found that living in a neighborhood with the highest levels of social disadvantage as a child was detrimental to mental health outcomes later in life, as far as 70 years of age. Therefore, law enforcement and public health actors, when addressing issues with place-based strategies, must differentiate what exact mental health issue they are trying to address as diagnosed individuals may differ in population than those with chronic stress.

Crime and BHI

Many studies found that witnessing community violence or being the victim of a violent crime is significantly connected to symptoms of depression and anxiety and, for juveniles in particular, developmental issues (Berman, Kurtines, Silverman, & Serafini, 1996; Buckner, Beardslee, & Bassuk, 2004; Fitzpatrick, Piko, Wright, & LaGory, 2005; Gorman-Smith & Tolan, 1998; Singer, Anglin, Yu Song, & Lunghofer, 1995). A Dutch study of victims of violent crime found that 45.9% displayed probable posttraumatic stress disorder (PTSD) symptoms and had higher rates of revictimization than the comparison group (Kunst & Winkel, 2013). Repeated victimization or exposure to violence in childhood and adolescence has a negative effect on developmental and emotional maturation (Singer et al., 1995). Some scholars have argued that exposure to and witnessing violence, not necessarily being directly victimized, also has a negative mental health effect on youth (Gibson, Morris, & Beaver, 2009; Pfefferbaum et al., 1999). In addition, the majority of crime victims do not report and, as a result, may not use health services to address subsequent BHI issues (McCart, Smith, & Sawyer, 2010). Victims of violent crime who do not seek treatment for trauma can have far-reaching consequences for mental health in the short and long term. Aside from depression, anxiety and PTSD symptoms victimization can affect role functioning such as the ability to perform well at work and lower life satisfaction (Hanson, Sawyer, Begle, & Hubel, 2010).

Hot Spots and BHI

The use of hot spots to address BHI is only starting to gain traction in the field of crime and place, so there are few studies of the concept. The few existing studies have suggested there is empirical evidence supporting the use of place-based strategies to identify areas of need for BHIs. Vaughan, Hewitt, Andresen, and Brantingham (2016) found that “emotionally disturbed” citizens and related calls had high levels of spatial clustering at the street segment level. In addition, micro-geographic places with a high frequency of BHI calls were not the same micro-geographic places with a high frequency of non-BHI calls. Taking the place-based strategy further, Weisburd et al. (2018) studied violent crime hot spots to see whether the residents had higher levels of PTSD and depressive symptoms. The study conducted face-to-face surveys of 2,724 residents of Baltimore by randomly sampling residents within sampled street segments. The methodology of the survey was created in a way that when administered, it allowed the researchers to make inferences about how residents of the hot spots were affected on a number of social health outcomes, one of which is BHI. There were three sets of spots—cold, cool, and violent hot spots within the city to compare BHI outcomes of residents in violent hot spots to residents of streets with minimal crime.

The results indicated that living in areas with high levels of violence can lead to greater mental health strain for residents (Weisburd et al., 2018). The mean depression symptomology was 61% higher for residents in hot spots compared with residents in cold spots. For PTSD, the symptomology was about 85% higher for residents of micro-geographic places with high levels of crime compared with micro-geographic places with little crime. Another study used place-based analyses to not only identify high crime areas, but also analyze mental health crisis calls to the police to see whether these particular types of calls concentrate in a similar pattern in micro-geographic places like violent crime does (White & Goldberg, 2018). Using data from Baltimore City police, the study focused on calls for service that were violent, drug, or mental health related. Of all service calls received for that year, 1.62% of them were mental health crisis calls. The results indicated that the mental health calls clustered on 14.4% of street segments. About half of the calls concentrated at 3% of street segments. The streets were also fairly dispersed throughout the city rather than clustered in certain areas of the city, such as the central downtown area.

Given the concentration of BHI calls at street segments dispersed citywide, found in White and Goldberg (2018), and the levels of depression and PTSD in violent crime hot spots street segments dispersed citywide (Weisburd et al., 2018), there is growing empirical support suggesting place-based strategies for identifying micro-geographic places most in need of mental health services as an evidence-based option for police departments. However, by nature of BHI calls, there is not always an element of criminality as there are in violent or drug service calls. Calls for service related to BHIs may be related to social disorder issues or welfare issues. Many individuals with a BHI spend much of their time in public spaces (Watson et al., 2008), which, by nature of some hot spots strategies, means these individuals may have more frequent contact with police. The public visibility is a particular issue that hot spot interventions should be cognizant of, in that when police are physically patrolling an area they are likely to come into contact with individuals with a BHI. Furthermore, due to this visibility, patrol officers also have a greater potential and ability to address these issues directly with those in need.

