Prisons Are a Public Health Crisis — and the Cure Is Right in Front of Us
The best way to curb pandemics like Covid-19 is to abolish the conditions that breed their spread
This article is part of Abolition for the People, a series brought to you by a partnership between Kaepernick Publishing and LEVEL, a Medium publication for and about the lives of Black and Brown men. The series, which comprises 30 essays and conversations over four weeks, points to the crucial conclusion that policing and prisons are not solutions for the issues and people the state deems social problems — and calls for a future that puts justice and the needs of the community first.
As we deal with the scourge of Covid-19, which has killed more than 210,000 people and rising, policy and public health experts are clamoring for strategies to stop the spread of the virus, in absence of credible and competent leadership at the federal level. Most of what works (without a vaccine or highly effective treatment that reduces transmission to others), is known — if unevenly practiced or implemented.
There is inspiring work happening in the U.S. and globally around how to reduce transmission of Covid-19 (or any future airborne pathogens) in settings like prisons, jails, and detention centers. Yet, much of what is being discussed seriously are meager reforms that would only slightly reduce the number of people in those settings or releasing people who have comorbidities such as old age, asthma, and heart disease that may make them more vulnerable to illness and death should they contract Covid-19. Some of the reforms, like the use of biometrics and regular temperature taking (despite knowing many people can carry and transmit Covid-19 even while asymptomatic), introduce more forms of surveillance into prison and jail settings.
Very few of these plans acknowledge that these spaces create opportunities for the spread of infectious diseases. If we know that to be the case, public health activists who are truly interested in social and racial justice should in fact be calling for the abolition of the prison industrial complex as part of a strategy to reduce the possibility of current and future epidemics.
On March 31, the U.S. Bureau of Prisons announced the next phase of a plan to help curb Covid-19 exposure in federal prisons. Those measures included a 14-day confinement in cells. The memo states that “to the extent practicable,” incarcerated people would be allowed to participate in some education and mental health services and provide labor in areas that required workers to keep the facilities running. The memo also noted that “asymptomatic inmates are placed in quarantine for a minimum of 14 days or until cleared by medical staff” and “symptomatic inmates are placed in isolation until they test negative for Covid-19 or are cleared by medical staff as meeting CDC criteria for release from isolation.”
It is forcing people into conditions of squalor — all intended to be part and parcel of the sentence itself. A sentence to violence, deprivation, illness, and sometimes premature death.
The original memo made no mention about providing masks or any other personal protective equipment to incarcerated people, nor medical treatment to those who tested positive for Covid-19, until several days after the CDC’s recommendation.
Activist groups and some elected officials called for stronger measures to protect those in prison. Rep. Jerrold Nadler, D-NY, advocated for the release of incarcerated people who are pregnant, older adults, or suffering from other conditions that would make them more vulnerable to Covid-19 complications and death. Attorney General William Barr subsequently issued such an order, but only focusing on federal facilities in Louisiana, Connecticut, and Ohio — all of which were already showing extremely high rates of Covid-19. (State facilities and local jails have all had their own protocols for testing, treatment, and early release.)
But these measures have not been enough. In mid-August, the New York Times reported that the top 10 Covid-19 transmission clusters in the country were in prisons, jails, and detention centers. To date, about 233,000 persons incarcerated and staff at these facilities have contracted the novel coronavirus, and about 1,372 of those have died. As alarming as those numbers are, they are incomplete: Several states have not reported key data including the breakdown of infection rates among incarcerated people and prison staff, or demographic data like the race of those diagnosed.
“There’s no way to social distance,” Adamu Chan, an incarcerated person inside California’s infamous San Quentin prison, told the New York Times. “We all eat together. We have a communal bathroom. There’s no way to address a public health issue in an overcrowded facility.”
The disproportionate impact of Covid-19 in carceral settings, the incomplete reporting of data, and the minimal public health and health care standards being uniformly implemented is no surprise to anyone who has been inside a facility, has a loved one who is or was imprisoned, or works as staff. Prisons, jails, and detention centers themselves are well known to be incubators of infectious disease outbreaks. This is not the fault of those confined in carceral settings, but rather is a result of how societies view people whom they send to such places of forced confinement. To condemn one to such a facility is to judge not just their actions, but their person.
