Top row, from left: Laurie Quimby, Bernie Jones and Salmaan Keshavjee; Bottom row, from left: Carmen Santos and Monik Jiménez

As an epidemiologist who studies the health of people in prisons and jails, Monik Jiménez, ScD, SM, FAHA, has become accustomed to hearing people react with cynicism or scorn when she talks about her work.

“I’ve actually had people say to me, ‘You know what? They deserve to be there,’” she said.

But rather than wear her down, such responses only re-energize Jiménez to remind others about why everyone should care about protecting the health of marginalized communities, including incarcerated people.

“I share my lived experience. My father was incarcerated for a large portion of my life — a big piece of my childhood and adolescence — and so I tell them, ‘You’re talking about my father. You’re talking about somebody’s brother, sister, mother or our elders.’ I try to humanize it for people,” said Jiménez, sharing her perspective during a recent Lead the Change virtual panel discussion, “Prisons and Jails: Reform, Re-entry and Decarceration.”

“The experience of incarceration on an individual or a community is an important public health issue, and it is a confluence of the structural racism and inequity within our country — manifesting in the ultimate type of marginalization,” Jiménez continued. “This is our lane. It impacts the lives of our patients and their communities.”

Moderated by Bernie Jones, EdM, vice president of Public Policy, the July 8 event also featured reflections from Salmaan Keshavjee, MD, PhD, a member of the Brigham’s Division of Global Health Equity and director of Harvard Medical School’s Centre for Global Health Delivery, Laurie Quimby, MD, former medical director of Essex County Correctional Facility, and Carmen Santos, a specialist in Workforce Development at Mass General Brigham and coordinator of the Brigham’s SUCCESS Program.

Breaking the Cycle

The panel’s wide-ranging discussion explored how incarceration affects the health of individuals and communities, contributing factors such as systemic racism and classism, and the continued stigma and inequities that current and former inmates face.

“We suspend our moral frame for how humans should be treated when we think of prisoners,” Keshavjee said. “They’re punished, but the punishment never ends. The punishment means they can’t get jobs. They’re stigmatized in society. When you start to look at this from the medical perspective, this is deleterious to people’s health.”

Speakers also discussed ways to address these inequities and support people re-entering society. One example of this is the Brigham’s SUCCESS Program, which provides job opportunities at the Brigham to people who have been disconnected from the workforce due to nonviolent offenses.

Participants in the program who successfully complete a 90-day pre-employment period can transition to a full-time position. Candidates also receive additional support for both professional and personal needs — including skills training and assistance with childcare, food and transportation — to set them up for success, Santos explained.

“The great part about this program is that we’re offering an opportunity — giving people a second chance and that feeling of belonging, connecting and employment, which is greatly needed,” Santos said. “It really makes me proud to say that we offer this at the Brigham because it’s an opportunity for someone to really have a chance to grow in the Brigham community and add to our fabulous organization.”

Addressing COVID-19

From a public health perspective, prisons and jails can become “epidemiologic pumps,” explained Keshavjee, who has long studied and developed interventions for the transmission of another contagious disease, tuberculosis, in Russia’s prison system.

“People go in and out of prisons and jails, so if someone gets infected, it actually puts the disease back in the community,” Keshavjee said.

During the COVID-19 pandemic, this reality became especially apparent as prisoners, detainees and guards were moved between different environments, he said.

“There’s 55 percent turnover in the U.S. jail population each week, so this provides a constant supply of people who may have been previously exposed to a virus — in this case, SARS-CoV-2,” Keshavjee said. “Because of this constant movement, it’s not a surprise that there have been 620,000 COVID-19 cases in prisons.”

Throughout the pandemic, it has also been important to look beyond the statistics and understand how COVID-19 has affected incarcerated individuals’ physical health, mental health and basic living conditions, Jiménez said. Getting these types of insights has been challenging for researchers, who have been able to accomplish it largely through partnerships with community organizations that work closely with incarcerated populations, Jiménez said.

In conducting their surveys, one discovery for Jiménez and her colleagues was how physical distancing — a cornerstone of preventing the transmission of COVID-19 — translated in a carceral (prison or jail) setting. Inmates were confined to their cells or housing units for 23 and half hours per day, with such lockdowns lasting for more than a year in some parts of the country.

“We learned was that a large proportion of people did not have access to basic needs — toilet paper, access to regular showers, water. They also had reduced access to mental health care and medical care,” Jiménez said. “COVID-mitigation strategies employed within a carceral setting have led to incredibly punitive conditions of confinement and, I would even argue, violations of human rights.”

One possible solution panelists explored was decarceration, or the early release of people from prisons and jails, with the goal of reducing density in such settings.

“Decarceration is a public health tool,” Jiménez said. “Carceral settings are very porous ecosystems; people are moving in and out. What happens behind the wall happens into the free world, so it’s imperative for us to broaden how we think about public health measures.”

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