Background: Around 482,000 people in the US are incarcerated before they have been convicted of the charges against them — and 90% remain incarcerated simply because they can’t afford to pay the bail amount set for them. Because of the over-policing of people experiencing poverty and people of color, pretrial incarceration disproportionately impacts people who are historically and structurally marginalized. People who are undocumented also face particular harm due to the interconnected nature of the systems of incarceration and immigration enforcement. In 2019, Human Impact Partners (HIP) collaborated with community organizers nationally to examine the health impacts of pretrial incarceration and money bail.

Objectives: This presentation aims to explain the ways in which pretrial incarceration constitutes violence in the harm it does to physical and mental health – and the ways in which organizers working to end pretrial incarceration and money bail are engaging in violence prevention.

Methods: We did a literature review of both peer-reviewed and gray literature to understand the health impacts of pretrial incarceration. We also conducted focus groups and interviews with those who have been incarcerated pretrial, their loved ones, and organizers and elected officials working on the issue.

Results: We identified six pathways by which pretrial incarceration harms health: economic insecurity via going into debt to pay bail, loss of employment, loss of housing, the harmful conditions of confinement, inadequate healthcare while incarcerated, and loss of social support and community cohesion. These harms extend beyond those who directly enter the system to their families and communities, with the highest burden faced by communities of color and people experiencing poverty.

Conclusion(s): Pretrial incarceration is a form of state violence particularly targeting historically and structurally marginalized populations. Organizers across the US are launching campaigns to prevent this violence by ending pretrial incarceration and money bail – and public health has a role to play in these campaigns.

Public health implications: Divesting from incarceration and investing in communities is a public health approach to create safety, healing, and well-being for everyone. Such a framework centers health, not punishment, as a means of creating community safety.

State and local vital statistics departments play an essential role in supporting public health programs and interventions, from initiating records for newborn home visiting programs and immunization registries to characterizing leading causes of death. Vital statistics are particularly critical in identifying and describing violent deaths. By sharing mortality data with injury and other programs, violent deaths can be tracked and characterized in near real-time. The New York City Department of Health and Mental Hygiene’s (NYC DOHMH) Bureau of Vital Statistics (BVS) has developed multiple strategies to support violence prevention programs. Using a mortality surveillance system (MortalSS) to identify anomalous increases in mortality, the NYC DOHMH BVS shares near real-time mortality data pertaining to violent deaths (homicides and suicides) with agency colleagues in injury prevention and mental health. MortalSS identifies possible cases by searching for cause-specific death codes and keywords on death certificates. When a violent death is identified, an email is automatically sent to relevant program contacts. Programs utilize this information for surveillance; in particular, the identification of potential clusters. Vital statistics programs can serve as a hub in the prevention of violent deaths and support better-informed violence prevention policies and programs.

UChicago Medicine (UCM) serves South Side communities experiencing among the highest rates of violence in Chicago. Longstanding discriminatory policies and practices continue to negatively impact environmental factors and long-term health outcomes of residents. To address this complex issue of inequity, UCM launched the Violence Recovery Program (VRP) on May 1, 2018, in conjunction with re-opening their Level 1 adult trauma center. This hospital-based violence intervention program (HVIP) was designed with extensive community advisory input, using best practices by the National Network of Hospital-based Violence Intervention Programs (NNHVIP) and existing HVIP models. The VRP uses a patient-centered approach to support patients during hospital admission and after discharge. VRP staff provide case management support and referrals to community-based partners to meet patient needs. Ultimately, the VRP seeks to reduce risk of violent re-injury and promote comprehensive long-term recovery of patients and families. This session will describe process evaluation results from data collected during the first year of program implementation (May 1, 2018 – April 30, 2019). The evaluation will analyze quantitative and qualitative data collected by VRP staff from 766 patients and 341 families during program engagement on patient-identified needs, interventions conducted, community-based service referrals made, and encounter notes. Univariate and bivariate data analyses will be used to identify (1) interpersonal and environmental risk factors of the program population, (2) program interventions, services and referrals conducted, and (3) UCM re-admissions due to violent re-injury. Findings from this process evaluation will be used for quality improvement of the program design and program implementation to better support patients and families impacted by violence. Lessons learned from implementing an evaluation of an HVIP in a hospital serving communities with high rates of trauma will also be shared.