Tag Archives: public health

The Red Cross was an Integral Part of the East Harlem Emergency Response

In the wake of any disaster, emergency response typically includes the American Red Cross, whose recognizable logo signifies a first stop for help. Volunteers respond quickly to set up communication centers, coordinate medical attention, arrange shelter for displaced people, provide food, and offer general support. This wide range of services requires tremendous coordination, which is particularly remarkable for an organization that is primarily staffed by volunteers. The explosion in East Harlem was no different. Red Cross volunteers went to work immediately and their work continued for a month afterward.

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According to a follow up report on their blog:

  • The Red Cross Emergency Operations Center was in operation and fully staffed 24/7 from the time of the collapse on March 12 through Sunday, March 23.
  • More than 338 adults and children were comforted and assisted by Red Cross caseworkers at NYC resident service centers.
  • More than 200 volunteers from across the Greater NY Region responded to the call to help those affected.
  • Over 20,000 meals, snacks and beverages were served to residents and first responders.
  • Between March 12 and March 14, more than 70 residents overnighted at the Red Cross operated shelter at the Salvation Army facility (for a total of 121 shelter stays; i.e., some of those 70 residents stayed more than one night).
  • Dozens of children received solace and safe haven at the Red Cross shelter, with a little extra help from the Good Dog Foundation therapy dogs in conjunction with the ASPCA.
  • Nearly 500 blankets and personal hygiene comfort kits containing soap, toothbrushes, face clothes, toothpaste, deodorant and additional items were distributed.
  • Red Cross Client Assistance staff connected with over 20 families in need of mental health and/or physical health support.

One experienced volunteer, Mary O’Shaunessy, spoke to us at a community conversation held at the CUNY School of Public Health on April 26, which brought together residents and community groups to discuss what happened following the explosion and how to better prepare for future emergencies. She shared her experience following the disaster:

Community Conversations – Red Cross Volunteer Mary O’ Shaunessy

My name is Mary O’Shaunassey, I am a Response Manager for the American Red Cross of Greater New York. On the day of the explosion on Park Avenue, I was actually at work at my day job as a technology manager for a legal services organization that helps low income women.

As part of response management at the Red Cross, I receive four-hour reports on general activities. Regular fires, evacuations of unsafe apartments, and other small disasters. I received special messages from the Office of Emergency Management and the Red Cross management regarding this explosion. As soon as I could leave work at 5:30 or so, I headed to the Red Cross where we have an emergency operations center. This is an office that is staffed only during major disasters. There are 24 seats and each seat is occupied by a person with a very specific responsibility: for obtaining large quantities of food, for arranging the setup of a shelter, for arranging for licensed mental health professionals and physical health professionals to arrive at a scene, and so on.

My job as operations management was to make sure that each of those seats were filled or that each phone at each seat was being answered. So it boils down to there are 24 phones, if it rings, answer it, respond appropriately, make the right decision.

A lot of people don’t understand that the Red Cross is not a government agency. We are 90% of us volunteers. The volunteers that were available were people who are retired, self-employed, or unemployed. That can really limit our ability to respond to people who are linguistically isolated. Our volunteers speak what they speak, they’re available when they’re available. We happen to be lucky that a couple of our people were native Spanish speakers. It is possible that at a fire you can have people that are so linguistically isolated that no one can help them. We have facilities for that, but it takes some time to set up.

When I arrived at the emergency response center, I found it in full swing. People were already at the blast site. They were already working on a reception center. Until we have the capability, that is, a released building from the Board of Education, a custodian, and shelter staff, we have reception centers. And that’s where clients —  and I have to define the word client here — we never call people victims because part of the Red Cross role is to encourage people in recovery and calling people victims does not encourage that. We have clients, and we have survivors. Clients, survivors, and family members were already at the site looking for information.

The definition of a disaster is that it is unplanned, therefore information is always partial, immediate, and changeable. It’s very difficult to set and manage expectations. We are also committed, individually, corporately, and internationally to client confidentiality. It is very common for family members to call, and we were getting these calls, and people saying “my sister-in-law was there, my nephew was there, my cousin was there.” We cannot release that information. We did not have the information about the deceased but even if we had it, we cannot. We cannot give information about who is registered at a reception center, or a shelter. What would happen if a man were to come and say my “wife is there, I need to get to my wife” and we released that information and that woman had an order of protection against an abusive spouse. That’s something that we always have to protect people against. We cannot make assumptions about what people are telling us.

Most people are honest. Most people want to help. We have to be realistic, as well as optimistic in our view of human nature. So we were getting calls from volunteers, we were getting calls from partner agencies, we were getting requests for food. We try to purchase food from local vendors. We try to purchase all our supplies from local vendors. Surviving vendors may have decreased foot traffic. They may have decreased customer assistance because their customers have been displaced. By the Red Cross spending money in these local businesses, we’re keeping these small businesses in business. We’re keeping their employees able to contribute to the community and therefore the function of the society is continuing to go.

Very often we get complaints from people who say “I didn’t want my money to do go overhead.” Overhead is very interesting. If you think about wanting a report about where money goes, you would say “yes I want a report.” A report needs a database, a list of expenses, and a list of donations. That computer needs electricity. The person who is putting that information in needs an office with electricity, running water, and maybe heat or air conditioning. The software needs to be purchased. That’s overhead. So it’s very interesting to try to explain what overhead means in terms of how people get their wishes in terms of donations.

We have overhead and we are not ashamed of that. We are very careful about donor dollars. In order for a Red Cross responder to go out by themselves, that is, to respond to a fire or a vacate, they have extensive training and extensive practice, and they undergo a background check. When I walk out to a fire, I can have as many as 30 debit cards, with a maximum value in the field of $1,000. If I’m handing someone, as a manager, $30,000 nominally in debit cards, I want to know who they are. That is why what we call spontaneous volunteers get asked to do really basic things: hand out water, hand out food. Trained responders go into people’s homes. We go into homes to evaluate damage, to determine how much cash assistance to give, whether to give hotel rooms. I would not want someone in my home that had not undergone a background check.

