By Matthew Chun
He Jiankui — a high-profile Chinese scientist convicted for conducting unethical gene-editing experiments — has been released from prison and is currently fundraising for his new gene therapy endeavor. As the scientific community grapples with how to respond, theories of criminal justice can provide important perspectives to better inform the conversation surrounding Dr. He’s return to research.
By Lindsay F. Wiley and Ruqaiijah Yearby
As our digital symposium on health justice comes to a close, we have much to be thankful for and inspired by. We are honored to provide a platform for contributions from scholars spanning multiple disciplines, perspectives, and aspects of health law and policy. Collectively with these contributors, we aim to define the contours of the health justice movement and debates within it, and to explore how scholars, activists, communities, and public health officials can work together to engage critical perspectives in health law and policy.
As we described in our symposium introduction, the questions we posed to contributors focused their work on four main themes: (1) subordination (including discrimination and poverty) is the root cause of health injustice, (2) subordination shapes health through multiple pathways, (3) health justice engages multiple kinds of experiences and expertise, and (4) health justice requires empowering communities, redressing harm, and reconstructing systems. Most of the contributions to this symposium cut across more than one of these themes, but we present them here in four broad categories.
By Ruqaiijah Yearby and Lindsay F. Wiley
Public health scholars, advocates, and officials have long recognized that factors outside an individual’s control act as barriers to individual and community health.
To strive for health equity, in which everyone “has the opportunity to attain . . . full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance,” many have adopted the social determinants of health (SDOH) model, which identifies social and economic factors that shape health. Yet, health equity has remained elusive in the United States, in part because the frameworks that most prominently guide health reform do not adequately address subordination as the root cause of health inequity, focus too much on individuals, and fail to center community voices and perspectives.
The health justice movement seeks to fill these gaps. Based in part on principles from the reproductive justice, environmental justice, food justice, and civil rights movements, the health justice movement rejects the notion that health inequity is an individual phenomenon best explained and addressed by focusing on health-related behaviors and access to health care. Instead it focuses on health inequity as a social phenomenon demanding wide-ranging structural interventions.
This digital symposium, part of the Health Justice: Engaging Critical Perspectives in Health Law & Policy Initiative launched in 2020, seeks to further define the contours of and debates within the health justice movement and explore how scholars, activists, communities, and public health officials can use health justice frameworks to achieve health equity.
By Elyssa Spitzer
Pregnant and postpartum people in the custody of the Bureau of Prisons (BOP) and U.S. Marshals Service receive care directed by policies that fail to meet national standards, according to a report recently issued by the Government Accountability Office (GAO).
This, despite the fact that, incarcerated women are among the most vulnerable people, according to the American College of Obstetricians and Gynecologists. In the GAO report’s terms, incarcerated women: “often have medical and mental health conditions that make their pregnancies a high risk for adverse outcomes, which is compounded by inconsistent access to adequate, quality pregnancy care and nutrition while in custody.”
Notably, the report found that the BOP and U.S. Marshals’ policies failed to satisfy the national standards — to say nothing of the gaps that may exist between written policy and the care that is, in fact, provided. Read More
By Francis X. Shen
A core failing of the criminal justice system is its inability to individualize criminal sentences and tailor probation and parole to meet the unique profile of each offender.
As legal scholar, and now federal judge Stephanos Bibas has observed, “All too often … sentencing guidelines and statutes act as sledgehammers rather than scalpels.”
As a result, dangerous offenders may be released, while offenders who pose little risk to society are left behind bars. And recidivism is common — the U.S. has an astounding recidivism rate of 80% — in part because the current criminal justice system largely fails to address mental health challenges, which are heavily over-represented in the justice system.
Advances in computational psychiatry, such as the deep phenotyping methods explored in this symposium, offer clinicians newfound abilities to practice precision psychiatry. The idea behind precision psychiatry is both simple and elusive: treat individuals as individuals. Yet advancing such a program in practice is “very ambitious” because no two individual brains — and the experiences those brains have had over a lifetime — are the same.
Deep phenotyping offers the criminal justice system the tools to improve public safety, identify low-risk offenders, and modify decision-making to reduce recidivism. Computational psychiatry can lead to what can be described as precision sentencing.
By Caroline Hinnenkamp
Racial disparities in the U.S. criminal justice system are well documented –– people of color are disproportionately arrested, convicted, and incarcerated.
Diversion efforts –– so named for their approach, which is to divert individuals away from the court process and instead offer opportunities for rehabilitation –– risk perpetuating these same racially disparate trends. Particularly if diversion programs have eligibility constraints based on prior records, people of color are more likely to be denied entry, because they are arrested and convicted at a higher rate than their white counterparts.
Historically, prosecutors tended to justify these constraints as mechanisms used to gauge an applicant’s capacity for rehabilitation, with recidivism (the tendency of a convicted criminal to reoffend) reduction as the central goal of diversion. Diversion was an alternative offered to the lucky few deemed “eligible” or “deserving,” with the implication being that reoffenders have a criminal disposition that is not amenable to rehabilitation.
But programs that use these screening methods tend to overlook the underlying facts and circumstances that might have brought about the applicant’s priors, such as implicit bias in law enforcement or the over-policing of specific communities. Without additional safeguards, the seemingly neutral constraint of “priors” fails to account for relevant pre-existing conditions, and risks barring entry to applicants who might otherwise benefit from diversion.
By Phebe Hong
The first death of a federal inmate from COVID-19 occurred on March 28, at a prison in Oakdale, Louisiana. The inmate had been incarcerated for 13 years for a nonviolent drug charge. At least four other infected inmates have died at the same institution.
The COVID-19 pandemic is wreaking havoc on prisons and jails, where proper social distancing is nearly impossible to maintain.