“Hey Doctor—you pitched a shutout.” The text message came from the police commissioner shortly after we had left a public meeting known as Mayor’s Night.
On that evening in early 2007, Baltimore, Maryland, residents directed about 25 questions to the police commissioner, covering neighborhood safety, mental illness, homelessness, and drug addiction. About 10 questions went to the head of housing and a few to the director of public works.
Zero came to the health commissioner—me.
I didn’t feel like I had pitched a shutout. I felt like I had struck out. The health department works to keep people healthy—to prevent injuries and violence and connect people with treatment for mental illness and addiction. That Mayor’s Night, I learned that our efforts were invisible. Crises led to 911 calls, so city residents looked to the police department as the responsible agency for a whole range of health problems.
I called the police commissioner the next day to discuss my concerns. “Let’s work together to make it stop,” he said. “I don’t care if it’s because of the police or the health department or because Martians landed in Baltimore. Let’s just make it stop.”
Make it stop. These words formed the backbone of our collaboration. We started by seeking out evidence from local and national experts, as well as ideas from community members, to develop new initiatives—and then tracked the outcomes.
To stop the violence, the health department expanded services to youth at high risk and placed outreach workers on the streets late at night to mediate disputes. The police commissioner himself helped raise funds for these unorthodox efforts. Evaluations of this early work showed that residents in neighborhoods where we implemented the program had less interest in using a gun to settle disputes. There were also fewer shootings. These efforts contributed to a substantial drop in city homicides, from historic highs over 300 per year to 197 in 2011.
To address mental health crises, we provided crisis intervention training for police and funded mental health teams to respond to hundreds of urgent situations. To stop overdoses, the health department dramatically expanded access to effective drug treatment in primary care clinics, hospital outpatient programs, and specialized treatment centers. Fatal overdoses due to heroin, which had peaked at 312 in 1999, fell to a low of 76 in 2011.
Looking back a decade later, I draw three primary lessons for public health. First, the health department should feel responsible and accountable for some of the city’s most pressing problems. Second, novel public health efforts can gain traction with endorsements and support from police leaders. And third, it matters for the health department’s work to be visible. The police commissioner didn’t seem to mind when I started to jump in on questions during Mayor’s Night about addiction and homelessness in city neighborhoods and to explain alternative approaches to reducing violence. Eventually, city residents began to direct these questions to me.
I recognize now that we were just scratching the surface of what policing and public health can do together. Today, leading police departments are rethinking the criminalization of drug use, making fewer arrests of people who use drugs while providing more resources to harm reduction, treatment, and support services. Public health researchers are identifying effective ways to keep guns from those at the highest risk of violence, with police departments involved in the design and leading the implementation of these efforts. Health departments are expanding crisis intervention services, with mental health teams now responding to certain 911 calls.
Our work together, in collaboration with the communities we serve, is what will ultimately make it stop.
Accelerating this work is cross-disciplinary training. Police leaders are learning the principles of epidemiology, policy analysis, and community engagement at institutions like Johns Hopkins , where we provide full scholarships for public health training through the Bloomberg American Health Initiative. One of our goals is for rising leaders in law enforcement to develop professional networks that stretch into public health departments, community-based anti-violence organizations, and research institutions.
These collaborations could not be taking shape at a more important moment. Following the murder of George Floyd and throughout the COVID-19 pandemic, both policing and public health have struggled to maintain the confidence of their communities. In their own ways, police and health departments have past wrongs to right and current practices to improve. Both are learning that good intentions are not enough to inspire trust.
Meanwhile, major issues of life and death still face the United States. COVID-19 remains a daily threat. Overdose and homicide numbers have spiked. Mental health challenges are cresting. Political polarization is undermining even well-intentioned and effective work for the common good.
These challenges are too much for either policing or public health alone. Our work together, in collaboration with the communities we serve, is what will ultimately make it stop.d