So these are the things that go into being a Red Cross responder. And it all gets really ramped up in the event of a large disaster. As you gain experience, it’s also important to know how to step back. I’ve been a volunteer for 7 years, I’m very experienced, and now I’m in management. I have to step back and allow other people to learn how to do this. That can be hard because they’re training and by definition, trainees make mistakes. Sometimes, in an event like this, a simple mistake can get very high profile very quickly, and it’s very difficult to manage. We never send trainees out alone, but in a fast-moving, crowded event, they make decisions. Sometimes they’re very good decisions and sometimes they could have been better. And we work on that in what we call hotflashes. After an event, and in some cases after every 24 to 48 hour period, we sit down together and figure out what went wrong, what went right, and how to keep doing what was right, and how to correct what was wrong. It’s a continuous process.

I love volunteering for the Red Cross. I like going out, I like adulation, I like people saying “oh you do wonderful things.” It’s an ego charge, and I’ll take that. Fires, disasters are an adrenaline charge, but you also have to balance that against the needs of the organization and the needs of the community. Those needs will go on long after I am able to respond to disasters.

Clear Communication is Vital in Emergency Response

Numerous volunteer groups joined in the recovery efforts following the deadly gas explosion in East Harlem, and while the community’s most important needs were met, there was some confusion and disruptions in communication in the aftermath. This was part of what inspired the CUNY School of Public Health and several co-sponsors to organize a community conversation on April 26 to reassess community response efforts and discuss ways to improve emergency preparedness.

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Several local members of the Office of Emergency Management’s volunteer Certified Emergency Response Team (CERT) were there. CERT members are trained to assist with fire safety, medical aid, and search and rescue, among other support tasks. Most of the time, they serve as community educators about emergency preparedness. The explosion in East Harlem was the first time some of them had dealt with a major emergency. They encountered challenges with knowing their role and communicating with other organizations, and a consensus from the community conversation was the need for clear, reliable communication channels so that all responders know where to go for information.

East Harlem resident and CERT member Sam Goudif shared his experience following the explosion, and highlighted how a lack of clear communication made things more difficult, but also demonstrated the desire to help that is the motivation for these volunteers.

Community Conversations – East Harlem Resident Sam Goudif

My name is Sam Goudif, I’m a CERT member for the last two years. And during the disaster with the gas explosion, I was in Harlem. I was at home watching the news. Naturally, that was the main focus of the news and I knew right away that I would be mobilized. I got the call from the chief and was mobilized to go to 118th Street. Trafficking and crowd control were the main components of what we did. It was about 3 or 4 blocks away from the incident. We wore our masks, which were inadequate, but we had something. We had to double up on them, as a matter of fact. It was interesting that people responded quite well with us. We didn’t have the issues of struggling or fighting with anyone. As a matter of fact, people were helping out in a number of ways. It wasn’t an issue with the crowd. The issue came about as the chain of command. What we were supposed to do in terms of where we were located. Who comes and goes, who was allowed and wasn’t allowed. I was in the first responders. They were very visible, very active. We all tried to coordinate the best we could, the best we had. It was a very challenging moment for us, and a learning process for us. This is the biggest incident I’ve ever gotten involved in.

We had a discussion, we went over a lot of things [referring to the community conversation]. The main thing we discussed was equipment and being safe. That’s the number one issue.

If you aren’t safe, you can’t make anybody else safe. If you don’t have communication you’re really left out there in the field.

So you need better communication than we did. Where were able to communicate, we were able to go over things, was at Hunter College, Zero One ground for us…to have community come together and actually support whatever needs were needed at the time, in terms of people coming in asking questions: where to go, where to get help. Facilitate them in the best way we knew how. And we did that. And that’s something else we learned about. Red Cross, we coordinated with them. With the other organizations we had to find a place where we can do the best job we can do.

 

Lynn Roberts on Public Health and Social Justice Activism

Lynn RobertsA key focus of JustPublics@365 is on the work of scholar-activists. Someone who exemplifies this model of engaged scholarship is Lynn Roberts, an Assistant Professor at the CUNY School of Public Health. Her broad range of work and research has included reproductive justice, youth development and juvenile justice, the prevention of intimate partner violence, models of community organizing for social justice; and the intersection of race, class and gender and its influence on health disparities. In this series on East Harlem, we’ll feature a number of scholar-activists.

Lynn Roberts on Public Health and Social Justice Activism

Collette Sosnowy: Thanks for talking with me today, Lynn. Can you share a little bit about your work in East Harlem and in the South Bronx?

Lynn Roberts: I suppose my work in East Harlem began actually many years ago when I was also teaching at Hunter College, in their public health program. I developed a course about 12 years ago focused on initially the South Bronx because I have been doing some work there and expanded it to include Harlem, not just East Harlem but Central and West as well, from the perspective of people who lived and worked there, so that you could look at it through various disciplines and also through lived experiences rather than just an academic lens and then updated the course when we moved into the community here of East Harlem in Fall 2012.

That brought me back to East Harlem with fresh eyes and in a different period of time in its, I guess, evolution, depending on how you look at it because a lot of changes in the community in terms of real estate and gentrification and then our being here and being able to reach out again and form relationships with those who are doing interesting and exciting community work here.

Collette Sosnowy: What are the parallels between South Bronx and East Harlem?

Lynn Roberts: They’re each very rich communities and one of the things that I think was highlighted in the course was just the diversity. I choose the South Bronx and Harlem because they both represented what I think are perceived by the general public as iconic communities.

People hear the South Bronx, they hear Harlem, and they might have a preconceived notion about what each one of those communities represent if they haven’t been there or lived there. I wanted to demystify and clarify the richness of each of these communities, not just as whatever someone’s preconceived notion of what might be described as a low income or an urban community is like. They each have rich histories of growth and decline of innovation in terms of the arts and just really rich histories in terms of the larger American story.

