Jurisdictions across the country are striving to increase equity in their pretrial justice systems by reducing their use of pretrial detention and money bail, which affect Black people and other people of color disproportionately and are linked to negative health and well-being outcomes. Despite the intentions of these reforms, there is little rigorous evidence available about whether they do, in fact, improve racial equity.  

In 2017, the state of New Jersey implemented a sweeping set of reforms to its pretrial justice system to improve fairness in decision-making by judges, prosecutors, law enforcement, and other actors in the system while also protecting public safety and making sure people with open cases still appear in court. With these reforms, the state shifted from a system that relied on money bail to a system that uses a risk assessment tool to inform release decision-making. This study will assess the New Jersey reforms’ impacts on racial equity in pretrial practices and processes.  

The research team will work with individuals with lived experience in the justice system to contribute to a participatory action research-informed approach, with the goal of understanding how the impacts and policy changes uncovered translate into the human experience—including implications for well-being, health, and mental health. 

The project will answer the following research questions: 

1. What is the impact of New Jersey’s reforms on arrest decisions, pretrial detention, and case disposition for different racial groups? What is the resulting impact on racial disparities? 

2. How did the reforms’ effects on racial disparities in pretrial processes and outcomes vary across New Jersey’s 21 counties? What local, structural characteristics (for example, reform-oriented leadership, community-informed approach, police reforms) may explain any county-specific impacts observed? In counties with more equitable processes post-reforms, what types of approaches and local reform efforts were implemented and what was the community input process?  

3. What did individuals’ criminal justice experiences look like across time, and what are possible health and well-being consequences? 

In assessing the extent to which New Jersey’s criminal justice reforms increased racial equity and identifying potential mechanisms that may explain any observed improvements, this study will help inform discourse around future reforms both in New Jersey and other states. 

With the global pandemic and the police killings of George Floyd, Breonna Taylor, and Tony McDade, among others, the summer of 2020 saw an explosion of media and public attention to health inequities and racial justice. As community organizers and public health researchers exposed the disproportionate toll of COVID-19 on essential workers, many of whom are Black, Indigenous, or other people of color, and corporate statements on the Black Lives Matter movement, a number of communities formally declared racism a public health issue.  

This study will examine how formal declarations of racism as a public health issue can be used to create, maintain, or strengthen local policies and systems intended to dismantle structural racism and invest in community well-being, asking: 

1. Of a sample of in-depth case studies, which public declarations that racism is a public health issue resulted in concrete government action intended to dismantle structural racism and invest in community health and well-being?  

2. How did the declarations come about? How were community partners initiating or engaging in the process? 

3. How was the debate represented in news coverage? 

In addition to providing insights into the processes through which declarations were developed, shared, and communicated, this research will identify and elaborate on the components of comprehensive policies that do - or do not - directly address racism, helping those in the public health to bolster mechanisms for addressing structural racism. 

The rise in mass incarceration since the 1960s in the United States—driven largely by growth in state prison incarceration—is unprecedented. The incarceration boom has disproportionately impacted Black Americans, who experience incarceration rates roughly four times higher than White individuals (National Research Council 2014; Sakala 2014). Research increasingly links racial disparities in incarceration to racial health inequities, with incarceration being associated with increased health risks for incarcerated and formerly incarcerated individuals as well as their families and communities. While state sentencing policies have contributed to racial disparities in incarceration rates, their impacts on racial health disparities are not known.  

This study will investigate the causal impacts of implementation—and, in more recent years, repeal—of state sentencing policies on racial disparities in health among infants and young adults, asking: 

1. How did the initial implementation of state-level sentencing policies impact birth outcomes and young adult health, as well as racial (Black versus non-Hispanic White) disparities in these outcomes, over the period 1968-2005? 

2. How did the repeal of state sentencing policies impact birth outcomes and markers of young adult health risk, as well as racial inequities in the outcomes (Black versus non-Hispanic White), over the period 2005-2018? 

Given historic levels of public interest in addressing structural racism and growing calls to reform incarceration policies, this research will provide new and critically-timed information for communities and policymakers seeking to mitigate racial disparities in health. 

In 2016, the Chicago Police Department developed a pilot pre-arrest diversion strategy, the Westside Narcotics Diversion and Treatment Initiative (WNDTI), to respond to the opioid crisis in underserved Chicago neighborhoods. The goal was to encourage police officers to redirect low-level drug offenders (users and sellers) to treatment, instead of jail and prosecution. This strategy was modeled after a promising program in Seattle, the Law Enforcement Assisted Diversion (LEAD).

