Social Problems in the Age of COVID-19 Vol 1: US Perspectives 9781447359869

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SOCIAL PROBLEMS IN THE AGE OF COVID-19 Volume 1: US Perspectives EDITED BY GLENN W. MUSCHERT KRISTEN M. BUDD MICHELLE CHRISTIAN DAVID C. LANE JASON A. SMITH

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RAPID RESPONSE

Social Problems in the Age of COVID-​19 Volume 1: US Perspectives

Edited by Glenn W. Muschert, Kristen M. Budd, Michelle Christian, David C. Lane, and Jason A. Smith

First published in Great Britain in 2020 by Policy Press, an imprint of Bristol University Press University of Bristol 1-​9 Old Park Hill Bristol BS2 8BB UK t: +44 (0)117 954 5940 e: bup-​[email protected] Details of international sales and distribution partners are available at policy.bristoluniversitypress.co.uk © Bristol University Press 2020 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 978-​1-​4473-​5981-​4  ePub ISBN 978-​1-​4473-​5986-​9  ePdf The right of Glenn W. Muschert, Kristen M. Budd, Michelle Christian, David C. Lane and Jason A. Smith to be identified as editors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved:  no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Bristol University Press. Every reasonable effort has been made to obtain permission to reproduce copyrighted material. If, however, anyone knows of an oversight, please contact the publisher. The statements and opinions contained within this publication are solely those of the editors and contributors and not of the University of Bristol or Bristol University Press. The University of Bristol and Bristol University Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. Bristol University Press and Policy Press work to counter discrimination on grounds of gender, race, disability, age and sexuality.

Contents



Acknowledgments v Presidential Welcome vii Corey W. Dolgon, Stonehill College Editorial Introduction xi Glenn W. Muschert, Khalifa University of Science and Technology; Kristen M. Budd, Miami University; David C. Lane, Illinois State University; Jason A. Smith, Kaiser Foundation Health Plan

Part I:  Victims and Justice 1 1. Creating Safer Environments for Survivors: Housing-​ Based Approaches to Intimate Partner Violence 2 Jenny K. Leigh, New York University 2. The Incarceration State in the Age of COVID-​19 13 Kristen M. Budd, Miami University; Bianca E. Bersani, University of Maryland 3. Incarceration during COVID-​19: Jail Shouldn’t be a Death Sentence 25 Felicia Arriaga, Appalachian State University; Jasmine Heiss, Vera Institute of Justice; Max Rose, Sheriffs for Trusting Communities

Part II:  Employment Dilemmas

35

4. Essential Work and Unemployment in the United States Biko Koenig, Franklin and Marshall College

36

5. The US African-​American Population Experienced a COVID-​19 Double Disadvantage: Unemployment and Illness 49 Teresa A. Sullivan, University of Virginia iii

iv Contents 6. Residential Crowding among Meat Processing Workers Stephanie A. Bohon, University of Tennessee; Rachel Ponder, University of Tennessee

Part III:  Precarious Populations

59

69

7. Experiencing Homelessness in the Time of COVID-​19 Cynthia Puddu, MacEwan University

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8. The LGBT Medical and Political Crisis in the Wake of COVID-​19 81 DaShanne Stokes, University of Massachusetts Amherst 9. Inequality in Isolation: Educating Students with Disabilities during COVID-​19 91 Nora C.R. Broege, Rutgers University –​Newark; Charity Anderson, Rutgers University –​ Newark

Part IV:  Health and Well-​Being

101

10. Birth in the US amid COVID-​19 102 Shannon K. Carter, University of Central Florida; Bhoomi K. Thakore, University of Central Florida 11. Access to Mental Health Care during and after COVID-​19 113 Andrea N. Hunt, University of North Alabama 12. Vaccine Opposition in the COVID-​19 Age 122 Jennifer Roebuck Bulanda, Miami University; Shelby Frye, Miami University; Valerie Thompson, Miami University

End Matter 13. The Social Problems of COVID-​19 Joel Best, University of Delaware

134

Afterword 143 Héctor Delgado, University of La Verne/​SSSP Executive Officer Index

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Acknowledgments

This rapid-​response volume has come to fruition due to the effective cooperation and support of so many people. We the editors wish to thank our authors first, for working with us under short deadlines, and for leveraging their academic expertise and insight to provide high-​ quality chapters. It is a pleasure to work with such a group of professionals to fill the need in society for rigorous knowledge regarding the impacts of the COVID-​ 19 pandemic on real people and societies more generally. We are indebted to Michele Koontz and Héctor Delgado (whose piece appears here as the Afterword) of the Society for the Study of Social Problems (SSSP) administrative and executive offices, respectively, for their support and encouragement. We thank acquisitions editor Victoria Pittman and her team at Policy Press, with whom we are pleased to collaborate on this rapid-​response book. Finally, we thank all our fellow students, scholars, practitioners, and activists, who make the SSSP such an exciting environment in which to study, research, write, and undertake meaningful social action. Even in the midst of a pandemic that has disrupted nearly all areas of mundane life, our colleagues remain dedicated to providing rigorous public sociology. Finally, this volume is dedicated to the selfless health care workers who have been humanity’s frontline in responding to the pandemic; to those who have suffered directly and indirectly from the loss of family, friends, colleagues, and community members; and to all those who serve without fail worldwide to provide stability in the face of substantial disruptions in social systems, including workers in education, transportation, groceries, pharmacies, and official agencies. v

Presidential Welcome

When our political activism isn’t rooted in a theory about transforming the world, it becomes narrow; when it is focused only on individual actors instead of larger systemic problems, it becomes short-​sighted. We do have to deal with the current crisis in the short term. That’s important. We have to have solutions for people’s real-​life problems, and we have to allow people to decide what those solutions are. We also have to create a vision that’s much bigger than the one we have right now. Patrisse Khan-​Cullors, Co-​Founder of #BlackLivesMatter, as quoted in Barbara Ransby, Making All Black Lives Matter: Reimagining Freedom in the 21st Century (University of California Press, 2018)

In a wonderful 2013 anthology, Handbook of Sociology and Human Rights by Brunsma, Iyall and Gran (Routledge, 2012), I noted that sociology began as an impassioned effort to apply scientific inquiry to studying and solving social problems, but somewhere along the line it became a rather dour academic discipline, well equipped to show students what is wrong with the world but stodgy at best in teaching them how to change it. The bulwark of the discipline, the social problems course, had evolved into a 14-​chapter litany of misery, whose stubborn yet enlightening data could effectively dismantle cherished ideologies and oppressive mythologies, but too often failed in guiding young people to make a better world. Still, as Joe Feagin, Hernan Vera, and Kimberley Ducey argue in their 2014 volume Liberation Sociology (Routledge), the discipline “ignites the imagination of countless students” because it promises to heighten their understanding of the vii

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Presidential Welcome

world and help them build a better society. The authors conclude:  “For generations now, not just college students but all who learn to read the world through sociological ideas have shared in the excitement and insight of being empowered by their newly acquired mindfulness” (p. vii). Sociology can meet the challenge issued by one of its founders, Karl Marx, to not only interpret the world, but change it. Such has been the dilemma for us as sociologists and for our organization, the Society for the Study of Social Problems (SSSP). We were founded by people who believed that professional, “fat cat” sociology was “enmeshed deeply in the bureaucratic, technocratic, plutocratic and imperialistic structure of our society.” Our second president, Alfred McClung Lee, proclaimed that, “The existing social scientific societies are parts of the problems sociologists should be probing in their efforts to make human society livable and hopefully more self-​fulfilling for a great many more people.” Lee gave that speech at the 1976 inaugural conference of the Association for Humanist Sociology—​ an organization he and others formed when they believed that the SSSP had become too much like the American Sociological Association, similarly enmeshed in elite professionalism and bureaucratic, corporate hegemony. Indeed, most of our societies hold conferences in expensive urban hotels where only blocks away homeless people struggle to find shelter, food, and necessary services. Meanwhile, most of our colleagues—​part-​time, adjunct, and otherwise precarious faculty—​ can’t afford to attend these conferences, maintain memberships, or participate in the increasingly corporate practices of academic publishing and teaching. Despite the myth of PC-​driven, tenured radicals who contaminate their campuses with White guilt and radical feminism, we actually work in very conservative institutions that stand as corporate bastions of White supremacy and what Barbara Ehrenreich, in her foreword to the 1997 volume Will Teach for Food:  Academic Labor in Crisis (University of Minnesota Press), once called the “bandit economy” of late capitalism. Despite being ensconced in colleges and communities where the social problems we study run rampant, professional sociologists too often fall victim to the very same

Presidential Welcome

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“trap” that C. Wright Mills, in The Sociological Imagination (Oxford University Press, 1959), so famously depicted over half a century ago. Although we study social problems, we tend to feel quite helpless in addressing them directly through politically engaged research or action. Still, the SSSP’s members have often fought against this professional malaise and the conservative forces of corporate bureaucracy, patriarchy, heterosexism, and White supremacy—​ albeit often with mixed results. Our journal, Social Problems, has published important articles on the politics of public sociology (such as Burawoy and colleagues in Vol. 51, pp. 103–​130); on the potential of “service sociology” (Treviño’s piece in Vol. 59, pp. 2–​20); on the need for sociological leadership from scholar activists of color (such as Hill Collins in Vol. 33, pp. s14–​s32, and Durr in Vol. 63, pp. 151–​160); on the power of abolitionist perspectives for addressing social problems (Fernandez in Vol. 66, pp. 321–​331); and also on the threats and intimidation that radical scholars face when they challenge the social inequalities of our professional institutions (Taylor and Raeburn in Vol. 42, pp. 252–​273). The organization struggles with the post-​modern dilemma of studying and pursuing radical social change while deeply embedded in the structures and ideologies that oppress us, but the current historical moment beckons us to do better. I am therefore honored and fortunate to introduce this volume, Social Problems in the Age of COVID-​19:  Volume 1:  US Perspectives, as a prime example of SSSP engaged scholarship at its best, featuring research specifically focused on analyzing and addressing social problems in fundamental and transformational ways—​ this edition is no exception. Looking at how COVID-​19 impacts already existing social problems and marginalized populations, Arriaga, Heiss, and Rose examine jail conditions and propose policies and actions necessary to keep incarcerated people from pandemic-​imposed death sentences. Cynthia Puddu, who writes about the experience of homeless people during COVID-​19, is someone practicing community-​based research as both advocate and activist. Similarly, Andrea N. Hunt’s work on access to mental health care during and after COVID-​19 is framed by her years of experience in advocacy and policy-​making endeavors

x

Presidential Welcome

throughout the State of Alabama. Our focus on the pandemic is important for many reasons, but perhaps the most vital is that each piece recognizes what journalist George Packer wrote recently, in the article “We are Living in a Failed State” in the June 2020 issue of The Atlantic:  “The corona virus didn’t break America. It revealed we were already broken.” The conversation here carries on the important tradition of exposing how inequality and injustice characterize every aspect of COVID-​19’s deadly path through our national and global institutional landscape. But most authors accomplish what SSSP members do at our best—​explain how the root causes of these social problems demand a rigorous and sophisticated analysis, while providing a vision of what is to be done about them. The explosive anti-​racist movement that has risen simultaneous to the pandemic—​following the police murder of George Floyd—​now demands we raise our game. The historical moment is ripe for a radical sociology heavily engaged in analyzing and acting on social problems. I believe this volume begins such a journey for all of us. Corey W. Dolgon, President of the Society for the Study of Social Problems, 2020–​2021