I think it’s important for all of us to know about these communities from those who know best and bringing the community into the classroom I think is really important. A large part of wanting to revisit the course was to, I guess, dispel some of the myth and even some of the apprehension and fear of that, some of my fellow colleagues and students had about being in East Harlem in particular, fear of crime, fear of some type of danger, which I didn’t experience and I didn’t think was any different than other parts of New York City.

I thought if they knew more about the community, that would widen their lens of working in any community and approach any community with eyes wide open and with ears more attentive to hearing from those community voices.

Collette Sosnowy:  How is health a social justice issue?

Lynn Roberts: Very much so. I think that social justice is necessary for health. When you have social justice you have health and wellness, all the positive attributes we associate with that. You have clean air. You have clean water. You have equity in terms of resources such as education and employment. You have a diversity of ideas and background. You have democracy. You have people who get to decide what will happen in their community, in their society, in their country and that is fundamentally good in terms of these peoples’ overall well-being but also just how they also feel about themselves and how much they feel willing to participate civically and have raised expectations for themselves, for their families, for their entire communities. I think they’re intertwined. I think they’re one in the same. I don’t think you can have one without the other.

Collette Sosnowy: As you were talking about before, some academics are hesitant to get involved in controversial issues like those confronting East Harlem. What do you say to critics who might question your “objectivity” as a scholar?

Lynn Roberts: First of all, I probably identify first as an activist and second, or simultaneously, as a scholar. They’re both a part of who I am. I don’t think scientists or scholars really can practice objectivity. I think all questions are based on our lived experiences, our exposures. What we consider valid depends on that. We’re all subjective in terms of how we pursue knowledge and what knowledge we consider important.

That’s not a quest of mine. I’m probably more inclined to just disclose what my subjectivities are, whatever my biases are as I know them. Not all of them are known to me but being more accepting of that, I’m much more inclined to be accepting of that in others. I’m much more inclined to engage with others in a way that I think, maybe it’s an objective but is open. If I’m open I can probably look at things and consider another point of view in a way that makes me more accessible and makes others with whom I interact more accessible to sharing.

I see it as an advantage in terms of my scholarship. How that plays out on the academy depends on, again, someone else’s perspective on that, so that can be a challenge.

Collette Sosnowy: A major focus of JustPublics@365 is bringing together academics and activists and journalists in ways that promote social justice through civic engagement and greater democracy. What sort of “lessons learned” do you have from your experience as an academic-activist in going into some of these fields that are usually more in the area of activism and journalism?

Lynn Roberts: First and foremost I go as a listener but that doesn’t mean that I don’t also bring who I am and my own point of view. It means sometimes hearing first and then hoping that we all come to some conclusions where I’m also listened to. I know that as an academic, in some instances, my voice might be given more credence than someone else’s, so needing to balance that and have some humility around that is really important.

Then using my voice may be perceived a greater agency or power, if you will. Effectively but again, in collaboration, not in speaking for or instead of others. I can contribute to in ways that others might not but I don’t really distinguish doing that in or outside of the academy. I really don’t. I think a lot of those lines are rather artificial.

There’s a lot of wisdom everywhere. There’s expertise everywhere and it’s just realizing that and when you approach it that way you tend to get a lot more done and people, once you dispel that notion of difference, I just find it’s just really easy to work with people.

 

The Interrupters: Public Health and Violence

The conventional response to violence has relied on criminalization, policing and longer prison sentences, yet violence persists. In 2011, Steve James released a documentary, The Interrupters, to capture the violent landscape of our cities through the eyes of “violence interrupters,” activists working in the tradition of non-violence to interrupt confrontations before they become violent. This documentary tells the story of three activists working to protect their Chicago community from the violence they once created.


The Interrupters, Trailer. 

The film’s main subjects work for an innovative organization, CeaseFire, founded by Gary Slutkin. Slutkin, an epidemiologist and physician who battled infections diseases in Africa, says that violence mimics infections like tuberculosis and AIDS. He believes that treatment for violence should follow the same plan as those for diseases: “go after the most infected, and stop the infection at its source.” Rather than thinking of violence from a moral issue (good people vs. bad people), Slutkin approaches violence from a public health one (healthful vs. unhealthful behavior).


Gary Slutkin, TedMed Talk. 

CeaseFire and the Violence Interrupters are part of an effort to apply the principles of public health to the violence of the streets. CeaseFire tries to deal with these quarrels on the front end through former gang members, or interrupters, who mediate criminal activity on city streets. They “operate in a netherworld between upholding the law and upholding the logic of the streets.”

You can watch the full length documentary online here.

You may also read the interview with filmmaker, Steve James, here.

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This post is part of the Social Justice Topic Series on From Punishment To Public Health (P2PH). If you have any questions, research that you would like to share related to P2PH or are interested in being interviewed for the series, please contact Morgane Richardson at justpublics365@gmail.com with the subject line, “P2PH Series.”

 

Guns and Suicide: A Public Health Crisis

Guns, the most lethal means of committing suicide, represent a public health crisis.

Most imagery conjured up by the idea of gun violence in the national debate involves on one end, a bad person with a gun, and on the other end, another person scared senseless by the bad person with the gun, waiting for the cavalry.

But the numbers paint a different picture – one that continues to prove difficult to digest for folks on both side of the debate .  In fact, suicide is the leading type of firearm death, and teenagers, young adults, and males aged 75 and older are currently at the highest risk for this type of death. According to the CDC, suicide is now the third-leading cause of death for teenagers.

