Tag Archives: Structural Racism

Gratitude for Being Invited into a New Community


Photo from LA convening of incarcerated women and women working in public health.
Charlene Sinclair, Center for Community Change, speaking at A Women’s Gathering on Criminalization and Community Health Inequities.

In mid-September, I attended A Women’s Gathering on Criminalization and Community Health Inequities. The gathering was different in many ways, but one aspect of it really stood out: We were being invited into a community that most of us knew very little about, a community of women who had been incarcerated at some time in their lives.

As Andrea James, founder of Families for Justice as Healing and The National Council of Incarcerated and Formerly Incarcerated Women and Girls (The Council) said, “I am a former lawyer, a community activist, the wife of a man who was incarcerated, an active resident of Roxbury, MA, and a mother. I have a lot of professional and personal experience. But I didn’t become a expert until I was incarcerated.”

Only now am I beginning to understand this reality. For the past two years, I’ve been researching the health and equity impacts of the criminal justice system and working with advocates to create a new system, one that puts health and wellbeing, instead of punishment, at the forefront. Some of the people I collaborated with had been incarcerated, and I felt as if I had some understanding of how the criminal justice system destroys people and families.

But, really, it wasn’t until September 15, 2016—when 30-plus women who had been incarcerated met with about 15 women who worked in the field of public health—that I became more profoundly and intimately connected to those experiences and impacts. The women I met drove home the urgency of needing to work together to create a system of justice that values every life, treats people with dignity, demonstrates compassion, promotes a restorative and rehabilitative approach, creates space for accountability, and improves both health and safety.

And particularly for women and girls.

The reality hit me that, as women, we all have some degree of familiarity with the conditions that led to the women being incarcerated. While I had not had the experience of being incarcerated, I had experience with many of the pre-cursors—and that was a connection I had not made until hearing their stories.

Consider this: No woman is immune to the threat of community violence, oppression, being judged by her looks, being harassed on the street. And so many of us women (1 out of every 3) have been physically, psychologically, or sexually abused. And out of women who become incarcerated, that number is even higher—a recent Vera Institute report showed that 85% of women in jail have been physically or sexually abused.

What I heard from the women who shared their experiences is that these exposures (as we say in public health) —combined with acute and ongoing bias, mistrust, and maltreatment among many government agencies and institutions—led to them making choices that were ultimately criminalized. Behaviors that a more humane society would respond to with an offer of support, healing, and recovery—were instead met with surveillance, arrest, and incarceration in the United States.

But while I felt a connection to those exposures, it became deeply clear that we experienced a different, and unequal, set of outcomes based on things like racism and where you live. My childhood and home life weren’t perfect and I had some of the same teenage behaviors that I heard about in the room. But growing up white, in a suburb, middle class—these worked in my favor. People—rooted in institutions and systems—gave me leeway to make mistakes and gave me second chances. That is what privilege looks like, and that is where much of my experience diverged from the women in the room. Being confronted with that in an honest and face-to-face dialogue was so important to our ability to establish trust and try and build an authentic partnership.

Another thing happened that also stretched my understanding of what it takes to build trust with communities who have experienced significant trauma. The public health women in the room, many of whom work in government, were held responsible and asked to own the fact that we worked in and with institutions that repeatedly harmed, alienated, and failed the formerly incarcerated women throughout their lives. The level of distrust that existed in the room—understandably—was, well, rough. But my level of respect and admiration for every single woman in that room went through the roof after hearing their honesty and their doubts. I had such respect for women who are formerly incarcerated for getting themselves to that room, sharing their stories, calling out institutions for failing them, but also having hope that we can work together. And I had such respect for women in public health who listened with compassion and anger at the stories of women, who were not offended by the call to be accountable for the sins of government, and who eagerly asked “What can we do? To help repair the harm.”

It was a full day. It was a day like no other I have ever had in my 20+ years of public health work. The Women’s Gathering on Criminalization and Community Health Inequities was a beginning and we are now figuring out what we can do together. Lots of ideas emerged: new research and advocacy campaigns, new collaborations and capacity-building efforts, invitations into our institutions to humanize each other. It is on all of us now to continue to build this fledgling trust.

