Transcript
Health in All Matters podcast
Series 2: If Not Now, When? | Racism: A 400-year public health emergency
Episode 3 : Race & Incarceration
Airdate: November 12, 2020
Duration: 21:00
[Opening music]
Michael Joyce: Richard Pryor is considered by many to be one of the greatest African-American comedians of all time. Here he is performing live in the early 1980’s:
“I went to penitentiary – I mean not me personally – I went to
to do a film in penitentiary. And I was up there six weeks:
Arizona State Penitentiary.
And man it was strange because it was like 80-percent black people.
And what’s strange about that is that there are no black people in Arizona
I met one brother his name was JayBo. He was doing a sentence – triple life!
How in the [bleep] do you do triple life?
I mean if he die, and come back, he got to go to penitentiary, right?!”
Michael Joyce: A few things about Richard Pryor. First, like many comedians, such as Dave Chapelle and others, his routine is firmly based in satire. So there’s often this unsettling paradox that people — in this case a mostly white audience — are laughing at tragic realities. A fellow comedian once said: “For Richard, the line between comedy and tragedy is as fine as you can paint it.” And Pryor definitely had his fair share of tragedy: abandoned by his parents, raised in a brothel, physically and sexually abused, in and out of jail, struggles with drug addiction, and something that many people remember him for more than his brilliance: lighting himself on fire while high on drugs.
Some people hear a story like Pryor’s and see a gifted man who endured a lifetime of trauma. Others see a black man on a trajectory they believe is somehow automatic or a sort of foregone conclusion. There’s even a name for this trajectory — it’s called the ‘Cradle-to-Prison Pipeline’. I’m Michael Joyce, host of the Health in All Matters podcast from the University of Minnesota School of Public Health, and in this episode we explore this pipeline, and how it relates to race and health.
Rebecca Shlafer: I don’t love the phrase. I don’t love the terminology. It’s not something I necessarily use in my work.
Michael Joyce: Dr. Rebecca Shlafer is an Assistant Professor at the University of Minnesota Medical School. She’s a developmental child psychologist by training who researches the impact of incarceration on health; especially for incarcerated mothers.
Rebecca Shlafer: But I recognize that thinking about ‘cradle-to-prison’ can be helpful for the lay public to think about how someone may be at increased risk based on where they’re born, or where they live, or the neighborhoods they are growing up in — from the very beginnings of their lives.
Michael Joyce: It’s meant to be a catchy phrase that captures an appalling series of challenges that disproportionately affect Black, Indigenous, and other people of color who are also living in poverty. Starting life with challenges like unsanitary or unsafe housing, inadequate or no health insurance, food insecurity, and parents who may be struggling with unemployment, drug use, or being arrested. Then moving on to under-resourced and overcrowded schools, where kids of color can be expelled 2 to 3 times more often than white kids. And then, facing a higher risk of either being murdered before they start shaving or dating … or … ending up in a criminal justice system where about two-thirds of those who are locked up are people of color.
Rebecca Shlafer: And so really from the get-go there are a constellation of risk factors that may put these kids at increased risk for having poor outcomes across a life course. You can’t help but think of the stat that I regularly remind people of: That 1-in-6 Minnesota youth has experienced the incarceration of a parent. And that’s staggering. And we think about what it means to have a parent involved in the criminal justice system and how that can systematically disadvantage folks, both before the parent becomes incarcerated, but the challenges families face post-incarceration in terms of access to housing, access to employment, access to health insurance — all the things that potentially compromise their health as adults have impacts for child well-being and intergenerational patterns of health and well-being. I mean, we’re asking kids to learn and thrive and pull themselves up by the bootstraps, and have personal responsibility in conditions under which most white, middle class people would never, ever, ever experience, let alone let their children go to.
Michael Joyce: I have no hesitation injecting myself into that: Here I am the proverbial middle class white male. I’ve never faced any of those issues, nor did any of my friends. And so none of those disruptions, none of those bonds were broken. Everything was intact, and I had every possible chance to succeed.
Rebecca Shlafer: Right. And I’d be hard pressed to think that you never did anything as a juvenile that wasn’t risky, or criminal, or could have gotten you in trouble with the law.
Michael Joyce: Oh we flirted with that edge all the time, and reveled in it!