Of the 100 people who take their own lives every day in America  – that’s almost – 40,000 deaths a year –  most use a firearm.  More people choose a firearm over all other intentional means combined, including hanging, poisoning or overdose, jumping, or cutting. But Americans are not more suicidal than the citizens of other comparable countries (populous, wealthy). They just have more access to the most lethal means of committing suicide. A gunshot is an irreversible response to what is often a passing crisis – possibly worsened by the temporary depressive fog of alcohol. Suicidal individuals who take pills or inhale car exhaust or use razors have time to reconsider their actions or summon help, but gunshots are merciless game-changers.

prviate guns public health

According to the Harvard Injury Control Research Center, the states with the three highest suicide rates (Wyoming, Montana and Alaska) are also the top gun-owning states, and researchers agree that bringing a gun into the home not only increases the risk of gun-related accidents, but also the risk of suicide. Specifically, that research finds:

“Gun owners and their families are much more likely to kill themselves than are non-gun-owners. A 2008 study by Miller and David Hemenway, HICRC director and author of the book Private Guns, Public Health, found that rates of firearm suicides in states with the highest rates of gun ownership are 3.7 times higher for men and 7.9 times higher for women, compared with states with the lowest gun ownership—though the rates of non-firearm suicides are about the same. A gun in the home raises the suicide risk for everyone: gun owner, spouse and children alike.”

It is perhaps time, then, to abandon the myopic view that those who would take their own life are not influenced by the availability of suicide methods, and accept that whether or not they survive is dictated primarily by how they choose to go about it. About 85 percent of suicide attempts with a firearm end in death (drug overdose, the most widely used method in suicide attempts, is fatal in less than 3 percent of cases.)

Research on suicide by the Harvard Youth Violence Prevention Center has also shown that one of the biggest myths is that suicides are typically the result of careful advance planning. While this may be the case — individuals who attempt suicide often succumb to a complex series of problems — empirical evidence suggests that they act impulsively in a moment of heightened vulnerability.

While the recent enactment of the Mental Health Parity Rule (which will guarantee that most insurance coverage offers access to mental health services on par with physical health coverage) brings hope to many whose lives would be vastly improved by access to mental health services, the collection and study of gun-related data has been severely undermined in the past two decades, and with it a crucial means of pushing forward sensible gun policies.

Despite President Obama’s reversal earlier this year of the NRA-sponsored amendment that barred the CDC from studying the causes and prevention of gun violence, researchers are still unable to answer many key questions such as the number and distribution of weapons across the country – slowing down prospects for life-saving policy reform. So much grief could be softened, if not avoided, by addressing the public health crisis of guns and suicide.

~ This guest blog post was written by Alice Cini is a social justice advocate and Social Work Fellow at the John Jay College of Criminal Justice’s From Punishment to Public Health Initiative. You can follow her on Twitter @CinikAl.

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This post is part of the Monthly Social Justice Topic Series on From Punishment To Public Health (P2PH). If you have any questions, research that you would like to share related to P2PH or are interested in being interviewed for the series, please contact Morgane Richardson at justpublics365@gmail.com with the subject line, “P2PH Series.”

Special Interview with Ernie Drucker

JustPublics@365 Ernie Drucker
Ernest Drucker is an epidemiologist at Columbia’s Mailman School of Public Health, a Scholar in Residence at John Jay College of Criminal Justice, and author of the 2011 book, A Plague of Prisons: The Epidemiology of Mass Incarceration in America. He is licensed as a Clinical Psychologist in NY State and conducts research in AIDS, drug policy, and prisons and is active in public health and human rights efforts in the US and abroad.

 

 

Can you share a little bit about how your research speaks to the issues of criminalization of public health?

Well, I’m an epidemiologist. It’s principally looking at the numbers independent of the individual experience. They tell a story in their own right basically because of how large they are, how big the disparities are between by race and ethnicity and how much of it is related to drugs.

How does criminalization and mass incarceration affected the lives of people in your research?

Well, it’s the fact that you’ve programmed a level of involvement in the criminal justice system into the lives of such a large portion especially the poor black male community of the United States that it’s almost like in a water supply and the nutriments that they get in the opposite direction of course.

The facts that are important here are that about 40% of young black men at this point can expect to be, if rates continued at the same rate, can expect to be in prison basically some time in their lifetime. The current figure is over 30%, about 35% but it’s going up. Even though the prison rates are going down, the probability of any individual being involved in this is so great.

The experience of Stop-and-Frisk in New York is a good example of the way the system reaches as it were and involves people in experiences that are based on an assumption that they’re involved in criminal activity reaching a peak of 700,000 stops-and-frisks in a year and a half ago in New York City. That, as an epidemiologist, who used to work on occupational and environmental health, we looked at people’s exposures to things like asbestos, mercury, toxins in the environment.

You can look at this as a toxin that’s very widespread in the African-American community of United States especially affecting young men who are most prone to be involved in behaviors like drugs, violence, being on the street that makes them vulnerable to getting picked up by the system.

Once they’re picked up by it, and so they’ve been infected. They carry it with them really pretty much their whole life because so much of that the structure of punishment, of mandatory sentences are connected up to what’s called predicate offenses – the idea that the first time you do something you make a probation for it. The next time you get a sentence, the next time you get a bigger sentence for exactly the same behavior. It’s a system that I imagine it’s deterring people but in fact that they reappear again and again shows that that’s not so.

What are your thoughts on policy approaches that draw from public health rather than criminal justice? Are there any examples of policy approaches that draw from public health rather than criminal justice? If so, do you think these are better or just reproduce the same systems of inequality?

Well, the policies in the criminal justice system don’t intentionally draw from public health. That’s not their model to that crime and punishment. One of the biggest contradictions or conflicts between the two models is that criminal justice model very much like medicine or a law enforcement is inherently on an individual basis, right? It’s about an individual who commits a crime. He gets charged, tried, convicted, acquitted, whatever but it’s a highly individual matter. In fact in the courts, sociological evidences are not really admissible as part of the discussion of the significance of an individual’s action. Therefore the individual case of crime and punishment is the unit of the criminal justice system.

