/‘We don’t have a health system:’ Expert on prisons, race, and COVID-19

‘We don’t have a health system:’ Expert on prisons, race, and COVID-19

We continue our series of articles that explore the racial health disparities exposed by COVID-19. In this interview, we examine the issue of incarceration as a public health concern in the United States, as well as the toll it takes on black communities, especially in the context of the pandemic.

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The importance of incarceration for public health often gets overlooked. (Photo by Dan Kitwood/Getty Images)

According to some of the most recent data, black Americans are 2.4 times more likely to die of COVID-19 than their white counterparts, and 2.2 times as likely as Asian Americans and Latin Americans. Other studies have also suggested that black communities, followed by Latinx communities, are being hit the hardest by the pandemic.

Through a series of Special Features and interviews, Medical News Today have been trying to untangle some of the mechanisms behind these racial disparities. 

In our previous interview on COVID-19 race-related health inequalities, Prof. Tiffany Green quoted the work of John Eason, Ph.D., associate professor in the department of sociology at the University of Wisconsin-Madison — to point out one such potential mechanism.

Prof. Eason’s ongoing research shows that black and Latinx people are overrepresented as corrections officers in county jails and suggests that these workers may be inadvertently spreading the new coronavirus.

In this interview, MNT has followed up on this issue by speaking to Prof. Eason himself about his research.

Prof. Eason’s expertise focuses on imprisonment, healthcare access, and health disparities across the rural-urban continuum. He is also the director of the University of Wisconsin-Madison Justice Lab. 

We have lightly edited the interview transcript for clarity.

MNT: Can you tell us about the role that incarceration plays in the uneven effect that COVID-19 is having on black and Latinx communities? Your research suggests that a disproportionate number of corrections officers may inadvertently serve as SARS-CoV-2 vectors in these communities, could you kindly expand on that?

Prof. Eason: We’ve paid a lot of attention to the disproportionate rate of incarceration for black and Latinx people in the U.S. — it’s more so for black people. So, while over 60% of Americans know someone or have a family member in prison, it’s more like 90% for African Americans, so the scale of mass incarceration is unprecedented. 

What’s also quite unprecedented in the U.S. compared to any other country is prison building, or what I’ve labeled as the “prison boom,” where we built over 1,100 prisons […] in about 35 years, and we’ve expanded the footprint [of these facilities].

Just the landmass is more than 600 square miles in terms of the number of prisons and how big they are.

In that expansion, we’ve grown to now 450,000 corrections officers, and in the last major study done on this, we saw black folks, more than Latinx, being overrepresented in the corrections officers […] labor force. Black folks were nearly double, 22 or 23% of corrections officers were black while only 11% were Latinx.

There’s also a lot of conjecture and a lack of understanding about the empirical reality of where prisons are built. 

My research has shown that while we think that these are overwhelmingly white towns, the average town that gets a prison has a higher percentage of black and Latinx people in it, and that’s accounting for whether or not it already has a prison (so I’m not counting the population of prisoners in predicting that).

[S]o this goes back to the heart of your question about the transmission of COVID between communities and prisons. If black and brown people — black people, especially — are over-represented in corrections officers, and most prisons are built in rural communities that have a higher number of black folks, the workers — not the incarcerated people — [could spread the virus.]

The incarcerated people come from anywhere across the state, as most prisons are built by states. Another source of confusion is the belief that most prisons are privately owned, but roughly only 12–13% […] are privately owned; the vast majority of them are owned by state operators.

So, Texas, Georgia, and Florida have built the most prisons; and in those places, in rural black communities, you have workers who are disproportionately black coming and going out of these facilities.

And because they’re essential employees […] who are disproportionately black and Latinx […] they’re serving as vectors for transmission of the disease, more so than prisoners.

Because in prisons, we haven’t decarcerated a whole lot of people under COVID. We’ve done more so through jails, which is a different system. In the U.S., about 1.6 million people are in prison, and about another 600,000 are in local jails, and most of the decarceration under COVID has occurred in [local county] jails.

Prison guards [may spread the virus] in particular. I formed a team of researchers, and we’re running analyses to see if this hypothesis holds true and if it will hold during the whole COVID crisis.