To be explicit about my gratitude: thank you to all the women who attended from The Council, women who are formerly incarcerated but may not be part of The Council, and all the women from the public health institutions. Your open hearts and minds is what made the day such a meaningful experience.

And a special thanks to our Women’s Advisory Team who helped plan the gathering: Jeanne Ayers (Minnesota Department of Health), Solange Gould (California Department of Public Health), Donna Hylton (The Council), Paula Tran Inzeo (University of Wisconsin Extension and THRIVE Wisconsin), Andrea James (Families for Justice as Healing & The Council), Marilyn and Pamela Winn (Women on the Rise & Georgia Racial Justice Action Center)—and especially to Charlene Sinclair, Caitlin Dunklee, and Cindy Eigler from the Center for Community Change for organizing the gathering and including HIP as co-conveners. Thank you all!


Group photo
Group photo at A Women’s Gathering on Criminalization and Community Health Inequities

The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records

For individuals with a criminal history, finding affordable and stable housing becomes extremely difficult in a place like the Bay Area, with high cost and limited supply. People with a criminal history can legally be excluded from housing. In a survey from the 2015 Ella Baker Center for Human Rights and Forward Together report, “Who Pays? The True Cost of Incarceration on Families,” 79% of people who had been incarcerated were either ineligible or denied public housing as a result of criminal history. More than half of those released from jail or prison have unstable or nonexistent housing.

Safe and affordable housing is a fundamental basis for success in all areas of life, and without stable housing, an individual’s health, employment and education opportunities, family reunification and social networks are compromised. In Alameda County, California, nearly 20,000 people are at risk of residential instability because of having a recent criminal history.

Having housing improves health directly and indirectly, decreases recidivism, improves the chance of becoming employed and having more income, and helps with family reunification. These factors, known in public health as the social determinants of health, create opportunities to succeed and are known to be important for health and wellbeing. For example:

  • Moving often affects recidivism. The odds of recidivism increase by at least 70% for every time someone who is formerly incarcerated changes their residence.
  • Six randomized control trials analyzed supported employment in public housing against other approaches to help residents find jobs, and found 58% of public housing program participants obtained employment compared to 21% in the control group.
  • More than 70% of those leaving prison indicated that family is an important factor in keeping them out of prison, and up to 82% of people leaving prison or jail expect to live with or get help from their families.
  • Having stable housing upon leaving jail or prison decreases a person’s chance of having their probation revoked.

It’s clear from the research; the lack of stable and affordable housing forces families to frequently move and live in unhealthy and crowded environments, increases stress and depression, and can lead to homelessness. Homelessness brings higher rates of infectious diseases; substance use and mental health disorders; exposure to violence; overexposure to cold and rain; and suicide. Studies show that 25% to 50% of people who are homeless have histories of involvement with the criminal justice system.

Public housing admissions screening policies play an important role in creating the conditions for successful reentry of people who were incarcerated. HIP recently released a report called, “The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records” done in partnership with Ella Baker Center for Human Rights (EBC). I worked closely with EBC staff starting in September 2015 to complete this Health Impact Assessment (HIA), as part of my Health & Equity Fellowship with HIP. We studied the Oakland Housing Authority (OHA) as a case study to understand the impacts of screening policies on health.

To fully understand OHA’s admission and screening policies, HIP met with two staff from their office. We learned that OHA denials due to a criminal history in the first round of screening have decreased significantly from 12% to 0.8% between 2010 and 2012. Of those who were screened out by OHA due to a criminal history, 75% request an informal hearing, and 64% of those have the decision reversed, allowing them to continue on in the application process. This is a powerful statement for the presentation of mitigating circumstances; at OHA, when people are allowed to tell their story and present supporting documentation, it often results in a reversal. We know that historical policies have created racial inequities in housing and health outcomes. However, data on race and ethnicity is not being recorded or reported, making it impossible in OHA’s case to analyze inequities in screening practices.

