Private Policing and Public Health: A Neglected Relationship

Introduction

Issues of public health are inseparable from the functions of policing. It is hard to conceive of a healthy population that is not an orderly society and free from victimization, harm, and trauma. “Insecure places are rarely healthy places” (Anderson & Burris, 2017, p. 300). Sadly, we are not short of examples that illustrate the health dimensions of crime and insecurity. Exposure to violence increases risks for mental health disturbance and risks for violent behavior among exposed people (Slovak & Singer, 2001). Sustained exposure to violence can even result in neurological changes (Leshem & Weisburd, 2019). Violence is now well recognized as an area of “common ground” between policing and public health (van Dijk et al., 2019). A framing of the violence problem that powerfully bridges the policing and public health sectors is the conception advanced by Dr. Gary Slutkin (2013) that violence contains all the core elements of a contagious disease; it clusters in space, it spreads, and it transmits from person to person. From this perspective, effective policing is epidemiologically informed.

Mental health is likewise an obvious area of intersection between policing and public health (van Dijk et al., 2019). It is known from early sociological studies that the public police routinely encounter individuals affected by mental illnesses and other medical and social complexities, often in socially disadvantaged areas (Bittner, 1967). Local jails in the United States house more people with serious mental illnesses than psychiatric hospitals (Frank & McGuire, 2011). Recent estimates in America suggest that 6% to 10% of public police encounters involve people affected by serious mental illnesses (Livingston, 2016), and figures elsewhere are at least double (Parker et al., 2018). Such estimates are conservative because many encounters occur in “gray zone” situations (Wood et al., 2017), whereby people are not engaged in serious criminal behavior, nor do they manifest a threat to themselves or others (the basic criteria for transporting a person to an emergency department or designated psychiatric facility; Wood et al., 2017). Although seen in some cases as threats to social order and public safety, the behaviors driving such encounters are usually not violent or felonious in nature (Draine et al., 2002).

A recent study in New Zealand found a significant increase in mental health–related calls for service to the public police between the years 2009 and 2016 (Li et al., 2018). As part of this trend, suicide-related calls (attempts/threats to commit) increased similarly (Li et al., 2018). This study observed an increase in calls for service ultimately deemed by police to be of low priority, including calls that did not merit police attendance (Li et al., 2018). These findings are consistent with epidemiological research challenging the lay view that people affected by serious mental illness are disproportionately responsible for serious or violent crimes (Swanson et al., 2015). Indeed, mental illness is more likely to be linked to victimization and suicide (Baumann & Teasdale, 2018; Cook & Goss, 2014). Other studies within and beyond the United States reveal that mental health, public safety, and social order are connected, but in complex ways that speak to issues of social vulnerability and structural disadvantage (see Albers et al., 2018; Metzl & Macleish, 2015).

The problem of drug addiction and drug overdose also sits at the nexus between policing and public health (Crofts et al., 2012). The opioid epidemic has afflicted countries around the world. According to the U.S. Department of Health and Human Services (2019), more than 130 people die each day in America from an opioid-related overdose. In 2016, approximately 40% of opioid deaths were due to prescription opioids and 81,000 people initiated heroin use. In 2017, about 68% of all 70,200 drug overdoses were related to an opioid (Centers for Disease Control and Prevention, 2019). The opioid epidemic has unfolded in three major waves, with the first wave beginning in the 1990s when pharmaceutical companies misled the medical community about the addictive potential of the pain relievers (Centers for Disease Control and Prevention, 2019; U.S. Department of Health and Human Services, 2019). This led to an increase in prescribing practices and ultimately an increase in deaths from prescription opioids. The second wave, initiating around 2010, was a rise in heroin-related deaths. A few years later, fentanyl and other deadly illicit opioids began to infuse the products of street markets, leading to a steep uptick in overdose deaths (Centers for Disease Control and Prevention, 2019). This public health crisis has many obvious implications for public safety and social order—lives are lost or nearly lost due to drug overdoses.

