It is said that every system is perfectly designed to yield the results that it produces. In the U.S., an $85 billion criminal legal system executes higher mortality rates and yields a greater prevalence of mental health, chronic illness, infectious disease and substance use disorders in people subjected to it as compared to the general population.
The architecture of criminal punishment includes an often-opaque network of over 1,500 state prisons, 98 federal prisons, 3,100 local jails, 1,300 juvenile correctional facilities, and 140 immigration detention centers. How does the diagnosis of incarceration transform the health and livelihood of patients, providers, and the legal system at large? What insight can health outcomes, premature deaths, and clinical research provide in efforts to reform, redesign, or disrupt the blueprint and footprint of the criminal legal system?
In June 2024, a group of experts in the field of criminal system health convened at the Harvard Radcliffe Institute to establish consensus around the central problems that produce or accentuate disparities in health equity for people subjected to criminalization and punishment. This Speaker Series, The Diagnosis of Incarceration, will build on that emerging consensus and continue to explore the nature and extent of health inequities in the system. Organized into three parts, this series will first define what the system of care looks like for people who cycle through the criminal legal system; then move through discussions around the implications and outcomes of this system; and finally, conclude with an examination of case studies and practical examples from people working to build a different future. We will be joined by a multidisciplinary ensemble of guests to critically explore perception, policy, and practice surrounding healthcare and incarceration.
Recordings of previous events will be posted on our website on individual event pages (with links to resources) as well as on our .
September 18, 2024
Just How Bad: The Nature + Extent of Health Inequities for People in the U.S. Criminal Legal System
Panelists:
- Emily Widra (Prison Policy Initiative)
- Leo Beletsky (Northeastern University)
- Katie McCreedy (Northeastern University)
The introductory session to this series will examine the depth and breadth of health inequities faced by individuals in the U.S. criminal legal system and how organizations across the country have attempted to capture the scope of this issue. We will scrutinize the extent to which these measures may or may not accurately reflect the realities of life inside the system. In an attempt to address critical gaps in understanding, we will seek to identify what remains uncharted about the full impact of incarceration on health, highlight the limitations of current assessments, and discuss the implications for future policy and practice.
September 25, 2024
Health Check Up: Current Medical āStandards of Careā in U.S. Jails, Prisons, and Detention Centers
Panelists:
- William Weber (Medical Justice Alliance)
- David Himmelstein (Hunter College, CUNY)
- Erick Eiting (NYC Health & Hospitals)
This session will critically examine existing frameworks guiding healthcare practices in carceral facilities and how the structure of these institutions hinder or help incarcerated individuals access essential healthcare needs. Our expert panelists will help to highlight the gaps between established protocols and the lived experiences of patients to identify areas where the system falls short and leaves substantial room for improvement. We aim to discuss potential overhauls and innovative approaches aimed at reforming carceral healthcare, as well as the feasibility and challenges to their implementation. Join us to envision pathways toward a more equitable and effective system of carceral healthcare at the intersection of policy, practice and patient experience.
October 9, 2024
Who Watches the Watchers? Challenges to Oversight and Accountability in Carceral Healthcare
Panelists:
- Eunice Cho (American Civil Liberties Union)
- Marc Stern (University of Washington)
- Esmaeil Porsa (Harris Health)
Join renowned advocates and researchers as we engage in critical dialogue around the issues related to transparency and oversight of healthcare in jails and prisons. The exposure of egregious outcomes such as disproportionate rates of mortality in jails, prisons and detention centers has revealed major shortcomings in the monitoring of safety, quality, and efficacy of services provided in carceral settings. Expert panelists will share insight about the gaps in existing mechanisms and the importance of enhanced reporting requirements, independent monitoring bodies, and community-based oversight initiatives. We will explore potential approaches to improving transparency in who watches those who watch and operate largely in the darkness of a system with a dearth of accountability.
