In October, well into the second year of the COVID-19 pandemic, public health workers across the U.S. were gathered virtually on computer screens spread throughout the country to attend the annual meeting of our professional organization. We sat awaiting the start of a session that would culminate in a series of votes where representatives from various internal divisions would decide on behalf of our organization to adopt or reject a set of newly proposed policy statements.
Several of us in the virtual audience had worked on and submitted one of these statements, titled “Advancing Public Health Interventions to Address the Harms of the Carceral System.” The statement reviewed research on the health consequences of incarceration and the health-promoting alternatives to incarceration — ultimately proposing a range of policies that would decrease reliance on the criminal legal system and move towards an abolitionist future, centering the public’s health and wellbeing. We had spent the months leading up to the vote engaging with the organization’s membership around the statement, discussing their concerns, incorporating their feedback, and addressing misconceptions.
On this day, however, as primarily non-voting members, we would not be permitted to speak. We waited, hoping our prior efforts would be sufficient to guide the discussion towards one rooted in a comprehensive evidence base, comprising collective, cross-sectoral knowledge.
Yet the first speaker to take the virtual floor spoke strongly against the proposed policy statement.
“If we abolish prisons, what do we do with career criminals? What do we do with sociopaths?” the speaker asked. They continued, “It is our position that if this statement is adopted by the council, it gives validity to a camp that has destruction as its goal.”
The speaker’s comment revealed a fundamental misunderstanding about the policy statement, and even more so about the abolitionist goals it supports. Far from destruction, abolition is about disrupting systems that create or compound harm, while establishing or reinforcing health-affirming ones in their stead — ultimately creating a world where people have what they need to live healthy and safe lives in their communities. As abolitionist scholar and activist Ruth Wilson Gilmore writes, “Abolition is about presence, not absence. It is about building life-affirming institutions.” This is, in fact, also a tenet of public health and the work its stated mission sets out to achieve.
As abolitionist scholar and activist Ruth Wilson Gilmore writes, ‘Abolition is about presence, not absence. It is about building life-affirming institutions.’ This is, in fact, also a tenet of public health and the work its stated mission sets out to achieve.
A second speaker then countered the first, illustrating the range of perspectives encapsulated in the membership: “Having studied the policy and the references, I disagree with speaker one and support the policy in that the references are clear, reliable, and the recommendations are sound and will move this nation forward to greater justice, peace, and health.”
And then a third: “I rise to speak in favor of the policy. It persuasively addresses the health harms of the carceral system, citing evidence at length. The overwhelming detrimental public health impact on individuals and communities is with incarceration; it is not with the release of so-called career criminals. That is the claim that lacks evidence.”
This was the annual meeting of the American Public Health Association, the largest public health professional organization in the United States. One of its central goals is to advance health-promoting public policies in the U.S. through advocacy, lobbying, public testimony, and letters to Congress. At its annual meeting, APHA adopts evidence-based policy statements that are meant to guide APHA’s policy agenda. Although the first speaker was the only dissenting opinion during the Governing Council’s vote, their words echoed other feedback we heard from within APHA before the vote. Public health, along with most of society, has often ignored or marginalized abolitionist ideas — despite their salience to the field’s mission — seemingly out of fears rooted in misunderstanding or a commitment to the status quo.
As co-authors of the APHA policy statement on carceral systems, we see abolition as central to public health policy and practice. Many of us were also co-authors of APHA’s 2018 policy statement, “Addressing Law Enforcement Violence as a Public Health Issue,” which grew from a graduate student project at San Francisco State University in 2015. Inspired by the uprisings in Ferguson to mourn, commemorate, and demand justice after the murder of Michael Brown, and the call from organizers for all sectors to leverage their power toward abolition, the statement’s original authors brought an ongoing discussion about police violence, anti-racism, class consciousness, and abolition to a mainstream public health space.
That initial statement documented a lack of evidence supporting typical policing reforms — such as body cameras, tasers, implicit bias training, and community policing — in preventing police violence or improving population health and wellbeing. It concluded that the existing evidence base supported divestment from law enforcement and investment in the community-based and community-led solutions that activists and organizers had been demanding for decades. Among them: increased access to stable housing, expanded educational and employment opportunities, and increased access to mental health care and substance use treatment. After three years of organizing both in and outside of APHA, the policy statement on law enforcement violence finally passed, recommending abolitionist solutions — but without using the word “abolition” explicitly, as a strategy to avoid misguided pushback around the language itself in turn facilitating the statement’s adoption by APHA.