These and other issues (e.g., human trafficking) that cut across the domains of policing and public health raise a complex question about how to reshape policing into the future. Arguably, public health researchers have focused on this question more than criminologists and policing scholars because policing practices are known to be “iatrogenic”—that is, increasing the health risks of structurally vulnerable populations (Anderson & Burris, 2017; Bohnert et al., 2011). For instance, studies have illuminated the ways in which public police officers adversely shape the health risk environments of sex workers through activities that are stigmatizing, coercive, exclusionary, and generally unprotective of their health (Kingston & Thomas, 2017; Klambauer, 2018; Platt et al., 2018). A similar consequence has manifested during targeted public police crackdowns of urban drug markets. In efforts to avoid the gaze of officers, injection drug users resort to a variety of avoidance tactics, such as rushing the needle sanitization process, or choosing not to secure clean needles from needle exchange facilities (Cooper et al., 2005; Maher & Dixon, 1999).

Policing scholars increasingly recognize the need to bridge disciplines and advance theoretical frameworks, methods, and practices that align public health concerns with practices for promoting order and security (see Zedner’s [2003] conception of security). The journal Policing and Society recently released a special issue on law enforcement and public health (Anderson & Burris, 2017; Bartkowiak-Théron & Asquith, 2017; Punch & James, 2017; van Dijk & Crofts, 2017; Wood & Watson, 2017). A recent issue of the Lancet examined the nexus between public health and security at both national and global levels (Michaud et al., 2019; Thomson et al., 2019; van Dijk et al., 2019). There is now a Global Law Enforcement and Public Health Association devoted to advancing research and practice at this nexus. These efforts are centrally concerned with transforming the mentalities and practices of public police agents and building new institutional arrangements across sectors that one might describe as “referral bridges” between police and community health services. Referral bridges help address the health-compromising effects of “governing through crime” (Simon, 2007) by channeling people with health risks and vulnerabilities toward institutions intentionally built to address health (e.g., treatment programs).

In what follows, I highlight such developments, commonly referred to as “pre-arrest diversion.” Following this, I highlight conceptual pillars from scholarship on private policing to make the case for examining questions of public health beyond the work of the public police. I attempt to make the case for moving toward a “full-spectrum view” of policing and its various public and private dimensions—institutions, mentalities, and geography—if we are to fully understand and evaluate policing’s relationship to public health.

A Police-Centered Focus on the Advancement of Public Health

In efforts to confront major public health threats, state and local government auspices have initiated a wave of change that blends the treatment and recovery mentalities of health professionals with the security and public safety concerns of police professionals. In this wave, we see various configurations of police and other entities enlisting people affected by addictions or mental illnesses into treatment and recovery. Such efforts emerged in part due to the gravity of public health threats including serious mental illnesses and more recently the opioid crisis (Greer, 2019), as well as a growing awareness that the mechanisms of criminal law and law enforcement do little to positively shape the behaviors of vulnerable populations and respond to their long-term needs (Bartkowiak-Théron & Asquith, 2017).

This wave is part of a larger criminal justice system agenda to minimize a “governing through crime” approach (Simon, 2007) and mechanisms (i.e., arrest, detention, incarceration) with people affected by behavioral health issues. A recent grant solicitation by the National Institute of Justice identified one of its priority areas as “police deflection strategies,” encompassing “alternatives to traditional responses to individuals who commit low-level criminal offenses” (National Institute of Justice, 2019, p. 6). These include programs that “steer certain offenders away from different stages in the criminal justice system by addressing their substance abuse or mental health challenges with resources such as community-based or in-patient treatment interventions” (National Institute of Justice, 2019, p. 6). The availability of federal and other sources of funding has allowed police agencies to experiment with initiatives that foster new institutional arrangements in ways that align public security interests with public health interests.

Recognizing the iatrogenic effects of officer interventions with people experiencing mental health crises, policing models blending treatment and security mentalities began to emerge in earnest in the late 1980s, when the crisis intervention team (CIT) model was developed in Memphis Tennessee. In essence, the CIT model involves a training component (generally 40 hours covering topics such as mental illness symptomology and de-escalation) as well as cross-sector institutional arrangements that provide for the smooth transfer by police of people in crisis to designed psychiatric facilities (Oliva & Compton, 2008). The evaluation research has found that CIT-trained officers are more inclined than non-CIT officers to transport people for treatment, thereby helping reverse the tide of criminalization when it comes to people with psychiatric conditions (Compton et al., 2006; Watson et al., 2008, 2010).