Editorial Introduction

This volume, Social Problems in the Age of COVID-​19, is a rapid-​response project intended to deliver rigorous academic knowledge on social problems during the coronavirus pandemic, also known as COVID-​19, to a broad readership. The focus is the effect of the COVID-​ 19 pandemic and subsequent disruptions on key social problems of widespread concern. The editorial team, chapter contributors, and publisher have pulled together to produce this volume in a fraction of the time such a project normally requires. All participants have been motivated by the need to get quality information rapidly disseminated as the world is living through the uncertain days, weeks, and months of this pandemic. In times of crisis, sociology and other social sciences seem more essential than ever to clarify new social development and challenges, not only for those working to understand what is happening, but also for those in positions to implement realistic, positive policy responses. This volume is a special project within the larger academic project of public sociology. It is produced by the Justice 21 Committee (J-​21) of the Society for the Study of Social Problems (SSSP), which periodically produces two series titled Agenda for Social Justice and Global Agenda for Social Justice. The project was inspired by the 2000 Presidential Address of Professor Robert Perrucci, 48th President of the SSSP (reprinted as Perrucci, 2001). In his address, Dr Perrucci offered a clear censure of academic social sciences, as he noted that social problems research had become increasingly abstract and detached, and therefore less useful for solving social problems or reducing human suffering. He reminded social problems researchers that they were missing the point, which was not only to study social problems, but also to reduce or xi

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Editorial Introduction

abolish them. Indeed, the SSSP was founded as an academic society to study social problems with the intent to generate knowledge, which should be translated into strategies for social action and policy intervention. Dr Perrucci’s speech provided an early contribution to the nascent conversation about public sociology, and within the SSSP it inspired the establishment of the J-​21 Committee, whose mandate is to produce volumes studying pressing social problems while providing practical suggestions to improve the situation. Fast-​forward to recent days. As the world has watched the spread of COVID-​19, social scientists have been particularly sensitive to the notion that, while a virus does not biologically discriminate, the benefits and burdens of society are unequally distributed. Therefore, vulnerable groups are disproportionally suffering from the pandemic and its after-​effects, and therein lies the motivation for this volume, which is to clarify ways in which COVID-​19 complicates and accelerates social problems. Just as many entered lockdown and time subjectively seemed to lag, there simultaneously emerged an urgent need for social scientists to clarify social problems and to disseminate that information rapidly. The editors, contributors, and publisher of this volume have worked together to produce this volume as quickly as possible, while also maintaining scholarly and academic publishing standards. The volume includes 12 topical chapters examining the COVID-​ 19 pandemic’s effect on some of society’s most pressing problems, and one think piece intended to spark rumination on the topic of social problems in a time of pandemic. The contributors are an impressive group of scholars, and each has answered the call to explore a specific social problem within these extraordinary times. Our authors are scholars from public and private universities, including undergraduate students, graduate students, postdoctoral researchers, and university faculty at all ranks, including assistant, associate, full, and emeritus professors. The group also includes past presidents and the current executive director of the SSSP, a former university president, and those employed in research and social action agencies. Each chapter can stand on its own, but also fits the general approach presented in the volume, which is to define problems,

Editorial Introduction

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survey rigorous evidence, and then to present practicable solutions. As a whole, the chapters cover a wide range of topics including justice, employment, vulnerable populations, and health concerns. The topics included certainly do not reflect the total range of possible social problems, and instead the volume’s coverage is limited by those submissions received in response to a call for chapter proposals, which within one week generated the overwhelming total of 95 submissions. This robust response allowed the selection of the strongest of proposals, which was also balanced to cover a breadth of topics. While the social problems discussed in the volume are all pressing, substantial, and important, there are many others that are not included. Thus, it is important to emphasize that this volume makes a contribution to public sociology and the solution of social problems, but to acknowledge that any such volume will provide modest coverage in relation to the breadth of extant social problems. It is the J-​ 21 Committee’s hope that this volume will provide students, policy-​ makers, researchers, activists, and the general public with guidance for the practicable solution of these social problems. We encourage our readers to consider the ideas presented here, and importantly also to take action. Please take these ideas into classrooms and public forums, leveraging them as points of departure for productive discussion among peers and communities. It is our hope that our readers will share the vision of social justice by implementing reasonable social action and policy responses for the solution of, as our volume’s title suggests, social problems in the age of COVID-​19. Glenn W. Muschert, Khalifa University of Science and Technology Kristen M. Budd, Miami University David C. Lane, Illinois State University Jason A. Smith, Kaiser Foundation Health Plan Key Resources

Perrucci, Robert. 2001. “Inventing Social Justice:  SSSP and the Twenty-​First Century.” Social Problems, 48(2): 159–​167. Electronic copies of all volumes of the Agenda for Social Justice are available for open-​access download at www.sssp1.org/​index.cfm/​ m/​771/​locationSectionId/​0/​Agenda_​for_​Social_​Justice.

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Electronic copies of the Global Agenda for Social Justice are similarly available for open-​access download at www.sssp1.org/​index.cfm/​ m/​323/​locationSectionId/​0/​Global_​Agenda_​for_​Social_​Justice.

I

Part 

Victims and Justice

1

1 Creating Safer Environments for Survivors Housing-​Based Approaches to Intimate Partner Violence Jenny K. Leigh The Problem

Intimate partner violence (IPV), often used synonymously with the terms domestic violence or dating violence, is an extremely prevalent form of gender-​based violence that occurs between romantic partners, spouses, or others living in the same home. IPV had been considered a public health crisis long before the COVID-​19 pandemic began. According to the US Centers for Disease Control and Prevention (CDC), in the United States, about one in four women+ and one in ten men report having experienced IPV at some point during their life. While many statistics focus on survivors who are heterosexual cisgender women, LGBTQ+ people are equally vulnerable to IPV. Rates of IPV are higher among people of color compared to White people. Though a wide variety of behaviors can be understood as IPV, the CDC defines five types of IPV, including physical violence, sexual violence, psychological aggression, stalking, and control of reproductive and sexual health. The United Nations Population Fund estimates that COVID-​19 will result in an increase of 15 million cases of IPV and a 20% increase in incidence of IPV globally. As violence is fundamentally about power and control, violent incidents often increase during times of crisis, when many experience a loss of control. Since the implementation of shelter-​ in-​ place orders that instruct residents to stay at home for non-​ essential purposes, as well as social distancing guidelines that discourage being in spaces where people may be in close 2

Victims and Justice

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contact with each other, rates of IPV appear to be increasing by many measures. Internet searches for assistance with IPV have surged, a growing number of people have been reaching out to domestic violence hotlines, and the media has drawn greater attention to domestic abuse killings reported around the globe. Social distancing and shelter-​in-​place orders have helped to prevent the spread of the virus; however, they have also increased survivors’ vulnerability to experiences of violence at home. Survivors who have previously experienced violence are trapped at home with their abusive partners, while the stress of COVID-​ 19 has also catalyzed the emergence of IPV behaviors in relationships where violence may not have previously occurred. Survivors have reported new forms of abuse during the pandemic, such as withholding access to and/​ or financial support for necessary medical treatment. Being forced to stay at home further reduces survivors’ already limited options for leaving an abusive environment. As many survivors are disconnected from their normal support networks, safety plans such as going to stay with a friend or family member are no longer options for most people. Emergency shelters pose dangers of their own due to overcrowding, and many critical support services have been closed altogether. For people facing IPV, this kind of isolation can be deadly. From the beginning of the COVID-​ 19 pandemic, the emphasis on staying at home as a critical preventative measure has shown that many do not have a safe place to call home. Safe housing is one of the most effective public health interventions to not only protect and support survivors, but also to prevent the spread of COVID-​19.

Research Evidence

As there remains a lack of academic research on IPV during COVID-​ 19, data have largely come from governmental organizations, first-​responders, and media coverage, which have all shown how the pandemic has limited survivors’ access to crucial support services. In the National Domestic

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Creating Safer Environments for Survivors

Violence Hotline’s COVID-​19 Special Report (2020), the Hotline reported a 6% decrease in contact volume in March 2020 compared to March 2019, reflecting the challenges of reaching out for help amid shelter-​in-​place orders. However, with the relaxing of shelter-​in-​place in April 2020, contact volume increased by 15% compared to April 2019. Research prior to the pandemic had already established a clear connection between IPV and housing insecurity. According to the National Network to End Domestic Violence (NNEDV), over 90% of women experiencing homelessness had also experienced some form of sexual violence during their lives, and domestic violence was the immediate cause of homelessness for over 50% of women (NNEDV, 2020). Research has largely focused on the “literally homeless,” that is, those who have been living on the street or in a shelter, yet rates are likely even higher when considering the “hidden homeless,” such as those who temporarily stay with family and friends. Other findings show that these numbers are increasing. For example, a 2019 report by the Office of the New York City Comptroller found that 41% of individuals entering city-​ operated homeless shelters were survivors of domestic violence, representing a 44% increase over the past five years (Office of the New York City Comptroller Scott M. Stringer, 2019). In many states, available housing resources for survivors of IPV are inadequate. The annual census conducted by the NNEDV in 2019 found that across the country, there were a total of over 11,000 unmet requests for services in one day, over two-​thirds of which were housing-​related (NNEDV, 2019). This is unfortunate, given that housing-​based interventions have been found to be highly effective in reducing violence and promoting long-​term healing. For example, an evaluation by the Washington Coalition Against Domestic Violence of the Housing First approach, which centered on getting homeless survivors into permanent housing and providing financial assistance to do so, found that at the end of the three-​year funding period, almost 90% of survivors were in permanent housing. Obtaining long-​term housing enabled survivors to recover from trauma, pursue education and employment, and connect to a larger community.

Victims and Justice

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While data on housing and IPV may not yet be available for COVID-​ 19, existing research has found that extreme circumstances and social crises create additional vulnerability to violence. For example, studies following Hurricane Harvey by the Texas Council on Family Violence found that the disaster put individuals at increased risk of domestic violence due to heightened demands on support services and loss of economic and social resources. Academic research has found similar increases in IPV following Hurricane Katrina, the Deepwater Horizon oil spill, and the 2010 earthquake in Haiti. Though research on the more specific impacts of COVID-​19 on survivors of IPV is critical, existing findings already provide strong evidence of the need for housing-​ based solutions to support survivors.

