How Mass Incarceration Makes Us All Sick
In response to pandemic-era increases in violent crime in the United States, some policy makers, police bosses, and media outlets insist that the remedy lies in yet more policing and incarceration. These familiar lines reflect a racially coded, ideological manipulation at the core of the US criminal punishment system: If we don’t lock up the “criminals” who might harm “us,” “we” cannot ensure “public safety.” But data indicate that exponential growth in policing and incarceration over the past 40 years are themselves both symptoms and causes of poor public safety, not solutions for it.
After nearly half a century of ballooning incarceration rates, the US is no safer than peer nations that, on average, incarcerate at only 15 percent the rate the US does. Additionally, not only does the world’s largest system of human imprisonment not effectively deter crime, but, as COVID-19 has made clear and as I explain below, it also severely undermines national public health and global biosecurity.
Redefining public safety to account for the harms of policing and incarceration rather than continuing to cede this influential discourse to reductive criminological terms is key for ensuring health, security, equality, and positive freedom for all US residents. To be true to these ostensible national ideals, we must not only interrogate the meaning of “safety” but also of “the public.” In the context of US racial inequalities and an unequal criminal legal system, we must ask this: Who is included in and who is excluded from “the public” of existing public safety rhetoric––that is, who is prioritized and who is sacrificed in the name of safety for some, whose short-sighted particular interests are falsely represented as universal interests? With this in mind, I propose two intertwined emphases for reframing public safety: “carceral-community epidemiology” and the meaning of violence and government’s responsibility to protect communities from it.
Carceral Facilities Are Incubators Of Infectious Disease
The COVID-19 pandemic has provided an unusually stark illustration of the long-standing harms of America’s policing and incarceration practices. There are few better infectious disease incubators than US carceral facilities, where there have been at least 661,000 COVID-19 cases. Due to political refusals to adequately address overcrowding, poor health care, and poor living conditions, incarcerated people in jails and prisons have been at 5.5 times greater documented risk of SARS-CoV-2 infection and 3.0 times the risk of death relative to those in the general population. But these figures are almost certainly considerable underestimates. No one knows the real number of COVID-19 cases and deaths in jails and prisons because there exists no reliable system for collecting data, ensuring proper testing protocols, or supervising conditions inside a system well-known for human rights abuses, perverse incentives, and coverups.
What we do know is that for every COVID-19 case inside, there are many times more in surrounding communities as a consequence of spread from outbreaks at jails, prisons, and Immigration and Customs Enforcement (ICE) facilities. Carceral institutions are highly porous with the commuter flow of more than 405,000 guards and 30,000 people who are released from jails and prisons each day. In 2019, local jails alone featured 10.3 million annual admission-release cycles.
Jails and prisons are not like Vegas: What happens there does not stay there. Carceral institutions worldwide have long functioned as disease multipliers and epidemiological pumps for surrounding communities in relation to HIV, tuberculosis, hepatitis C, influenza, and other infectious diseases. With SARS-CoV-2, the US is now suffering an acute-on-chronic crisis that is making the fact that carceral conditions are inseparable from community health––the reality of “carceral-community epidemiology”—clearer than ever.
Furthermore, the unequal harms of US mass incarceration have intensified during the pandemic. In research with Daniel Chen published last summer in Health Affairs, we showed that spread of COVID-19 from a single jail accounted for close to 16 percent of all cases in Illinois last spring. Nearly all of the these cases appeared in majority-Black or -Latinx ZIP codes––an unsurprising result given that about 90 percent of detainees cycled through the jail are Black or Latinx. Our new study in Proceedings of the National Academy of Sciences specifically measures the degree to which jail-linked spread of the virus can account for racial disparities in COVID-19 infection rates. We find that cases attributable to the cycling of individuals through Cook County Jail in March 2020 alone accounted for 17 percent of total cases in majority-Black and/or -Hispanic ZIP codes and 21 percent of COVID-19 racial disparities in Chicago by August 2020. In the context of disproportionate policing of communities of color across the country, such jail- and prison-linked spread is almost certainly a major factor behind the racial disparities in COVID-19 cases and deaths observed nationally.
This is an urgent matter of racial justice. It is also a reality that threatens everyone. Biological networks mean that even the most segregated bodies are entwined by infectious diseases. An early modeling study, for example, estimated that 100,000 deaths in the US would be caused by spread of COVID-19 driven by carceral outbreaks. That study anticipated a total national death toll of 200,000. The US is now staring down the barrel of an anticipated toll of approximately 600,000 deaths.
Decarceration Can Prevent Epidemic Outbreaks
Fortunately, policy makers have at their disposal a clear means of preventing epidemic outbreaks at jails, prisons, and ICE facilities. Several studies have shown that decarceration is extremely effective at reducing disease spread in carceral contexts. Decarceration consists of three key policies: front-end diversion away from unnecessary incarceration, ending pretrial detention in nearly all cases, and release of roughly one million incarcerated people who do not pose a clear ongoing threat of violence to others and whose detention does not serve collective safety. These interventions were cited as best practices for protecting public safety during COVID-19 by the National Academies’ October 2020 expert policy consensus report.