So punishment is not just taking away freedom of movement. It is forcing people into conditions of squalor — places that are overcrowded, violent, and without access to adequate (let alone high quality) health care — all intended to be part and parcel of the sentence itself. It’s a sentence to violence, deprivation, illness — physical and psychological, and spiritual — and sometimes premature death. According to the Bureau of Justice Statistics, 40% of all people in prison reported having a current chronic health condition, while over half said they have had a chronic medical condition at some point in their lives. And 21% of people in prison and 14% of people in jail reported ever having tuberculosis, hepatitis B or C, or other STDs. HIV rates in prisons are five to seven times higher than in the general population.
At the state and local levels, public health officials most often have no legal authority to implement or enforce sanitation, medical care, food, water, and air quality inside facilities, despite what might be written into state law or the codes of operation for carceral settings. It usually takes lawsuits on behalf of incarcerated people to enforce medical care, basic sanitation, or other public health measures.
Federally, the Centers for Disease Control and Prevention only provides guidelines for public health policies and procedures for carceral settings and have no enforcement authority over the Bureau of Prisons. These decisions about public health and health care mostly left to state departments of corrections — often down to the whims of the warden to implement or not. Medical staff are often part-time, and may not be qualified to provide care to people.
The recent scandal at an immigrant detention center in Southern Georgia demonstrates this. Dawn Wooten, the licensed practical nurse who worked at the center, is the whistleblower in the case against the facility where Mahendra Amin, MD, allegedly performed nonconsensual hysterectomies on scores of women. If true, not only is this a serious abuse of power, and in fact a violation of medical ethics and human rights, but Amin is not certified by any of the 24 member boards of the American Board of Obstetrics and Gynecology, according to news reports. While forced sterilization has a long history and has been fought primarily by reproductive and disability justice activists (mostly Black and Brown feminists), people in prisons, jails, and detention centers are often the most vulnerable still to these practices.
But this is not surprising. It is not uncommon for many facilities to employ doctors who do not have the training to perform certain kinds of medical care in carceral settings. Also, some doctors may take those jobs to abuse populations that have little power or access to systems of accountability. Wooten also alleged in her complaint that the conditions in the facility did not meet standards to best prevent the spread of Covid-19, nor did it even meet the standards for basic human decency. There is an unknowable number of cases of people who die in custody every year for being denied access to lifesaving care. In recent years several people with HIV in immigrant detention facilities were denied access to their antiretroviral medication, and subsequently died, most notably transgender activist Roxana Hernandez in 2018.
Whether it’s Covid-19, hepatitis, tuberculosis, or other infectious disease outbreaks that are regularly occurring inside carceral settings, we have to begin to think about these issues as constitutive of the prison industrial complex, not as aberrant. And the best strategy to help curb the spread of infectious diseases, and promote health among all people residing in the U.S., is to begin to put the same kind of energy, resources, and intellectual thought into what role a future without prisons can play in a future without Covid-19, or other pandemics. Bacteria and viruses will always exist and cause disease — but the conditions that breed pandemics are most often human-made.
Ending pandemics is going to take not only calls to defund the police or abolish the prison industrial complex, but to also plan for a new social contract. One that devises community-developed systems that provide for lives of dignity and joy, and minimize violence, greed, and deprivation. Our carceral system renders those who are locked in it as outside the parameters of citizens, of community members, and even outside notions of “the public.”
In order for public health to not ring as a meaningless phrase, we have to begin to tackle public health from an abolitionist framework, and not only expressed care or concern for the people on the outside who are not in prison now, or are not rendered as reasons for the carceral state to exist in the first place — Black, Latino, Native American, poor, homeless, queer, immigrant, transgender, sex worker, drug user, or dealer.
Our planning for future life should not end with our desire for the return of boozy brunches and taco Tuesdays. We should be planning for a future for human life. Prisons, jails, and detention centers are the antithesis of that by design.