Recommendations and Solutions

Current responses to IPV largely approach it as a personal matter to be resolved between individuals, centering law enforcement as first-​ responders and the criminal justice system as the primary avenue for safety. The COVID-​ 19 pandemic offers an opportunity to reshape this narrative to highlight the social and economic foundations of IPV and work toward preventative approaches. Macro-​level change, such as advancements in social welfare policy, as well as local initiatives, such as investment in community-​ based resources, both offer solutions that address the deeper roots of the problem, a contrast to the individualistic and surface-​ level criminal justice approaches that have long dominated survivors’ available recourses for justice. Reliance on criminal justice-​ based approaches not only fails to address the fundamental social issues that perpetuate violence, but also fails to support survivors who have experienced violence at the hands of the criminal justice system, such as people of color, members of the LGBTQ+ community, and people of lower socioeconomic status. As pre-​COVID research has already demonstrated the clear relationship between housing instability and IPV, housing policy is one key realm for

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Creating Safer Environments for Survivors

innovations that can keep survivors safe not only during the pandemic, but in the long term. 1. End punitive tenant laws and enable survivors to get out of violent home environments more easily. • One key first step in protecting survivors of IPV would be to reauthorize the Violence Against Women Act (VAWA). The Violence Against Women Reauthorization Act of 2013 provided crucial financial support to shelters and violence prevention organizations as well as protections for survivors, particularly in relation to housing and tenant rights. For example, under VAWA, survivors cannot be evicted or rejected from federally subsidized housing solely because of their experience of IPV. However, VAWA has not been reauthorized since its expiration in February 2019. A reauthorization of VAWA could incorporate protections specific to the pandemic and the likely long-​term economic fallout, such as rent forgiveness for survivors who have lost their jobs. • In most states, survivors must provide evidence of violence (i.e., a note from a doctor or social worker, or a police report, and/​or an order of protection) in order to break their lease without penalty. In many circumstances, survivors may not be able to collect such evidence until they leave the abusive environment. In the case of COVID-​19, many survivors may not be able to leave the house to visit a medical provider or social worker who could provide the necessary evidence. Therefore, existing laws should be relaxed such that evidence of violence is not required at the point of breaking the lease. Furthermore, landlords should accept a wider variety of evidence—​specifically, forms of evidence that are not reliant on reporting to the criminal justice system—​such as survivors’ verbal or written testimony or a letter from a friend or family member. • Many states require that survivors give advance notice to terminate their lease, such as 30 days (as in New York, Massachusetts, and Texas) or 14 days (as in

Victims and Justice







7

California, Hawaii, and Oregon). In order to better assist survivors in leaving dangerous environments, such time requirements should be significantly decreased, with a maximum of 14 days. • Nuisance ordinances allow landlords to evict tenants if the police are called to the home to investigate “disorderly behavior” a specific number of times during a specific period (often using a points-​based or three-​ strike system). Such nuisance behaviors can be characteristic of IPV, and studies have found that nuisance ordinances disproportionately affect survivors of domestic violence. There is no evidence that nuisance laws are effective in reducing crime; indeed, they are often ultimately punitive toward victims, and are enforced disproportionately against low-​income people, people of color, and people with disabilities. Though contacting the police may not be the preferred option for many survivors, ending these sorts of private nuisance laws would benefit those who do want support from law enforcement. 2. Increase funding for emergency, transitional, and long-​ term housing options for survivors. • While helping survivors to leave violent environments is a critical first step, housing policy is perhaps even more important in supporting their long-​ term health and well-​ being. Increasing funding for the construction of shelters and additional emergency housing is necessary; however, we must also go beyond an emphasis on short-​term care to ensure that long-​term housing options are available to survivors of IPV. • Housing support programs—​ for example, shelter services and transitional housing programs—​ should be expanded within violence prevention organizations, as many do not currently offer support for housing. Among the organizations that do offer housing, the focus is often on emergency shelter; therefore, transitional and/​ or long-​ term housing resources are particularly lacking. Long-​term housing is a critical step in helping survivors to live both safe

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Creating Safer Environments for Survivors

and independent lives. For example, the Housing First pilot study in Washington State demonstrated the importance of getting survivors into long-​term housing as a key step of their survival and healing. Funding for similar initiatives should be expanded across the country. • Federal and state bills related to economic relief for COVID-​19 should include funding for both shelter services as well as long-​ term housing specifically for survivors. Funding must also support existing violence prevention agencies and support services. • One major concern around the expansion of housing and other social services is how to fund such efforts. Protests against police brutality have underscored the disproportionate amount of funding that city police departments receive compared to other social services. For example, the budget of the New York City Police Department is almost $11 billion per year –​more money than the city spends on funding the Departments of Health, Homeless Services, and Housing Preservation and Development combined. City budgets should allocate more funding for both housing and domestic violence prevention services as part of a larger movement away from criminal justice-​ based approaches to violence prevention. Redirecting this funding toward housing and related resources would both offer an alternative to the criminal justice system and better address the root causes of IPV. 3. Integrate housing support and other social services into the work of other key first-​responders. • During the COVID-​19 pandemic, workers in health care and social services have been spread thin. Many critical social services and community organizations face severe financial uncertainty in the months and years to come. Yet the COVID-​19 era also shows how health care, social welfare, and community-​based support are inextricably connected. Finding creative ways to bring these resources together would ensure higher-​quality care both during appointments and in the long term.

Victims and Justice



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• Interprofessional work and training between physicians, nurses, social workers, counselors, and legal advocates is becoming increasingly common in clinical spaces. The growth of such efforts is necessary in order to meaningfully address the social determinants of health for not just survivors, but all patients. Continuing to develop both educational and work environments that bring together health care and social service workers is advantageous to both providers and patients. For survivors of IPV, having more support services available in one space—​ for example, a clinic that includes a primary care physician, a social worker, and a legal advocate—​ enables coordinated ongoing support and reduces the number of visits that they must make to different providers. • Hospital-​ based programs that provide financial support to people who do not have a safe home to return to after treatment are especially vital in the COVID-​19 era. Such services have had a profound positive impact on both survivors and hospitals. For example, in 2015, the University of Illinois Hospital implemented a pilot project that paid for the housing of frequent emergency room visitors who were experiencing homelessness, which ultimately reduced costs for the hospital. Similar programs could be established for survivors who regularly visit the ER with domestic violence-​related injuries. • All health care and social service professionals should receive training in trauma-​ informed practices to improve their awareness of IPV and understanding of how to appropriately support survivors. As many health care workers still feel nervous to ask questions about IPV, training in trauma-​informed care helps to not only facilitate these conversations, but also to connect survivors to necessary resources sooner. 4. Integrate violence prevention into neighborhood and community initiatives and develop new avenues for neighbors and community members to be involved in violence prevention efforts.

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Creating Safer Environments for Survivors

• A survivor’s home includes not only the space they live in, but also their broader community. Creating safer environments for survivors must therefore involve their neighbors and surrounding community as key support resources. • Information about services for survivors must be made more publicly accessible. Posting the phone numbers for local domestic violence hotlines or shelters in the lobby of apartment complexes would both help to connect survivors to available resources as well as to promote broader awareness of IPV as an issue among community members. Making these resources readily available in public spaces also helps to protect survivors who may have trouble discreetly accessing information at home without their abuser finding out. • Mutual aid networks that emerged during the COVID-​19 pandemic have laid a strong foundation for consistent community support infrastructure that can endure after the pandemic has passed. Though mutual aid networks largely focus on redistributing financial resources and delivering food and other necessities to community members, support could also take the form of regularly checking in on those who request it. Survivor advocates could also target such networks as spaces for regular training in bystander intervention, helping to disseminate knowledge of violence prevention strategies and encouraging neighbors to protect and support one another. • The COVID-​ 19 pandemic has shown that vital community support resources are not limited to hospitals and social service agencies. Essential businesses such as grocery stores and food banks are key community spaces to publicize information about housing and other resources available to survivors. Collaborations between survivor advocates and essential businesses in the community could offer new ways of reaching survivors, particularly when other services are not accessible. For example,

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survivor advocates could work with pharmacies to set up weekly drop-​in hours when advocates are available for consultation. The COVID-​19 pandemic has clearly shown the dangers of housing insecurity for those facing IPV, underscoring the importance of a safe home in promoting health and well-​ being. Our efforts moving forward must focus on addressing the social roots of IPV and revealing the interconnected nature of all forms of violence and oppression. By understanding IPV as a manifestation of greater societal power inequities, we can begin to treat it as such, moving away from individual-​ oriented interventions in violence to advance socially rooted approaches that prevent it from occurring. Key Resources

Black, Michelle C., Kathleen C. Basile, Matthew J. Breiding, Sharon G. Smith, Mikel L. Walters, Melissa T. Merrick, Jieru Chen, and Mark R. Stevens. 2010. The National Intimate Partner and Sexual Violence Survey: 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Clough, Amber, Jessica E. Draughon, Veronica Nije-​Carr, Chiquita Rollins, and Nancy Glass. 2013. “‘Having Housing Made Everything Else Possible’:  Affordable, Safe, and Stable Housing for Women Survivors of Violence.” Qualitative Social Work, 13(5): 671–​688. Covid-​19 Task Force on Domestic Violence. The Task Force is an interdisciplinary team of students, activists, and scholars working to aggregate and analyze data on domestic violence during the COVID-​19 pandemic, as well as to use this data to shape policy recommendations. More information about the Task Force is available at www.covid19taskforcedv.org/​, and preliminary analyses are available at https://​medium.com/​@covid19taskforcedv. Goodmark, Leigh. 2018. Decriminalizing Domestic Violence:  A Balanced Policy Approach to Intimate Partner Violence. Berkeley, CA: University of California Press. Mbilinyi, Lyungai. 2015. The Washington State Domestic Violence Housing First Program:  Cohort 2 Final Evaluation Report. Seattle, WA:  Washington Coalition Against Domestic Violence. Available at http://​wscadv.org/​wpcontent/​uploads/​2015/​05/​DVHF_​ FinalEvaluation.pdf. National Domestic Violence Hotline. 2020. “COVID-​ 19 Special Report.” Available at www.thehotline.org/​wp-​content/​uploads/​ sites/​3/​2020/​06/​2005-​TheHotline-​COVID19-​report_​final.pdf. National Housing Law Project. 2018. “Housing Rights of Domestic Violence Survivors: A State and Local Law Compendium.” Available

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at www.nhlp.org/​wp-​content/​uploads/​2018/​07/​2017-​DV-​State-​ and-​Local-​Housing-​Laws-​Compendium.pdf. National Law Center on Homelessness and Poverty. 2012. “There’s No Place Like Home: State Laws that Protect Housing Rights for Survivors of Domestic Violence.” Available at https://​nlchp.org/​ wp-​content/​uploads/​2018/​10/​Theres_​No_​Place_​Like_​Home. pdf. National Network to End Domestic Violence. 2020. “14th Annual Domestic Violence Counts Report.” Available at www.NNEDV. org/​DVCounts. Office of New York City Comptroller Scott M. Stringer. 2019. “Housing Survivors:  How New York City Can Increase Housing Stability for Survivors of Domestic Violence.” Available at https://​ comptroller.nyc.gov/​wp-​content/​uploads/​documents/​Housing_​ Survivors_​102119.pdf.

