Which Side Are You On? Policing, Prisons, & Abolitionist Nursing

 

Which Side Are You On?

Policing, Prisons, & Abolitionist Nursing      

The COVID-19 pandemic has fundamentally shifted public discourse around race, violence, and health. The converging crises of income inequality, police violence, and systemic racism collided with the SARS-CoV-2 virus and have created novel paradigm shifts in public health. The pandemic widened cracks in our societal structures and magnified existing divisions and inequality. Violent crimes and deaths are rising nationally, and stay-at-home orders and lockdowns resulted in increased rates of interpersonal violence and homicide ¹. COVID-19 has also caused an increase in secondary risk factors associated with interpersonal violence, namely substance use, mental health issues, unemployment and economic stress, and social isolation ². Against the backdrop of increased violent crime, the murder of George Floyd in 2020 by Minneapolis Police Officer Derek Chauvin sparked a national and global reckoning with racism, policing, and community safety. These dual trends have laid bare an inherent contradiction in approaches to violence: increased policing and mass incarceration do not lead to public safety.

 

The 3 P’s: Public Health, Police, and Prisons

The paradigm of social determinants of health (SDOH) has become the dominant theoretical and practical framework for public health nursing. The origins of SDOH lie in the roots of epidemiology and the sanitary campaigns of the early nineteenth century, which highlighted the interconnectedness of health, social position, and living conditions. Provision 8 of the American Nurses Association’s Code of Ethics highlights the importance of SDOH: “Nurses understand that the lived experiences of inequality, poverty, and social marginalization contribute to the deterioration of health.” Today, the SDOH paradigm is a central framework for health policy in the United States.

"The evidence is clear: social determinants of health, such as access to stable housing or gainful employment, may not be strictly medical, but they nevertheless have a profound impact on people’s wellbeing.” -Seema Verma, CMS Director

Discussing the social determinants of health without acknowledging the role of state-sanctioned violence is impossible. Policing and incarceration disproportionately impact poor and low-income communities, disabled people, immigrants, and communities of color ³. Incarceration shortens life expectancy by five years and has disastrous health effects, including high rates of chronic and infectious diseases, substance use, and mental health issues ⁴. Like SARS-CoV-2, structural institutions like healthcare and law enforcement don’t overtly discriminate against groups of people, but as Steven Trasher eloquently shares in his book The Viral Underclass, “their effects do discriminate against the bodies of the underclass, because those bodies have been placed in proximity to danger by the structural design of powerful humans.”

The American Public Health Association, the American Nurses Association, and the American Medical Association have all issued statements condemning the epidemic of racist police violence in the United States ^{5, 6, 7, 8}. While these statements represent an essential step in acknowledging the structural inequities in policing and prisons, they fail to identify how the carceral state maintains and upholds the structural determinants that cause health disparities in the first place. Ruth Wilson Gilmore’s concept of organized abandonment serves as a further call to action for healthcare workers to interrogate the entanglement of healthcare with prisons and policing. Gilmore argues that public health agencies, particularly education and healthcare systems, have absorbed policing and surveillance functions. At the same time, jails, prisons, and the police absorb social work and mental health care functions they are neither equipped nor want to perform. Organized abandonment has resulted in massive state and municipal budgets devoted to policing and jails, with commensurate disinvestment in the institutions that keep people out of the carceral system: schools, housing, and healthcare.

Nursing and public health values fundamentally contradict the practices of surveillance, policing, and incarceration. While the SDOH framework offers a paradigm for understanding the linkages between health, violence, and policing, it falls short of offering solutions. To address the upstream drivers of health inequities, nurses must move beyond understanding to action.

Abolitionist Nursing Praxis

 

Abolitionism is a critical framework that interrogates how healthcare is intertwined with police and prisons and offers a vision for health-based solutions to violence outside of the carceral state. Abolitionist theory is a political and social philosophy that aims to abolish or dismantle oppressive systems, such as slavery, racism, sexism, and other forms of social inequality. Abolitionist theory also argues that the prison system, rooted in punishment and retribution, perpetuates cycles of violence and fails to address the root causes of violence or crime. It questions our assumptions that violence is an inevitable feature of human society and that the existing systems of policing and incarceration are a necessary response to violence. These systems are neither inevitable nor permanent but instead emerged from specific political and economic contexts and are actively buttressed by influential people and institutions.