But places with prisons — I’ve already done the analysis on this — counties with prisons have higher rates of COVID than counties that don’t [have prisons]. 

So that’s the baseline descriptive, and now we have to look to see the number of cases per facility and worker.

MNT: Do the type of employment contracts that these workers work under play a role as well? 

Prof. John Eason: I think they would […] In a lot of states you have unionized corrections officers; and even if they’re not unionized, the level of pay for a corrections officer is going to be better compared to other jobs in the state. So, in a state like Arkansas, […] the pay for a corrections officer is going to be pretty good compared to most other salaries.

So, you may see variation; you might see differences not so much by employee status — like whether they’re temporary or permanent — but corrections officers tend to have a less fluid job than one might imagine. I think there’s higher fluidity in the private sector, […] so we could look to see if privately-owned prisons have a higher infection rate.

[I]’m not sure if we have that level of data on the individual employees at this point, but that is something we could definitely investigate. I think that is an interesting question and I’d expect to see a higher rate of transmission in private facilities. 

MNT: Have you encountered any issues in terms of accessing COVID-19 data broken down by race or ethnicity in prisons?

Prof. John Eason: Jails would be a little different [but] with prisons, yes, there’s difficulty. I actually have another project locally here in Madison, Wisconsin, where in Dane County, the county sheriff has given me data on the jail, and it’s looking at race. That’s because they’re actively trying [to reduce their number of inmates; they’ve reduced the number of people incarcerated in their facilities by over 40%.

Early on, they saw that this is a public health crisis and they didn’t want that on their hands, so they’ve done a lot — they can do a lot more, but they’ve done a lot to reduce the number of people in their jail. 

But overall prisons? No, this data [for prisons] is very difficult to get and quite separately, if you go to immigrant detention facilities, it’s impossible to get good data on that. We have multiple penal regimes in the U.S., [there are] multiple ways that we incarcerate people.

[I] have another research project where I’m looking at [immigrant detention] and […] we lack data. We’re going to see a lot of death coming out of immigrant detentions because of [this lack of data].

“We’re scraping data from the web from the Federal Bureau of Prisons daily, but we can’t get race data in that right now. [W]e have COVID cases by facility, but we can’t get a racial breakdown.”

– Prof. John Eason

MNT: Do family visits play a role in transmission rates, or are there physical distancing measures in place to prevent that from happening?

Prof. John Eason: [A] lot of facilities have shut down visits. They were also starting video visitations [and] there’s been some push to get video and phone calls for free. Some municipalities have done that, others […] allow private companies to run […] the phones and video visits in the jails.

[So you] have private companies running your videos and your phone calls, and they charge astronomical rates for loved ones to keep in contact. 

Some states have pushed, and some local municipalities have pushed for free phone calls and free video visits, which has helped the inmates and their families during these difficult times. 

But overall, […] family contact would come in the form of the guards, the corrections officer. So those workers and their families and their communities — because they often live at a distance from the jail or prison. That’s where the transmission would come from because they would be the main vectors. 

MNT: Are there any systems in place in prisons and jails for containing COVID, for example, access to testing or using PPE, etc.? What happens to a prisoner if they have symptoms, are they encouraged to come forward or are they likely to avoid doing that for fear of repercussions?  

Prof. John Eason: [T]here is a huge outbreak at this prison in Alabama, and I can imagine a scenario where prisoners would be afraid of reprisal and being thrown in isolation […] I can imagine that being true in Alabama. 

The issue is that there’s this view of the U.S. prison system — because we lead the world in incarceration — that there is one criminal justice system or one prison system, and it’s highly privatized. While there are private entities, it is not privatized, most of it is state-run.

There are 5% of our prisons that are federal, 82–84% are run by states, and you have that much variation across the prison system. So what’s true for prisoners in Alabama, [might not be true for prisoners elsewhere]. 

You have to look at the governor of Alabama — [I] haven’t checked in the last week if she still denies whether or not COVID is real. She held on; she was one of the last stalwarts minimizing COVID, [and Alabama] was one of the states that wouldn’t test. 

So if the free citizens aren’t getting tested, the people who have been denied the right to citizenship, who have been taken out of free society — I can’t imagine them being a priority.