About the Author

Jenny K. Leigh, MPH is a doctoral student in the Department of Sociology at New York University. Her research focuses on mental health, violence prevention, and health and social policy. She has been involved in research on gender-​based violence for five years, working in both the United States and Japan, and is an assistant editor of Sexual and Gender-​ Based Violence: A Complete Clinical Guide (Springer, 2020). In addition to her scholarly work, she has been a survivor advocate for both university-​and city-​based crisis services for almost a decade.

2 The Incarceration State in the Age of COVID-​19 Kristen M. Budd and Bianca E. Bersani What Do We Know About the Problem?

As COVID-​19 started to spread throughout the United States, organizations like Human Rights Watch warned that custodial settings, such as federal and state prisons and immigration detention centers, would be particularly vulnerable to outbreaks. The number of people criminally incarcerated or civilly detained in the US, who are disproportionately racial and ethnic minorities, has grown exponentially in recent decades. On average, roughly 2.3 million people are confined annually nationwide, with 1.5 million people incarcerated in state and local prisons and 42,000 in detention facilities. These individuals are more likely than not from communities already enduring perpetual social and health inequalities. Custodial settings compound the consequences of these inequalities where routine overcrowding, unsanitary conditions, lack of basic hygiene products, and limited and inadequate medical care function to exacerbate vulnerabilities for a population that suffers from disproportionately high rates of chronic disease and pre-​ existing medical conditions. Together, institutional characteristics and individual vulnerabilities pose a formidable public health challenge whereby the conditions of confinement present a perfect breeding ground for the contraction and spread of communicable illnesses exacerbated by the COVID-​19 global pandemic. While federal and state governments have implemented strategies to fight the spread of COVID-​19, such as stressing the importance of social distancing (e.g., staying at least six feet from other persons, avoidance of group gatherings or crowded places), the actual implementation of these recommendations is highly problematic for those in US 13

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custodial settings given constraints on physical space and resources. This is particularly true in states where prisons and immigration detention centers have dangerous levels of overcrowding, unsanitary conditions, and a lack of adequate medical care. Facilities are also far from state-​of-​the-​art and instead have outdated infrastructures, poor ventilation, and filtration systems that promote the flow of airborne diseases. Daily life of incarcerated and detained individuals involves a communal lifestyle with shared living and bathroom facilities and food service. Moreover, social processes within and between custodial settings make the spread of COVID-​19 more likely. For instance, prison-​to-​prison transfers heighten the risk of spreading the virus. Frequent transfers, common among detained immigrants, and a lack of restrictions for geographic placement, contribute to the risk of a rapid and diffuse spread of COVID-​19. The conditions of confinement that fuel the elevated risk for COVID-​19 also affect frontline justice workers whose ability to socially distance may be limited by their job duties, such as conducting pat-​ downs, breaking up fights, and mundane tasks like scanning IDs. These individuals typically lack medical training making them ill-​equipped to respond to emergent medical concerns or attend to those requiring medical care. Additionally, unlike incarcerated or detained individuals, frontline justice workers are transient returning to and from their communities and heightening the risk for the transmission of the virus to family and community, or the introduction of the virus from the community into facilities. The American Civil Liberties Union, who partnered with experts to re-​model the COVID-​19 death rate taking into account custodial settings, uncovered a stark reality:  If our public health response continues to exclude incarcerated and detained people, the estimated government death rate could as much as double.

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Research Evidence Infections, Recoveries, and Deaths

Data presented here represent known evidence as of April through June 2020. For comparison, the US Centers for Disease Control and Prevention (CDC) estimates a 10% rate of infection among those tested in the general population. Numerous sources of data show the infection rate in custodial settings far exceeds the rate of infection in the community.

• As of 18 June 2020, the US Federal Bureau of Prisons (BOP) reported the following COVID-​19 cases: 1,266 federal inmates and 171 BOP staff have tested positive; 4,960 federal inmates and 503 staff have recovered; 85 federal inmates and 1 BOP staff member have died. • By June 16, 2020, the Marshall Project (MP) reported the following COVID-​19 cases:  At least 46,249 state and federal prisoners tested positive and 548 prisoners have died. Among correctional staff, there were 9,665 confirmed cases and at least 41 deaths. According to the US Bureau of Labor Statistics, there are more than 400,000 correctional staff nationwide. Because only 19 states are publicly releasing data on correctional staff who have contracted COVID-​19, these estimates seriously undercount the true number of confirmed cases and deaths. • MP data show that a majority of states see higher infection rates in their prison populations versus the general population. To illustrate the magnitude of infections, Ohio’s prison system has an infection rate of 1,006 per 100,000 prisoners—​2,700% higher than Ohio overall. • As of 9 May 2020, US Immigration and Customs Enforcement (ICE) reported 1,145 confirmed cases among those in custody out of 2,194 tested. This is a 52%-​ positive test rate. The first reported death occurred three days prior, on Wednesday, 6 May 2020. Rampant undertesting and underreporting means that these numbers are lower than actual rates of

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infection. Estimating the extent of confirmed cases and transmission of the virus among detainees is complicated by the fact that immigrants are detained in a variety of facilities (e.g., detention centers, local prison facilities), and that many have been released and/​ or deported prior to testing. With these and other limitations in mind, Coombs and colleagues estimate that within 90 days, 72–​ 100% of detained individuals will contract COVID-​19. • In detention facilities, 44 ICE employees have tested positive. Unknown is the extent to which private contractors have tested positive; however, in a report from a National Public Radio affiliate in Atlanta, Georgia, 42 CoreCivic employees (19% of its total workforce) tested positive as of 28 April 2020, at its Stewart Detention Center, located in southwest Georgia. Vulnerabilities to COVID-​19

• The CDC reports that individuals with pre-​ existing conditions are at higher risk for severe COVID-​ 19 complications and related death. Prison systems are rife with individuals with such pre-​existing conditions. According to the US Bureau of Justice Statistics (BJS) data, 50% of prisoners had a chronic condition (e.g., cancer, stroke-​ , heart-​ , or kidney-​ related problems, asthma, diabetes) and 21% had an infectious disease (e.g., tuberculosis, hepatitis B or C, sexually transmitted diseases). • The CDC finds people aged 65 and older at high risk for severe COVID-​19. Within the federal BOP, there are 4,618 incarcerated individuals > age 65. BJS data show there are at least 29,100 incarcerated individuals ≥ age 65 in the state prison system. Conditions of Confinement



• Researchers who investigated chronic disease in prisons classify prisons as risk environments for the infection

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and transmission of infectious diseases (e.g., communal living, dilapidated infrastructure). • According to the Equal Justice Initiative, prisons are in crisis due to overcrowding, violence (sexual and physical), and failing to provide adequate medical care—​elements that put people who are imprisoned or detained at risk of COVID-​19 infection. • The conditions of confinement that make prisons particularly vulnerable to the spread of COVID-​19 are exacerbated in detention facilities. As recently as 2 July 2019, Homeland Security released a Management Alert regarding dangerous levels of overcrowding and lengthy periods of detention. The report details prolonged standing-​room-​only conditions for adult detainees held for more than a week’s duration. Even before the risk of COVID-​19, these conditions signaled a red flag or a ticking time bomb for serious and immediate health and safety issues according to a senior manager.

Recommendations and Solutions

US custodial settings have long been the focus of critical analysis with evidence documenting challenges posed by overcrowding, lack of access to medical care, and the confinement of persons with acute vulnerabilities. The risk of COVID-​19 transmission is elevated by these conditions as well as the transiency of the detained and correctional staff within and between facilities and the community. Recommendations to address these challenges are grounded in empirical evidence from sociology, criminology, and public health, the Justice Roundtable, a coalition of more than 100 organizations working to reform federal criminal justice laws and policies, the Vera Institute of Justice, physicians and infectious disease experts, and ongoing efforts enacted among local and criminal justice leaders across the country.

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Immediate Solutions for Prisons and Immigration Detention Centers

1. Decarcerate. Increase the use of release valves that offer humane, responsible, and empirically grounded options to reduce the number of confined individuals. Many individuals currently confined in prisons or detention centers pose negligible to no risk to public safety. Legislative bodies at the state and federal level should expand legal options for judges to expedite the release of these individuals and remove labor-​ intensive and bureaucratically complex barriers to release. • Use incarceration alternatives. Allow incarcerated persons and immigrant detainees to complete their terms of incarceration or detention under house arrest, electronic monitoring, and/​ or community supervision. This strategy continues to meet criminal justice goals of public safety while decreasing the density of custodial populations. • Release older persons. The Department of Justice defines geriatric as age 55 for incarcerated populations. States that have geriatric release laws should use them. States that narrowly tailor these laws (e.g., exclusion of those due to the severity of offense at conviction) should consider broadening their approach given consistent evidence of aging out of crime and the diminishing returns of incarceration. • Release the medically vulnerable. Provide compassionate care release to those with medical conditions that make them particularly vulnerable to the consequences of COVID-​ 19 infection. Vulnerabilities include advanced age, pregnancy, and chronic health conditions. Guarantee compassionate release regardless of race or ethnicity, gender, age, or class. • Release immigrants on their own recognizance. Immigrants are detained for a variety of reasons and include legal migrants and asylum seekers. More than half of immigrants in detention have no criminal conviction record and are held in civic confinement; many others have old and/​or misdemeanor records.

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Among those with a conviction history there is no expiration date for prior offenses, meaning that a conviction decades prior is grounds for removal. Many remain detained simply because they are unable to afford to pay the courts for their release before adjudication. Compliance with legal requirements like return hearings is very high for this population. 2. Suspend new admissions. Suspend the following processes immediately to stop the churn of individuals into custodial settings. This will help alleviate pressure on capacity constraints and overcrowding to allow for physical distancing for those who remain. • Suspend new detentions of individuals residing in the US who are suspected of being non-​citizens. Many have been residents of the US for long periods of time and have strong ties to family and community, factors known to decrease risk and increase cooperation and compliance with the law. • Suspend issuing parole and probation violations that would result in correctional confinement unless violations are for the commission of a serious felony. According to the Council of State Governments, nearly one in four individuals (approximately 280,000 people) are reincarcerated due to a technical violation such as missing an appointment with a correctional officer or failing a drug test. 3. Reallocate the funds. More than $43 billion are spent incarcerating individuals annually and nearly $2 billion goes to funding immigrant detention annually. Appropriate funds retained from decarceration and the suspension of new admissions to support increased testing, access to medical care, and the data recording and reporting recommendations below.