While more people with criminal histories are able to move forward in the screening process when OHA allows them to present mitigating evidence, there are additional changes OHA and other public housing authorities can make to improve housing stability for individuals with criminal history:

  • Allow mitigating circumstances to be presented in the initial application for public housing
  • Ensure proper implementation of policies that allow individuals with criminal history to join their family in public housing, and eliminate any practices of evicting existing residents from public housing for allowing a family member returning from prison or jail or denying admission if there is no valid reason for doing so
  • Collect, track, and publicly report the race and ethnicity of applicants and those screened out due to their criminal history to examine the potential impact of screening policies on people of color with a criminal history

Read more of the findings & recommendations in the full report.

Dismantling the Bars on the Birdcage

The recently released Coming of Age in the Other America by Stefanie DeLuca, Susan Clampet-Lundquist, and Kathryn Edin asks the question: why do some kids in the poorest neighborhoods thrive and meet their potential despite overwhelming odds when others don’t?

As summarized in an excellently in-depth Atlantic article, which I am leaning on until I get my hands on a copy of the book, two separate factors stand out for those who thrive: their neighborhood or having an “identity project”, meaning a strong passion such as music, art, or a dream job. But there are important caveats to underscore. Living in a safer neighborhood or having an identity project can help, but either of these alone is not a 100% guarantee that a person meets his or her potential. According to authors, other factors can simultaneously pull down and overwhelm even promising students – things like the absence of a parent, living in overcrowded homes, or living in blighted neighborhoods. As The Atlantic article powerfully notes, “A journey from poverty to the middle class or beyond is a birthright of many of these kids, their shot at the American dream. But the research indicates they can’t just get there themselves. Like anybody, they need a little help.”

But what can that help look like?

Help comes in different forms and at different levels – but what is central is putting the emphasis on supporting people. For example, it comes at a policy level by society enacting incarceration policies that focus on uniting adolescents and parents rather than separating them. It comes at a resource level by investing in housing and public services for neighborhoods deeply and historically overlooked. And it comes at a personal level by providing individual support. One example of the latter is a promising program profiled in a two-part series in The New York Times. Thread is a Baltimore-based program that brings together teams of volunteers to support at-risk teenagers, through unconditional support 24 hours a day for 10 years, and by providing increased access to community resources.

Thread Program Model 


(source: Thread.org)

But there’s a larger idea also at work here. A colleague of mine wisely suggested, “structural problems need structural solutions.” When we look at structural solutions, focusing separately on schools, family, policing – one of these alone is not enough. It’s too easy to fall through cracks if you focus on only one. This same concept came up at a staff meeting recently. Looking at an article on structural racism by Andrew Grant-Thomas and john a. powell, there is a metaphor borrowed from Iris M. Young who borrowed it from Marilyn Frye. (Still with me?) In talking about racism the article says the following – and I include the full excerpt because it’s important language:

“If we approach the problem of durable racial inequality one ‘bar’ at a time, it is hard to appreciate the fullness of the bird’s entrapment, much less formulate a suitable response to it. Explaining the bird’s inability to take flight requires that we recognize the connectedness of multiple bars, each reinforcing the rigidity of the others. In confronting racism we must similarly account for multiple, intersecting and often mutually reinforcing disadvantages, and develop corresponding response strategies.”

So in thinking about the work you do and the structural challenges you are working to confront, consider: how are you working on dismantling multiple bars on the birdcage, and not just one?


Lead Poisoning and Crime: Why the Pipeline to Prison is Running Dry

In my previous post (Does less lead mean less crime?), I wrote about research showing how the rise and decline in environmental lead levels could account for the bulk of crime trends in the US since the 1940s. (In fact, lead exposure is correlated to crime as far back as the 1870s.)

At the end of my post, I asked about the seemingly growing gap between lead exposure levels and crime rates since the early 2000s. Rick Nevin, a Senior Economist with ICF International and one of the researchers at the forefront of investigating the lead/crime connection, reached out to HIP to address that question and write a guest blog providing more information about his research, how lead exposure is driving the aging of the U.S. prison population, and the implications that may have for the criminal justice system.

At HIP, we are passionate about understanding the complex ways that social, political and economic factors interact with the environment to impact health outcomes, and the relationship between lead exposure and crime is a perfect example of this dynamic. We thank Rick for contributing his time to help us learn more about this phenomenon and sharing his professional and personal perspective on the topic.

