Alang Sirry, McAlpine Donna, McClain Malcolm, Hardeman Rachel
Department of Sociology and Program in Health, Medicine and Society, Health Justice Collaborative, Lehigh University Bethlehem Pennsylvania, United States.
Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States.
Prev Med Rep. 2021 Mar 23;22:101361. doi: 10.1016/j.pmedr.2021.101361. eCollection 2021 Jun.
Police brutality is a social determinant of health that can directly impact health status. Social determinants of health can also impact health indirectly by shaping how people access health care. In this study, we describe the relationship between perceived police brutality and an indicator of access to care, unmet need. We also examine medical mistrust as a potential mechanism through which perceived police brutality affects unmet need. Using data from the 2018 Survey of the Health of Urban Residents (N = 4,345), direct effects of perceived police brutality on unmet need and indirect effects through medical mistrust were obtained using the Karlson-Holm-Breen method of effect decomposition. Experiencing police brutality was associated with greater odds of unmet need. Controlling for covariates, 18 percent of the total effect of perceived police brutality on unmet need was explained by medical mistrust. Experiences outside of the health care system matter for access to care. Given the association between police brutality and unmet need for medical care, addressing unmet need among marginalized populations requires public health leaders to engage in conversations about reform of police departments. The coronavirus pandemic makes this even more critical as both COVID-19 and police brutality disproportionately impact Black, Indigenous, Latinx and other communities of color.
警察暴力执法是一种健康的社会决定因素，可直接影响健康状况。健康的社会决定因素还可通过影响人们获得医疗保健的方式间接影响健康。在本研究中，我们描述了感知到的警察暴力执法与医疗服务可及性指标（未满足的需求）之间的关系。我们还考察了医疗不信任感，将其作为感知到的警察暴力执法影响未满足需求的一种潜在机制。利用2018年城市居民健康调查的数据（N = 4345），采用卡尔森-霍尔姆-布林效应分解法得出了感知到的警察暴力执法对未满足需求的直接影响以及通过医疗不信任感产生的间接影响。经历过警察暴力执法的人未满足需求的几率更高。在控制协变量的情况下，感知到的警察暴力执法对未满足需求的总影响中有18%可由医疗不信任感来解释。医疗保健系统之外的经历对获得医疗服务很重要。鉴于警察暴力执法与未满足的医疗需求之间的关联，解决边缘化人群中未满足的需求要求公共卫生领导人参与有关警察部门改革的对话。冠状病毒大流行使这一点变得更加关键，因为新冠疫情和警察暴力执法对黑人、原住民、拉丁裔和其他有色人种社区的影响尤为严重。