Solutions for Health and Safety

1. Increase access to testing among the confined community.

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• Allow COVID-​19 testing to be free of charge for all incarcerated and detained individuals. According to the Brennan Center for Justice, at least 35 states charge incarcerated or detained individuals medical fees such as co-​pays. If an incarcerated or detained person shows symptoms associated with COVID-​19, such fees may be a deterrent from seeking medical testing. Moreover, many incarcerated and detained individuals lack access to acceptable health care and it goes against the inherent interest in public health to have barriers in place that may reduce the likelihood of persons seeking medical testing and/​or treatment. • Allow access to testing and treatment options within the community to be confidential and barrier-​free. Fear of deportation has kept undocumented immigrants from seeking medical care. With COVID-​ 19, the lack of access to treatment increases the likelihood of serious and deadly consequences among immigrants, their families, and the broader community. • Reduce the global transmission of the virus by testing and quarantining all those who are in the process of being deported. 2. Increase access and require testing among correctional staff, even for those who are asymptomatic. Require staff to wear masks, wash hands, and abide by all other CDC recommendations. • These strategies increase the potential to stop the spread of COVID-​ 19 within facilities and to and from communities. 3. Increase access to potentially lifesaving supplies such as facemasks and hand sanitizer for all incarcerated and detained individuals and frontline justice workers. • Facilities currently ban alcohol-​based hand sanitizer. Reevaluate these policies as non-​ alcohol hand sanitizers are not recommended by the CDC. 4. Implement mandatory quarantining for new detainees who are entering US custodial settings. Provide clean spaces for individuals in custody who need to be quarantined.

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• Depending on space constraints, this may mean moving quarantined individuals outside of the prison walls for the duration of their quarantine period. Solitary confinement is not an appropriate method of quarantine, causes long-​term psychological trauma, and should always be avoided. 5. If evidence shows there is low to zero probability of reinfection for COVID-​ 19, leverage correctional staff that have recovered from COVID-​19 to manage correctional facilities. 6. Sanitize and clean all correctional facilities and detention centers at a minimum of three times per day, particularly high-​traffic common areas such as bathrooms. 7. Require federal and state prison systems and immigration detention facilities to adhere to CDC guidelines for physical distancing of all those who remain in facilities, including incarcerated and detained people, and staff. 8. Increase time allowances for outdoor activities where the likelihood of virus transmission is significantly reduced.

Broader Criminal Justice System Changes

Implement and expand the use of strategies that allow individuals to follow social distancing guidelines and access potentially lifesaving supplies (e.g., soap, hand sanitizer, facemasks). 1. Eliminate cash bail and pretrial detention to reduce the number of people in custody who are accused of crimes, many of which are minor. The effectiveness of cash bail and pretrial detention are negligible and disproportionately harm marginalized communities. 2. Use pretrial community supervision for those posing the highest risk. 3. Increase the use of diversion and non-​ justice system alternatives during sentencing stages and/​ or plea negotiations. The use of confinement alternatives such as supervised release, electronic monitoring, and community-​based options offer effective solutions.

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Data and Research

All US custodial settings should increase transparency and accuracy of COVID-​19 data. Such data can be used to drive evidence-​based responses to infections/​outbreaks and be used to advocate for the resources needed to address COVID-​19 within custodial settings. At a minimum, data recording and reporting should include the following. 1. Level of testing. Without testing generally, custodial settings are blind to any possible spread of contagions in their facilities. As evidenced above, COVID-​19 is particularly dangerous and deadly within US custodial settings. Moreover, without testing, it is difficult to make informed decisions about who to quarantine to promote the health and safety of incarcerated and detained persons as well as staff. 2. Infection rates. Without infection rates, it is difficult to track which prisons and/​or immigration detention centers have become hot spots for COVID-​ 19 transmission and if rates are changing (increasing, decreasing). 3. Resulting deaths. Without death tolls, it is more difficult to track the spread of COVID-​19 due to limitations in tracking the infection rates (e.g., lack of testing, delays in symptomatology). 4. Demographic breakdown. Evidence supports that COVID-​ 19 disproportionately affects certain populations, such as older persons and minority communities, which includes more severe outcomes such as death. Data collection efforts should include information about sex, race, ethnicity, age, and status (incarcerated, detained, staff) to better track these demographic patterns within custodial settings. Overall, COVID-​ 19 has made increasingly public the conditions of confinement and their consequences for responding to infectious disease. When coupled with COVID-​ 19, these conditions present a toxic mix that, particularly for the most vulnerable, compromise health and jeopardize life.

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The state has an ethical and moral obligation to promote the health and safety of those who are incarcerated or detained, as well as those in direct service to incarcerated and detained populations, to prevent, treat, and stop the spread of COVID-​ 19 within and across facilities, into local communities, and globally. We are not without options. The immediate implementation of a variety of actions will help slow and stop the spread of COVID-​19 in custodial settings and will consequently increase overall public health and safety. Key Resources

Centers for Disease Control and Prevention. 2020. “COVID-​19 in Racial and Ethnic Minority Groups,” Washington, DC: Centers for Disease Control and Prevention, available at www.cdc.gov/​coronavirus/​2019-​ncov/​need-​extra-​precautions/​racial-​ethnic-​minorities. html. Doherty, Elaine E. and Bianca E. Bersani. 2018. “Mapping the Age of Official Desistance for Adult Offenders:  Implications for Research and Policy.” Journal of Developmental and Life-​Course Criminology, 4: 516–​551. Dolovich, Sharon. (n.d.). “UCLA Covid-​19 Behind Bars Data Project,” Los Angeles, CA:  UCLA School of Law, available at https://​law. ucla.edu/​ c enters/​ c riminal-​ j ustice/​ c riminal- ​ j ustice- ​ p rogram/​ related-​programs/​covid-​19-​behind-​bars-​data-​project/​. Dumont, Dora M., Brad Brockmann, Samuel Dickman, Nicole Alexander, and Josiah D. Rich. 2012. “Public Health and the Epidemic of Incarceration.” Annual Review of Public Health, 33: 325–​339. Human Rights Watch. 2018. “Code Red: The Fatal Consequences of Dangerously Substandard Medical Care in Immigration Detention,” New York:  Human Rights Watch, available at www.hrw.org/​ report/​2018/​06/​20/​code-​red/​fatal-​consequences-​dangerously-​ substandard-​medical-​care-​immigration. Marouf, Fatma, E. 2017. “Alternatives to Immigration Detention.” Cardozo Law Review, 38(6): 2141–​2192. Miller, Holly V., Melissa Ripepi, Amy M. Ernstes, and Anthony A. Peguero. 2020. “Immigration Policy and Justice in the Era of COVID-​19.” American Journal of Criminal Justice. https://​doi. org/​10.1007/​s12103-​020-​09544-​2. Ryo, Emily. 2019. “Understanding Immigration Detention:  Causes, Conditions, and Consequences.” Annual Review of Law and Social Science, 15: 97–​115. Wildeman, Christopher, Maria D. Fitzpatrick, and A.W. Goldman. 2018. “Conditions of Confinement in American Prisons and Jails.” Annual Review of Law and Social Science, 14: 29–​47. Vera Institute of Justice. 2020. “Coronavirus Guidance for the Criminal and Immigration Legal Systems,” Brooklyn, NY:  Vera

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Institute of Justice, available at www.vera.org/​ publications/​ coronavirus-​guidance-​for-​criminal-​and-​immigration-​legal-​systems.

About the Authors

Kristen M. Budd, PhD is an Associate Professor of Sociology and Criminology at Miami University, Oxford. She holds a PhD in Sociology from Purdue University (2011) with a specialization in Law and Society. Her research focuses on interpersonal violence, law, and policy, including how they intersect with perpetrator and victim sociodemographic characteristics. Currently, she researches patterns and predictors of offending behavior in relation to sexual assault, public perceptions in relation to criminal behavior, law, and criminal justice policy and practice, and social and legal responses to interpersonal violence and other social problems. Bianca E. Bersani, PhD is an Associate Professor of Criminology and Criminal Justice at the University of Maryland, College Park. She holds a PhD in Criminology and Criminal Justice from the University of Maryland (2010) and is a 2011 W.E.B. Du Bois Fellow of the National Institute of Justice. Her research involves the study of the generational disparity in immigrant offending, patterns and predictors of offending over the life course, desistance and persistence in offending, family and intimate relationship dynamics, divergence in offending across race/​ ethnicity, gender, and immigration status, and the application of innovative methodologies to understand the mechanisms of behavioral change.

3 Incarceration during COVID-​19 Jail Shouldn’t be a Death Sentence Felicia Arriaga, Jasmine Heiss, and Max Rose

The Problem

The nation’s thousands of jails originate in White supremacy and oppression—​a role that has continued with the rise of mass incarceration. The spread of COVID-​19 behind bars has magnified both the public health and social consequences of jails, and also the lack of timely, transparent data about who is behind bars and what they are enduring. The pandemic has shown the urgency of defunding jail construction, investing in true public health and safety measures, and mandating transparency from local authorities. Scholars document a troubled history. Starting in the antebellum South, sheriffs and other local officials used jails to control poor White people charged with vagrancy. After the Civil War, jails became central to convict leasing—​the wrongful arrest of formerly enslaved Black people by sheriffs, who sold them to corporations and plantations. Jails still maintain their function of racialized social control, and are now central to mass incarceration. One in four incarcerated people in the world reside in the US, one third of whom are in jail. These institutions have a deep reach into communities; according to the Bureau of Justice Statistics, people are booked into jails 11 million times each year, nearly 18 times the number of prison admissions. In Divided Justice: Trends in Black and White Jail Incarceration (Subramanian, Riley, and Mai, 2018), researchers find the justice system jails Black people at 3.6 times the rate of White 25

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people, and Latinx communities are both overcriminalized and persistently miscounted in jail populations. Prior to the pandemic, a jail construction boom was underway, particularly in smaller cities and rural areas, according to the Vera Institute of Justice (hereafter “Vera”). That happened in part because jails have become default public health and social service providers, a process that advocate James Kilgore calls “carceral humanism.” However, jails cannot play those roles well; public health experts say incarceration can exacerbate substance use disorders and mental illness, and leads to other consequences, including homelessness, preterm births, and overdose deaths. COVID-​19 presented two major challenges to the status quo. First, the danger of coronavirus spurred rapid jail population reductions. Based on incomplete data, the jail population decreased by a median of 30%, with some jails cutting their populations by 70% or more. That happened because:  1) Justice system actors implemented statewide or local policies, in part because of fears of legal liability and pressure from organizers. Many of these changes focused on releasing people nearing the end of short sentences or charged with lower-​level offenses or parole violations. Law enforcement reduced arrests for misdemeanor offenses; and 2) the changed societal patterns, including shelter-​in-​place orders, led to less opportunity for interaction with the justice system. Second, despite that reduction, jails have become a key center of the public health crisis. Major outbreaks in Cook County, Los Angeles County, and dozens of suburban and rural jails have led to deaths, and outrage from people inside the jail and in surrounding communities. However, the full extent of the spread of COVID-​19 is unknown. Jails lack transparency, with few requirements to publicly report data, and those requirements differ by state. While some states, like Texas, have provided consistent public information about the spread of COVID-​19 in jails, most have done nothing. The decarceration in response to COVID-​19 should catalyze a reexamination of local justice systems, magnify scrutiny of jails, and spur reinvestment in public health. However, without significant data collection,

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and subsequent policy change, the coronavirus could lead to another jail boom.