Conclusion

Future studies have quite a few areas to address in this growing subset of crime and place research and health. Perhaps one of the largest topics needing more empirical focus is the causality direction of place and health. Does place cause the health issues and crime or is it selection? Weisburd et al. (2018) found that residents in violent hot spots, with social characteristics were controlled for, had PTSD symptoms more aggravated than residents in the cool or cold spots. From these results, the authors (Weisburd et al., 2018) noted that perhaps there is some characteristic about these micro-geographic places rather than the characteristics of the residents that are connected to mental health issues. Are people with physical and/or mental health conditions already disadvantaged and therefore limited in their choices of residences or are their health conditions a result of the disadvantaged areas they reside in? These disadvantages can affect mobility in terms of residents leaving a stressful environment, caused either by clustering disadvantage or by violent crime. Consequently, these stressors can also exacerbate physical health symptomology.

Another implication for future research is how crime and place scholars define “healthy” places. Creating concepts for “healthy” places is critical for operationalization of measurements aside from hot spots and cold spots, but can include other factors of physical space that may affect health such as access to fitness centers, medical specialists, or air quality. In their paper on the current state of the research, Macintyre et al. (2002) argue that researchers do not sufficiently conceptualize measurements of “place effects.” Specifically, they state that researchers need detailed frameworks to effectively test hypotheses that include “place effects.” One way to shed light on the “black box” (Macintyre et al., 2002) of place-based research is defining what makes a specific neighborhood “healthy,” better operationalizing these concepts. These features can either promote health or discourage/damage it in residents.

Future interventions that use crime and place theory to address health issues should also determine whether place-based interventions will be more successful if applied to an entire geographical area (i.e., city) or smaller, micro-geographic places (i.e., traditional hot spots; White & Goldberg, 2018). New York City Mayor De Blasio, for example, has ordered a city wide “blitz” of guaranteed health care to individuals considered illegible, providing health and mental health services to an estimated 600,000 people (Katersky, 2019). However, not all cities or regions can combat health issues at that macro level. Weisburd et al. (2014) argue that concentrating on micro-geographic places is more efficient and practical for localities. Crime and place strategies could also assist law enforcement minimize the possibilities of a mental health crisis occurring, therefore lessening the total amount of calls officers, specialized law enforcement units, or co-responder teams need to respond to (White & Goldberg, 2018; White & Weisburd, 2017). Place-based strategies could also identify areas of concentrated health risks—such as drug use, prostitution, and other risky behaviors that can lead to physical conditions.

To take a step beyond traditional place-based policing, an important policy implication for this novel solution to public health issues is the active cooperation between law enforcement and other non-CJS agencies. In addition, training-based interventions need to address the gap between police and other health actors connected to cities, particularly those that are focused on “place management” (Eck, 1994). Law enforcement cannot be the only actors, as the laws are designed, that can influence the environmental factors of places such as business practices, abandoned homes, or liquor laws that attract both crime and unhealthy behaviors (Wood et al., 2015). Another aspect policies, not necessarily just place-based interventions, need to be cognizant of are racial disparities in CJS and social factors such as poverty and health-related issues (Williams & Collins, 2001). Place, segregation, and health all interact with one another. Any CJS policy needs to integrate safeguards that do not widen the disparity of these issues. There are also economic implications for policy interventions. Victimization has a significant effect on health. In 2001, US$4 billion was spent on medical treatments for violent injuries (Hanson et al., 2010). In addition, there is a loss of productivity due to victimization from physical and mental health consequences. Using studies of interpersonal violence victims, males and minorities were less likely to seek treatment (Hanson et al., 2010). Other studies have validated that finding; many victims do not report their victimization or use treatment services (McCart et al., 2010), meaning that physical and mental health consequences of victimization can become more salient and affect all aspects of a person’s life. This could be general health, loss of work productivity, and untreated diagnoses. As victimizations go unreported, policies using place-based strategies must acknowledge that currently, the CJS underestimates the true harm when determining the scope of interventions.

In the study of crime, place has become an important contextual factor for furthering the understanding of both why crime occurs and how to address it (Cummins et al., 2007). In other disciplines, geographical concepts of places have also become vital for understanding issues of health care—both physical and psychological (Latkin & Curry, 2003; Mair et al., 2008). In criminology and criminal justice, hot spots policing, a place-based strategy that identifies micro-geographic places with high concentrations of crime incidents, has gained great empirical traction as an evidence-based practice (Braga et al., 2012; Sherman & Weisburd, 1995; Skogan & Frydl, 2004; Weisburd & Eck, 2004; Weisburd & Majmundar, 2018). There is potential for collaboration between disciplinary bodies of research, as well as among practitioners and policy makers to understand the complexity of health, crime, and place and develop informed approaches to address health issues in communities. Although many studies have looked at how geography and health interact, the strategy of using hot spots policing to address health needs is a relatively new concept for both criminology and public health research. An interdisciplinary approach with both criminology and public health research is needed to create intervention programs using crime and place strategies to address health issues in places.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Rachel H. Jensen is a doctoral student at George Mason University. She completed her master’s degree in Criminology, Law and Society at George Mason and her bachelors in Applied Psychology from Penn State University. Her research interests are policing and mental health as well as the intersection of psychology and law.

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