Poster #48 - Exposure to fatal killings by police and enrollment in safety net services

• In Event: Saturday Poster Luncheon

Abstract

Use of safety net services has been shown to improve health outcomes. However, not everyone who is eligible, enrolls in these programs. Lack of take-up among eligible individuals may be impacted by negative experiences with institutions including law enforcement. Experiences of negative police encounters, regardless of whether the individual perceived the encounter necessary, is associated with higher levels of medical mistrust, compared to those with no negative encounters.1 Police brutality is associated with increased medical mistrust among all racial groups.1 Neighborhood exposure to fatal police killings is associated with adverse health outcomes.2 Neighborhood exposure to fatal police killings could incite distrust in institutions provoking individuals to withdraw from engagement in other institutions that could benefit their health.1,3 The purpose of this study is to examine the relationship between ecological-level exposure to fatal police killings and enrollment in Medicaid and SNAP. We hypothesize that communities with more instances of fatal police killings have lower levels of enrollment in Medicaid and SNAP.

We created a novel dataset of county Medicaid enrollment at the month-year level, compiled from state reports. To our knowledge, this is the first study to use this innovative dataset. We use county-level SNAP data from USDA Food and Nutrition Service. We use data from the Mapping Police Violence project to identify individuals killed by police from 2013-2024.

We computed descriptive statistics to describe the community characteristics of counties with recorded fatal police killings. We estimated a multivariate linear regression model to assess the association between county-level police killings and (1) SNAP and (2) Medicaid enrollment, adjusting for county-level sociodemographic and structural characteristics.

In preliminary analysis, we find there are 13,311 individuals killed by police from 2013-2024 across 2,029 counties - representing approximately 65% of all 3,144 counties in the United States. Counties with police killings in every year from 2017 to 2019 tended to have a higher share of Black residents and were more socioeconomically disadvantaged compared to counties without such incidents. For example, nearly one-third of residents in these counties had no college or postsecondary degree. Additionally, these counties also experienced a 15.6% higher level of income inequity between White and Black households and a 27.8% higher level of residential segregation, compared to counties without these incidents. In the SNAP take-up analysis, we examined enrollment trends from 2013 to 2022 across 1,928 counties, with an average of 20,075 individuals enrolled per county. Using a simple fixed-effects models, we found that counties with a police killing history had lower SNAP enrollment.

These findings suggest that ecological exposure to fatal killings by police officers is associated with lower enrollment in safety net services. Counties with a history of police killings often experienced greater racial and socioeconomic disparities. To address these challenges, local jurisdictions should work to build institutional trust and reduce violence in communities affected by police brutality. Targeted, community-informed approaches that acknowledge and address institutional distrust in government and health care could be crucial to increase the use of safety net services among eligible groups.

Authors

• Sih-Ting Cai, Indiana University
  Non-Presenting Co-Author

• Cydney Marie McGuire, Indiana University
  Presenting Author

• Nicole Y Siegal, Indiana University
  Non-Presenting Co-Author