October 23, 2024
How to Count Those Who Donāt Count: Criminal System Health Data, Outcomes, and Research
Panelists:
- Lauren Brinkley-Rubinstein (Duke University)
- Keri Blakinger (independent press)
- Ingrid Binswanger (Kaiser Permanente)
- Craig Waleed (Disability Rights North Carolina)
The carceral healthcare system consists of hundreds of disparate institutions with distinct and complex recordkeeping practices that use both electronic and paper health records, public and private funding of health care services, and support varying degrees of access to available medications and treatments. In this session we tackle the challenge of collecting data around health disparities in the U.S. criminal legal system, a realm where data is often deliberately obscured. We will explore how when we are able to capture and interpret carceral health data, it pushes the boundaries of what we know about the impact of incarceration on health, and how system opacity and data manipulation on the part of carceral institutions render the health crisis of their patient populations invisible to public scrutiny and policy intervention. In particular, the COVID pandemic created a small window of transparency through which the world learned of the disproportionate death rates for those in custody and exceptionally disturbing trends in infectious disease exposure and vulnerability. By pairing an examination of innovative research methodologies and data collection strategies such as those created in the midst of the COVID pandemic with investigative human-first journalism practices, we aim to illuminate the urgent need for transparency in counting those who donāt always get counted, or accurately so.
November 20, 2024
Justice on the Frontlines: Case Studies in the Delivery of Community Healthcare & the Potential of Medicaid 1115 Policy as a Practice Changing Tool
Panelists:
- Sanjay Kishore (Equal Justice Initiative)
- Margaret Hayden (Equal Justice Initiative)
- Mary Bassett (FXB Health & Human Rights, Harvard University)
- John Card (Harvard Law School)
In this session we are joined by experts who have provided healthcare to individuals affected by the criminal legal system. A range of case studies will propel our discussion on the unique challenges to care and continuity in this patient population. We will discuss tactics and strategies stemming from models implemented in both urban and rural contexts, as well as states that have had varying degrees of access to Medicaid expansion services. Our expert panelists bring years of experience working on the integration of radical philosophical frameworks, collaboration with community health workers, as well as in the technology of telemedicine, and flexibility of mobile health clinics to address gaps in care. In the last few years, significant discussion has centered on the potential of Medicaid 1115 waivers to revolutionize health care delivery for those touched by the justice system by expanding funding for re-entry and other services. We will explore the promise of this pathway as well as its limits for systemic reform and the need for continued exploration of adaptable, sustainable policy-based healthcare solutions.
December 11, 2024
Broken Bars: Reimagining a Blueprint for Healthcare in and Beyond Carceral Settings
Panelists:
- Christine Mitchell (Human Impact Partners)
- Carlos Martinez (UC Santa Cruz)
- David Fathi (American Civil Liberties Union)
- Shamsher Samra (Harbor-UCLA Medical Center)
In this session we seek to envision a transformative future for carceral healthcare systems that breaks away from outdated frameworks to be responsive, inclusive, and centered on the well-being of individuals. Drawing on decades of experience and data, experts will help us reimagine a blueprint of solutions to systemic issues that have persisted and propose new directions to models that extend beyond traditional carceral systems to address both the immediate and long-term health needs of individuals. We will explore how technology could be leveraged for continuity of care, and the role of community-based interventions and policy reforms that prioritize equitable health access. We will also question how policy changes within and beyond healthcare systems can protect patients from criminal system contact ā particularly individuals already living at the margins. Through this discussion we look forward to inspiring a call to action for stakeholders to collaboratively develop and implement visionary strategies to drive meaningful and creative change into a reimagination of the framework of carceral care.
The Diagnosis of Incarceration speaker series is moderated and organized by Kennedy School MPA Candidate Dr. Cara MuƱoz Buchanan, in collaboration with Katy Naples-Mitchell, Program Director of the Program in Criminal Justice Policy and Management, and Sandra Susan Smith, Guggenheim Professor of Criminal Justice; Faculty Director, Program in Criminal Justice Policy and Management; Director, Malcolm Wiener Center for Social Policy; Professor of Sociology; and Carol K. Pforzheimer Professor at the Radcliffe Institute.