Task: Healthcare Policies Essay
Task: Healthcare Policies Essay
Write a brief thought paper that reflects on the readings for each class that includes your full name, date, and the class number on the top left corner (Times New Roman font, 12 font sizes, 1” margins, single space, full page). The papers must be integrative and may not focus on only one reading.
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Articles Fatal police violence by race and state in the USA, 1980–2019: a network meta-regression GBD 2019 Police Violence US Subnational Collaborators* Summary Background The burden of fatal police violence is an urgent public health crisis in the USA. Mounting evidence shows that deaths at the hands of the police disproportionately impact people of certain races and ethnicities, pointing to systemic racism in policing. Recent high-profile killings by police in the USA have prompted calls for more extensive and public data reporting on police violence. This study examines the presence and extent of under-reporting of police violence in US Government-run vital registration data, offers a method for correcting under-reporting in these datasets, and presents revised estimates of deaths due to police violence in the USA. Methods We compared data from the USA National Vital Statistics System (NVSS) to three non-governmental, opensource databases on police violence: Fatal Encounters, Mapping Police Violence, and The Counted. We extracted and standardised the age, sex, US state of death registration, year of death, and race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic of other races, and Hispanic of any race) of each decedent for all data sources and used a network meta-regression to quantify the rate of under-reporting within the NVSS. Using these rates to inform correction factors, we provide adjusted estimates of deaths due to police violence for all states, ages, sexes, and racial and ethnic groups from 1980 to 2019 across the USA. Lancet 2021; 398: 1239–55 See Editorial page 1195 *Collaborators listed at the end of the paper Correspondence to: Prof Mohsen Naghavi, Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, WA 98105, USA [email protected] Findings Across all races and states in the USA, we estimate 30 800 deaths (95% uncertainty interval [UI] 30 300–31 300) from police violence between 1980 and 2018; this represents 17 100 more deaths (16 600–17 600) than reported by the NVSS. Over this time period, the age-standardised mortality rate due to police violence was highest in non-Hispanic Black people (0·69 [95% UI 0·67–0·71] per 100 000), followed by Hispanic people of any race (0·35 [0·34–0·36]), nonHispanic White people (0·20 [0·19–0·20]), and non-Hispanic people of other races (0·15 [0·14– 0·16]). This variation is further affected by the decedent’s sex and shows large discrepancies between states. Between 1980 and 2018, the NVSS did not report 55·5% (54·8–56·2) of all deaths attributable to police violence. When aggregating all races, the age-standardised mortality rate due to police violence was 0·25 (0·24–0·26) per 100 000 in the 1980s and 0·34 (0·34–0·35) per 100 000 in the 2010s, an increase of 38·4% (32·4–45·1) over the period of study. Interpretation We found that more than half of all deaths due to police violence that we estimated in the USA from 1980 to 2018 were unreported in the NVSS. Compounding this, we found substantial differences in the agestandardised mortality rate due to police violence over time and by racial and ethnic groups within the USA. Proven public health intervention strategies are needed to address these systematic biases. State-level estimates allow for appropriate targeting of these strategies to address police violence and improve its reporting.
Funding Bill & Melinda Gates Foundation, National Institute on Minority Health and Health Disparities, and National Heart, Lung, and Blood Institute. Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Introduction The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) in 2019 found that police conflict and executions accounted for 293 000 global deaths (95% uncertainty interval [UI] 215 000–344 000) from 1980 to 2019.1 In 2019, the USA accounted for 13·2% (95% UI 11·6–15·1) of the 8770 global deaths (7710–9930) due to police conflict while only accounting for 4% of the global population;1 police conflict and executions was the estimated cause of death for 1150 deaths (998–1310) in the USA.1 The burden of police violence fatalities in the USA is known to fall disproportionately on Black, Indigenous, and Hispanic populations.2–5 Recent studies suggest that over the life course, about one in every www.thelancet.com Vol 398 October 2, 2021 1000 Black men are killed by the police in the USA, making them 2·5 times more likely to be killed by police than White men.2 Black women are about 1·4 times more likely to be killed by police than are White women.2 Systemic and direct racism, manifested in laws and policies as well as personal implicit biases, result in Black, Indigenous, and Hispanic Americans being the targets of police violence.6–9 Within GBD, deaths due to police conflict and executions include civilians killed by police, police killed by civilians, and government-led executions.1 Police violence is defined in GBD as police-related altercations leading to death or bodily harm. For the purpose of this study, we estimate numbers of civilians killed by police 1239