The statistics that you do about populations in the throne of justice system are very similar to the ones that we do in public health-what could be done to help populations instead of individuals. What most of them don’t realize is that public health like medicine which is alive too is an interventional field. It’s like medicine. It’s involved in doing something about things. However these things that does that are not on the individual case basis but on the population affected. You reduce exposure to toxic fumes for everybody, not just people who get sick for a moment.

Try to apply that model to the criminal justice system is a stretch and needs an explanation because its’ engine, it’s the basis of decision making and justification is highly individual.

Now of course the intention behind it is exactly not individual, it’s societal, it’s collective. The idea of deterrents as referred for criminal penalties as opposed to deterrents for other people from doing bad things is inherently social. The effects although not examined that way usually are also very social. A guy goes to prison and leaves behind a family. That family is profoundly affected but what they do even public health for example that affect the mortality rate, the life expectancy and the achievement in college, the likelihood of going to prison. All those things are dramatically affected for the children of people who go to prison. It’s set in motion before they’re even old enough to commit a crime and get arrested.

That becomes the epidemic aspect of it, that’s how something is transmitted from generation to generation or passed from individual to individual by exposure the same way a coal miner coming home from the coal mines with coal dust on his clothes would make his child more likely to get lung disease. Likewise for a parent involved in criminal justice system in addition to the … I mean the fact of it is clear and the mechanism of it. It’s not the same as a physical exposure. It’s a psychic exposure, more in common with war and PTSD and trauma than it has in common with physical exposure to toxins but yeah, it does act as toxin.

We have a concept now that’s gaining. Currency about toxic stress actually comes out of pediatrics and developmental studies. Children, the idea that levels of abuse in a family that go on over time-living with an uncle that sexually abuses a little girl who keeps quiet about it. The stress of that builds overtime. No doubt there’s damage and that’s being recognized now.

The same thing with this large rate of criminal justice involvement – arrest, prison time, coming out with a stigma, going back in again – its relation to other criminal activities that aren’t inherently, drug use especially, it’s not the same as natural, the things that everyone agrees that are bad and shouldn’t do them, like assault, rape, kidnapping. Everybody agrees that those are things people shouldn’t do and you want laws against doing it. You want to enforce those laws.

The issue of punishment is a separate one but the idea of criminalization and why criminalization takes the form that it does is a very good question. We are obviously in a period now of criminalization amongst everything. About 35% of all Americans have a criminal record at this point.

The last question I have is a major focus of the just publics at 365 Project is bringing together academics, activists and journalists in ways that promote social justice, civic engagement and greater democracy. What sort of lessons learned do you have from your experience with your research about academics entering a terrain more frequently trialed by activists and journalists?

Well, academics have been involved in criminology forever. They’ve invented it but the more critical issue now is in the current world where you have ideas you want to have a voice in public policy and be understood by the general public are very important. You run up against, in terms of the way in which academics and journalists can play a role in public attitudes, literacy and ultimately support for or antagonism to new policies directly relates to what you’re talking about in just publics, and that is the development of public literacy, public understanding, public attitudes and not leave that to Fox News. The people who exploit to either gain attention, which is certainly true in politics like the tough-on-crime posture, is not particularly interested in statistics or outcomes because it’s another tool of promoting political careers and staking out of a place has become a mainstay of political strategies now. Anybody who doesn’t take that road get slammed by their opponents and so stays away from it. You haven’t heard a word about drugs and drug sentencing, drug regularization laws which are going on in the country. You haven’t heard a word about that in any political campaign in recent years, I haven’t at least. What was once upfront and can fit the most important issue even a dozen years ago isn’t there anymore because they recognize that there’s a lot of politicians, that there’s a lot of change in attitudes about drug recently, about drug laws, drug legalization now, a lot of legalizations now supported by 58% of adult population. You have legalizations in two states, Colorado and Washington for marijuana and other states doing a similar thing now. You can begin to see a crumbling on the war of drugs which has been the mighty engine that has driven massive incarceration but it will take its place in the immigration, immigration consulates and again the same thing again with the politicization of that discussion at the expense of immigrants who built this country with their hands, 400,000 deep rotations last year, a whole private industry. It’s imprisoning these people and transporting them. Sex offense is another growing issue of criminalization – watching porn on the internet. It can get you entrapped into major prison time. The financial crimes, not the Burney Maddox things but the small things like child support which fairly connects with child support. This is often built into the release arrangements, parole of people coming out of prison who are piling up to pay child support would come out of prison unable to earn any money certainly to pay back those debts. That becomes an example of something that’s set up to feed the criminal justice and prison system, which is going down from the drop in drug enforcement and drug arrest which is sad even though drugs are doing fine in America, methamphetamine trade especially. There isn’t the same appetite for pursuing it as there was. It becomes less of an issue in creating a prison population versus other things – immigration and financial crimes and sex offenses take its place.

Could you tell me about your work in harm reduction and, more broadly, organizations that have a desire to shift from a criminalization modality to a public health modality?


Harm reduction you asked about organization that have arisen, have a desire to change this model from criminal to public health. We have an organization called From Punishment to Public Health which is a collaboration of John Jay The City University, you guys, the Columbia School of Public Health, NYU School of Medicine and other departments on these institutions focusing on the issues for New York City that sit at the intersection of public health and criminal justice, things like domestic violence, drug overdoses, violence of all sorts actually done especially.

You really have to extend some effort to separate the public health view of something like gun violence from the criminal view of it, because the numbers and so even though they have a much lower than this, they’re still very substantial. You can’t pick up a paper in New York or Chicago. How do they know Los Angeles without review of awful shooting that destroyed people’s lives. When you count those up they become the major source of death and injury for many young adults and not to mention all the bystanders who get hit.
In the face of the politics of guns in United States and the NIH, it’s suppression of exactly public health research. The NIH managed to get the freeze on the CDC’s ability to do gun research going back to back 10 years, because when you look for the answers to these things, the question is like how many are affected, who, what makes a difference, what time of day – all those stuff is very hard to find because it allowed to be funded by CDC or NIH in the last decade. That’s changing now I think on the new machines that are coming in but there’s a real vacuum here. But that’s a natural place for public health methods looking at the angry kid effects, making maps looking at risk by age and location and gender. All are very, very powerful tools that in fact make a lot of sense for looking at criminal justice issues through a public health lens.