Darío Maciel

Rick Nevin is a Senior Economist with ICF International. More information about his research can be found at www.ricknevin.com.

I want to thank HIP for this opportunity to present more evidence linking lead exposure and crime trends. The ongoing strength of this relationship has important implications for debates over the death penalty, criminal justice racial disparities, and mass incarceration.

I knew very little about the effects of lead poisoning, or crime data, when I began work in 1994 on an Economic Analysis of lead paint hazard regulations. My initial bias was to doubt that the costs of that regulation were justified by benefits. I was mistaken: costs were far lower than benefits associated with how lead exposure affects IQ, education, and lifetime earnings. My client also mentioned that we didn’t even count crime prevention benefits, suggested by recent research. I was aware of studies showing a strong relationship between lead exposure and leaded gasoline use in the past, and I wondered if there might be a relationship between crime trends and earlier gas lead trends. What I found was a stunning visual fit with a 23-year lag, consistent with early childhood lead exposure affecting the peak age of violent offending.

In 2000, Environmental Research published my first peer-reviewed study on lead exposure and USA violent crime trends. The same journal published my 2007 study on lead exposure and international crime trends, and my 2009 study on lead exposure and education trends. My 2009 study reported related shifts in incarceration rates by age and race, and showed that the lead research literature demonstrates all of the accepted indicators of causation: lead exposure is not just correlated with subsequent trends in intellectual disability, education achievement, and crime rates – lead poisoning caused those societal trends.

I have acknowledged that the strength and consistency of societal impacts from preschool lead exposure sounds like a bad science fiction plot. As an economist, starting out with a healthy skepticism about the costs of lead poisoning prevention, I am also an unlikely advocate for this improbable plotline, but the evidence is overwhelming.

Historic Trends: Dangerous Dust, Delinquency, and Crime
The most pervasive cause of lead poisoning is lead in dust, contaminated by lead in paint and air lead fallout. Lead in dust is ingested via normal hand-to-mouth activity as children learn to crawl. The bloodstream carries lead to the brain where it causes neurodevelopmental damage. Behavioral impacts are most evident after affected children reach adolescence, during another period of rapid brain growth.

Variations in biological vulnerability and lead exposure severity result in different outcomes for individual children, but higher risks of delinquent behavior among youths with preschool lead exposure have been documented by Denno, Needleman, Dietrich, and Wright. My study in 2000 found that homicide rates from 1900-1998 were also largely explained by the use of lead in paint and gasoline from 1879-1977.

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The use of lead paint fell over the 1920s and 1930s but we didn’t ban lead paint until 1978. From the 1940s through the 1980s, average blood lead tracked trends in air lead fallout from leaded gasoline, as lead paint exposure changed slowly with changes in the housing stock. Many children in the 1960s had additive exposure to city air lead and lead paint in old homes, sending “large numbers of comatose and convulsing children” to inner city hospitals. Lead in dust from lead paint in older homes is the main cause of USA preschool lead exposure today.

My 2000 study also found that 90% of violent crime rate variation from the early-1960s to 1998 was explained by earlier lead exposure trends. The time-lag relationship between lead exposure and violent crime has now been confirmed in state and city crime studies. My 2007 study found that lead exposure also explained most of the violent and property crime rate variation across decades in the USA, Britain, Canada, France, Australia, Finland, Italy, West Germany, and New Zealand. The best-fit lag was 18 years for property crime and 23 years for violent crime, consistent with peak ages of offending. In seminal reporting on this issue, Kevin Drum calls this “an astonishing body of evidence. We now have studies at the international level, the national level, the state level, the city level, and even the individual level.”

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Ongoing Trends: Shifts in Arrests and Incarceration by Age

The crime decline in recent years has been slower than the earlier decline in blood lead because steep arrest rate declines for youths have been partially offset by rising arrest rates for older adults. From 1991-2013, arrest rates for children under 10 fell by 83% for violent crime and 94% for property crime, and juvenile (under 18) arrest rates fell by 63% for violent crime and 71% for property crime, as arrest rates for adults ages 50 and older increased. In absolute terms, the violent crime arrest rate for juveniles was twice the rate for ages 35-49 in 1991, but the juvenile rate was lower in 2013. The property crime arrest rate for children under 10 was about the same as the rate for ages 35-49 in 1991, but the 2013 rate for children under 10 was just 7% of the 2013 rate for ages 35-49. This shift in arrest rates shows ongoing massive declines for youths born across decades of declining lead exposure, smaller arrest rate declines for adults born in the early years of the lead exposure decline, and increasing arrest rates for older adults born when lead exposure was increasing.