Some jurisdictions have experimented with co-response models whereby police officers and clinicians (e.g., psychiatric nurses) or social workers provide on-site responses to people in crisis. This hybrid approach blends security and health expertise on the front lines and provides for shared decision making on the part of the multidisciplinary response team in terms of how best to address the health needs of the individuals concerned while ensuring public safety (Morabito et al., 2018; Wood et al., 2011).

In efforts to align public health and security in the management of drug use behaviors, police agencies across the United States have worked to promote treatment and recovery through new hybrid institutional arrangements with the behavioral health sector. The Police, Treatment and Community Collaborative (PTACC) has developed a conceptual model and visual diagram on five core “pathways” that have been built so far to steer people away from criminal justice interventions toward health interventions (Charlier, 2015). Criminal law functions as a direct or indirect lever for behavior change in some pathways but not others. For instance, a public police officer may identify person who is not engaged in criminal behavior but who manifests a behavioral health or well-being issue “that places the person in a health risk or exposure risk to the justice system” (Charlier, 2019) and refer them to treatment. The Law Enforcement Assisted Diversion (LEAD) program (Baltimore Police Department, 2017) contains a “Social Contact Referral” pathway whereby police link people to treatment people “who are perceived as having a high risk of future arrest for minor drug activity or prostitution.”

In other police-led initiatives, officers use either criminal or civil law as levers for behavioral change. In such cases, there is a putative offense, generally minor in nature, and officers hold charges in abeyance under the condition that the individual completes treatment. The Civil Citation Network in the State of Florida contains Adult Pre-Arrest Diversion Programs and Juvenile Diversion Programs, both of which are designed to channel first-time misdemeanants—who must admit to committing their offenses—into treatment. In line with state statutes, each local jurisdiction provides a process for issuing citations, assessing clinical need and providing services (Civil Citation Network, 2019). This program therefore blends “carrot” and “stick” mechanisms to foster behavioral change.

In some jurisdictions, police work collaboratively with clinicians to engage people who survived an opioid overdose in efforts to reduce their risks for a future overdose. One example is the quick response teams (QRTs) operating in dozens in locations (Charlier, 2019). In Hamilton County, Indiana, newly established QRTs, which consist of a police officer, a firefighter, and certified peer recovery specialists that visit the home of overdose survivors, assess the needs of the person, try to link them to treatment, and provide information to their family members on various community resources and how to access them (Greer, 2019). In other locales, individuals suffering from addictions can actively reach out to police, without fear of criminal action or stigma, to get linked to treatment services (Charlier, 2019; Gang, 2017). The Angel Program was launched by the Gloucester Police Department, Massachusetts that “reframed addiction as a disease, not a crime” (The Police Assisted Addiction and Recovery Initiative [PAARI], 2019).

Taken together, such efforts to transform the way public police agencies respond to people with health vulnerabilities can be viewed as a larger push to “reinvent government,” involving “efforts to recalibrate traditional state institutions and practices to improve their capacity . . .” (Burris et al., 2007, p. 156). This wave of reinventing government, however, is not linked (as it was some 20 years ago) to an ideological emphasis on small government, but rather to a wide recognition that current social problems at the nexus of public health and security require coordination among government and nongovernment institutions (see Burris et al., 2007). In the fullness of time, researchers can answer the question of whether this wave has generated a broad and sustained shift toward the alignment of public health concerns with concerns of social order, security, and crime reduction.

What are the implications for public health if one moves from a police-centered conception of policing to a broad conception recognizing a spectrum of policing entities, activities, and spaces? The next section draws from the theoretical advances of private policing scholars to explore this question.