The harm reduction, how it relates to drugs and a view of accepting the fact that drug use is pretty universal. Always has been, always will be. That our goals have to be to reduce the consequences especially, those related to violence. More and more countries are thinking about drug policy in these terms.

Now, all the policy creates this violence. The most dramatic cases being those near us, in sexual marriage in Mexico, which is a huge epidemic of violence associated with the drug business to sell products that are essentially almost worthless. They are very worthless but free. The efforts to bring these drugs: cocaine, marijuana, heroin into the American market are associated with 60,000 murders in Mexico over the last 5, 6 years.

Talk about outsourcing. This is a problem that was in the United States at the time of the peak of the war on drugs in the 80s crack wars when between the start of the war on drugs in the 70s and the decline in crime in the 90s in the 20-year-period, there were 200,000 extra homicides compared to the 10 years before and the 10 years since when the enforcement and the violence associated with drug enforcement in the United States diminished dramatically but moved over to Mexico into the supply side and the local markets.

A wonderful film called The House I Live In by Jarecki which is really, does a very good job of telling the whole story but especially depicting the level of violence of drug enforcement in this period and the exposure to that of so many people. That’s was the mechanism that built the prison population and once you’re in it, you stay in it one way or another, reset in the prison, re-entry and all that.

 

Reframing Gun Violence as a Public Health Issue

Our series on “Punishment to Public Health” continues. This week, we turn our attention to gun violence as a public health issue.  In many ways, this is a key example of the way that our usual policies of criminalization around guns have failed us as a society.

No Gun Sign - Mall of America(Image source)

The harm from guns to peoples’ health is hard to deny.  The U.S. leads the world in gun deaths, according to a World Health Organization (WHO) study. Guns claim more than 30,000 lives each year in the U.S., more than five times the number of deaths from illegal drugs each year. While a great deal of media attention focused on the tragic shooting of elementary school children at Newtown, CT.,  the Children’s Defense Fund estimates that 2,391 children have been shot by guns since the beginning of 2013 alone.

Currently, our response to guns and gun policy is one that oscillates between a punitive criminalization of some gun owners and a staunch, Second Amendment defense of other gun owners.  How might society be changed if our approach to guns and gun violence were reframed as a public health issue, like seat belts or smoking?

no smoking sign(Image source)

We’ll explore some of the research on guns and look at some of the ways that activists and documentary filmmakers are contributing to a resistive reframing of gun violence as a public health issue.

Challenging Punishment: From Mass Incarceration to Public Health , Human Rights, and Restorative Justice

This post is written by Ernie Drucker.

In my book A Plague of Prisons , The Epidemiology of Mass Incarceration in America  (New Press, 2013) I proposed a public health model of mass incarceration, arguing that the war on drugs and its harsh sentencing policies ignited our epidemic of imprisonment. But the fact of  the imprisonment of 10 million  Americans in the last 40 years  demands more than re-imagining the problem – it demands solutions.

Plauge of Prisons book cover

The war on drugs fueled a “race to incarcerate”, deepening America’s racial and economic disparities , and drawing resources away from other vital social and health programs. The resulting criminalization and mass incarceration of three generations of young minority males has left a trail of mass trauma and imposed systematic disadvantages on this population – direct consequences of “toxic punishment” (Golash  D. The Case Against Punishment: Retribution, Crime Prevention, and the Law. NYU. 2005). The vast  “criminal industrial complex” that has been built upon mass punishment, is now rapidly commoditizing criminal justice through privatization , e.g.  in halfway houses for re-entering prisoners and special schools for juveniles – with little accountability for outcomes or collateral consequences.

The politically powerful and highly institutionalized system of mass punishment has taken on a life of its own and will not easily give up the lifetime grip it maintains on the population of former prisoners, all the while continuing to confer severe disadvantages on successive generations in urban communities where they are concentrated – i.e. increased homicide and suicide rates , greater risks of their own children’s future imprisonment , higher infant mortality rates , and shortened life expectancies , lower rates of employment and wages , less education ,  more failed marriages , and lower voting participation , associated with near universal felony disenfranchisement.

With growing privatization  of prisons , we can expect even less transparency and public accountability, as we  extend criminalization and mass punishment to other areas of social conflict – immigration, race relations,  sexuality – each of which now provides multiple  opportunities for our “culture of punishment” to assert itself in new areas  e.g. in 2012 over 500,000 “illegal” immigrants were held in detention centers and 400,000 deported; 500,000 sex offenders arrested , imprisoned,  and placed on computerized registries .

 Eric Holder, Attorney General(Image Source)

A Watershed Moment

Fortunately we are now at a turning point in this struggle – one we must take advantage of . US Atty. General Eric Holder recently said that  “too many Americans go to too many prisons for far too long, and for no truly good law enforcement reason.” This was an important first step toward a national recognition that our decades long war on drugs has been ineffective, expensive, and cruel.  As bipartisan support grows in  Congress for overhauling U.S. drug laws, Holder has ordered Federal prosecutors to remove any reference to quantities of illicit drugs that trigger mandatory minimums .

But it is only through re-thinking and challenging  our fundamental ideas about punishment that we will  find a way out of the shadow of this great crime against humanity that mass incarceration represents.  The recent case of Trayvon Martin demonstrates the limitations of our criminal justice system –  based as it is on narrow model of blame and punishment . But what are the alternatives to this ancient and almost universal trope that has now become the  foundation of our system of justice in America? One vital step in that direction is challenging punishment itself , turning our attention to the social injustices that underlie both crime and punishment.

