Spatial marking as a structural determinant of health: evidence from the labelling of neighborhoods as vulnerable by the Swedish police

In 2015, the Swedish police released a list of urban neighborhoods that it deemed ‘vulnerable’ (utsatta områden) with the intended purpose of reducing crime in those areas. We argue that this highly publicized list is a case of Spatial Marking, which refers to the institutionalization of positive or negative perceptions of a place via the enactment of a place-based intervention. Spatial marking leads to formal and informal rules dictating the differential treatment of communities largely based on racial composition, and should therefore be conceptualized as a structural determinant of health. In the case of the Swedish police list, we argue Spatial Marking amounts to the criminalization of entire neighborhoods, whose residents are subject to stigma and increased police interventions which should negatively impact the health of the people that live there. We assess this possibility with geo-located register data using a staggered difference in differences design to estimate the effect of being added to the police list across 9 health outcomes. Our results show that both the number of overdoses, babies born with low birth weights, and babies born out of pregnancies without adequate prenatal care increased as a result of being added to the police list. We find no evidence that of meaningful changes in the number of suicides, violent deaths, violent hospitalizations, or rates in mental health prescriptions. The analyses highlight how policing and criminalization, institutionalized through Spatial Marking can contribute to inequalities in health.