Evidence Limited Data pre-​COVID-​19, Dubious Public Safety Returns

To date, jail populations have increased without any link to public safety. Evidence from decades of mass incarceration shows no statistically significant impact on decreasing crime. Further, research shows that pretrial detention actually increases the likelihood of future arrest. However, as evidenced by the lack of widespread reporting and the continued rise of jail populations in recent years, many policy-​makers and justice system actors systematically fail to analyze and expose the system’s flaws. The Bureau of Justice Statistics (BJS) fields two major surveys: 1) The Annual Census of Jails, with a sample of several hundred jails; and 2) the Census of Jails, which captures all jails, and occurs roughly every five years. In both cases, BJS releases reports several years after collection, and lacks disaggregated data by race, ethnicity, gender, and charges or status. Information about the health of people behind bars is even more limited. More than 1,000 people die annually in jails, according to a 2016 survey, the most recent federal data. However, this number is likely an undercount—​ reporting is uneven and, to avoid public scrutiny, sheriffs often release people to die in hospitals, according to ProPublica. Same data limits hide the spread of COVID-​19 in jails

COVID-​19 has exposed how this lack of data might hide danger to people inside jails. The only consistent data collection efforts during the crisis have come from journalists, private-​sector researchers, and a few state agencies, including the following.

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• Journalism. The New York Times is tracking COVID-​19 hot spots, and as of 27 June, approximately 24 jails had 100 or more cases. Existing data show that COVID-​ 19 has infected more than 75,000 people incarcerated in jails and prisons and killed more than 667, though these numbers are almost certainly an undercount due to a widespread lack of testing. Reuters, the Marshall Project, and The Appeal have covered the crisis in jails, as have local media. • Private-​sector researchers. Vera collected data on more than 1,000 jails from before and after the pandemic, scraping jail rosters and aggregating reports, and collecting directly from the jailers. The NYU Public Safety Lab has gathered information from more than 1,000 jails, mostly through data scraping. Vera’s analysis of the data suggests that the nation’s total jail population declined by 26% in a matter of months. • Estimates from state agencies. Texas, North Carolina, and isolated counties are voluntarily reporting COVID-​ 19 cases and deaths from COVID-​19 in jails. Together, these data show that the jail population has significantly decreased and that the virus still continues to spread rapidly behind bars. However, the data do not break down the jail populations by gender, race, and ethnicity or help discern the differential impact of decreased bookings, increased releases, or the expedited resolution of cases. A Possible Return

The pandemic calls for a reexamination of state and county reliance on jails, particularly as a default response to poverty, mental health, and substance use. Continued decarceration is not a foregone conclusion, however, and evidence shows that mass incarceration could worsen as a result of the pandemic. Both Vera-​collected data and NYU Public Safety Lab data show that a substantial number of jail populations have already begun to increase after reaching lows in late April and early May. The Harris County jail in Texas, one of the hardest-​ hit by the virus, is returning to pre-​COVID-​19 population

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levels. Some sheriffs are suggesting that larger jails would improve medical treatment and social distancing. The Dane County, Wisconsin sheriff, for example, pushed for more than $140 million to build a new jail with enhanced medical facilities. The Henry County, Virginia sheriff is also using the coronavirus to speed jail construction, arguing that it is key to social distancing. Groups that aid sheriffs, including the National Sheriffs’ Association and Major County Sheriffs’ Association, are sharing webinars and memos to inform their constituents about using federal stimulus dollars to increase jail revenues. Moreover, counties have historically used federal and state payments to jails to stave off bankruptcy and to balance budgets.

Recommendations and Solutions

Even before the murder of George Floyd, the push for local, state, and federal reforms across the prison–​industrial complex was well underway. Moreover, state and local spending had not uniformly returned to pre-​recession levels. The COVID-​ 19 crisis has further magnified the need for decarceration and true reinvestment in services and resources that promote public safety and public health, including treatment and education. The starting point for criminal justice after the coronavirus is to develop systems for more transparent, publicly available data, to reduce jail populations, and to disinvest in incarceration, including by restricting the construction of new jails. More specifically, we should do the following. 1. Increase data transparency. Some sheriffs and jail system authorities will say that they do not have the basic internal capacity necessary to produce data on jail population and conditions. However, voters and policy-​ makers need information to evaluate whether jail investments are necessary. Family members need information on their loved ones’ health and well-​being. The jail system, which touches 11 million lives and costs billions of dollars, should not continue to be the only

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public system that evades basic questions of transparency and viability. The COVID-​19 crisis has reiterated the extent to which jails operate in the shadows, at high cost to lives. To change that, we propose the following. • Federal law should require that the Bureau of Justice Statistics implement strict requirements on data reporting and should create grants for states to build data systems, modeled on national data collection and production in the health and education fields. Jail and prison systems should also be required to implement facility-​wide testing during public health emergencies and regularly report data on the health and mortality of people behind bars. US health programs have long implemented data systems to track and report health outcomes, so that small medical facilities could easily present data showing they are following basic rules and have the safety mechanisms in place to improve mortality rates. The federal government should take the lead on building a similar data system for jails, which would help provide real-​time information on jail population trends. • After prioritizing substantive reforms, state policy-​ makers should adopt legislation requiring data collection and public reporting on jail deaths, safety protocols, and daily population and booking data, including anonymized charge, bail, race, ethnicity, and gender data. At the state level, Florida passed a sweeping data collection bill in 2018, mandating that counties report data on jail populations, courts, and other agencies. Implementation has been slow, bedeviled by both local capacity and cost. Several states issue monthly or weekly jail reports that capture topline data, and some states and counties have contracted with vendors to build jail analytics dashboards—​though the data is not always public-​ facing and can reflect a narrow set of policy questions. The new reforms should include public-​ facing data, support for local implementation, and a set of policy questions that reflect public priorities and the consequences of jail incarceration. One model is

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Utah’s Senate Bill 205, which was signed into law in 2018 and requires the Department of Corrections and county jails to report deaths in custody—​including deaths that occur while someone is being transported for medical care or has been hospitalized directly from the jail to close reporting loopholes. Current events have pushed organizers to refocus their attention on those who die at the hands of law enforcement, which should include those in jail. 2. Further decrease jail populations. • Sustain COVID-​ 19-​ era reforms that reduce jail admissions and lengths of stay. Judicial actors and prosecutors have broad discretion to make decisions about pretrial detention, diversion, speedy trials, and dispositions. Law enforcement and jailers can exercise discretion too, by decreasing arrests and bookings and facilitating early releases. Aaron Littman of UCLA outlines the discretionary power of sheriffs, wardens, and jailers in every state, including: • The ability of an arresting officer to cite and release or release people with verbal warnings; • the ability of a sheriff or relevant jail personnel, regardless of the arresting agency, to release people at booking; • the ability of sheriffs, wardens, and jailers to release people from jail based on an emergency, overcrowding or time served. Before this emergency, fewer arrests, fewer bookings, and quicker releases would have reduced deaths and improved public health outcomes. Justice system actors should make these changes permanent after the COVID-​19 crisis and shift responsibility for first-​ response to mental health and substance use crises away from police to non-​law enforcement emergency personnel. • State policy-​makers should follow suit by reducing the use of incarceration as a punishment or sanction. Emergency legislation should narrowly define who can be subject to pretrial detention, decriminalize many misdemeanor crimes and felonies, eliminate

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incarceration as a response to violations of supervision, increase funding for alternatives to incarceration, eliminate most or all legal financial obligations that further criminalize poverty, and expand multiple release mechanisms. 3. Stop jail growth and new construction projects. This moment has made clear the dangers of jail construction, particularly at the expense of community-​ level investments that serve public safety, and should mark the end of jail expansion. This should include the following. • Eliminate federal funding sources that incentivize county governments to invest in new jail construction that sustains the ongoing jail construction boom. This includes Intergovernmental Service Agreements (ISGAs) with Immigration and Customs Enforcement (ICE) and the US Marshals Service, which incentivize counties to build new jails with the capacity to house federal detainees. Jails should also be ineligible for federal loan and grant dollars meant for essential community facilities or economic development. • Counties and jail oversight bodies should pause all jail construction and expansion until they have undertaken meaningful analysis, in partnership with communities, of the drivers of incarceration and implemented all policies and investments that can safely reduce incarceration. County commissioners should earmark the cost savings from reduced incarceration for community-​ based services and resources and non-​ law enforcement responses to mental health and drug crises. As investment in and oversight of law enforcement gains national attention, local reformers continue to advance decarceration and decriminalization. Those local organizers are leading the way, reining in arrests and pretrial detention, curtailing law enforcement discretion, challenging the school-​ to-​ prison pipeline, limiting law enforcement budgets, and calling for additional accountability and transparency. These efforts, including the response to the murders of George Floyd and Breonna Taylor, are pushing for a future where any

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interaction with jails is far more limited and won’t be a death sentence. Another world is possible. Key Resources

Blackmon, Douglas A. 2009. Slavery by Another Name:  The Re-​ Enslavement of Black Americans from the Civil War to World War II. New York: Anchor Books. Eisler, Peter, Linda So, Ned Parker, and Brad Heath. 2020. “Special Report:  ‘Death Sentence’—​the Hidden Coronavirus Toll in U.S. Jails and Prisons.” Reuters, 18 May. Available at www.reuters.com/​ article/ ​ u s- ​ h ealth-​ c oronavirus-​ u sa-​ j ails-​ s pecailr/​ s pecial-​ r eport-​ death-​sentence-​the-​hidden-​coronavirus-​toll-​in-​u-​s-​jails-​and-​prisons-​ idUSKBN22U1V2. Henrichson, Christian and Oliver Hinds. 2020. “Use This Data to Hold Your Local Jail Accountable During the Pandemic.” Vera Institute of Justice, 8 April. Available at www.vera.org/​blog/​covid-​19-​1/​use-​ this-​data-​to-​hold-​your-​local-​jail-​accountable-​during-​the-​pandemic. Kang-​ Brown, Jacob, Oliver Hinds, Eital Schattner-​ Elmaleh, and James Wallace-​Lee. 2019. “People in Jail in 2019.” Vera Institute of Justice, December. Available at www.vera.org/​ publications/​ people-​in-​jail-​in-​2019. Sawyer, Wendy and Peter Wagner. 2020. “Mass Incarceration:  The Whole Pie 2020.” Prison Policy Initiative, 24 March. Available at www.prisonpolicy.org/​reports/​pie2020.html. Stemen, Don. 2017. “The Prison Paradox More Incarceration Will Not Make Us Safer.” Vera Institute of Justice, July. Available at www.vera.org/​ publications/​for-​the-​record-​prison-​paradox-​incarceration-​not-​safer. Subramanian, Ram, Kristi Riley, and Chris Mai. 2018. “Divided Justice: Trends in Black and White Jail Incarceration, 1990–​2013.” Vera Institute of Justice, February. Available at www.vera.org/​publications/​divided-​justice-​black-​white-​jail-​incarceration. Zeng, Zhen. 2019. “Jail Inmates in 2017.” US Department of Justice Bureau of Justice Statistics, April. Available at www.bjs.gov/​content/​pub/​pdf/​ji17.pdf.