When viewed through a public health lens which views  mass incarceration as a collective problem that require social solutions

I’m working on a new book challenging America’s “culture of punishment” within a pubic health model based on human rights and restorative justice principals and practices. Instead of relying, as it does now, despite lip service to ideas about  rehabilitation  based on  “correctional” systems that are, in practice vast engines of cruel retribution – even torture . My new book will map the road to restorative justice through such challenges and how these new models can allow us to put an end to mass incarceration and heal the mass trauma it has left behind .

Three Key Steps to Move from Punishment to Public Health

To launch this process in America here are three steps we must take:

  1. Recognize the  Toxicity of Punishment:  Punishment can be a form of state violence and mass trauma, where pain and suffering are intentionally applied to human beings in the name of justice. Research shows that “toxic punishment” is “excessive or prolonged activation of stress response systems ( and has) damaging effects on learning, behavior, and health across the lifespan” (Harvard, Center on the Developing Child).  [2] Mass incarceration is mass exposure to toxic stress. The public-health model and epidemiology of punishment , as a form of violence, allows us to examine the impacts of  mass punishment and its health consequences (Velasquez-Manoff, “Status and Stress,” New York Times, Jul 27, 2013).
  2. Challenge Our Most Toxic Systems of Punishment:  we need to recognize and end the most toxic forms of  punishment that characterize our system of  mass incarceration. This first means reducing the size of the problem, for it is the huge scale of incarceration that drives the significance of its impact on public health and casts a shadow over American life.  We can do this by setting a goal of limiting the use of prisons as the default response to so many actions by so many people – with a goal of getting back to levels before the epidemic of mass  incarceration began – a figure of 100/100,000 populations in line with that of other modern democracies .  Challenging mass incarceration we can build on other successful campaigns against punishment in America :  e.g. opposition to the death penalty and rolling back the Rockefeller drug Laws. A great place to start is with reining in the massive use of solitary confinement – the most prominent and most torturous of all methods use in modern incarceration – the US , with 5% of world population and 25% of its prisoners, America accounts for over 50%  of those held in punitive isolation. We must take on and learn from  these cases , examine their  sustaining sources, organizations, and  leadership. Publicize the ways in which we can reduce incarceration without compromising public safety and work to build public support for alternatives to punishment .
  3. Build New Systems Based on Public Health , Human Rights , and Restorative Justice: Restorative principals and models of conflict resolution based on human rights do not impose toxic punishment – they work to break the cycle of retributive violence by challenging the use of collective punishment as tools of state power, replacing them with public health methods and outcomes, and  show that these better serve legitimate public concerns about public safety.

Positive changes in drug polices are gaining new momentum in the US , with more state undertaking marijuana’s legalization. But reducing the length and frequency of drug-related incarceration going forward, however welcome, wont do anything about the large population of drug users already stuck in our prisons and the post prison correctional control over the lives of millions more. Over 300,000 drug offenders are still serving out long terms under the now discredited mandatory sentencing policies. Most of these are young minority men with children, drawn from our poorest urban communities. We must consider ways to remove most prisoners from the strangle hold of the criminal justice system  – an amnesty that would allow those who  can do so to re-establish a useful place in our society and in those communities most affected by mass incarceration – restoring them to full citizenship – the most essential ingredient to human rights.

~ Ernie Drucker, PhD, is a Research Associate at John Jay College-CUNY and on the faculty of the Mailman School of Public Health.

From Punishment to Public Health: Our Next Social Justice Topic Series

Today begins our new month-long social justice series called From Punishment to Public Health.  In this series we will explore how public health might offer a more humane and just approach to social ills than the current approach that is based on criminalization.

Overcrowded Prison Source: http://en.wikipedia.org/wiki/Prison, Creative Commons Attribution

Is this the best response to social ills?
Source: http://en.wikipedia.org/wiki/Prison, Creative Commons Attribution

Since at least the 1970s, the response to drug use has been one that emphasized punishment and criminalization. The punishment framework has shaped the collective response to drug use for the past thirty years, in the US and globally. Catch phrases like “lock ‘em up and throw away the key,” “three strikes and you’re out,” and “let them rot in jail,” have characterized this time period and this attitude toward drug use.

More recently, the reliance on criminalization has been giving way to an approach that is more rooted in a public health. For example, in 2013, US Attorney General proposed moving away from mandatory minimum sentences for drugs. And, as the Patient Protection and Affordable Care Act (ACA) – colloquially known as “Obamacare” – goes into effect, an estimated 32 million Americans will have new access to drug treatment programs. Outside the US, other countries are moving to legalize drugs (such as Portugal, Uruguay) and closing prisons due to lack of inmates (such as the Netherlands).

How are these policy changes transforming the lives of everyday people? Are public health approaches to the criminalization of drugs really better or do they simply expand control over citizens? Through a variety of knowledge streams (e.g., podcasts, data visualizations, and blog posts) we will host a month-long conversation between academics, activists and journalists about the shift from punishment to public health and if that moves us closer to a more just society. As we did with the stop-and-frisk series, at the close of this series we’ll pull all these resources together in an all-in-one guide that you can download for your own use.

In the coming weeks, we’ll also curate a mix of academics, activists, and journalists talking about how to address this complicated social justice issue.  To open this series, we will feature the following:

The aim of JustPublics@365 is to foster just the innovative work that can foster connections between academics, activists and journalists who are working to address some of the pressing social problems of our time.  From where we sit in the heart of New York City, criminalization is at the top of the list of pressing social problems because of the deleterious effects it has on the democratic life of the city and the nation.

So, we offer this series on Punishment to Public Health as another case study of how we might reimagine scholarly communication for the public good.

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Click here for more information about our Monthly Social Justice Topic Series.

 

Using Big Data to Improve Public Health

Big data holds the promise for helping solve big problems and improve health. In their book Big Data, authors Kenneth Cukier and Viktor Mayer-Schonberger describe how tracking flu symptoms via Google searches is much faster than the traditional methods used by the Centers for Disease Control (CDC).