Articles Research in context Evidence before this study Current data on deaths from police violence are constrained by the limitations of government-run vital registration systems. Vital registration data are often considered high quality for cause of death estimation; however, vital registration systems can be biased. Considerable evidence in the USA suggests government vital registration data under-report police violence. We completed a systematic review of databases on police violence in the USA by searching the terms “police violence OR killing OR shooting OR conflict database” on June 2, 2020, using Google and Google Scholar. Added value of this study We evaluated the extent of under-reporting of deaths due to police violence in the USA at the state level by race and ethnicity by comparing vital registration data to three nongovernmental, open-source databases:
Fatal Encounters, Mapping Police Violence, and The Counted. We chose these databases on the basis of the following factors: (1) their comprehensive coverage of the entire USA, (2) their detailed inclusion of both the state of death and race or ethnicity of decedents, and (3) their consideration of all forms of violence. For more on Fatal Encounters see https://fatalencounters.org/ For more on Mapping Police Violence see https:// mappingpoliceviolence.org For more on The Counted see https://www.theguardian.com/ us-news/series/counted-uspolice-killings 1240 disaggregated by race and ethnicity, referred to throughout this work as fatal police violence. The GBD 2019 estimates for police conflict and executions were corrected for under-reporting using a similar method as described in this Article.1 These corrections will also be applied in GBD 2020 and in future iterations of GBD. Before GBD 2019, the exclusive data source used for fatal police violence in GBD was the National Vital Statistics System (NVSS), leading to underestimation of fatal police violence by 52·6–67·8% each year from 1980 to 2017. Movements against racially motivated violence have been long standing throughout the USA’s history.
Recent tragedies have spurred social movements such as Black Lives Matter (initiated in 2013 by community organisers Patrisse Cullors, Alicia Garza, and Opal Tometi in response to the killing of Trayvon Martin)10 and public declarations identifying police violence and racism as a public health crisis.11,12 Violence is a public health issue, affecting both physical and mental health and undermining individual and community safety and wellbeing.13–15 Since the creation of Black Lives Matter, the crisis of police violence and its associated systemic racism has been broadly identified as a public health concern in other high-income nations besides the USA,16 and the international spotlight on racial disparities in US police violence has incited protests globally.17 Despite the magnitude of the loss of life and the evident disproportionate burden of deaths from the police on Black, Indigenous, and Hispanic people in the USA, these deaths can be misclassified and subsequently undercounted in official statistics.18–21 Many countries, To correct for under-reporting in US vital registration data, we developed a statistical framework using both open-source and government data sources to provide appropriately revised estimates of deaths due to police violence stratified by age, sex, year of death, and race and ethnicity for each state within the USA from 1980 to 2019.
The revised estimates highlight the extent to which these deaths are under-reported and the disproportionate effect of police violence on non-Hispanic Black, non-Hispanic Indigenous, and Hispanic Americans. Implications of all the available evidence Stark inequities in the burden of police killings by race and ethnicity within the USA highlight the urgent need to address systemic racism within the US police force. The ability to accurately compare rates of deaths between countries is pivotal in addressing systematic issues across global policing systems. This study can serve as a framework in guiding future research to address the under-reporting of police violence in additional countries. Future work remains for researchers and public health officials to swiftly adopt open-source data-collection initiatives to provide accurate estimates and advocate for policy change to address this long-neglected public health crisis. including European and Latin American countries, Australia, and high-income Asian nations, rely on government-run vital registration systems to collect cause of death data.22–29 Although vital registration systems in many countries are considered to be reliable sources on causes of death,1,30–32 they present a potential conflict of interest for deaths from police violence, since the same state responsible for violence is also responsible for reporting it.3,18 The NVSS is a government system coordinated by the National Center for Health Statistics to provide guidance, collate, and standardise vital registration data collected by US states.