Toward a Full-Spectrum View of Policing and Its Implications for Public Health

For Sparrow (2014), private policing is “broadly construed and means the provision of security or policing services other than by public servants in the normal course of their public duties” (p. 2). Other scholars offer a more complex definition. For instance, Johnston (1992) sees the policing field as one which “comprises a complex morass of agencies, many of which are ‘hybrid’ organizations whose formal status and operating territories cut across the public-private divide” (p. 114). Johnston’s insights emerged during a time where a small and growing body of scholars began to recognize and document the “quiet revolution” (Stenning & Shearing, 1980) in private and plural forms of policing (Jones & Newburn, 2006; Loader, 2000). Building on this work, Bayley and Shearing (2001) offered a framework for characterizing entities and territories comprising the policing field. Like Johnston, they wished for readers to adopt a fluid view of the field, recognizing, in Johnston’s (1992) words, that “the functions, practices, jurisdictions, and legal powers of the various bodies overlap in potentially complex ways” (p. 115).

In the same vein, Button (2019) contends that policing has different dimensions that are best viewed along a spectrum of “publicness” and “privateness,” a point that complements the scholarship of Jones and Newburn (1998) and Benn and Gaus (1983). One such dimension is the spatial context or the nature and scale (Valverde, 2011, 2014) of the space where policing is carried out, ranging on the public end to spaces fully accessible to members of the public to the more private end of the spectrum that includes quasi-public spaces like shopping centers, to exclusively private spaces limited to members. Other dimensions include the sources of funding for policing, ranging from public sponsorship through taxes to exclusive funding by a private entity(ies). The location of the policing function is another dimension (Button, 2019). The policing function may be publicly located in a government body, or if one moves toward the private end of the spectrum, its location could be a vigilante group or private company. Another dimension—the authority and tools of a policing entity—could range from the full legal authority granted to the office of the public police, to no special authority at all beyond that held by ordinary citizens (Button, 2019).

Beneficiaries of policing—another dimension put forward by Button—can similarly be located on a spectrum between public and private. Beneficiaries could range from everyone, as in the case (theoretically, at least) of public policing, to only those people or groups that fund policing (Button, 2019), akin to Crawford’s reference to a “club good” (Crawford, 2006). Complementing Button’s distinction between the location and beneficiaries of policing, Bayley and Shearing (2001) refer to the difference between “auspices” of policing and “providers” of policing. A police-centered view of policing assumes that the same institutions that identify the policing needs for a population (auspices) also perform the policing function (providers). However, a full-spectrum view of policing acknowledges that auspices of security include but are not limited to economic interests (e.g., businesses), residential communities (e.g., gated communities), and governments (e.g., via delegating, sponsoring, collaborating) and one can add community groupings like churches (as we see later). Providers of security include, but are not limited to, commercial security companies, neighborhoods, and governments (e.g., moonlighting) as well as nonstate entities including vigilante groups.

Bayley and Shearing also stress the importance of explaining and normatively assessing the underlying “mentalities” of policing. For instance, they suggest that the public police, as an institution of the criminal justice system, inherently possess a punishment or coercion-based mentality propelled by their authority as agents of the criminal law and their capacity to apply state-sanctioned force (Johnston & Shearing, 2003). This focus on mentalities of policing denotes the idea of an attitude, sensibility, and even a culture. The practices that give life to mentalities make use of formal, informal, and “symbolic” tools for shaping behaviors and fostering compliance with directives (Mopas & Stenning, 2001).

As discussed above, there are clear signs of health-oriented sensibilities penetrating the work of the public police in relation to issues of mental illness and drug addiction. From a full-spectrum view of policing, some recent literature has examined mentalities located in public and private forms of policing in a more granular way, revealing that mentalities are fluid and changeable within and across different policing entities (Abrahamsen & Williams, 2009; Berg, 2010; Braithwaite, 2003, 2014; Kyed, 2014; Marks et al., 2017). For instance, Berg (2010) has observed in the South African context the presence of punitive policing mentalities among private providers. Also in South Africa, Marks and colleagues (2017) observe the fluidity and even an internal tension in the thinking of public police officers as they negotiate and give effect to harm reduction principles (central to public health) in addressing drug-related issues.

