Continuing the conversation: Abolition, incarceration, and the public’s health

The U.S. criminal legal system is characterized by its unprecedented scope and its deeply ingrained racial and ethnic bias. But while over-policing and mass incarceration are now familiar concepts, the criminal legal system is rarely acknowledged for its importance as a social determinant of health. In a recent Public Health Conversation, the Boston University School of Public Health addressed the criminal legal system’s role in producing adverse and disparate population health outcomes and abolition as a path forward.

Public health offers valuable tools for identifying problems and solutions, said the panelists, who represented advocacy organizations, think tanks, and academic institutions. Health is widely agreed to be a basic need, and health status is measurable. A public health approach can identify immediate, pragmatic steps to reduce harm and upstream changes to reshape systems.

Panelists agreed that this public health approach is urgently needed. However, the roadmap to a less punitive, racist, and unhealthy criminal legal system is still being drawn. As Dana Rice (DrPH ’10), Assistant Professor at UNC Gillings School of Public Health pointed out, public health students and practitioners can become mired in questions of whether to reform existing systems or abolish them entirely. Other key themes from the discussion included:

• Harm reduction: For Insha Rahman of the Vera Institute, the goal of reform is not only to reduce encounters with the criminal legal system but to build “life-affirming institutions” that better serve community needs. She gave two examples of alternatives to traditional policing practices. Mental health first response, a strategy pioneered in Eugene, Oregon, sends trained crisis responders to 911 calls involving mental and behavioral health needs. These responders are better equipped than police to solve problems on-site, and far less likely to use violence. Another example is community violence intervention (CVI), a set of strategies that center on credible messengers who can de-escalate conflicts and connect individuals with services. The hospital-based Violence Intervention and Advocacy Program at Boston Medical Center is a well-established example of CVI, developed on the premise that “hurt people hurt people” and that trauma-informed services are needed to help break cycles of community violence. CVI is ever-more important since community violence spiked during the pandemic.
• Root causes: The end goal of abolition, Emile DeWeaver of Prison Renaissance argued, is to create conditions so that prisons are no longer needed. He said the root causes of imprisonment include poverty and childhood trauma, but the “root of the root” causes are White Supremacy and structural racism, which orient our systems towards the criminalization of people of color. Concretely, he said, the work of abolition is to center power in the communities that have been harmed most by the criminal legal system. Therefore, even when considering shorter-term harm reduction strategies, it is necessary to avoid further investing in unhealthy institutions—not only are these changes unlikely to work, but they will likely have to be undone later to create healthy institutions.
• Public health research: Zal Shroff of the Lawyers’ Committee for Civil Rights uses litigation to block harmful practices in the criminal legal system. One important cycle to break, he said, is between homelessness and incarceration, since people experiencing homelessness are exposed to heightened policing and formerly incarcerated people are more vulnerable to housing insecurity. Shroff and other panelists discussed how public health research can influence public policy, but must become more nimble and tailored to timely questions—research need not have completed the academic peer-review process to influence policymaking. As one successful example, Angela Aidala of Columbia Mailman School of Public Health shared results from her research on the FUSE initiative, a New York City project that used a housing-first approach to improve outcomes for adults exposed to the criminal legal system.
• Public health teaching: BUSPH and other schools of public health must highlight the importance of the criminal legal system to population health in a variety of ways. What are we doing at present? “Not much,” pointed out Dr. Rice, who laid out the importance of coursework that trains students to understand the criminal legal system and its intersection with other social determinants of health.

Now that decarceration and police reform efforts have slowed, it is necessary to jumpstart changes that will reduce the health harms and inequities associated with the criminal legal system. BUSPH has a history of challenging the status quo on over-policing and mass incarceration, and we are working across the university, including through a new initiative on Safety, Justice, and Health, which I co-lead with Jessica Simes, Assistant Professor of Sociology. In step with our community partners, our academic community must work together to advance proven strategies and innovate new ones.

Reflections were offered by moderator Dr. Jonathan Jay, DrPH, JD, Assistant Professor in the Department of Community Health Sciences at Boston University School of Public Health.

Watch the full Conversation here:

Abolition, Incarceration, and the Public’s Health from BU School of Public Health on Vimeo.