police cars lined up.

Health Justice and the Criminal Legal System: From Reform to Transformation

By Aysha Pamukcu and Angela P. Harris

Using health justice to reframe and reshape the criminal legal system

The demand to “defund the police,” circulated by the Movement for Black Lives and allies after the brutal 2020 murder of George Floyd, was a departure from the usual discourse of police reform. The demand garnered backlash as being both politically unrealistic and potentially dangerous. But in our view, it demonstrates the transformative potential of social movements focused on justice for marginalized communities. As these justice movements build and strengthen partnerships with public health and civil rights advocates, we see the potential of using the health justice framework to reimagine the future of the criminal legal system.

Calls to deploy the American criminal legal system to enforce national health anxieties are not new, but they too often have produced unjust outcomes, such as adopting criminal punishments for people who are HIV-positive or who are dependent on drugs and pregnant.

In contrast, the health justice framework centers the leadership of social movements for justice and inclusion. Such movements have the capacity to rapidly shift the terms of public debate, making previously unimaginable policy initiatives first discussable, and then doable. And centered in values of anti-subordination, justice movements can challenge biases within elite, highly professionalized disciplines like law and public health.

Policy innovations that emerge from this triple alliance of law, public health, and social movements stand a better chance of improving the lives of marginalized communities than those that treat these communities as targets of discipline or charity. The call to defund the police demonstrates some of these possibilities.

Moving policy and budgets “upstream”

In the United States, we often hand complex public health problems — from homelessness to addiction to mental illness — to the criminal legal system to solve. As one example, New York City’s 2020 police budget of nearly $6 billion was greater than the total resources allocated to the Departments of Health, Homeless Services, Housing Preservation and Development, and Youth and Community Development.

The call to “defund the police,” of course, is an umbrella concept that includes many regulatory and budgetary possibilities. An important first step, however, is the recognition (including among police themselves) that the police should not be the default first responders to all social and medical emergencies, and that limited public dollars ought to be directed toward their most effective and efficient use. Advocates have, for instance, documented the serious harms of relying so heavily on the criminal legal system for mental illness crisis care. Yet for many communities, the carceral system is the largest provider of mental health care.

Some cities are taking action to move their budgets upstream from the criminal legal system to invest in the social determinants of health. Denver, Portland, and Oakland are dispatching health care workers and community members instead of police for certain calls for emergency assistance. San Francisco is redirecting $120 million of law enforcement funds into services like mental health, youth development, and economic opportunity. Austin is reallocating funds from its police budget toward supportive housing for the city’s homeless population.

The criminal legal system as a social determinant of health

Research suggests that overall well-being suffers from exposure to the criminal legal system. Black, brown, and Indigenous communities exposed to predatory policing experience dramatically heightened levels of suffering and death. The criminal legal system has been intimately involved in perpetuating racism, from simultaneous over- and under-policing of communities of color, to the perpetuation of residential segregation, to the diversion of youth from schools to prisons. The racialized injustices of the American carceral system widen racialized health disparities.

In this context, the boldness of the call to “defund the police” — arriving as it does on the heels of the critique of mass incarceration — forces us to consider why police exist in the first place, and what the goals of the criminal justice system are and ought to be. Conventional criminal law and policy identifies individuals, and their “bad acts and guilty minds,” as the cause of social harm, targeting them for deterrence, rehabilitation, retribution, and incapacitation. But criminologists have long recognized that crime is rooted in social institutions and processes, not individual wrongdoing.

The abolitionist critique gives public health advocates the opportunity to identify public safety as rooted in the democratization of economic and political institutions, and in the reduction of pervasive inequality. It also provides an opening for policy innovations that disrupt the criminal legal paradigm, such as community processes of truth and reconciliation; restorative justice programs in schools and courts; and embedding social work into the criminal legal process. Though conventionally framed as civil rights interventions, these policies are also public health interventions.

Collective reimagining as the precursor to innovative policy

Social movements have long helped expand our policy horizons through reframing. A recent example is the movement for marriage equality successfully reframing the conversation around freedom and family. And before that, advocates achieved the passage of the Americans with Disabilities Act by reframing disability from an individual problem to a social and environmental one.

Advocates have demonstrated how a once-fringe demand from a social movement for marginalized people can permeate public consciousness. As imaginations expanded as to what social solutions were possible and who could be included, so too did policy.

Today’s call from justice movements to “defund the police” invites the participation of public health and civil rights advocates to co-create what safety and security ought to look like. Jobs that pay a livable wage; neighborhoods full of trees; free, high-quality child care and mental health care; community centers with after-school activities for the young and rich social opportunities for older adults… A health justice perspective impels us to ask, what if squad cars and SWAT teams were the last line of response to social dysfunction, rather than the first?

Aysha Pamukcu is the founder of Movement Praxis and currently leads the Policy Fund at the San Francisco Foundation. 

Angela P. Harris is a Distinguished Professor of Law at the UC Davis School of Law.

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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