The NVSS collates all death certificates issued in the USA, including each decedent’s age, sex, race, Hispanic ethnicity, place of residence, date of death, and cause of death.33,34 Physicians are typically responsible for filling out the cause of death section of the death certificate; however, a medical examiner or coroner who may or may not also be a physician will do so for homicides or cases where there is suspicion of crime or foul play, including police violence.19,35 Systemic misclassification and undercounting of deaths due to police violence in USA vital registration data has been well documented.18–21 To address the public health crisis of police violence, reform is needed on how to document and respond to such violence. We have devised a framework to quantify and adjust for under-reporting in the NVSS using opensource data in the USA. In this study, we compared deaths identified as police violence in the NVSS to three outside, non-governmental databases that rely on opensource information:
Fatal Encounters, Mapping Police Violence, and The Counted. The primary purpose of this www.thelancet.com Vol 398 October 2, 2021 Articles Article is to examine and resolve the impact of underreporting in the NVSS on the estimation of police violence in the USA at the state, race, and ethnicity level by developing a method to correct for under-reporting in these data. This method has the potential to provide a framework for other countries with similar vital registrations systems to correct their police violence data and to encourage the use of open-source data collection, allowing for global comparison of this key cause of death. The manuscript was produced as part of the GBD Collaborator Network and in accordance with the GBD Protocol.36 Methods Overview This analysis complied with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).37 The full GATHER checklist is provided in the appendix (p 13). This study is a subanalysis of GBD, which the University of Washington Institutional Review Board has approved under IRB ID 9060. A flowchart of our methods for the estimation of police violence can be found in the appendix (p 20). Data seeking To find databases that capture fatal police violence more accurately than the NVSS, we searched the terms “police violence OR killing OR shooting OR conflict database” on June 2, 2020, using Google and Google Scholar. We included in our analyses all databases referenced in the search results that met the following criteria: (1) inclusion of both firearm-related and non-firearm-related deaths, (2) inclusion of state and race or ethnicity detail, and (3) improved coverage compared with the NVSS, if the database also met the first two criteria. Three databases fit these criteria:
Fatal Encounters, Mapping Police Violence, and The Counted. A discussion of prominent datasets that we excluded from analysis, including the Washington Post’s Fatal Force, the National Violent Deaths Reporting System, and the Arrest-Related Deaths Program, is included in the appendix (p 3). The Fatal Encounters, Mapping Police Violence, and The Counted databases cover all 50 states and Washington, DC (hereafter referred together as “states”), and were compiled by collating news reports and public records requests. The strategy of capturing police violence deaths using publicly available information is known as an open-source methodology.38 The opensource databases collectively cover only 20 years from 2000 to 2019, much less than the 39 years of the NVSS that we had available from 1980 to 2018, limiting the scope of accurate estimates of police violence (table). The longest-running open-source database, Fatal Encounters, has a very broad case definition that includes all deaths during encounters with the police, with no requirement of police culpability. Mapping Police Violence and The Counted, which follow a more specific definition of police violence in only considering civilians killed by police, collectively cover only 7 years, from 2013 to 2019. See Online for appendix Data standardisation We extracted and standardised the age, sex, US state, year of death, and race and ethnicity of each decedent for all data sources. Details on the standardisation of age and sex are included in the appendix (p 4). Race and ethnicity categories reported in the raw data varied across data source, by US state, and over time,39 presenting a substantial challenge for standardisation. We chose to standardise the data to the four categories non-Hispanic Black, non-Hispanic White, non-Hispanic of other races, and Hispanic of any race, because they have sufficiently large populations to support our statistical analyses. Within these categories, we considered Indigenous people to be part of non-Hispanic of other races. The Percentage of cases missing race or ethnicity Sources of bias from gold standard Organisation type Years of data available Case definition Data collection method Fatal Encounters 501(c)(3) non-profit 2005–19*† People killed during encounters with the police 22% Open-source methodology: researchers collate news reports and public records requests Case definition; percentage missing in race or ethnicity Mapping Police Violence 501(c)(3) non-profit research collaborative 2013–19*
Police killings Open-source methodology: researchers collate news reports and public records requests 9% Percentage missing in race or ethnicity The Counted Project of The Guardian newspaper 2015–16 People killed by the police and other law enforcement agencies Open-source methodology: researchers collate news reports and public records requests 2% Not applicable (gold standard) National Vital Statistics System Government system coordinated by the National Center for Health Statistics 1980–2018‡ Legal intervention ICD code as underlying cause of death (Y35.0–Y35.4, Y35.6–Y35.9, and Y89.0 in ICD-10, and E970–E977 in ICD-9§) 15% Death certificates: medical examiner or coroner determines cause of death Data collection method; percentage missing in race or ethnicity ICD=International Classification of Diseases. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *Data collection is ongoing; the last complete year of data at the time of this study was 2019. †Fatal Encounters includes data for 2000–04, which we chose to exclude due to concerns about their completeness (see appendix pp 6–7). ‡The National Vital Statistics System existed before 1980; however, we limit our analyses to data from 1980 onwards to enable use of the time series produced by GBD. §See appendix pp 23–25 for full code names. Task: Healthcare Policies Essay
Table: Key facts on included data sources for police violence in the USA www.thelancet.com Vol 398 October 2, 2021 1241 Articles separation of race and Hispanic ethnicity is based on the standards for race and ethnicity categorisation maintained by the USA Office of Management and Budget (OMB).40 It is important to note that race and ethnicity are social classifications that, while able to affect peoples’ lives through social and political forces, have no biological or scientific basis. The OMB has acknowledged the lack of scientific basis for their race and ethnicity categories.41 For the open-source databases, we reassigned deaths with unknown race or ethnicity proportionally to the standard categories based on the pattern of deaths with known race and ethnicity in each data source.
