No individual leaves prison or jail healthier than when they arrived. Every encounter with law enforcement—including arrest, criminalization, and incarceration—is associated with illness and premature death.The experience of incarceration is so damaging to one’s health that health-care workers, scholars, and formerly incarcerated people have identified Post Incarceration Syndrome as a discrete condition that is now under review for diagnostic criteria.
That is why, as a coalition of community members and public health professionals, we are deeply concerned by and opposed to Sheriff Marlin Gusman’s proposed plans to expand the city’s jail, including the continued operation of the Temporary Detention Center (TDC). Extensive research and our own lived experience conclusively show that imprisonment creates adverse health outcomes for all people (particularly those with preexisting illness, including mental illness). There is no evidence to support the belief that jail expansion, which necessarily leads to increased incarceration, enhances public safety. Furthermore, our city is in dire need of funds for social services—we see this crisis every day in our communities and in the lives of our patients. We need to shut down the Temporary Detention Center (TDC), and we need to divert all relevant funds out of corrections and into social goods.
Although our most urgent concern is the need to close the TDC, we cannot begin to discuss the harmful consequences of expansion without first acknowledging the deleterious effects of imprisonment on currently imprisoned people. This is demonstrably true, consistently borne out by facts and research, writ large, and specifically true within the facilities over which Sheriff Gusman presides. Within those facilities, death—including by suicide—and other forms of negligence are endemic and well-documented in local and national media. Sexual misconduct by guards also has come to light, and these are just the incidents we hear of. The tremendous barriers imprisoned people face when bringing their conditions to light, and the opacity of these institutions when disclosing such tragedies, ensures that such harms are far more widespread. All of this violence and neglect is occurring within the context of a federal consent decree. It is irresponsible to place more human beings in harm’s way, full stop. But the reckless disregard for their safety even under consent decree is further cause for alarm.
These impacts fall particularly heavily on the most vulnerable populations in our city, including New Orleans’ undocumented residents who are far less likely to seek health care due in part to fear of deportation. This has been made painfully clear by stories like that of Yoel Alonso Leal, a chronically ill asylum seeker who was denied proper medical care for months at Louisiana detention centers. ICE deported Leal in September despite community outcry and concerns from medical professionals that his lung cancer was so severe he might have passed away on the plane. Nobody should be denied health care, frightened to seek it, or face retaliation, due to their documentation status. Right now, Louisiana is one of the top three imprisoners of immigrants in the country, both in public and private facilities. The facilities in which they are being held are nothing short of a public health atrocity with far too few health care professionals per detainee and detainees regularly falling ill or dying in custody, as well as facing deportation despite life-threatening conditions. This disturbing reality is directly responsible for the American Public Health Association’s recent denunciation of the practices implemented in these facilities. If the Temporary Detention Center is not closed, there is no reason to think it wouldn’t be used (as many jails are) to detain asylum seekers and other undocumented people.
Prisons like Orleans Parish Prison (OPP) also represent a direct public health threat. While Louisiana has recently taken measures to combat Hepatitis C in prisons, carceral settings remain the spaces in which new infection rates are the highest in our state. People leaving prison take the physical and mental health consequences of imprisonment with them: public health implications of imprisonment extend beyond cell walls. A 2018 study published in the international peer-reviewed journal Annals of Epidemiology suggests that Black people who live in neighborhoods with high rates of incarceration have worse cardiometabolic health profiles than those who live in neighborhoods with lower incarceration rates, and that criminal justice reform may help reduce these race-specific health disparities. Related studies, including a 2015 report by researchers at the University of Pennsylvania, Minnesota, and Georgia have found that individuals who reside in states with larger numbers of former prison inmates have diminished access to healthcare, less access to specialists, less trust in physicians, and less satisfaction with the care they receive.
Not even the infants of New Orleans are spared by incarceration’s catastrophic fallout. New Orleans’ maternal and infant mortality rate is among the worst in the industrialized world, with a stark racial disparity. A 2012 study by Christopher Wildeman revealed that high imprisonment rates are associated with higher total infant mortality rates, high racial inequality in infant mortality, and a high Black infant mortality rate beyond that of their Hispanic and White counterparts. Evidence informs us that jail expansion is literally killing babies. For those who survive birth and become children or young adults, the outlook remains bleak. A 2003 Stanford University study found that children of imprisoned individuals are up to six times more likely than their peers to be convicted of a crime or imprisoned. The imprisonment of a parent is a serious risk factor for antisocial behavior, mental health problems, drug use, school failure and unemployment for the remainder of a child’s life, according to a 2012 study led by researchers at the University of Cambridge. In recent years, New Orleans has sought to reframe the issue of children participating in criminalized activities, acknowledging that root causes have a lot to do with unaddressed serious trauma and a lack of social and economic resources. Yet at the same time, our city continues to criminalize youth activities through measures such as a curfew and, even more alarmingly, by placing children in adult jails, leading to death and immeasurable damage to mental health.
