Last week, the New York City Medical Examiner ruled that Eric Garner died on July 17 as a result of a choke hold by a police officer. In other words, Garner’s death was ruled a homicide, even though his health conditions—including asthma, heart disease, and obesity—were found to be “contributing factors.” The confrontation with police, which was caught on video by a bystander, and his death have captured the nation’s attention and sparked much outrage.
But Garner’s death is about much more than a police choke hold or police brutality, as critical as these are. As this tragic case unfolds, one can also see in Garner’s life many of the conditions contributing to our large and growing “US health disadvantage” and especially the role of social determinants. These are the social and physical environments that shape our behaviors and experiences from the day we are born, as well as the public policies that affect our family, community, and life circumstances. These are things beyond genetics, biology, medical care, or even the healthcare system that affect our health. Here are just a few examples (I’m sure there are many more) of how the social determinants of health mattered to Eric Garner.
Garner was as African American man, age 43, with a history of chronic health problems. His weight of 350 pounds and his other underlying health conditions are almost always mentioned in media and other reports describing his encounter with the police and his subsequent death. Chronic illnesses are the nation’s leading cause of death and disability; they affect 90 million Americans and absorb 75 percent of our health care dollars. They lead to premature and preventable death and cause lifelong disability and a much lower quality of life. Among people who are less educated, unable to work, or struggle to make ends meet, the rates and burdens of chronic illness are even greater.
Although his health was a contributing factor, Garner’s death was ruled a homicide. Homicide, along with other intentional injuries and violence generally, is a major social determinant of health. Among black men, it is a leading cause of death, reducing life expectancy by almost one year. Murder rates among black Americans are four times higher than the national average.
But Garner’s death was also linked to two other less obvious “upstream” social determinants of health – tobacco taxes and policing policies. On the day he died, police had suspected Garner of hawking illegal tax-free cigarettes, an offense he was charged with several times before. Cigarette taxes have been effective in reducing smoking, an important social determinant of health. But a recent study of low-income smokers in New York found that they spend nearly a quarter of their household incomes on cigarettes. At $4.25 a pack, New York’s cigarette tax rate is the highest in the country. These taxes place a very high burden on low-income households, whose members smoke at higher rates, experience higher levels of trauma and stress, and are less able to afford smoking cessation supports. Obviously no one is forced to sell untaxed cigarettes and the practice is illegal, but this tax policy coupled with the challenges of fighting nicotine addiction is one example of how policies can and do shape people’s lives and behaviors.
Finally, Garner’s death has been implicated in a policy known as “broken windows” policing: the idea that aggressive enforcement of minor offenses, such as peddling untaxed cigarettes, leads to safer and more orderly communities. The strategy was adopted in New York City decades ago, but it is unclear if it is what has led to reductions in violent crime because levels have fallen across the country. What is clear, however, is the impact this policy is having on the lives of many New Yorkers. As the New York Times editorial board explains:
The mayor and the commissioner should acknowledge the heavy price paid for heavy enforcement. Broken windows and its variants—“zero-tolerance,” “quality-of-life,” “stop-and-frisk” practices—have pointlessly burdened thousands of young people, most of them black and Hispanic, with criminal records. These policies have filled courts to bursting with first-time, minor offenders whose cases are often thrown out, though not before their lives are severely disrupted and their reputations blemished. They have caused thousands to lose their jobs, to be suspended from school, to be barred from housing or the military. They have ensnared immigrants who end up, through a federal fingerprinting program, being deported and losing everything.
It is striking how many social determinants of health are reflected in the life and death of one man. This case is still playing out for his family, his community, and the entire city of New York, and the nation is waiting for the justice system’s response to this tragedy. But one beneficial outcome would be our greater understanding and action on policies and practices that affect people’s health and life chances. Improving these for everyone, but especially for people like Eric Garner, is a worthy goal for us all.
Photo: Ellisha Flagg, sister of Eric Garner cries during a vigil demanding justice for Eric Garner, a Staten Island man who died while being arrested by New York City police, Tuesday, July 22, 2014, in New York. Demonstrators gathered at a park Tuesday, near where police attempted to arrest Garner, 43, on suspicion of selling untaxed cigarettes. (AP Photo/John Minchillo)