As more infectious variants are now emerging and the pandemic is far from over, the public health and safety case for urgent decarceration remains clear. Although many US jails depopulated to a significant degree early in the pandemic, since the end of summer 2020, jail populations have rebounded toward prepandemic averages, despite the fact that carceral epidemics have continued at high rates. From the beginning of the pandemic until now, the stakes of decarceration have been clear, but policy makers have nonetheless refused to act.
Some have wishfully believed that vaccines would end the urgent need for decarceration. They don’t. This is in part because far too few states have properly prioritized incarcerated people for vaccination, let alone actually delivered vaccines. It is also because the effectiveness of vaccines depends, in part, on the epidemiological context in which they are used. In the context of high jail turnover rates, some of the highest viral reproduction ratios documented anywhere in the world, and significant rates of vaccine hesitancy among staff, vaccines alone appear unlikely to be sufficient to stop carceral outbreaks in the near future.
Unless large-scale decarceration measures are implemented, epidemics––of coronavirus but also much else––inside carceral facilities will continue operating as disease reservoirs that put those detained at unnecessary risk and pump out wide-rippling pools of sickness and death. Furthermore, it is certain that the present pandemic will not be our last. If policy makers do not address the way that mass incarceration undercuts national public health and global biosecurity, they will be inviting a repetition of our present catastrophe.
Redefining The Rhetoric Of Public Safety
Experts have sought to reassure skeptics that decarceration measures are safe, emphasizing, for example, that no increase in rebooking rates has been associated with hundreds of thousands of exceptional pandemic-associated releases. But efforts to pragmatically use existing “public safety” frameworks without explicitly redefining them risk misrepresenting the issue at hand and inadvertently perpetuating fear-mongering tropes. We must be very clear: It is mass incarceration itself that threatens our collective safety.
Despite this demonstrated fact, ideological resistance to decarceration remains strong and almost always involves the rhetoric of public safety. These conventional invocations of safety are dominated by narrow criminological metrics defined only by crime rates, ignoring the routinized harms of policing and incarceration that are themselves forms of violence enacted under the guise of protection. Incarceration doesn’t just incubate and spread infectious diseases; it also mutually reinforces poverty, racial inequality, homelessness, and cumulative economic and health disadvantage. In the wealthiest large nation on Earth, all of these harms should also be understood as violence from which government has a basic duty to protect communities. Instead, misleading safety rhetoric and cultural obsessions with interpersonal criminal violence––frameworks that obscure underlying structural violence and our collective responsibility to care for the most disadvantaged––perpetuate irrational, nationally self-destructive policies.
Public health scholars must reclaim and redefine the influential rhetoric of public safety to make clear that collective safety is best improved not by policing and prisons but rather by building robust public systems of care––that is, of economic security, environmental protections, labor rights, and housing. Evidence shows that mass incarceration is not an effective means of achieving public safety and that it is associated with severe harms for those exposed to incarceration, their families, and excessively policed communities of color. These harms include psychiatric and medical fallout––including increased rates of chronic diseases that impose long-term medical needs and cost––and reduced life expectancy. Even just pre-trial detention without a conviction enforces persistent economic hardships and drives high rates of unemployment, homelessness, and food insecurity. Clearly, the framework of carceral-community epidemiology applies well beyond infectious diseases: Incarceration is a powerful engine for the multiplication and dissemination of a broad range of intersecting injuries to individuals and to the body politic.
After decades of spending trillions to strip people of their rights, break family bonds, and imprint the mark of a criminal record that enforces long-term housing and employment challenges, the US has incurred a massive human debt. Simply opening the doors of jails and prisons will not be enough to repair the damage that has been done nor will moral projects of empathy, good will, or philanthropy that do not prioritize building strong public institutions of social support backed by sustained public dollars as essential to the abolition of mass incarceration. The payment of our collective debt and the abolition of mass incarceration will require a concrete program of large, targeted public infrastructure investments of the kind that the US government routinely allocates to police and military budgets, regime change and drone bombing, and tax cuts for the wealthy. Although there has been increasing bipartisan recognition that the US criminal punishment system must change, achieving real changes to massive problems requires that we act at a massive scale that has, to this point, been lacking in policy proposals.
For an effective national decarceration strategy, federal and state programs must provide support (for example, housing, guaranteed basic income, meaningful work, educational opportunities, community health worker services, and Medicaid coverage) to facilitate successful re-entry for formerly incarcerated individuals and must invest in racialized youth populations currently subjected to high risk of arrest. As a nation, we must restore to dispossessed communities the financial resources required to be free to craft full, satisfying lives on their own terms. Given the historic scale of wealth in the US, the obstacle to achieving this goal is not fiscal; it is political. To deconstruct the violence of America’s irrational, demonstrably racist incarceration and policing system will require political courage to face and overcome the hatred and fear that so many Americans have been taught to channel into our national obsession with endless cycles of punishment, retribution, and racial denigration.
Moralistic insistence on punishment rather than effective reintegration and care harms everyone. A sincere project to “build back better” must abolish mass incarceration and build in its place a genuine practice of justice. True justice is not a state we can ever claim to have triumphantly achieved; it is an open-ended project of infinite repair. Justice lies always beyond us, pulling us forward such that we might find courage enough to turn and face the haunting wreckage of our collective past so as to tend to the injuries we have caused. If we can bear the truth of this scene and own responsibility for remedy, we might yet someday learn to live together rather than in cages of our own making.