Amber Akemi Piatt, Health Instead of Punishment Program Director, Human Impact Partners
Two years into the COVID-19 pandemic, the field of public health has sprinted a marathon to address the ongoing crisis — we have implemented mass vaccination plans, pushed back against misinformation campaigns, and taken action in the face of slashed budgets and outright assaults on our lives. But as a public health researcher and advocate, I believe there is a critical place where we have fallen short, and with dire consequences: connecting the dots between incarceration and health.
Jails and prisons — including Immigration and Customs Enforcement (ICE) detention centers — have remained consistent sites of COVID-19 outbreaks throughout the pandemic. This is not surprising. Due to overcrowded living conditions and lack of adequate health care, carceral facilities have long failed to prevent, contain, and treat infectious diseases. Studies that predate the pandemic show a high prevalence of scabies, lice, influenza, tuberculosis, hepatitis, and other public health hazards in jail settings. With a virus as contagious as COVID-19, we have seen especially catastrophic impacts on incarcerated people. ICE detention facilities have reported a COVID-19 case rate 13 times higher than that of the general U.S. population. Recent reporting from The Prison Policy Initiative reveals that “the COVID-19 death rate in prisons is almost three times higher than among the general U.S. population, even when adjusted for age and sex (as the prison population is disproportionately young and male).”
This is a devastating tragedy in its own right and, at the same time, it is important to emphasize that the public health crisis in carceral facilities has wide-reaching impacts. More cases inside prisons and jails means more outside of them, too. Another statistical analysis by the Prison Policy Initiative estimated that United States incarceration added about 566,800 cases — among people both inside and outside of carceral facilities — between May 1 and August 1, 2020 alone. That’s roughly 13 percent of all new U.S. cases for the same time period.
What’s Public Health’s Role in Addressing Incarceration?
Public health actors — from philanthropy to academia to government to nonprofit organizations to member associations — are increasingly speaking out about the health harms of incarceration. The organization I work for, Human Impact Partners, has long advocated that public health must address the harms of incarceration and policing to advance community safety, racial justice, and health equity, and we have produced a substantial body of research in support of such a strategy. In 2018, the Robert Wood Johnson Foundation published an in-depth report on how incarceration threatens health equity in America. A group of public health scientists from major academic institutions have come together through the COVID Prison Project to provide data and analysis on how COVID-19 is impacting incarcerated people. In 2020, the Director of Jail Health Services at the San Francisco Department of Public Health repeatedly urged county executives to release people from the jail to protect public health. Last year, the American Public Health Association (APHA) passed a policy statement on why prison abolition is an evidence-based solution to the health harms of incarceration.
This is a great start. And we can and must do more.
Structural Solutions to Incarceration that Center Equity
Public health is notoriously better at describing problems than solutions. We must move beyond simply naming incarceration as a public health issue, and we must take great care to uplift solutions that are structural, evidence based, and equitable as we do.
Big problems require big solutions. When tackling other public health issues — like food insecurity or housing instability — we aim high. We launch zero hunger initiatives and we aspire to have zero people sleeping on the streets. Incarceration should be no different. As a field, we know that if we want to improve community health and advance health equity we cannot focus on individual behavior change; we must shift the structures, systems, and environments that shape people’s conditions and predetermine their choices.
Why, then, do we exceptionalize behavior that is criminalized? Why do we understand that smoking cigarettes and eating highly processed food are choices driven by targeted marketing, lack of access to alternative coping mechanisms, and neighborhood design, but still believe drug use, theft, sex work, and even violence are somehow inherently individual moral failures?
In reality, the criminal legal system handles issues that are largely social, political, and economic in nature. A public health approach would give us better results. Are public health workers, organizations, and funders willing to put their neck out to demand it be so?
Let’s Get Political
Public health today is more politicized than it was before the pandemic, yet it is paradoxically decreasingly political. Ed Yong’s October 2021 piece in The Atlantic argues: “As the 20th century progressed, the field [of public health] moved away from the idea that social reforms were a necessary part of preventing disease and willingly silenced its own political voice.” As a public health worker, I feel both deep resonance with what he writes and also dissonance with what I know to be true. Yes, as a field, public health has buckled under the pressure to pursue policies, create norms, and maintain systems that do not challenge the root cause of illness, injury, and death: structural oppression. But also, yes, there are public health workers — and increasingly, organizations — who are standing fiercely in their radical politics, fighting for the soul of our field and for justice in our communities.
In this incredibly polarized time, it is critical that public health practitioners (re)embrace the political nature of our work. That means promoting solutions that actually get us where we need to be without simply dressing up or putting a band aid on the system. We would not tackle black mold in public housing by just throwing a fresh coat of paint on the walls or write painkiller prescriptions to combat high levels of lead in people’s drinking water. Such “solutions” do nothing to solve the actual problems; in fact, they create more problems than they solve.
We must ensure that our solutions to the public health crisis of incarceration do not inadvertently cause new harm or perpetuate inequities. Ankle monitors, for example, are often pointed to as a possible alternative to incarceration but have been shown to lead to job loss and cause foot swelling, cramps, and burning of the skin as the ankle monitor charges. We need to bolster non-police, non-carceral systems of safety, care, and accountability while also stripping power and resources from the carceral system.
The Path Forward: Embracing Change, Building Power, and Fostering Hope
I believe in a public health that is unapologetically political; repairs the harms it has directly and indirectly caused, especially to Black and Indigenous communities; and stands shoulder-to-shoulder with communities and grassroots organizers who are building the people power necessary to create a better world. We all have a responsibility to address the harms of incarceration. Specifically, funders should give long-term, unrestricted grants to the grassroots organizers and policy advocates who are leading change.
As abolitionist organizer, educator, and curator Mariame Kaba says, “hope is a discipline.” With our combined resources, commitment to justice, and grit, having hope feels easy. I can imagine a future where we respect and protect the right of all people to live freely and with dignity, where we foster our ability to learn from our mistakes, keep each other safe, and hold each other accountable with love. Can you?