- By FYH News Team
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Introduction
The COVID-19 pandemic and the ongoing epidemic of mass incarceration are closely intertwined. Despite containing less than 5% of the world’s population, the USA has recorded 66 526 927 confirmed cases as of Jan 18, 2022, accounting for 20% of the world’s COVID-19 infections and 15% of deaths.
Similarly, a disproportionate percentage (25%) of those incarcerated across the globe are in the USA.
According to the COVID Prison Project, state prisons have over three times the rate of COVID-19 infections than the general population, and most of the largest COVID-19 outbreaks in a single site in the USA have been in prisons and jails.
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People who are incarcerated, staff who work in carceral facilities, advocates, and researchers have long known that incarceration negatively affects health and wellbeing. These harms include individuals’ physical health (eg, increased mortality after release from prison) and mental health (eg, trauma), family members’ physical and mental health, and the community’s health (eg, HIV incidence).
However, the pandemic has made many people aware of the widespread effect of the criminal legal system on health and the need for increased efforts towards prisons and jails: notably, in October, 2021, the American Public Health Association formally recommended “moving towards the abolition of carceral systems”.
The COVID-19 pandemic spotlights health harms of mass incarceration
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Akiyama and colleagues
highlighted the pervasive risk of infectious diseases in jails and prisons (eg, hepatitis C and tuberculosis), how the 2009 H1N1 influenza pandemic exposed the lack of preparedness of carceral settings, and how prisons and jails are largely unable to follow physical distancing measures. The Prison Policy Initiative documented how prisons and jails did little to reduce their populations during the pandemic.
The Marshall Project revealed the lack of implementation of COVID-19 protocols in prisons and jails.
In light of this, Nowotny and colleagues
amplified the need for progressive criminal legal reform based on a prison abolitionist ethic to address the public health emergency of mass incarceration itself. In the year that followed, these warnings had not been heeded quickly enough, incarcerated populations had been deprioritised, progressive reform had been ignored (eg, the Centers for Disease Control and Prevention does not mention decarceration as a mitigation strategy),
and COVID-19 had infected and killed those in carceral settings at rates that far outpace that of the general population.
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Although, these discussions have long been taking place in the academy among those focused explicitly on mass incarceration, among advocates and impacted communities, their attention in popular media and the general public provides a time-sensitive imperative to act. The urgent nature of this action is punctuated by the American Public Health Association finally adopting the statement in October, 2021, that mass incarceration poses a threat to public health.
This is reiterated by Bailey and colleagues who describe how mass incarceration and police violence are facets of structural racism, defined as “the totality of ways in which societies foster [racial] discrimination, via mutually reinforcing [inequitable] systems… (eg, in housing, education, employment, earnings, benefits, credit, media, health care, criminal justice, etc) that in turn reinforce discriminatory beliefs, values, and distribution of resources”, reflected in history, culture, and interconnected institutions.
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Mass incarceration not only affects individuals with criminal legal contact, but affects entire communities in which mass incarceration is concentrated. These disproportionately Black, low-income communities are often heavily overpoliced, and a large number of people are removed from these communities or under state control through community supervision. This high level of criminal legal involvement disrupts social and family networks and relationships, erodes social capital, and lowers informal social control, affecting the wellbeing of communities.
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Nevertheless, data on those incarcerated has largely been absent from nationally representative health datasets.
Less than 0·1% of US National Institutes of Health funded grants focus on mass incarceration,
and the topic of mass incarceration has largely been absent from epidemiological studies and analyses, masking the harmful and reverberating effects of this system on health, specifically racial and ethnic health inequities.
Towards a carceral epidemiology
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Furthermore, the more we are able to see structural racism and, in turn, mass incarceration, as the modifiable risk factors they are, the better we will be able to address health inequities.
Residential segregation and housing opportunity are extensively researched as key proxies of structural racism, since they often set the stage for race-implicit distribution resources and hazards.
For example, most residents in the USA live in racialised and economically segregated neighbourhoods, such that neighbourhoods in which people of colour reside have a high concentration of dilapidated housing, poor social and built environments, high exposure to pollutants and toxins, and low access to quality health care—all of which are associated with poor health—when compared with predominantly White neighbourhoods.
Mass incarceration must also be considered as one of the integral mutually reinforcing systems that operate together to drive structural racism, as mass incarceration not only steps from racialised policing practices in segregated communities, but also fosters racial and ethnic inequalities in social determinants of health including housing, employment, and access to health care, reinforces stereotypes that are the basis of discrimination, and consequently drives racial and ethnic health inequities.
Although prisons and jails have high COVID-19 infection rates overall, given their congregate living settings, overcrowding, and minimal COVID-19 mitigation, poor underlying health is also associated with transmission and severity of disease.
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Much of the disproportionately poor health among incarcerated populations is driven by underlying, society-wide disparities in health combined with higher incarceration rates in Black, Native American, and Latinx communities when compared with White communities.
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Again, these inequities are observed in the COVID-19 pandemic. Black individuals are more likely to develop severe COVID-19 outcomes, being hospitalised at 2·9 times the rate of White individuals.
The mortality rate of COVID-19 for Black individuals is 2·75 times the rate of White individuals and for Hispanic individuals it is 4·18 times the rate of White individuals, with these disparities being heightened among younger age groups.
These inequities are also present within carceral systems. In Vermont, USA, where these data are available, Black prison residents experience 2·3 times the risk of acquiring COVID-19 compared with White prison residents.
Yet, widespread COVID-19 data by race within prisons and jails are largely absent, making it impossible to understand the racial health inequities present among those involved in the criminal legal system.
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Beyond these factors, with over 200 000 people coming in and out of correctional facilities in any given week,
a large proportion of community COVID-19 cases have been attributed to incarceration (eg, jail churn) across the USA.
The vast health inequities we are able to document with our scarce data, and the need for more transparently reported data, further emphasise the need for epidemiology to focus on mass incarceration as a structural determinant of health and as a key mechanism of structural racism.
Conclusion
When we decide that issues such as abolition are outside of our scope of work, we betray both our field and the health of those affected by mass incarceration. We, as researchers and advocates, must address the harms of the carceral system by not only pursuing carceral epidemiology, but also reducing the incarcerated population;
, investing in social determinants of health rather than carceral systems; committing to non-carceral measures for accountability, safety, and wellbeing; restoring voting rights for those with criminal legal involvement; and funding research to evaluate determinants of exposure to the criminal legal system and propose alternatives.
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KL conceptualised, drafted, reviewed, edited, and finalised the manuscript, and did the literature searches. LB-R and KN conceptualised, reviewed, and edited the manuscript, and acquired funding. MM and MP did the literature searches, and drafted, reviewed, and edited the manuscript. ZB conceptualised, reviewed, and edited the manuscript.
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