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The shift in arrest rates has caused a corresponding shift in prison incarceration. From 2001 to 2013, incarceration rates fell by 59% for males ages 18-19 and 30% for males in their 20s, but increased 33% for men ages 40-44 and surged 86% for men ages 45-54. Proponents of “tough-on-crime” sentencing credit prison incapacitation for much of the USA crime decline – “when a criminal is locked up, he’s not ransacking your house” – but the largest arrest rate declines have occurred among younger age groups with large contemporaneous incarceration rate declines.

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From 2000 to 2013, there was also a 69% decline in the number of juveniles in adult prisons, and a 46% decline in juveniles placed on probation. Juveniles in local jails also fell 40% from 2000-2014, and the number of youths in residential placement fell 50% from 1999-2013 (juvenile offenders account for 90% of youths in residential placement). The largest percentage declines were recorded by the youngest juveniles, including an 82% decline in the number of children under age 13 in residential placement. Mendel reports that lead exposure can explain juvenile justice trends that cannot be explained by reform efforts or other crime theories.

Ongoing declines in juvenile arrests reflect blood lead declines over the 1990s (the birth years of juveniles in 2007-2013). The percent of children ages 1-5 with blood lead above 5 mcg/dl fell from 31.4% in 1988-1991 to 2.6% in 2007-2010, due to new homes without lead paint, demolition and renovation of old housing, and implementation of the Residential Lead Hazard Reduction Act of 1992 (including regulations that were the subject of my 1990s analysis).

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Future Trends: A Road Less Traveled
Two decades after I first saw the correlation between gasoline lead and crime, the research on this issue is still ignored in many news stories related to lead poisoning. Jim Haner, who wrote extensively about lead poisoning for the Baltimore Sun, was the only reporter who wrote about my study in 2000, just a few years after Freddie Gray was poisoned by lead paint in Baltimore, steering his life toward academic and crime problems shared by many lead poisoning victims. In 2006, John Pekkanen wrote a brilliant story about this issue for Washingtonian magazine, but we are still waiting for an answer to the question posed by his story title: “Why Is Lead Still Poisoning Our Children?”

The “pipeline” to prison has alliterative appeal, but it is a misnomer. There is a road to prison, with signs that some offenders fail to heed. A 1991 prisoner survey found that 80% of inmates had served prior sentences to probation or incarceration, including 40% with prior sentences as juveniles. Another analysis found that prisoners released in 1994 after serving sentences for nonviolent offenses had criminal records that included, on average, 9.3 prior arrests and 4.1 prior convictions. We can disagree about many criminal justice issues, but one thing we know for certain is that very few prisoners made it to age 20 before their first felony arrest. The steep declines in juvenile arrest rates and the age 18-19 incarceration rate ensure that the road to prison will be a road less traveled for many years to come.

The Supreme Court has ruled that the death penalty and life without parole are excessive sanctions for crimes committed by juveniles, citing evidence that “adolescent brains are not yet fully mature in regions and systems related to higher-order executive functions such as impulse control, planning ahead, and risk avoidance”. We now know that preschool lead exposure impairs those specific types of brain development linked to impulse control, planning, and risk avoidance; other research links those specific types of brain impairment to homicide offending; murder trends by city size have tracked lead exposure trends from 1900-2013; and murder arrest rates by race and racial disparities in death penalty sentences have tracked racial disparities in lead poisoning.

From the 1950s through the 1970s, African-Americans were disproportionately exposed to city air lead and lead paint hazards in substandard urban housing. The percent of black preschool children with blood lead over 30 mcg/dl fell from 12% in the late-1970s to less than 1% in the late-1980s, and the black juvenile murder arrest rate then fell by 83% from 1993 to 2003. Black children are still disproportionately exposed to lead contaminated dust in older homes, but the racial disparity in elevated blood lead has narrowed from the late-1980s through 2010.