The problem with traditional data collection on health such as those at the CDC is that they can be time-consuming and cumbersome.  A key reporting mechanism that the CDC uses is from doctors, who are, in turn, reporting on the patients they’ve seen in their office consultations.  Relying on these reports builds in a delay of a week, sometimes longer, into the data the CDC is collecting.

Big data, the data that’s collected already in a variety of ways, can be mined, analyzed, and curated in ways that can help improve health of whole populations, not just individuals.  As with the example of the Google flutrends, there is some hope for addressing asthma through the use of big data.

Making progress in the treatment of asthma requires data outside of the self-reported information from asthma sufferers that doctors generally rely on. The new Asthmapolis may offer part of the solution. Asthmapolis seeks to eliminate the “inability to collect information about where and when people develop symptoms.” Asthmapolis uses inhaler sensors, mobile applications, advanced analytics – in other words, big data –  to help physicians identify those patients who need help controlling the disease before exacerbation.

How does this research impact the public?  In Louisville, Kentucky, for example, a city with particularly difficult air quality conditions for those with breathing disorders, Asthmapolis teamed up with health officials to collect data by sensor in the inhalers of project participants. This helps Asthmapolis and city leaders understand when and where people with asthma develop symptoms, in turn identifying community-wide asthma triggers that can be eliminated. This means that using big data has the potential to improve health by monitoring individual asthma attacks  as well as creating population-level changes in environmental policies that may trigger asthma.

Some policy makers and physicians have raised the concern that the nation’s most pressing health epidemics are in fact appallingly low-tech, and that it’s local reforms and relationships, not high-tech solutions that are needed. The brains behind Asthmapolis are trying to fuse the two approaches together; the on-the-ground experiences of asthma sufferers, the technology that allows for location-specific data, lightweight sensors, and continual monitoring, with a continued conversation about enacting real change on the municipal level.

As promising as Google flutrends and Asthmapolis are, big data raises big questions about that information gets used.  Do we have faith in our institutions to create change that will improve health for everyone from the enormous amounts of data that such a project will gather?  Or, will political action still be necessary to compel leaders to do the right thing?  Only time will tell.

Round Table Public Health: Resisting or Expanding Criminalizaton?

How should we respond to drug users – with jail or treatment?  Is a public health approach to drug use a way to resist criminalization? Or, does public health just replicate control in new forms? These are some of the issues raised when people talk about public health and criminalization, and this has been an important week for talking about these issues.

Just yesterday, the Drug Policy Alliance and the New York Academy of Medicine released their Blueprint for a Public Health and Safety Approach to Drug Policy (pdf).  A multi-year effort, the Blueprint makes a strong case for what they call a “four pillar approach” to drug policy.  The pillars are:  prevention, treatment, harm reduction, and public safety.  The first three of these – prevention, treatment and harm reduction (such as syringe exchange) – are rooted in public health responses to drugs rather than the “lock them up and throw away the key” approach of the last 30 years.

Blueprint DPA NYAM graphics

On Monday, the day before the Blueprint release,  I took part in a round table conversation with a mixture of academics, activists, and journalists about these same issues. In a small group we tackled the following question: is public health resisting or expanding criminalization?

As each of us went around the table to introduce ourselves, I realized that there was a mixture of historians, lawyers, LGBTQ activists, public health professors, and journalists that made for an engaging, lively discussion.

The conversation opened with a declarative statement: the public health model is concerned with communities and populations, not individual behavior. “The criminal justice model is an individual behavior model,” said Ernie Drucker, author of Plague of Prisons, “and that’s why we should not use the criminal justice model to address issues of drug use and addiction.” Others agreed, but pointed out that public health has been a coercive tool and that it was important to be skeptical of behavior control methods being practiced under the guise of public health.

This part of the discussion produced more questions than answers. We wondered, how would public health drug policies be any different than criminal justice drug policies? What were the public health options for addressing drug use and addiction? Would public health officials be better suited for the problems of addiction than criminal justice officials? PHTweet_03

(You can see more of the Twitter updates from this session here.)

Rebecca Tiger (@rtigernyc), author of Judging Addicts: Drug Courts and Coercion in the Justice System, was especially wary of turning the problem of drug use and addition over to public health without some critical examination of the history of public health practices.

PHTweet_02

(You can see more of the Twitter updates from this session here.)

Recognizing that public health has increasingly focused on individual behavior change, the group questioned when public health began to focus on behavior modification. I suggested that the visual anti-tuberculosis campaigns in early twentieth century, which aggressively targeted individuals with posters that told them to stop behaviors such as spitting and coughing, could have been the beginning of the use of mass media for individual behavior change.

Rebecca Tiger questioned how the media contributes to the public discourse about drugs in the United States. In response, Sandeep Junnarkar talked about how he encourages his students to move away from mass media and focus their own blogs or even radio blogs. Rebecca said she thought the mass media has been perpetuating the “criminalization conversation” and one of the biggest obstacle in switching the conversation towards decriminalization and public health. By encouraging his students to think more broadly about where they publish their work, Sandeep said he hopes there will be a new generation of journalists that can help sway the conversation.

Tweets

(You can see more of the Twitter updates from this session here.)

The conversation cycled back to a discussion of the American public health framework when someone brought up the legacy of Progressive Era reform movements on present day public health. There were those who adamantly declared that public health was necessarily population and community based and those who were wary of public health practices. Clearly, we had not come to a consensus about the role of public health in decriminalization efforts.

The conversation, appropriately, raised more questions than it answered. Ernie Drucker said that part of the solution to the many questions and problems raised in the discussion was to have more cross boundary/cross disciplinary conversations like this one.

I completely agree.

You can see the archived livestream of our discussion here.  And, soon, we’ll have a more polished, edited video.

If you’re in the Buffalo, NY area and want to continue this conversation, you’ll want to attend this conference, May 2-3, at the Baldy Center for Law & Policy.  FREE and open to the public.