police cars lined up.

Policing Public Health: Carceral-Logic Lessons from a Mid-Size City

By Zain Lakhani, Alice Miller, Kayla Thomas, with Anna Wherry

When it comes to public health intervention in a contagion, policing remains a primary enforcement tool. And where a health state is intertwined with carceral logics, enforcement becomes coercive; emphasis is placed on the control of movement and behavior, rather than on support and care.

Our experience in New Haven during the first few months of the COVID-19 pandemic well illuminates this, while also revealing a logic of exceptional force lying dormant in municipal health practices.

Attending to the local is all the more important, albeit difficult, for fast moving and intensely quotidian practices, as COVID in the U.S. seems to be settling in as a pandemic of the local.

Our experience as activist-scholars working with a New Haven-based sex worker-led harm-reduction service and advocacy group, SWAN, suggests that by focusing on municipal practices, we can better understand what public health police power actually is. By orienting our scholarship toward the way social movements engage with local politics, we can then address how these police powers complicate the ability of those most at risk of both disease exposure and police abuse to engage with local authorities. Absent this engagement and critique, progressive policies for constructive state public health powers may be more vulnerable to attack from the right.

Read More

Blue house in grass field.

Community-Based Response to Intimate Partner Violence During COVID-19 Pandemic

By Leigh Goodmark

Intimate partner violence has been called “a pandemic within the pandemic.”

A study of fourteen American cities found that the number of domestic violence calls to law enforcement rose 9.7% in March and April 2020, compared to the previous year. A hospital-based study spanning the same time period found significant increases in the number of people treated for injuries related to intimate partner violence. And a 2021 review of 18 studies relying on data from police, domestic violence hotlines, and health care providers found that reports of intimate partner violence increased 8% after lockdown orders were imposed.

Although almost half of people subjected to abuse never call the state for assistance, our responses to intimate partner violence are largely embedded within the state and rely heavily on law enforcement. A disproportionate amount of funding under the Violence Against Women Act — by one estimate, 85% — is directed to the criminal legal system. A growing number of activists skeptical of state intervention are arguing that responses beyond the carceral state are essential.

The pandemic showed that community-based supports, like pod mapping, mutual aid, and community accountability, originally developed by activists critical of law enforcement responses to violence, can foster safety and accountability without requiring state intervention. The pandemic could spur advocates seeking to distance themselves from state-based responses to expand their services.

Read More

Police car.

Blurring the Line Between Public Health and Public Safety

By Jocelyn Simonson

Collective movement struggles during the twin crises of COVID-19 and the 2020 uprisings have helped blur the concepts of public safety and public health.

These movements have shown how all of our public health and all of our public safety suffers when we use the police, prosecution, and prisons to solve our collective problems. Their collective resistance to the status quo underscores how these terms — public health and public safety — too often carry with them an exclusionary understanding of which “public” matters.

Read More

Prison watch tower.

Government Report Finds Care Deficits for Pregnant People in Federal Custody

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

Up close shot of an orange prison jumpsuit

COVID-19 and Women in the US Criminal Legal System

By Cynthia Golembeski, Carolyn Sufrin, Brie Williams, Precious Bedell, Sherry Glied, Ingrid Binswanger, Donna Hylton, Tyler Winkelman, and Jaimie Meyer

Health and economic inequities exacerbated by the COVID-19 pandemic disproportionately harm women, and particularly women of color, involved in the criminal legal system.

Structural racism, sexism, poverty, substandard healthcare in jails and prisons, and the health effects of incarceration worsen women’s health. The pandemic only compounds these effects. Often overlooked or less visible, incarcerated women are at significantly increased risk of acquiring infectious illness, including COVID-19.

Alternatives to incarceration, and care continuity for chronic health conditions, including substance-use and psychiatric disorders, which disproportionately affect women, are necessary within the current pandemic and beyond.

Read More

Austin, Tx/USA - May 23, 2020: Family members of prisoners held in the state prison system demonstrate at the Governor's Mansion for their release on parole due to the danger of Covid-19 in prisons.

Jails and COVID-19: An Overlooked Public Health Crisis in Philadelphia

By Katherine Zuk

Since the start of the pandemic, jails and prisons have continuously struggled to stop the spread of COVID-19 cases.

The novel coronavirus has been ravaging the U.S. since late February, with over 6 million cases and 185,092 deaths. Emerging data shows alarmingly high rates of COVID-19 in jails and prisons nationwide, including over 85% of inmates testing positive at two facilities in Ohio. As of September 3, there have been at least 180,045 cases and 928 deaths in prisons alone – and many fear these numbers are severely underreported.

Philadelphia offers an unfortunate case study.

Read More

corridor with hospital beds

Hospitals Bear the Costs of Detention and Incarceration

By Blake N. Shultz and Pooja Agrawal

While individuals with recent criminal justice involvement represent only 4.2% of the population, they make up 8.5% of all emergency department (ED) expenditures, which translates to an additional $5.2 billion in annual spending across the health care sector.

The federal government has complete control over access to medical care for incarcerated individuals and immigrants in detention facilities, and is primarily responsible for the quality of the sanitation, nutrition, and shelter accommodations. Despite this level of control, conditions in many detention facilities and prisons are exceptionally poor.

Over eighty percent of recently released prisoners are uninsured, and upon re-entry into society they struggle to obtain quality medical care for both pre-existing conditions and those that may have been caused or exacerbated by detention.  As they often do not have a medical home, upon release many will present to emergency departments (EDs) for their health care needs, and, because of the low rates of insurance coverage, hospitals are left to pick up the bill for the gaps in care created by the government’s deficiencies.

The disaggregation of government detention facilities and financial responsibility for downstream health care costs of released individuals creates a “regulatory moral hazard,” in which the government has little incentive to invest in the health and health care of incarcerated and detained individuals. In the absence of federal reform incentivizing investment and reducing cost-shifting to the health care sector, hospital systems should build interdisciplinary care teams focused on formerly incarcerated and detained individuals while investing in comprehensive, community-based health care.

Read More