After its adoption, organizers, researchers, and public health educators shared the ways in which they had found the statement useful for their work. In light of this, we considered whether another statement, focused on the health harms of incarceration specifically, would be useful. Not wanting to duplicate existing efforts or pursue a policy statement simply for the sake of writing one, in January 2020 we discussed the utility of such a statement with people organizing in this area. We ultimately decided to prioritize encouraging APHA — and supporting others outside of APHA — to use the existing policy statement on policing in teaching, research, practice, advocacy, and organizing.
Two months later, the COVID-19 pandemic took hold in the United States, leading to an enormous push for decarceration as the virus tore through jails, prisons, and detention centers. Study after study found case rates and mortality to be several times higher in prisons and jails than in the general population. Though organizing initially led to some successful decarceration policy changes during the pandemic, not nearly enough people were released from prisons and jails quickly enough to prevent carceral settings from becoming COVID-19 hotspots. The long existing harms of incarceration — higher prevalence of acute and chronic conditions, the health harms of solitary confinement, and family separation, among others — became magnified by the pandemic. Despite other leading global public health and healthcare organizations beginning to join calls led by organizers and activists for decarceration as a fundamental public health strategy, APHA had yet to speak out. Recognizing the urgent need for the public health field to clearly and collectively call for decarceration in U.S. jails, prisons, and detention centers — and the important role that APHA has in coordinating that endeavor as a leading U.S. public health organization — we revisited our earlier conversations and decided to pursue the new policy statement.
We began preparing a new statement that put the challenges of COVID-19 in context with the long-standing health harms of incarceration. At the time, we again decided that it would be easier for the statement to pass if we didn’t name abolition explicitly, but still presented recommendations that lead to abolition.
A few months later, the police murdered Breonna Taylor, George Floyd, and Tony McDade. As communities mourned globally, uprisings spread across the country, becoming the largest documented protest wave in U.S. history. Abolition made its way into discussions in mainstream outlets like The New York Times and The Atlantic, and the topic was raised in the 2020 presidential race. Organizers and scholars who had for decades been unapologetically using the framing of abolition to convey a different path forward were suddenly lifted up on mainstream platforms, infusing everyday conversations with comprehensive descriptions of abolitionist tenets, and laying a foundation for continued discussion. We realized there was neither a clearer nor a more promising time than this to explicitly name abolition in the statement. Even if that meant the statement would not be adopted, we were encouraged by this national shift to recognize the importance of having this discussion within the field of public health. Few of us thought that APHA would pass the statement with abolition named explicitly.
Thankfully, we were wrong.
Few of us thought that APHA would pass the statement with abolition named explicitly. Thankfully, we were wrong.
In November 2020, the incarceration policy statement passed as a late-breaker, which meant the APHA Governing Council felt the issue of COVID-19 in carceral facilities was of critical concern for public health officials in the thick of managing the pandemic. This allowed the statement to become official APHA policy for one year after a condensed review process.
In order to be adopted permanently into APHA policy, we were required to resubmit the statement for the standard and more lengthy review process in 2021. We wanted to ensure that APHA understood abolitionist strategies as a solution to the public health harms of incarceration in general, not only during a pandemic. So we edited this iteration to more comprehensively review the broader health harms of incarceration to people who are incarcerated, their loved ones, their communities, and overall population health, inclusive of and beyond COVID-19. We also explicitly named the fundamental alignment between abolitionist strategies and core public health tenets.
Twice, we received negative assessments from APHA’s Joint Policy Committee, the body responsible for reviewing policy statements and making recommendations to the Governing Council about which statements to adopt or reject. This was a strong indication that the committee was recommending that we withdraw the statement from consideration as APHA policy.
However, we chose to push ahead through the review process. We felt the review critiques were addressable, and that even if the statement did not ultimately pass, the process would initiate important conversations within APHA, with potentially reverberating effects across the external work of its members. In the weeks that followed, we emailed almost every membership section and caucus within APHA to ask for their support and feedback on the statement. We had Zoom calls with supporters and dissenters to discuss the ideas and evidence in the statement. We claimed our allocated time during the public hearings to elevate abolitionist public health policy and encouraged supporters to submit their written and oral comments in favor of the statement. We used these discussions to strengthen the statement, adding to the statement’s evidence base and refuting new opposing arguments.
For example, one major concern repeatedly raised by supportive and opposing reviewers alike was that “alternatives to incarceration would not be fair to survivors of crime.” While recognizing that survivors do not have uniform experiences of harm, the draft statement reviewed existing evidence, which describes how carceral system practices are largely misaligned with survivors’ justice goals. But hearing this feedback prompted us to pool and expand on that evidence in two dedicated sections. One of them began, “Rather than assuming punitive measures are preferred by survivors of harm, an abolitionist public health approach uses evidence-based strategies to understand the complexity of survivors’ expressed needs in order to collectively and effectively build systems that support healing and both prevent and account for harm.”