A broad view of policing therefore recognizes different dimensions of the field—spatial context, auspices, providers and beneficiaries, authority, and tools. Moreover, such dimensions can be understood along a spectrum of “publicness” and “privateness” (Button, 2019). Based on this broader conception, this article considers a theoretical path forward for examining the implications of policing along the “private” end of the spectrum for public health. It draws from insights from the very limited, but provocative research in this area and makes the case for future lines of inquiry into the relationships between private policing and public health. One area of concern relates to the potential for policing by private entities in public, quasi-public, and private spaces to generate iatrogenic effects on public health. At the same time however, there is qualitative evidence from outside the United States that bottom-up forms of policing under private (noncommercial) auspices by private providers merit further attention for their potential to advance public health (Berg & Shearing, 2018; Ko Ko & Braithwaite, 2019).

Private Policing and Public Health: A Neglected Relationship in Need of Attention

As noted above, one dimension of policing is its spatial character or locus. The expansion of privately owned communal spaces used by members of the public has propelled the growth of private policing (Bennet et al., 2008; Markwick et al., 2015, p. 1118). Determining ratios of private agents to public agents is invariability hard to do with much accuracy (Sparrow, 2014), but it is clear that private policing entities surpass the latter in sheer numbers and to varying degrees across established democracies and countries in transition (Sparrow, 2014). Private providers operate under a range of commercial and noncommercial auspices (Strom et al., 2010), including business improvement districts (BIDs; Bisson et al., 2006) and even private cities (Tabarrok & Rajagopalan, 2015). Complicating our understanding of where private providers function is the fact that such providers intervene with people on public spaces, including sidewalks (Markwick et al., 2015).

Early scholarship on policing beyond the police pointed out that an instrumental mentality of risk reduction prevails in forms of policing under economic auspices. Issues of moral culpability and the writing of wrongs through punishment are secondary considerations in efforts to avoid harm and loss in the first place (Johnston & Shearing, 2003). One mechanism used by policing providers under corporate auspices is spatial sorting, including banishment, in and around the “communal” spaces owned by the auspices (Kempa et al., 2004). Communal space in this sense is space that is privately owned, but traversed by members of the public in the course of recreational activities (e.g., Disney World, shopping malls), housing (e.g., gated communities), or employment (e.g., corporate office) activities (Kempa et al., 2004; Shearing & Stenning, 1984).

Shearing and others have argued that spatial sorting is not benign in its effects and in fact may deepen disparities in the distribution of public goods (Bayley & Shearing, 1996; Shearing & Wood, 2000, 2003). In particular, there are concerns that people unable to participate in and comply with the behavioral norms and social orders of privately owned communal spaces may be more “intensively policed” (Bayley & Shearing, 2001, p. 36) through punitive measures in the public “conduit” spaces surrounding the privately owned areas (Shearing, 1999). Conversely, people who can participate in “bubbles” of security (Bottoms & Wiles, 1995; Rigakos & Greener, 2000) created by nongovernment auspices may benefit due to their membership in the bubbles, which may be secured through the mechanisms of employment, or private funding or other guarantees that they will comply with a given social order.

So far, the literature on variations of policing institutions, mentalities, and practices has been concerned with distributional inequities in the delivery of the public good of security, paying very little attention to the public good of health. From a health perspective though, research by Markwick et al. (2015) reminds us that people living on the margins of society, experiencing “intersecting socio-structural inequities” (p. 1118), are generally more likely to encounter policing entities more often and be affected by the ways in which policing is carried out. In a rare study of its kind, they examine some public health consequences of private policing practices in Vancouver, Canada. Based on interviews with people who use drugs, the researchers learned about the ways in which different private policing practices served to exacerbate respondents’ vulnerabilities and health risks. Participants reported forms of “discriminatory surveillance,” where they felt profiled, watched, and sometimes followed as they traversed different kinds of spaces and places including malls, pharmacies, hospitals, government offices, and transit systems. Participants reported that their unkempt appearance led to this profiling and were at times asked to leave these spaces. In addition to experiencing spatial sorting practices, participants reported experiencing forms of “everyday violence,” including verbal abuse as well as physical violence (often due to suspected shoplifting) such as kicking. Moreover, some female respondents reported sexual harassment, such as being exploited for sexual favors (Markwick et al., 2015).

