How a public health program can usher police, prisons into obsolescence

What is an alternative to police and prisons that builds safety and prevents violence in the U.S.?

In the wake of Tyre Nichols' murder and the ongoing debate around U.S. public safety systems, Northwestern Medicine's Dr. Eric Reinhart outlines such a plan.

Reinhart proposes in a special Feb. 8 report in the New England Journal of Medicine (NEJM) the creation of a new federal department of community safety and repair to lead a national decarceration program.

The program would be enabled by hiring two million community health and justice workers (giving preferential employment to formerly incarcerated people) as part of a national health and justice corps.

"The abysmal state of United States public health and safety are fundamentally intertwined, and neither can be separated from the destructive consequences of mass incarceration," said Reinhart, a resident physician-scientist in psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.

"We need to stop treating health and safety as if they're separate policy domains. To build either public health or safety in America, we have to build both simultaneously –– for that, we need a new approach that supports communities from within.

"Investing in this human infrastructure is essential for progressively replacing counterproductive reliance on police and prisons while also improving community safety, building effective systems with which to provide community-based care for people with disabilities and severe mental illness, and repairing the long-term health and economic harms that mass incarceration has caused for many of the more than 77 million people in the U.S. with criminal records."

The 2,800-word special NEJM report is titled, "Reconstructive Justice—Public Health Policy to End Mass Incarceration."

In the report, Reinhart outlines the scale of the widely ignored role that incarceration ––both before and during COVID-19 –– has played in undermining U.S. public health and health care, which he said now both rank worst among peer nations.

"Evidence also shows how poor public health and health care systems, in turn, exacerbate crime, violence, arrest and incarceration," Reinhart said.

Reinhart reframes the movement for prison abolition as not just about dismantling oppressive institutions, but also a necessary reconstructive project of building community-based care infrastructure sufficient to usher police and prisons into obsolescence.

Reinhart has been working with government officials in Illinois on securing funding for pilot programs to implement the community health and justice worker model he describes in the NEJM article.

"Building on well-established success of community health worker programs for improving health outcomes and reducing health care spending, we are working with Illinois' communities to demonstrate that the benefits these underutilized programs bring to communities aren't just about health," Reinhart said. "They also are essential for building shared safety for everyone rather than just the privileged few."

The hope, he says, is to use Illinois as a proof-of-concept site en route to generating broader uptake of this paradigm nationwide.