These sections went on to review that evidence base, describe its findings, and summarize its overall conclusions. “While, at present, incarceration is often the only available recourse for harm — and therefore often pursued as an alternative to ‘nothing’ — survivors express concern over its capacity to achieve their justice goals and to ensure individual and community safety, healing, and well-being,” the proposed statement read. It added that “interdisciplinary scholars, researchers, practitioners, and survivors increasingly propose developing evidence-based, prevention strategies and community solutions for healing and accountability guided by the expressed needs of survivors as opposed to the limitations of currently available systems.”
To our relief and surprise, the Joint Policy Committee shifted course 12 hours before the vote and recommended adoption of the policy statement based on its scientific rigor, comprehensive response to prior critiques from the review body, and the broad support among membership, as shown in the hearings.
We knew that with the positive assessment from the committee, the statement was much more likely to pass at the next and final step: the Governing Council vote the next morning. We waited with hopeful but cautious optimism, signing into Zoom at 9 a.m. to watch the proceedings.
Ultimately, the policy statement was adopted by the American Public Health Association at the 2021 conference with majority support from Governing Council members (86% to 14%).
Read the policy statement
Through the permanent passage of the statement, APHA calls for measures to be taken by public health and other decision-making bodies across the U.S., including: “mov[ing] towards the abolition of carceral systems and build[ing] in their stead just and equitable structures that advance the public’s health.” APHA recommends, among other things: (1) decarceration; (2) divesting from carceral systems and investing in the social determinants of health, including housing, employment and other resources to support health; (3) committing to non-carceral measures for accountability, safety, and well-being that are aligned with survivors’ justice goals, such as transformative and restorative justice; and (4) decriminalization. The statement argues these public health solutions are long overdue measures needed to address the longstanding, widespread health harms of carceral systems on individuals, families, and communities.
The work to get an abolitionist policy statement adopted by the largest public health association in the country was considerable. At every step, we encountered challenges, resistance, recommendations to remove abolitionist language, and mercurial support. We are grateful to those who supported this statement throughout the entire process and offered feedback to strengthen it. We are also clear-eyed that the adoption of this statement wouldn’t have been possible were it not for the work of activists and organizers — mostly Black women — who created the conditions for abolition to be on the national stage through decades of often unrecognized work on abolishing the prison industrial complex and building just, healthy, and equitable systems in its stead. Just as their work informed the content of the statement, we hope that APHA’s policy statement will further amplify their work and serve as an evidence base that organizers, teachers, researchers, policymakers, and others can draw upon in their work. Our experience organizing within APHA to pass the statement suggests that many in our field are ready to challenge the legacy of punitive policies and envision ways to align public health with abolition through actions, not just mission statements.
Our experience organizing within APHA to pass the statement suggests that many in our field are ready to challenge the legacy of punitive policies and envision ways to align public health with abolition through actions, not just mission statements.
The field of public health cannot afford to stay stagnant. The health equity we frequently claim to seek will not come from fair-weather support, adherence to mere incrementalism, or fears of structural transformation. This has become abundantly clear in the face of great challenges like white supremacy, racist police murders, the disproportionate and systemic harm of incarceration, and the COVID-19 pandemic, which demand public health, government, and healthcare systems act swiftly, courageously, and with the utmost value placed on human life and dignity.
What may be novel for the field of public health is what activists, organizers, survivors of violence, and others directly impacted by the prison industrial complex have been naming for decades. Future generations will look back at the way the carceral system operates today and be speechless at why the public health community sat back as such an inhumane and harmful system at odds with its core mission persisted. Today, each of us, within and outside of public health, must demonstrate that we believe in building a world where prisons are obsolete. To do so, we have to build and sustain new systems of public safety and public health that nourish and care for our communities and address harm in humanistic, restorative, and compassionate ways.
As Ruth Wilson Gilmore urges, our institutions should affirm life, not harm it. Abolition is public health. The sooner we collectively realize that, the sooner we can fulfill our ethical responsibility as public health workers and as members of society dedicated to creating the systems of equity, justice, and care we all deserve.
The End Police Violence Collective is a growing group of public health researchers, teachers, graduate students, non-profit leaders, and community organizers who first came together to draft and organize around passing the APHA statement “Addressing Law Enforcement Violence as a Public Health Issue” and have since also drafted and passed the APHA statement “Advancing Public Health Interventions to Address the Harms of the Carceral System.” Since we consider every writer, researcher, organizer, public health worker, and supporter who has touched this statement a part of the collective, we have also chosen to author this article as a collective, rather than as named individuals. For more information, visit endingpoliceviolence.com.