This study revealed that the spatial sorting practices of private police, combined with tactics of surveillance and everyday violence, functioned as tangible barriers to health care access (Markwick et al., 2015). The authors report that, according to respondents,

security guard activities had adversely impacted their access to health services by preventing entry to or removing them from health care spaces, including public hospitals and clinics. Many participants described how they were prejudicially removed from these settings due to their real or perceived non-compliance with behavioral codes of conduct, resulting in the denial of care . . . (Markwick et al., 2015, p. 1123)

Moreover, access to routine amenities, such as pharmacies, felt similarly constrained, thereby undermining “ongoing disease management and drug treatment (e.g. methadone maintenance therapy, HIV medication)” (Markwick et al., 2015, p. 1124).

These qualitative findings are limited to one jurisdiction and beg for further inquiries into the effects of spatial sorting practices on the distribution of public health goods. They point to the fluidity of policing mentalities (Berg, 2010) and reveal that coercive, punishment-oriented logics are not unique to the public police. These findings resonate with Berg’s South African finding that private security “increasingly also engages in law enforcement duties in public spaces, while in some respects becoming increasingly involved in physical coercion, demonstrating greater symbolic and real powers (since much of what private security does remains largely unchallenged)” (Berg, 2010, p. 289).

One of the developments along the private spectrum that Berg (2010) examined was BIDs and she found that private policing “simultaneously retains ‘traditional’ private security mentalities of loss prevention as well as ‘traditional’ state policing mentalities of crime control and coercion” (p. 287). BIDs working under economic auspices ban together private actors—with government support—to collect taxes that support local governance activities from trash collection to physical improvements (Greene et al., 1995). Here BIDs function to control both crime and “grime” (Berg, 2010), working to eliminate physical or social disorder. As part of this, private security agents have come to “claim” particular public spaces as if they were private spaces that shoppers, investors, and tourists find attractive and through which they desire to flow and conduct their business (Berg, 2010). This finding implies that a question deserving greater attention is how private policing entities secure compliance and manage noncompliance, through various forms of “symbolic” and “real” authority in essentially public spaces (Berg, 2010; Mopas & Stenning, 2001).

In the American context, criminologists have focused exclusively on questions of whether BIDs help reduce crime and promote security (MacDonald et al., 2010). However, a recent New York–based study on BIDs revealed concerns about the potential for the spread of these commercially governed spaces to deepen structural inequalities and adversely affect the distribution of public goods (Gross, 2013). In the New York context, Gross notes,

when one looks at . . . BIDs through the lens of equity in the provision of public benefits that the more negative consequences of the BID phenomenon are revealed . . . [A]reas with wealthier property owners, higher BID assessment revenues, and greater expertise are able to leverage their competitive advantages, thus generating greater spatial inequality across the greater New York area. (Gross, 2013, p. 358)

The small but provocative studies above imply the need to examine two related questions when it comes to exploring the neglected relationships between private policing and public health. The first relates to the spatial dimension of private policing and the second relates to the mentalities of private policing. Do forms of private policing affect the equitable distribution of, and access to, health and social resources in communities and cities? Private policing practices should be assessed in terms of their potential to undermine efforts by vulnerable populations to access health resources. Relatedly, are private policing entities engaged in practices of spatial sorting, including coercive sorting practices, that may exacerbate the vulnerabilities of people with health risks? Borrowing from Markwick et al. (2015), we need to better “comprehend the overall public health impacts of policing systems” including “the distribution of health risks and harms” (p. 1119).

Scholarship in the area of place-based criminology as well as literature from the fields of health and medicine is instructive for scrutinizing the spatial character of public and private policing and their holistic effects on public health. Specifically, this literature has shed light on the ways in which physical and behavioral health vulnerabilities concentrate in space. For instance, problems of mental health and mental health–related incidents display spatial patterns that can be examined at small geographic units of analysis (Vaughan et al., 2018, 2019). An analysis of Philadelphia Police Department incidents involving mental health transports by police revealed an obvious concentration of mental health crisis incidents in the city’s central core, a particularly vibrant area for business enterprises, tourism, and other mixed use activity and one governed by various policing arrangements including the public police and the Philadelphia BID (Wood & Beierschmitt, 2014). Within that dataset, there were specific residential, commercial, and service provider addresses that experienced acutely high rates of repeat police response to mental health crises (Wood & Beierschmitt, 2014).