About the Authors

Felicia Arriaga, PhD is an Assistant Professor of Sociology in the criminology concentration at Appalachian State University. Her research interests are in the areas of race and ethnicity, immigration, and crimmigration (criminalization of immigration policy and procedure). She is especially interested in how these policies and procedures relate to issues of criminal justice accountability, transparency, and reform. Jasmine Heiss is the Campaign Director for In Our Backyards, an initiative exploring the shifting geography of

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mass incarceration, and elevating the surprising truth that America’s highest rates of incarceration are not in the biggest cities, but in the nation’s hundreds of smaller cities, towns, and rural areas. Her work is meant to inform the public dialogue, engage new allies, and advance change in order to end mass incarceration where it begins—​in all of our backyards. Max Rose is the Executive Director of Sheriffs for Trusting Communities, which works with organizers to stop deportations, end mass incarceration, and build progressive, multiracial political power. His research and writing, both academic and for popular publications, has focused on race, inequality, and the American South.

II

Part 

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4 Essential Work and Unemployment in the United States Biko Koenig The Problem

After a record-​high stock market and only a 5.3% unemployment rate in February of 2020, the end of March would find a 30% stock market crash as the COVID-​19 pandemic swept the United States. By April stay-​at-​home orders proliferated across the country and unemployment would spike to 14.7%, the highest rate since the Great Depression. While many suddenly found themselves out of work, between 49 and 62 million workers were estimated to be employed in “essential,” “life-​ sustaining,” or “critical infrastructure” industries. In this chapter I assess the impact of COVID-​19 on workers in the United States, focusing on the circumstances of essential workers and the unemployed. As I will show, the health risks of COVID-​19 intersect with economic risks linked to job status for many workers in the US. While the impacts of COVID-​19 are unique, they must be understood against the ongoing challenges that US workers face in a labor market characterized by low wages and the weak enforcement of labor protections. First, in 2019 an estimated 44% of the workforce was low-​wage, with a median annual wage of $18,000. This is a trend that is expected to continue, as the Bureau of Labor Statistics projected even before the crisis that through 2024 two-​thirds of new jobs would pay roughly $15 per hour or lower, with a third offering just over $10 per hour. The characteristics of modern low-​wage jobs are worth noting. White workers are the largest demographic and thus hold the majority of low-​wage jobs. At the same time, immigrants, people of color, and women are overrepresented 36

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in this wage band. Second, the policy landscape designed to protect and empower workers suffers from weak policies and poor enforcement. Today employers routinely violate employee rights in areas of wage regulation, union protection, employee classification, and health and safety. For the majority of essential workers who must travel to a job site to perform their functions, the designation as “essential” implies increased health risks compared to those who can shelter in place or work remotely. Workplaces that do not implement safe practices designed to limit exposure compound these problems, yet there are no national requirements or enforcement mechanisms in place for safe procedures. Essential workers who are concerned about their own or their family’s health are typically unable to collect unemployment benefits if they leave their jobs, forcing many to make a choice between economics and health. By the end of June 2020, roughly 34.5 million workers had applied for unemployment insurance since the crisis began. While Congress has expanded the eligibility and amount of unemployment insurance payments, these benefits are nonetheless hard to access, limited in their duration, and vary greatly by state. Further, Congressional expansions are set to expire in July of 2020. Low-​wage workers face particular hardships due to their reliance on employer-​ sponsored health insurance and low rates of savings. As a whole, policy responses to unemployment have not done enough to counter the economic risks for those who are out of work, while the implementation of benefit expansions have been scattershot, limited, and beset by implementation problems. For many workers, these delays have translated into missed payments for housing, debts, and food. For some, unemployment also translates into a loss of health insurance coverage. Women, workers of color, and immigrants are overrepresented among essential workers and the unemployed, primarily due to their prevalence in low-​wage work. Indeed, low-​ wage workers are overrepresented in both essential worker and unemployed populations. Taken together, the data strongly illustrate that the risks associated with essential work and the impacts of unemployment are not evenly distributed across the economy. Low-​wage workers endure the worst of

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Essential Work and Unemployment in the United States

the economic risks associated with COVID-​19, as do women, people of color, and immigrants. Given the likelihood of an economic recession with double-​digit unemployment levels through 2021 and the possibilities of future outbreaks, it is essential that policy-​makers take steps to protect workers from the health and economic risks associated with this crisis.

Research Evidence Essential Work

There are some challenges in determining the number of both essential workers and the unemployed. While the Department of Homeland Security (DHS) has offered guidance on which industries are necessary for “critical infrastructure,” individual states have crafted their own specific lists and timelines. Further, federal and state actors have not always developed lists with language that is compatible with government data on employment by industry or occupation. As a further complication, not all businesses deemed essential have remained open, and not all workers at these businesses have continued working. Given these limitations, researchers have estimated that DHS guidelines would categorize between 49 and 62 million workers as being in essential industries, with survey data and occupational data suggesting a number closer to 55 million workers. Below I show how people of color, women, and low-​wage workers are overrepresented in essential categories and present the health and safety problems that these workers face on the job. • Essential work is not evenly distributed across society and women, people of color, and immigrant workers often are overrepresented. This is particularly true for frontline workers—​those who do direct, often face-​to-​ face service provision. • The largest shares of essential work are in industries with significant proportions of low-​ wage workers such as health care, food and agriculture, and the facilities and services industries.

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• People of color are overrepresented in all essential industries. White workers have the largest share of jobs in high-​ wage essential industries, such as financial services, the chemical sector, and wastewater management. • Of all workers who can work from home, 84% are White compared with 8% Black workers and 7% Asian workers. Additionally, 9% are Hispanic or Latinx, and 47% are women. • Frontline workers are disproportionally women, people of color, and immigrants. Women are especially overrepresented in health care, child care, and social services. Over 40% of frontline workers are people of color, and 17% are immigrants. • Over 33% of frontline workers are over the age of 50. • Over 35% of frontline workers live with a child. • Over 70% of essential workers do not have a college degree. • In line with the overall economy, essential work is often low-​wage work, especially among frontline workers. • Roughly 35% of essential workers make $40,000 or less per year. Wages vary considerably by industry and race. For example, Black health care workers have a median wage of $16.01 an hour compared to $23.97 for White workers. These differences are due to the overrepresentation of White workers in management and professional jobs in most industries. • One quarter of frontline workers live in families that earn an income below 200% of the federal poverty line. • Survey data indicates that significant proportions of essential workers have difficulty paying for essentials such as utilities (15%) and food (10%). • When asked how they would pay for an unexpected $500 medical bill, 31% of essential workers noted they would need to borrow money and 16% indicated they would be unable to pay it at all. • Essential workers face health risks higher than Americans who can shelter in place or work remotely. These risks are higher for frontline and low-​wage workers.

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Essential Work and Unemployment in the United States

• The top occupations for low-​ wage workers are frontline positions such as cashiers, restaurant employees, and delivery/​ transportation services, all of which require face-​ to-​ face interactions with colleagues and customers. • Roughly 19.4 million workers are employed in the health and social services industry, the industry with the highest risks of contracting COVID-​ 19; 3.4 million (18%) of workers in this industry are low-​wage. • Low-​wage workers are more likely to be at higher risk of spreading infections to their families. They are more likely to live in large households, to live with an elderly person, or to live with someone who has a personal care need. • Essential workers are more than twice as likely to know someone who has died from COVID-​ 19-​ related complications. • While the Centers for Disease Control (CDC) recommends that members of the public should quarantine for 14 days after exposure to COVID-​ 19, employers are allowed to require their employees continue to work provided they are asymptomatic. • While labor unions historically provide additional protections and empowerment for workers, they face an increasingly hostile political environment and historically low membership numbers. • Unionization rates today are low, at 10.3% of the workforce. Public-​ sector workers are unionized at much higher rates (33.6%) than private-​ sector workers (6.2%). • Widespread employer violations of worker rights are a key cause of low unionization rates. Between 2016 and 2017 employers violated federal law in 41.5% of all union campaigns, including illegally firing workers for organizing in 29.6% of all campaigns. Employers who engage in illegal behavior are not subject to civil or criminal penalties under current statutes. • Weak protections for workers have also encouraged employers to use expensive and sophisticated

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anti-​union strategies and technologies to run anti-​ union campaigns during the COVID-​ 19 crisis. For example, leaked internal documents show how Amazon officials coordinated an online campaign against a New York warehouse worker who had spoken out against a lack of protective equipment and procedures. The company fired the worker after he led a walkout to combat unsafe conditions. At Trader Joe’s, managers have used firings and forced meetings to quash unionization efforts stemming from COVID-​19-​related health fears. • The Occupational Health and Safety Administration (OSHA) lacks the resources and political mandate to keep workers safe. • OSHA is facing a historic low in terms of the number of inspectors. In 1975, the year OSHA was founded, there were 1,102 inspectors. Today, with a workforce four times as large, there are only 862 inspectors. This corresponds to a 10% reduction in inspections during the Trump administration compared to the previous two presidential administrations. • Roughly 42% of OSHA leadership positions remain unfilled under the Trump administration. • While OSHA officials have noted that limited resources require the agency to focus its efforts on protecting health care workers, the agency has yet to issue any enforceable guidelines to employers regarding COVID-​19 standards. • There have been roughly 4,000 COVID-​19-​related employee complaints, though OSHA has yet to issue any citations for improper conduct. • White House recommendations for reopening the economy have indicated that worker health and jobsite safety are the responsibility of individual states, though this is OSHA’s federal mandate. Only 22 states have OSHA-​approved state plans to operate their own workplace health and safety programs.

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Essential Work and Unemployment in the United States

Unemployment

As of mid-​ June, 34.5 million workers—​ over one in five of all members of the workforce—​ were either receiving unemployment or were waiting to see if they qualify. This figure is an understatement given that it does not include Pandemic Unemployment Assistance (PUA) claims for six states that have not yet released data on these figures. PUA is a federal program for workers who do not qualify for traditional unemployment insurance, such as the self-​ employed, and accounts for 32% of the total unemployment applications. • The economic impacts on job losses are not evenly distributed across society. • Available state-​ level data on unemployment claims show that the industries most affected are those where workers are disproportionately low-​wage, such as service occupations (27.1%), shipping (17.9%), and construction (18.2%). Management and professional occupations have the lowest levels of unemployment (7.7%). • While rates are high for all categories, Blacks and Hispanics are unemployed at higher rates than Whites, immigrants at higher rates than native-​born workers, and women at higher rates than men. • Roughly 22% of low-​ wage workers receive their health care through Medicaid and will likely continue to remain on the program if unemployed. • Estimates based on state-​level unemployment claims and average health care coverage by industry suggest that roughly 45.8% of unemployed workers, or 16.1 million, received health insurance through their employers. • For workers who received employer-​sponsored health insurance, unemployment may mean an end to health insurance. The COBRA program allows workers who lose their jobs to continue to purchase health insurance, though the rates are typically very high, averaging $600 a month for an individual plan and $1,700 for a family.