Rebecca Shlafer: Right! Because that’s developmentally appropriate and adolescents take risks. And some adolescents are growing up in contexts in which they are allowed to take those risks and are safe to do so. And then we have some kids who are growing up in contexts where those risks could compromise their health, their well-being, and they’re in situations where the public’s response to those is to treat them not as typical adolescent risk-taking but as criminals.
Michael Joyce: Here’s how the nonprofit group, The Sentencing Project, frames this issue: “Overall, African Americans are more likely than white Americans to be arrested; once arrested, they are more likely to be convicted; and once convicted, they are more likely to face stiff sentences.” In short, it’s an unequal system. No question. But what makes incarceration a public health issue? It’s a question I posed to Dr. Shlafer.
Rebecca Shlafer: I think one of our biggest failures as a country has been this failure to recognize that jails and prisons are extensions of our communities. The very people who are incarcerated in our jails and prisons were members of our community before they went to prison or jail, and they return to the community, right? When you have large groups of individuals who are returning from prison not able to find stable housing, what does that mean in terms of having high numbers of homeless people?
When we think about individuals who don’t have access to preventive health services, and they are gravely ill, or using the emergency department for services that might have otherwise been addressed earlier through prevention in primary care settings, we see folks who are then using the hospital system in ways it was never intended, and that puts stress and strain on those hospital systems. That has implications for everybody who is trying to use that system. The costs are rising for everyone, even those of us with private/good health insurance. And for those folks who don’t have access to that, it’s taxing the entire system.
And when we consider that we’re removing individuals from our community and not bringing them back in ways that they are healthier — or our families are healthier, or our communities are healthier — that, to me, makes it a public health problem.
[Interlude]
Tyler Winkelman: You start to wonder: Why is this called a healthcare system? Is it a system? And what goal is it trying to achieve?
Michael Joyce: Tyler Winkelman is a pediatrician and internist with Hennepin Healthcare in Minneapolis. Part of the time he’s researching poor health outcomes in this so-called pipeline; most of the time he’s trying to improve those outcomes for his patients in the Hennepin County Jail.
Tyler Winkelman: Certainly if the goal is to make sure that every community can have equal access to the same level of well-being we’re … certainly far from that.
Michael Joyce: Most of Tyler’s patients are not white. And most have not had consistent health care. But most do qualify for Medicaid — the health insurance program available to the roughly 1 out of 5 Americans with low income. But there’s a problem …
Tyler Winkelman: When you look at Medicaid policy, it systematically stacks the deck against people who are involved in the criminal justice system. The policy I’m referring to in particular is that once you enter a correctional facility you can’t use your Medicaid anymore. You’re not allowed to. So all of that care has to be paid for by the jail or prison. So your Medicaid is shut off. In some cases it’s terminated. And then you have to re-apply for the whole thing.
This is, in my opinion, how systemic racism works. The policy is designed in a way that disproportionately impacts people with brown and black skin. And while, perhaps at one point the intent of the policy made sense, clearly today it has a real impact on access to care for certain communities.
Michael Joyce: The United States has an incarceration problem. The U.S. makes up only 4% of the world’s population, but it accounts for nearly 25% of the world’s incarcerated people. Once released from prison, the percentage of those who return to criminal behavior — called recidivism — ranges from about 60% to 80%. Complicating matters is a boom in privatized prisons across the country. There’s money to be made, which means imprisoning people is essentially incentivized. So the system isn’t just unequal, it’s broken.
But statistics are simply numbers. Let’s add a face to them. Consider this: A Black boy born while you listen to this podcast has a nearly 1-in-3 chance of going to prison in his lifetime. For a Latino boy, it’s about 1-in-6. For a white boy it’s roughly 1-in-23.
Tyler Winkelman: I think one of the most shocking numbers that I’ve heard is that the Native American community makes up less than 1% of people in Minnesota. But when you look at who is, today, in the Minnesota Women’s Prison, nearly a quarter of women in that prison are Native American. And that is just totally unacceptable.
The other piece on a more personal level that is really shocking and disturbing to me is when I’m at a clinic in the jail, and talking to my patients about their health, the level of trauma that people have had to go through in their lives is just extraordinary.
It is anything from childhood physical abuse, sexual abuse, to violence … either having witnessed a family member being murdered, or have been shot, or physically harmed themselves.
And nearly every clinic I have I hear these stories. And it just never stops being heart-breaking.
In our clinic we’re trying to do the best we can to help them, but just knowing that it’s a lifetime of trauma that has really never been addressed. And often we’re one of the first healthcare providers to ever even start to flesh out the impact that the trauma has had on their lives.
