Intended for healthcare professionals

Views And Reviews

Covid-19 and decarceration

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1865 (Published 12 May 2020) Cite this as: BMJ 2020;369:m1865

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  1. Karthik Sivashanker, medical director for quality safety and equity, clinical innovation scholar12,
  2. Jessie Rossman, staff attorney3,
  3. Andrew Resnick, senior vice president, chief quality officer1,
  4. Donald M Berwick, president emeritus and senior fellow2
  1. 1Brigham and Women’s Hospital, Boston, USA
  2. 2Institute for Healthcare Improvement
  3. 3American Civil Liberties Union of Massachusetts, USA

Healthcare needs to lead the charge

The US currently carries the ignoble distinction of being the world leader in both incarceration and prevalence of covid-19. Worse still, around 12% of the 2.3 million people currently in state and federal prisons are over 55 years old, three times more than in 1999.1 This makes the US especially prone to a large scale outbreak of covid-19 among vulnerable prisoners. This could quickly overwhelm our already strained medical infrastructure. To protect the health of patients and the public, healthcare professionals are already leading the efforts to manage covid-19. But there are other ways in which we can help. We must urgently organise to advocate for safe decarceration and collaborate broadly with other advocates and professionals to advance that cause.

The US has less than 5% of the world population, yet it accounts for more than 20% of the world’s prisoners. The causes include a combination of misguided drug laws, harsh sentencing requirements, psychiatric deinstitutionalisation, centuries of structural racism, and an increasingly for-profit prison and bail industry. The resulting human and economic cost of mass incarceration has especially devastated black communities and people with mental illness. And now the pandemic will disproportionately impact these same communities and further …

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