However, Chicago’s target population differs significantly from the one served by Seattle’s LEAD program. Thus, the Chicago Police Department partnered with the University of Chicago's Crime and Health Lab to evaluate and test the expansion of its diversion strategy. Researchers there will focus on three questions:

1. Does diversion to treatment for individuals who experience substance use disorders impact health outcomes?
2. Is diversion more cost effective for the community than incarceration?
3. Can the lessons learned from this program help improve health equity on a larger scale?

Within the last several years, views on substance abuse have shifted, with law enforcement recognizing substance abuse as a public health issue, rather than a purely criminal justice issue. Many other cities are piloting harm reduction interventions, and this rigorous evaluation should support them in their efforts to design effective policies and programs. 

In recent decades, the “broken windows” approach to policing has led several large U.S. cities to employ the proactive policing program known as “Stop, Question, and Frisk” (SQF). The New York City Police Department (NYPD) made over 5 million such stops between 2002 and 2016.

At this time, there is little known about the health effects of these kinds of programs. To fill this gap, the research team will use millions of observations of police-citizen encounters contained in the NYPD’s SQF database from 2008-present, and Medicaid patient claims from 2008-present, to assess the effect of police encounters on individual health outcomes. To causally identify this effect, the team will exploit an unanticipated change to the NYPD’s protocol for making pedestrian stops. On March 5, 2013, the NYPD suddenly mandated that officers provide thorough narratives justifying the reasons for pedestrian stops. In addition, officers were required to photocopy and submit these narrative descriptions to supervisors after each shift. Following this procedural reform, the number of stops abruptly decreased and the rate of stops producing evidence of suspected crime increased.

The team will map pedestrian stops to the neighborhoods surrounding Medicaid recipients’ home addresses to see whether Medicaid claims for trauma and anxiety to decrease after the NYPD’s procedural reform reduced the incidence of pedestrian stops.

In many jurisdictions, offenders who commit relatively minor offenses are arrested and prosecuted to the full extent of the criminal law. Yet subjecting these offenders to pretrial detention, post-conviction incarceration, and searchable arrest and conviction records, may have hidden social costs. This practice may undermine defendants’ already fragile social, economic, and health circumstances, aggravating defendants’ preexisting medical conditions, disrupting their health care regimes, increasing stress, reducing physical activity, reducing sleep, and decreasing nutritional quality. The disruptions imposed on defendants’ family members may likewise negatively impact the health status of defendants’ partners and children.

In March 2016, the Manhattan District Attorney’s office and the New York City Police Department implemented a plan to rely on criminal summonses rather than arrest and prosecution for offenders committing violations-level offenses like urinating in public, drinking in public, putting feet on subway seats, or riding between subway cars. This reform eliminated the possibility of pretrial detention, post-conviction incarceration, and searchable arrest and conviction records for those offenders subject to the new policy.

Working in partnership with local criminal justice agencies, the research team will match offenders’ court records to NYS Medicaid records to evaluate the impact of this reform on health outcomes.

Each day in the U.S. there are approximately half a million individuals detained while awaiting trial. This high rate of pretrial detention may be due both to the widespread use of monetary bail, and to the limited financial resources of most defendants. Less than 50 percent of defendants in the U.S. are able to post bail even when it is set at $5,000 or less. While some defendants are detained for only a few days, others are detained for the entire period prior to the final dispositions of their cases.

Long durations of pretrial detention disrupt defendants’ lives, putting their jobs at risk, placing them into extended contact with other offenders, and increasing the pressure on them to accept unfavorable plea bargains. Yet, no studies to date have examined the health consequences of pretrial detention for defendants and members of their families.

Using the detainee records for New York City’s jails, online county detainee rosters, and public incarceration data—and linking these data to NYS Medicaid records—the team will explore how pretrial detention may precipitate serious health issues for both defendants and their families, especially as it relates to long durations of pretrial detention. 

Like many communities in the U.S., the Twin Cities metropolitan area has become increasingly vocal around social justice—exposing and documenting local poverty, inequity, and discrimination. Amid this wave, Hennepin County is actively seeking out population health policy opportunities to engage high-risk families and children, with the goal of developing and implementing upstream, cross-sector interventions to preserve unified, healthy families and avoid out of home placements (i.e., foster care).

Previous scholarship has primarily focused on children already in the foster care system, and there is little known about how to identify and support families before out of home placement occurs.

To fill this gap, the research team will link datasets across Medicaid, human services, public health, criminal justice, and corrections to look at a population of Hennepin County families that experienced the out-of-home placement of a child aged 0-5. The analysis will use descriptive evaluation and predictive modeling techniques to better understand the demographic characteristics and patterns of service utilization of children and families in the five years prior to out of home placement, and to uncover the strongest predictors for out of home placement.