So, why is abolitionism relevant to nursing? Alternatives to policing and the criminal justice approach to violence are needed, and health-based interventions could fill this gap. Abolitionist nursing offers a theoretical framework that advocates separating healthcare from policing and incarceration and addresses the upstream drivers of violence and health outcomes ^{9, 10}. The healthcare system, however complex, is still a space that can offer refuge from harm and healing from violence. Abolitionist nursing redirects resources away from prisons and police and towards violence prevention, intervention, and healing. By expanding our SDOH framework to include an abolitionist lens, nurses can play a crucial role in understanding health inequities and preventing the state-sanctioned violence that creates and exacerbates those health inequities.

The COVID-19 pandemic has upended the healthcare system and generated high levels of mental exhaustion, trauma, and burnout among nurses and other healthcare staff. Nurses trained in an SDOH framework often struggle with a sense of futility and overwhelm: the upstream drivers of health inequities can seem impossible to tackle, and the patients and harm are endless. Abolitionist nursing offers an alternative framework that seeks not gradual reform of the structural institutions that drive violence and illness but moves nurses towards an ethic of mutual aid. In the words of Ruth Gilmore, “Abolition is not absence; it is presence…. So those who feel in their gut deep anxiety that abolition means knock it all down, scorch the earth and start something new, let that go. Abolition is building the future from the present in all ways we can.”

References:

1. Kourti, A., Stavridou, A., Panagouli, E., Psaltopoulou, T., Spiliopoulou, C., Tsolia, M., Sergentanis, T. N., & Tsitsika, A. (2023). Domestic Violence During the COVID-19 Pandemic: A Systematic Review. Trauma, violence & abuse, 24(2), 719–745. https://doi.org/10.1177/15248380211038690
2. Robinson, E., Sutin, A. R., Daly, M., & Jones, A. (2022). A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020. Journal of affective disorders, 296, 567–576. https://doi.org/10.1016/j.jad.2021.09.098
3. Sawyer, W. (2020). Visualizing the racial disparities in mass incarceration. Prison Policy Initiative. https://www.prisonpolicy.org/blog/2020/07/27/disparities/?gclid=Cj0KCQjwr82iBhCuARIsAO0EAZxXUPO4GZT9o44RSTdX2MhnFsx_exdgAa4Sy_BVY71zCCj9aKSRuWYaAihJEALw_wcB
4. Healthy People 2030. Incarceration. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/incarceration#:~:text=Studies%20have%20shown%20that%20when,%2C%20hepatitis%20C%2C%20and%20HIV.
5. American Public Health Association. (2018, Nov 18). Addressing law enforcement violence as a public health issue. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2019/01/29/law-enforcement-violence
6. American Public Health Association. (2021, Oct 26). Advancing public health interventions to address the harms of the carceral system. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Advancing-Public-Health-Interventions-to-Address-the-Harms-of-the-Carceral-System
7. American Nurses Association. (2020, Jun 20). Resolution on racial justice for communities of color. https://www.nursingworld.org/news/news-releases/2020/ana-calls-for-racial-justice-for-communities-of-color/
8. American Medical Association. (2020, Nov 17). AMA policy recognizes police brutality as a product of structural racism. https://www.ama-assn.org/press-center/press-releases/ama-policy-recognizes-police-brutality-product-structural-racism
9. Khan, Z., Iwai, Y., & DasGupta, S. (2022). Abolitionist reimaginings of health. AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/abolitionist-reimaginings-health/2022-03
10.  Paynter, M., Jefferies, K., Carrier, L., & Goshin, L. (2022). Feminist Abolitionist Nursing. ANS. Advances in nursing science, 45(1), 53–68. https://doi.org/10.1097/ANS.0000000000000385