Michael Joyce: I know that feeling all too well. I once worked as a physician with the uninsured, the homeless, the incarcerated, and a host of other “untouchables,” as much of society saw them and treated them. The operative word here being “them” or “other.” Certainly not your neighbors and certainly easy to ignore. Was it hard work? Absolutely. Was it harder than what my patients were going through? Absolutely not. And it was really easy to get discouraged. I asked Dr. Winkelman about that — about facing the sheer scope of the problem day after day.
Tyler Winkelman: To say that there are multiple broken systems, it leaves me with an overwhelming sense of: “How can we ever fix it?”
But I’d also say that we, as academics and thinkers, we also spend a lot of time thinking about everything that doesn’t work, and I think we spend less time looking for things that are working, and how do we build on those?
I guess a question would be: What are some of those bright spots? I would say I don’t think we have a good sense of what the bright spots are, and where are the places that we can build on, because we just don’t look for them.
But I think equally important is looking at: What are the strengths of different communities? And, where are the places that we want to be expanding and helping to flourish, instead of always looking at what things are broken, and in how many different ways can we describe the brokenness of our communities?
[Interlude]
Michael Joyce: To me the term pipeline is a little problematic. Because it connotes an ‘inevitability’.
Tanya Bransford: Right! So a pipeline makes it sound like there is only one way in and one way out.
Michael Joyce: Tanya Bransford is a Hennepin County Judge with nearly 30 years experience in the juvenile justice system.
Tanya Bransford: And there are some children and some people that are very resilient. And are able to get out despite their adverse childhood experiences.
Michael Joyce: Getting people out of the system — out of the pipeline — is what Judge Bransford considers her top priority.
Tanya Bransford: One of the things that I think makes a difference in the justice system is to not have people unnecessarily detained.
So we’re no longer detaining young people for nonviolent offenses. There are a lot more community-based alternatives available than before. Because there’s been a realization that just sending young people to an out-of-home placement, to a correctional facility or treatment facility, or residential treatment center is not the do-all or end-all — if there’s some way you can keep them in the community with family, that situation is better.
Part of what we’ve learned is that it doesn’t do much good to treat the young person and not treat the family. Because they’re going to be part of the family. The point is, if you can work together with a family unit and get the parents engaged, then that might be helpful.
Now you think that might go a little bit to the root but, for instance, if you have parents that refuse to engage — parents that are dealing with their own chemical dependency and/or criminal behavior — it’s hard to get to the root.
Another possibility might be bail reform. Because why should we have people in custody just because they weren’t able to pay bail. And it is pre-trial, so they haven’t been determined to have committed any offense (it hasn’t been adjudicated), yet they might lose their job, they might lose their support in the community and all those things.
Michael Joyce: Perhaps it’s not surprising that when we approach a problem as long standing, far-reaching, and complex as systemic racism, and we ask people for possible solutions, their suggestions are equally complex. They tend to focus on big systemic changes — things like policies and procedures that most of us don’t have access to. So, I asked Judge Bransford this: What can we do as individuals?
Tanya Bransford: First thing is making sure you’re getting educated. Doing whatever you can to get educated and recognize our own biases. Second, now that you’re educated, exercise your right to vote. And I know people are focusing on national elections, but those local elections — like who you’re putting on your school board — those are also vitally important. And then, maybe the last thing I would say that every person could do to make a difference is, maybe you could volunteer. Volunteer at a local school and be a mentor to a kid, really getting involved, whether it’s your local schools or community groups or individually helping a kid.
Michael Joyce: Let’s close this podcast with Tyler Winkelman, our Minneapolis-based physician working in the county jail. I asked him the same question I asked Judge Bransford, What can each of us do? And I found his answer both compelling and potentially very important.
Tyler Winkelman: I think we need to be humble, and realize that we don’t have the answers, but there are people who have some pretty dang good ideas. And often they don’t look like me. And I think we need to help raise those voices. And I think we need to look for opportunities to support their message and their ideas.
Clearly the white male power dynamic has not produced the equality that many people want to see. And so, if we just keep trying the same thing over and over again, we’ll keep getting the same results.
And I also think that if we just pause before we start talking about solutions, and are really honest with ourselves, that we can make space to elevate people whose ideas need to be heard and have the lived experiences that we don’t have, and to give them the opportunity to lead, and for us to play a supporting role in making that change.
[Closing music]
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