As health professionals, we understand safety as applying not just to the individual but to the condition of the entire public. It is inextricably tied to a variety of factors including consistent access to stable housing, food, health care (including mental health care), and social services. A city is only as safe or healthy as it is for its most vulnerable residents: undocumented people, unhoused people, people with mental illness, people of color, low- and no-income people, people with disabilities, people who use drugs, LGBTQ people, the young, and the elderly. There is no definitive correlation or consensus between increased criminalization and improved public safety. However, many studies fail to acknowledge that carceral facilities—as a public entity itself—perpetrate violence, rape, and other harms that would be criminalized if committed by an individual. How can jail expansion make us safer when the jail itself is a menace?
Regarding the Sheriff’s argument that the jail needs to be expanded to provide permanent housing for people with mental illness, we utterly and indefatigably reject the premise. People with mental illness are 10 times more likely to be victims—not perpetrators—of violence. When incarcerated, they are subjected to conditions that would lead a previously healthy person to develop symptoms of mental illness. They have difficulty accessing care, and they are isolated from their support systems. In public meetings regarding these proposed expansions, we have been told by city officials that officers and prison staff will receive training to recognize and treat symptoms of mental illness. Why take these expensive and dubious measures when there are already professionals who have spent their entire careers recognizing, treating, and caring for patients? As the saying goes, “you can’t get well in a cell.” Prison officials are not public health nor medical practitioners. We are. New Orleans should be eliminating imprisonment as an approach to every social ill we continue to shrug off. The truth is, imprisonment makes our communities sicker and less safe.
Rather than expanding our jails, our common funds—the yield of our taxes, our combined wealth—can and must be allocated to proven, evidence-based programs for treating people with mental health needs and other goods outside the purview of the Department of Corrections and Sheriff Gusman, who has presided over enough violence and death. The Orleans Parish Sheriff’s Office (OPSO) budget in 2017 was more than $77 million, with over $50 million allocated for direct jail costs. Sixty-three percent of New Orleans’ city budget in 2017 was spent on public safety, compared with just 19 percent spent on children and families, sustainable and resilient communities, and economic development combined. Every dollar spent on incarceration is a dollar not spent on infrastructure. It is a dollar not spent on programs directly and indirectly related to protecting and improving the social good of public health that keep New Orleanians safe. Social goods like flood protection, mental health and substance abuse treatment, job training, and affordable housing, to name a few.
New Orleanians experience one of the highest poverty rates of any major city in the country. This reality comes with its own set of public health ills, all inextricably tied with criminalization and imprisonment. The whole country is watching as we struggle to eliminate some of the points at which money is extracted from already low-income New Orleanians. Let us become a model for public health-informed approaches to public safety rather than yet another cautionary tale, yet another “worst performing” score by this country’s evaluations of nearly every quality of life metric.
Instead of continuing to pour our funds into incarceration, the engine of illness and inequity, we must use those funds to expand services that make New Orleanians healthier and more stable, and increase accessibility to safe, affordable housing, education, and nutritious food. We must use those funds for community-based health services, particularly for our neighbors living with mental illness and those disproportionately affected by our failure to do so to this point.
As public health professionals, caregivers, health care workers, and community members, we can say with certainty: jail expansion and increased funding do not reflect the best interest of our patients, communities, or ourselves. This moment is an existential crisis for our city. Are we going to acquiesce to state trends of increased incarceration of undocumented people and tepid reforms? Are we going to submit to the national policy of responding to every social problem with cages and camps? Or are we going to step up and say: “Our health matters. We are a city that intelligently responds to scholarly research, data, best practices, and morality.”
Louis Gregory is a public health advocate and is currently studying to be a civil rights attorney at Tulane Law School. He is the former President of the Yale Chapter of the American Public Health Association.
This column is supported by the following community organizations and public health professionals:
Trystereo New Orleans Harm Reduction Network; New Orleans Democratic Socialists of America’s Healthcare Committee; New Orleans Abortion Fund; Joanna Dubinsky, Physician Assistant; Stephen Anen, PhD; Catherine Jones, MDl Alana Carstens Yalom, MD/MPH Candidate; Christine Breland Lobre, MHS, MPH, LPC; Nora Maria Fuller, MD Candidate; Michelle “Crow” Lopez, Housing Social Worker; Allison Tebbe, Certified Rehabilitation Counselor, Certified Brain Injury Specialist; Ali Khoobehi MD, FACS; Kalila Pellerin, LCSW; Kristen Markel, BSN; Sabrina Lewis, MSW; Birthmark Doula Collective; Ashley Hamilton, Doula, LLC; Stephanie Visco, Doula, LLC; Audrey Stewart, Doula, LLC
The opinion section is a community forum. Views expressed are not necessarily those of The Lens or its staff. To propose an idea for a column, contact Lens Founder Karen Gadbois.