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There is a stale statistic that one in three black boys will end up in prison at some time in their life, based on an old analysis that assumed arrest and incarceration rates by age and race would remain unchanged at 1991 levels. Criminologists in the early-1990s used that same assumption to forecast a rising violent crime rate, largely based on projected demographic growth in the black juvenile population. Those forecasts were wildly wrong because the assumption about stable black juvenile offending was wrong. From 1991 to 2012, black juvenile arrest rates fell by 59% for violent crimes, 55% for property crimes, and 61% for weapons offenses. From 2001 to 2013, the incarceration rate for black males fell by 43% for ages 25-29, 50% for ages 20-24, and 62% for ages 18-19.

Lead exposure impacts on crime are as global as the rise and fall of leaded gasoline use. My 2007 study found that 80% to 90% of burglary rate variations in Britain, Canada, and Australia through 2002 were explained by earlier trends in lead exposure. The burglary rates in all three nations fell by more than 50% from 2002-2014, tracking earlier lead exposure trends. The title of a 2013 story in The Economist asked: “Where have all the burglars gone?” Now you know. In the future, the road to prison will be less traveled all over the world.

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Organizing the Narrative for Health Equity: Minnesota Department of Health Leads with Race

Guest blog by Evan Bissell, Catherine Harrison and Susie Levy
UC Berkeley School of Public Health and Department of City & Regional Planning
For more information about the basis of this post, visit our web-based narrative.

Health agencies across the country are working to develop leadership in advancing health equity. These efforts often look to build power through developing partnerships through an inside-outside strategy.

In one such effort, last February the Minnesota Department of Health (MDH) released its Advancing Health Equity Report to the state legislature. The report was striking in its explicit analysis of structural racism – the normalization of an array of dynamics, historical, cultural, institutional, and interpersonal, that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color. The report says:

“Race is not the only factor in structural inequities, but is a significant one. Even when outcomes related to other factors such as income, gender, sexual orientation, and geography are analyzed by race/ethnicity, greater inequities are evident for American Indians, African Americans, and persons of Hispanic/Latino and Asian descent. A concerted effort to specifically address the issues of structural racism and to develop the language and tools to uncover and change the structures shaped by racism will be invaluable for addressing other structure-based inequities.”

According to the report, “Health is something we create as a society and as communities, not something an individual can purchase or produce alone.” It recommends an array of actions that focus on many sectors of governance and the structure of the Department of Health itself. The report received prominent news coverage and its analysis has been used by community groups fighting for minimum wage, workers rights, and other issues. But the story of MDH leading with race did not start with the release of the report.

Image credit: Evan Bissell
Image credit: Evan Bissell

For many years the Department and community partners have worked to reframe the narrative of what creates health for Minnesotans, but have faced political pushback when working to address the social determinants of health. For MDH to address issues like housing, education, transportation, and incarceration, it needed to build relationships externally, across agencies and with community partners. The Healthy MN Partnership, a collaboration between the Health Department and community members and organizations, was formed and has proved influential in shifting the narrative of health. By challenging MDH to shift its view from measuring sickness to ensuring healthy living conditions, the broader lens of social determinants of health was adopted.

Image credit: Evan Bissell, adapted from MDH image
Image credit: Evan Bissell, adapted from MDH image
Image credit: Evan Bissell, adapted from MDH image
Image credit: Evan Bissell, adapted from MDH image

This shift didn’t happen in a vacuum. The theory of change guiding this work is grounded in a community-organizing perspective, which moves beyond the connection between health and living conditions, and recognizes that the capacity to act is critical to impact health.

According to MDH, the capacity to act – another way of saying power – is built through organizing people, narrative and resources in the following ways:

  • People: Develop accountable relationships and partnerships that align interests and directly impact decision-makers.
  • Narrative: Build public understanding and public will to support action that reflects health equity.
  • Resources: Shift the way resources, processes and systems are structured to advance health equity.

To learn more, see our web-based narrative, from which the infographics above are reproduced.