In other states and other municipalities or locales, you have an opposite response.

After we had several cases here in Madison, the local county jail decided they were testing everyone who was incarcerated and every guard. 

So you have extremes, and it depends on what state you’re in, and what municipality within a state you’re in, because if you’re in a rural prison in the South, your best option may be to not say anything.

[W]e’re going to see a lot of people die in prison, die in immigrant detention, die in jails — all separate systems, these are different regimes — and we won’t even know if it’s COVID. 

Maybe at the morgue, they’ll test for it, but we won’t know before then […] because we don’t have testing as widely available as it should be, and we have such wide variation. 

California is still under lockdown, and places like Florida and Texas are not. And then [there’s] the international [Black Lives Matter] protest on top of all of this.

Editor’s note: Prof. Eason continued to discuss some important points regarding the intersections between public health and public safety, which we will tackle in a future article.

MNT: You mentioned the differences between jails and prisons and various other incarceration systems across the U.S. — are there any policies that you think should be put in place to homogenize these systems? And are there any policies that would help even out some of the racial disparities induced by incarceration?

Prof. John Eason: [I] understand why different offices are separated and why we’ve encouraged that, but I think if we started at the top, we could connect some local municipal efforts to a vision that’s articulated from the top. Our current administration has no capacity or interest in doing such a thing.

But […] public safety is essential to public health, and [the two] should not be at odds. [W]e have Departments of Health and Human Services at the federal and state levels, and then the Department of Corrections and all of these different things are laid out quite separately, and rarely do they meet. And when they do, they meet at odds, and they’re fighting over budget dollars.

Anybody can see how, on the ground, these experiences matter. [These experiences should be] better coordinated and [there should be a] vision laid out where we not just talk about, but understand culturally that you can’t have one without the other. 

[J]ust like I said about the “prison system” or the criminal justice “system” — we don’t have a health system. We have multiple competing health systems that are interested in maximizing profit. So that’s why among developed nations, we’re being hit so hard — because we’re so fractured.

– Prof. John Eason

And there aren’t just cleavages along racial lines, but also along rural versus urban, north versus south, all of these things matter.

[T]his is how bad our public health system is: [t]here are many studies that show that people who went to prison — black people in particular — have a lower life expectancy because of prison. 

But there are also countervailing consequences of going to prison, one of which — especially pre Obamacare — was that people who went to prison, […] who lived in poor neighborhoods, black men especially […] who didn’t have access to healthcare […] improved their health for that short time while they were in prison.

That’s how terrible our healthcare system is, that people can get access to healthcare in prison [but] they can’t afford it outside. 

[I]’m working on a study looking at pancreatic cancer. And people who are on Medicaid — which means they’re poor — who are free have worse outcomes for pancreatic cancer than people who are in prison. Just let that set on you for a minute. 

– Prof. John Eason

[W]e have some things that work; but we have so many gaps within our healthcare system, so many gaps within our so-called criminal justice system that, to really address issues in either, we’re gonna have to step back and take a more holistic approach — or else we’re wasting dollars (because that’s what people care about in this country, the almighty dollar).

[T]he inefficiencies created by all of these gaps cost us billions upon billions of dollars — if that’s what people care about — but you can see how it also lets people fall in the cracks and [that] we’re basically allowing whole generations of people to die.

And COVID is showing this; it’s a hyperbolic way of revealing all of these cracks that already existed.

[I]f you’re poor in this country, if you’re poor and you’re in a rural community, and you’re a person of color, your life chances do not look good.

– Prof. John Eason

[A] lot of our research looks at these huge gaps between the ultra-wealthy [white] and the really poor black and brown people in urban centers. When you go out to rural communities, you have incredible wealth in the hands of a very few people as well, [and] poverty and lack of resources — they don’t have hospitals, or if they do, they’re not as well equipped.

If you go out to those places, or the [Native American] reservations here — the COVID rate is through the roof in many of them, so it really shows how much inequality matters across public health or public safety.

And these cleavages, these cracks that are created, COVID has revealed them in ways that are unimaginable, [a]nd it just continues — what we’re going to see from the U.S. will not be the best of us. 

[U]nless we get a cure today, the longer this drags on, the worse this is going to get.