This approach assumes that within a given dataset, the likelihood of a decedent’s race or ethnicity being unknown is independent of their true race and ethnicity. The potential bias introduced by this assumption diminishes as the proportion of deaths with unknown race in a given dataset decreases; therefore, The Counted will have the most accurate race and ethnicity distribution after reassignment, as only 2% of 2239 deaths had unknown race or ethnicity before reassignment (table). Task: Healthcare Policies Essay
The NVSS presented a particular challenge in the handling of deaths with unknown race or ethnicity, since every state is missing ethnicity for more than 90% of deaths for several years starting in 1980, ranging from 3 to 17 years depending on the state (appendix pp 21–22). For these state-years, we calculated the relative rate of police violence between Hispanic and non-Hispanic people for the smallest viable series of succeeding years with more than 50% ethnicity completeness and back-extrapolated this ratio on the basis of ethnicity-specific population estimates. This approach assumes that the relative rate of police violence between Hispanic and non-Hispanic people was constant across the early years of the 1980–2019 time series. Details on the redistribution of unknown race and ethnicity are included in the appendix (pp 4–6). Quantifying biases in data sources From the four included datasets, we considered The Counted to be the gold standard because of its opensource methodology, case definition of police violence, and high completeness on race and ethnicity. Task: Healthcare Policies Essay
We used a network meta-regression (NMR)42–46 to quantify the biases of the three other datasets compared with The Counted for any given state, race and ethnicity, and year. The advantage of using NMR is that it uses all available pairwise comparisons between datasets to deduce the relative biases between them: both direct comparisons between the non-standard datasets and The Counted, which can necessarily span only 2 years (2015–16), and indirect comparisons made among the non-standard datasets from the years where they overlap (2005–19). This increases the amount of data available to the metaregression by 5·5 times. We specified the NMR as a mixed-effects logtransformed linear regression, with fixed effects β on 1242 state (l), race and ethnicity (r), and percentage of police violence deaths in the NVSS caused by firearms (PF), and a random effect (u) on the state, race and ethnicity, and year combination: =(β ( rate rate ( ln x₁ l,y,r x₂ l,y,r x₁ 0 x₂ – β 0 ) + (β x₁l – β x₂l ) + (β rx₁– β x₂r ) (1) x₁ + (β PF – β x₂PF) × PFl,y,r + ul,y,r + ε where ratexl,y,r is the cause-specific mortality rate due to police violence for state l, year y, and race and ethnicity group r in dataset x, and βxv represents the mean effect of variable v on the log-mortality ratio of dataset x to The Counted. By definition, the βv coefficients for The Counted are zero for all variables v. We also impose a prior such that βxPF=0 for x=Fatal Encounters or x=Mapping Police Violence. For x1=NVSS and x2=The Counted, the quantity estimated by the linear predictor is the log of the reporting rate of the NVSS, assuming that The Counted represents the full burden of fatal police violence. By using this model specification, we assume that systematic biases between all datasets, including under-reporting in the NVSS, vary by state, race, and ethnicity and are constant across age and sex. Task: Healthcare Policies Essay
We assume that the systematic biases between Fatal Encounters, Mapping Police Violence, and The Counted are constant over time from 2005 to 2019, which is well supported by the years in which these sources overlap, but the inclusion of βNVSSPF allows under-reporting in the NVSS to vary over time according to this variable. A discussion of our covariate selection process, how we calculated the cause-specific mortality rate, how we offset state-race-ethnicity-years with zero deaths in the raw data to apply the log transform, and why we aggregated age and sex for this analysis is included in the appendix (pp 7–8). Producing comparable estimates To produce comprehensive, comparable police violence estimates, we used the estimates of the under-reporting rates in the NVSS by state and race and ethnicity obtained from the NMR to correct the observed deaths D in the NVSS using the following equation: NVSS,corr NVSS,obs Dl,y,r =Dl,y,r × exp[– (β NVSS + βNVSS + β NVSS 0 l r (2) + β NVSS × PFl,y,r)]