Using crime mapping and epidemiological methods can help delineate the spatiality of health vulnerabilities as well as provide a geographic lens through which to examine the ways in which mixes of public and private policing entities interact—in terms of mentalities, authority, and practices—in a bounded geography. This type of qualitative spatial analysis of policing in its various forms could then be tied to a related analysis of how heath resources are distributed in the spatial context examined. One question to guide such an analysis is whether vulnerable individuals are able to flow safely and comfortably in and through the places they need to access health and harm reduction resources. At the same time, it would be informative to understand whether there are health resources to which agents of policing could refer people in need to help (an alternative to exclusion and coercion). Ready access to health resources expands the dispositional options available to policing entities (Comartin et al., 2019).

Researchers have also examined the spatial concentration of drug-related events (Carter et al., 2018; Siegler et al., 2014; Thomas et al., 2008; Vaughan et al., 2018). This research demonstrates that the official data collected by police can only partly inform this geographic understanding (Hibdon & Groff, 2014; Hibdon et al., 2017). Triangulating these data with health-related incidents from emergency medical service records tells a more nuanced story about the geography of addiction and vulnerability and can inform place-based approaches to distributing health resources in areas where health risks are at their highest. Moreover, research on the “activity spaces” of vulnerable populations (Martinez et al., 2014) can help inform research on how private entities play a role in policing such spaces and how they might work to make harm reduction resources more accessible.

Weisburd and White (2019) provide strong evidence that health problems cluster in “micro-geographic hot spots” (p. 11). Moreover, such problems encompass an array of physical and emotional health issues ranging from asthma, to lung disease to depression (Weisburd & White, 2019). In understanding this clustering, they stress the importance of situating issues of poor health and insecurity in the context of social disadvantage (Weisburd & White, 2019). As such, they argue for the “targeting of health services in cities,” explaining that “it may be time to consider focusing public health interventions to provide services to those in need, not at the community-level, but at the micro-geographic level, particularly hot spots of crime . . .” (Weisburd & White, 2019, p. 12). As part of this agenda, researchers could study the beneficial or deleterious effects of private policing on the targeting of health services at the microgeographic level.

To date, private policing has been considered for its deleterious effects on public health. However, it is important to consider the possibility that private policing may contribute to public health in ways not fully understood. With a focus on security, Berg and Shearing (2018) argue that it is important to challenge the assumption that only the public police is best placed to promote public goods effectively and legitimately. In the Global South and non-Western contexts with “vacuums of social order” (Ko Ko & Braithwaite, 2019) left by illegitimate and ineffective public institutions, this conceptual challenge is particularly imperative because varieties of private policing are already a well-established part of everyday life (Marks & Wood, 2010). What matters most in such contexts is to fully understand and explain these various forms that have stepped in to fill vacuums and to undertake serious research into their public health effects.

In Kachin State in the Southeast country of Myanmar (Burma), Ko Ko and Braithwaite (2019) provide a fascinating illustration of a “response of citizens to extreme conditions of anomie and total collapse of public confidence in policing” (p. 3). In their study of “Baptist policing,” they describe a volunteer-driven response to a drug epidemic fueled by a long history of illicit drug trade and export in the neighboring region of the “Golden Triangle.” This decades-long epidemic has ravaged the state, where “drug addiction among Kachin youth has been catastrophic” (Ko Ko & Braithwaite, 2019). As part of a response to this catastrophe, hundreds of thousands of members of the Christian churches, including the Kachin Baptist Convention, came together to perform functions traditionally associated with the public police.

