Health Departments Taking Action on Incarceration: A Framework for Advancing Health Instead of Punishment During COVID-19

January 2021

The COVID-19 pandemic — and the large number of cases and deaths in jails, prisons, and detention centers — has laid bare the urgent need for decarceration as a public health strategy. This resource includes 8 recommendations and specific actions health departments can take to address the harms of incarceration.


Heavily policed communities — including Black people, Indigenous people, immigrants, people with disabilities, queer and trans people, people in poor neighborhoods, and sex workers — have long sounded the alarm that incarceration is a public health crisis. Public health consensus and research on this has grown in recent years, documenting how incarceration measurably harms individual, family, and community health. The far-reaching and long-lasting impacts include increased prevalence of chronic health conditions among those impacted — such as hypertension, diabetes, and arthritis — and decreases in life expectancy.

The COVID-19 pandemic has added a layer of unprecedented threat and urgency to this already chronic issue. Because of the characteristic overcrowding, medical neglect, and inadequate sanitation in the nation’s jails, prisons, and immigration detention centers, carceral facilities have become hot spots for COVID-19 outbreaks. The practices required to limit the spread of the virus — such as practicing physical distancing, wearing a mask, and limiting indoor contact with others — are all impossible in carceral settings. It is therefore no surprise that carceral facilities regularly appear in the top ten largest sources of COVID-19 infections nationally.

We know that there is no way for anyone to be truly safe and healthy inside a jail, prison, or immigration detention center, especially during the COVID-19 pandemic. Due to the inability to physically distance and widespread lack of proper sanitation, all incarcerated people are at high risk for contracting the virus. Indeed, early estimates suggest that the case rate of COVID-19 in US prisons is 5.5 times higher than in the US general population. While mass releases are our priority as the primary prevention strategy, we need to simultaneously employ harm reduction strategies to protect those who remain incarcerated.

Health departments can and must take action to curb the dual and overlapping threats of COVID-19 and incarceration. As we move toward collective action from a place of shared moral responsibility and sectoral power, we recognize that health departments and officials have varying amounts of formal jurisdiction over implementing the strategies outlined below.

At the same time, jurisdiction and regulatory scope can change over time depending upon conditions and health crises. COVID-19 offers both impetus and opportunity to move public health work further “upstream” to address the policies, systems, and environments that create health— beyond solely individual-level health behaviors and health care. Moving upstream may require developing a shared analysis within health departments, broadening regulatory scope, and/or championing transformative change. Ultimately, divesting from systems of policing and punishment that harm individuals and communities and instead investing in institutions and systems that promote community well-being (like public health departments, public schools, affordable housing, and quality employment) is more sustainable and will move us closer to health equity and collective liberation.

Based on our work nationally with community organizers on the frontlines of advancing racial justice, community safety, and health equity, the following are key prevention and mitigation strategies for health departments to consider when formulating their powerful role in addressing the harms of incarceration during the COVID-19 pandemic and beyond.

  1. Focus action toward mass decarceration
  2. Advocate against transfers between carceral facilities
  3. Improve health care access for people who are incarcerated
  4. Prioritize incarcerated people in your jurisdiction’s COVID-19 vaccine allocations
  5. Speak out against the use of solitary confinement units, including for those who test positive for COVID-19
  6. Ensure COVID-19 testing is equitable in design and enforcement
  7. Promote transparent, accessible, and regular reporting of COVID-19 testing, cases, and deaths in carceral facilities
  8. Leverage the power of inspections to document abuses and neglect occurring inside carceral facilities

Across all strategies, action steps that health departments can take include:

  • Develop and deepen relationships with community organizers in your jurisdiction who are building power directly with people impacted by incarceration and who are leading local campaigns
  • Use your public health platform to validate, amplify, and meet the needs of those who are directly impacted by incarceration.
  • Strengthen the evidence base on how incarceration harms individual, family, and community health in your jurisdiction while protecting people’s privacy and sensitive health data
  • Get clear on your legal and institutional authority within and outside the context of a state of emergency.
  • Build the consensus needed within your department to understand the public health crisis of incarceration, to advance the solutions that will be most strategic, and to exercise the authority you have

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For more details about this issue, please visit our Health Instead of Punishment Program page or contact Christine Mitchell at

For more information or to request technical assistance on ways health departments can address the harms of incarceration, please contact Kia Thacker, Capacity Building Program Director, at