PF We made similar adjustments to Fatal Encounters and Mapping Police Violence using their respective over-reporting and under-reporting rates, due to their differing case definitions and lower race and ethnicity detail compared with The Counted. At this point, we had corrected the data sources so that all four matched the methodology and case definition of our goldstandard source. However, each dataset still represented a distinct observation of the overall problem of police vi olence and covered only a specific segment of time www.thelancet.com Vol 398 October 2, 2021 Task: Healthcare Policies Essay
Articles from 1980 to 2019. To obtain comprehensive estimates of police violence that are comparable across all dimensions from 1980 to 2019 and that include the uncertainty associated with each underlying observation, we ran a predictive model on the NMRadjusted data sources. We started with a Poisson regression on time for each state, race, and ethnicity combination: deathl,y,r ~ Poisson(λ l,y,r × populationl,y,r) ln(λ l,y,r)=α l,r + β l,r × y (3) where λl,y,r is the cause-specific mortality rate due to police violence for state l, year y, and race and ethnicity group r. We then used a log-transformed spatiotemporal Gaussian progress regression (ST-GPR), as used in GBD causes of death ensemble modelling (known as CODEm), to incorporate any systematic variation in the data from the initial Poisson model across state, race and ethnicity, and time into the model predictions. Task: Healthcare Policies Essay
47 A table of the ST-GPR parameters that we used is included in the appendix (p 28). Finally, we split the estimates from ST-GPR into detailed age bins and by sex using the age-sex pattern of cause-specific mortality in the underlying data and the GBD causes of death age-sexsplitting algorithm.1 This splitting was independent of state, year, race, and ethnicity, and therefore assumed a constant age-sex pattern across these dimensions. Estimating further race and ethnicity detail at the national level Within our primary analysis, our statistical methods were unable to accurately analyse smaller race and ethnicity groups than non-Hispanic White, nonHispanic Black, non-Hispanic of other races, and Hispanic of any race at the state level, primarily due to instability in the offsetting method for observed zeros that we use to apply log transforms. However, these broad categories can hide large disparities in police violence against smaller race and ethnicity groups. In particular, previous research has shown that Indigenous people are killed by the police at higher rates than any group other than Black people.2 To address this, we did a secondary analysis in which we produced national-level estimates of police violence deaths for five race and ethnicity groups from 1990 to 2019: Hispanic of any race, non-Hispanic White, non-Hispanic Black, non-Hispanic Indigenous, and non-Hispanic of other races, where the last two categories collectively cover the same races and ethnicities as non-Hispanic of other races in our main analysis. Task: Healthcare Policies Essay
We were only able to do this secondary analysis for 1990–2019 due to a lack of sufficiently detailed population estimates for 1980–89. We began by re-prepping all input data sources with these five race and ethnicity groups (denoted rʹ). We then aggregated the data to the national level to compensate for the www.thelancet.com Vol 398 October 2, 2021 smaller populations and ran an NMR to quantify dataset-level biases: ln =(β – β ) + (β – β ) + u ( rate rate ( x₁ y,r’ x₂ y,r’ x₁ 0 x₂ 0 x₁ r’ x₂ r’ y,r’ +ε (4) We did not include percentage of NVSS police violence deaths caused by firearms as a covariate in this regression due to lack of significance at this level of aggregation. We adjusted the data to remove these systematic biases in a method analogous to equation 2 and used the adjusted data to calculate the proportions of decedents in the nonHispanic of other races group, as defined in our main analysis, that were non-Hispanic Indigenous and nonHispanic of other races as defined in our secondary analysis. Finally, we used these proportions to split the national-level results from the primary ST-GPR model into final estimates for the five race and ethnicity groups. Role of the funding source This study was funded by the Bill & Melinda Gates Foundation, National Institute of Minority Health and Health Disparities, and the National Heart, Lung, and Blood Institute. Coauthors affiliated with these organisations provided feedback on initial maps and drafts of this manuscript. Otherwise, the funders had no role in study design, data collection, data analysis, data interpretation, writing of the final report, or decision to submit for publication. Task: Healthcare Policies Essay
Task: Healthcare Policies Essay
Task: Healthcare Policies Essay

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