The Baptist policing activities depicted by Ko Ko and Braithwaite evoke a mix of mentalities and practices. For instance, a central activity of volunteers, some of whom are former drug addicts, is to warn or “arrest” drug users as well as dealers. They warn users that drug use is not tolerated and in some cases they offer help and provide education about the consequences of drug use to the individuals and their families. Ko Ko and Braithwaite note that “arrest” usually does not occur until two warnings and offers of help have been provided. Practices of arrest with ethnic Kachin lead to detention in a drug rehabilitation facility run by a church. Individuals who are not ethnic Kachin (e.g., Chinese, Indian) are sent to the public police following the arrest. The rehabilitation programming observed by Ko Ko and Braithwaite would not, they report, meet the evidence-based treatment standards of Western democracies—the substance is theologically driven. Nonetheless, the authors observe that “[a]s unsophisticated as the drug rehabilitation centers are, we are not convinced by our interviews that drug users have much prospect of receiving superior professional support from the state health system . . .” (Ko Ko & Braithwaite, 2019, p. 8). Ko Ko and Braithwaite (2019) go on to explain other aspects of the Baptist policing function, including the “arrest” of drug dealers, and, in cases of resistance to arrest, an organized community “swarming” of drug dealers orchestrated as a nonviolent intervention (p. 9). Study respondents claim that the swarming techniques usually foster compliance among dealers, resulting in a voluntary handcuffing. Ko Ko and Braithwaite (2019) reports, “[r]elational pressure is what they say works here because in any gathering of 50 from your local community there will be relatives, classmates, business associates, neighbours, congregation members of others with whom the offender has valued relationships” (p. 9).

There are other components to Baptist policing, including but not limited to creative efforts for exposing and shaming the corrupt police officers that help perpetuate the vicious drug trade. The normative implications of this form of policing are complex and difficult to appraise from a Western point of view. Policing practices here are legally questionable, not to mention quite dangerous. However, in contexts with deep vacuums of social order, reforms driven by the state and focused centrally on reforming the public police may be less effective and less realistic than efforts to govern such alternative forms of policing within a human rights framework (Ko Ko & Braithwaite, 2019). Such oversight efforts would be especially worthwhile if this form of private policing held promise in tackling the public health crisis that is the drug epidemic. The next section offers brief remarks on the future of scholarship at the nexus of policing and public health.

Conclusion

Policing scholarship is generally organized around lines of inquiry related to broader questions about social ordering, public safety, and security. More recently, policing scholars recognize that such questions are implicated in questions of public health. Yet, our understanding of policing’s contribution to public health is limited by its conceptual emphasis on the public police. This article argues for a similar conceptual move that has already been made by scholars focused on processes of social ordering, security, and safety beyond the public police. A full assessment of policing’s relationship to public health is only possible, I suggest, within a conception of policing that recognizes its various dimensions along a spectrum of relative “publicness” and “privateness” (Button, 2019).

One can characterize the field of research at the intersection of policing and public health in the way that Braithwaite has portrayed criminology, particularly in the United States, as being “excessively tied to categories of institutions as objects of study, rather than being organized around theory” (Braithwaite, 2014, p. 402). This institutional focus has come at the expense of forging new theoretical ground and pushing to make discoveries that might solve complex social problems (Braithwaite, 2014). Echoing this point, Gurinskaya and Nalla (2018) similarly contend that “the time has come for criminologists to look beyond criminology’s narrow focus on criminal law and the criminal justice apparatus . . .” (p. 36).

This article highlighted a wave of efforts under government auspices designed to integrate health-oriented sensibilities into functions of public police institutions. This wave is part of a growing recognition that policing by the public police must change not only to address big public health threats, but also to reverse the trend of coercive and punitive policing practices that have exacerbated health vulnerabilities. From a public health perspective, this wave of innovation is laudable and indeed critically necessary. However, by pulling back the lens on policing as a function, not an institution, more work is required to understand how policing, in its rich variety of forms, both undermines and advances public health. The established conceptual scholarship on private policing provides an underpinning for this broad line of inquiry.

One implication of this conceptual argument is the practical argument that the future of policing in furtherance of security and public health should not rest solely on the shoulders of the public police. This is especially important in societies experiencing order and security vacuums left by weak and illegitimate state structures. Moreover, the project of aligning the public goods of security and health is inevitably, or at least partially, a local governance project. In practical terms, local authorities should muster their legal authority and policy instruments to monitor the intended and unintended outcomes of public and private policing entities, mentalities and spaces on the distribution of, and access to, the public good of health. A growing field of robust, cross-disciplinary research on the vulnerabilities of people, spaces, and places of cities can provide the data-driven infrastructure needed for such an endeavor.