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• The 21% of low-​wage workers who are uninsured as well as recently unemployed workers who received health insurance through their employers may qualify for Medicaid or Affordable Care Act (ACA) marketplace subsidies depending on their income and location. Medicaid requires that an applicant meet a household income ceiling. Further, workers will be unable to apply for ACA-​ subsidized insurance in the 32 states that do not have their own insurance marketplace. And some workers may find themselves in the coverage gap in the 14 states that did not expand Medicaid under the ACA—​with incomes too high to qualify for Medicaid, but too low for ACA subsidies. • State-​ level unemployment insurance programs have tremendous variation in the amount of benefits, the application process, and the number of weeks benefits are paid. • The Coronavirus Aid, Relief, and Economic Security (CARES) Act is a temporary expansion of unemployment benefits provided by the federal government. The Act includes a $600 weekly increase in unemployment payments to all claimants, providing a crucial increase for workers in states with exceptionally low weekly payments. The CARES Act also funds 13 extra weeks of benefits and expands eligibility to the self-​ employed, part-​ time workers, workers without sufficient work history, and the unemployed who have exhausted their benefits. As noted above, these categories constitute 32% of total claims. • Some states offer poverty-​level benefits even at the maximum amount. For example, Florida pays a maximum benefit of $275 per week for a maximum of 12 weeks, while Massachusetts pays a maximum of $1,234 per week for a maximum of 26 weeks. • Following the 2008 recession, many programs were redesigned to make benefits harder to obtain. In 2007, roughly 37% of all unemployed workers received benefits. In 2019, only 28% received benefits. In 26

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Essential Work and Unemployment in the United States

states, less than a quarter of unemployed workers received benefits in 2019. For example, in 2019, 65.9% of unemployed residents in Massachusetts received benefits, compared with 7.6% of Floridians. • Unemployment programs across the country suffered intense delays due to the combination of the sudden influx of claims, application programs designed to reject applicants, and expanded eligibility by Congress. Many states have been forced to delay benefits by weeks. • Survey data indicate that for every ten people who successfully filed for unemployment, four were unable to have their claim processed and two did not finish their claim due to the difficulty of navigating the application process.

Recommendations and Solutions

Many of the current health and economic risks associated with the impact of COVID-​19 stem from a policy history that aims to privatize risks onto individuals and families. Alternative policies could build on existing policies as well as new laws such as the CARES Act to socialize health and economic risks, especially for low-​income and high-​risk workers. Many of the recommendations below hinge on stronger enforcement of pre-​existing laws, adjustments of policies designed to deny protections to workers, and expansions of policies to address gaps in coverage. Given that economic and health risks associated with COVID-​19 hurt women, people of color, immigrants, and low-​wage workers at disproportionate levels, these recommendations will help ensure equitable outcomes during the coming economic recession. 1. Strengthen union rights and empower worker voices. Research indicates that unionized workplaces suffer fewer fatalities and injuries stemming from the active participation of workers in maintaining safety standards. At non-​ union workplaces it is more likely for safety problems to go unreported and uninvestigated. As one

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example, anti-​union “right to work” state legislation is associated with a 14% increase in workplace fatalities. Since most workplace regulation hinges on worker complaints, empowering the voice of workers is a clear way to increase jobsite health and safety. • Union workers have more access to paid sick leave and carry health insurance at far higher rates than non-​ union workers. Further, union workers earn higher wages in all occupations. • Policy-​makers should strengthen union rights through new policies such as the Employee Free Choice Act or the Protecting the Right to Organize (PRO) Act, which empower the National Labor Relations Board to combat illegal employer practices and streamline union election procedures. • In addition to policy action, customers who want to support workers at stores like Amazon and Trader Joe’s should find worker organizations from which to take direction (such as @TraderJoesUnion on Twitter) and look for organized boycotts that seek to pressure companies to change their behaviors (such as www.threshold.us). 2. Improve worker health and safety regulations. OSHA has a federal mandate to protect American workers and cannot effectively empower states to fill this gap. Without clear, enforceable guidelines, workers and customers are left to the whims of employers and policies may vary dramatically across worksites. • At minimum, OSHA should develop specific workplace requirements to mitigate possible COVID-​ 19 infections between employees and customers. Temporary emergency standards should dictate rules such as the number of customers or employees allowed in workplaces, the use of protective equipment, and physical setups such as one-​ way aisles and plastic barriers. • Current CDC recommendations on worker quarantine after COVID-​ 19 exposure should be made equivalent to recommendations for the general public.

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Essential Work and Unemployment in the United States

• Currently, OSHA has indicated that it will mainly conduct investigations at health care and emergency response worksites. Employers at other sites have been mandated to investigate COVID-​19 complaints on their own, with no record-​keeping or enforcement mechanisms. As per federal mandate, OSHA should provide guidelines for record-​ keeping and enforcement of workplace requirements and policy violations. • OSHA has historically been funded at limited levels, which necessitates employee complaints to substitute for widespread inspections. OSHA must investigate employee complaints for possible misconduct and use enforcement mechanisms to ensure that workplaces follow required practices. • All safety protocols and policies should be enforced with on-​site inspections and citations. 3. Expand access to unemployment insurance. The Congressional Budget Office estimates unemployment will not drop below 10% before the end of 2021 without additional relief. Currently, the CARES Act is set to expire in July 2020. • Congress and states should work together to ensure that the expansion of eligibility remains in place until unemployment drops to pre-​crisis levels. • Congress should continue to add additional weeks of unemployment eligibility through the end of 2021. • Currently, undocumented immigrants are unable to collect unemployment insurance even when they pay into insurance pools. Congress should address this gap and ensure that immigrant workers have access to the unemployment benefits their wages help to fund. • Given the varying levels of funding across states, Congress should continue to add extra weekly payments to supplement poverty-​level unemployment benefits in certain states. • Congress should provide funding to states to update their unemployment infrastructure and to hire additional staff to speed up and streamline claim processing.

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• Many states have application processes that assume applicants are lying about their status, and are intentionally difficult in order to dissuade applicants from applying. States and the federal government should adjust unemployment programs to shoulder the burden of truth and assume applicants are unemployed until proven otherwise. • Some commentators have noted that the extra benefits may disincentivize workers from returning to work—​ passing a higher federal minimum-​ wage law and abolishing the federal tipped minimum wage would ensure paycheck equity. • Moving unemployment insurance programs from states to the federal government would allow for more uniform policies and equitable outcomes across the country. 4. Preserve health insurance benefits. The prevalence of employer-​sponsored health care in the United States means that an unemployment crisis is also a health insurance crisis. Congress should act quickly to ensure that unemployed workers are able to receive health care. • Federal funding for COBRA could act as a stop-​gap for the unemployed, though the program does not cover workers at small businesses. • Enrolling unemployed and underemployed workers in Medicare and Medicaid would ensure that workers keep their coverage as they navigate the pandemic. • De-​ coupling health insurance from the workplace would be a large but important step in reducing both economic and health risks for workers both during and after the COVID-​19 crisis.

Key Resources

Badger, Emily and Alicia Parlapiano. 2020. “States Made It Harder to Get Jobless Benefits. Now That’s Hard to Undo.” The New York Times, 30 April. Available at www.nytimes.com/​ 2020/​ 04/​ 30/​ upshot/​unemployment-​state-​restrictions-​pandemic.html. Berkowitz, Deborag. 2020. Worker Safety in Crisis:  The Cost of a Weakened OSHA. National Employment Law Project. Available

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at https://​s27147.pcdn.co/​wp-​content/​uploads/​Worker-​Safety-​ Crisis-​Cost-​Weakened-​OSHA.pdf. Galvin, Daniel J. 2016. “Deterring Wage Theft: Alt-​Labor, State Politics, and the Policy Determinants of Minimum Wage Compliance.” Perspectives on Politics, 14(2): 324–​350. Garfield, Rachel, Matthew Rae, Gary Claxton, and Kendal Orgera. 2020. “Double Jeopardy: Low Wage Workers at Risk for Health and Financial Implications of COVID-​19.” Kaiser Family Foundation, 29 April. Available at www.kff.org/​coronavirus-​covid-​19/​issue-​ brief/​double-​jeopardy-​low-​wage-​workers-​at-​risk-​for-​health-​and-​ financial-​implications-​of-​covid-​19/​. Gould, Elise and Valerie Wilson. 2020. “Black Workers Face Two of the Most Lethal Preexisting Conditions for Coronavirus—​Racism and Economic Inequality.” Economic Policy Institute, 1 June. Available at www.epi.org/​publication/​black-​workers-​covid/​. Grabell, Michael, Bernice Yeung and Maryam Jameel. 2020. “Millions of Essential Workers Are Being Left Out of COVID-​19 Workplace Safety Protections, Thanks to OSHA.” ProPublica, 16 April. Available at www.propublica.org/​article/​millions-​of-​essential-​workers-​are-​ being-​left-​out-​of-​covid-​19-​workplace-​safety-​protections-​thanks-​to-​ osha. Koenig, Biko. 2018. “Economic Inequality and the Violation Economy.” Poverty & Public Policy, 10(4): 505–​523. McNicholas, Celine and Margaret Poydock. 2020. “Who Are Essential Workers?” Economic Policy Institute, blog post, 19 May. Available at www.epi.org/​blog/​who-​are-​essential-​workers-​a-​comprehensive-​ look-​at-​their-​wages-​demographics-​and-​unionization-​rates/​. Ross, Martha and Nicole Bateman. 2019. Meet the Low Wage Workforce. Metropolitan Policy Program at Brookings. Available at www.brookings.edu/ ​ w p-​ c ontent/​ u ploads/​ 2 019/​ 1 1/​ 2 01911_ ​ B rookings-​ Metro_​low-​wage-​workforce_​Ross-​Bateman.pdf. Zipperer, Ben and Gould Elise. 2020. “Unemployment Filing Failures.” Economic Policy Institute, 28 April. Available at www.epi.org/​blog/​ unemployment-​filing-​failures-​new-​survey-​confirms-​that-​millions-​of-​ jobless-​were-​unable-​to-​file-​an-​unemployment-​insurance-​claim/​.

About the Author

Biko Koenig, PhD is an Assistant Professor of Government and Public Policy at Franklin and Marshall College in Lancaster, Pennsylvania. His writing focuses on social movements, inequality, and labor. His methodological background is grounded in qualitative, fieldwork-​based, and interpretive approaches to politics and policy.

5 The US African-​ American Population Experienced a COVID-​19 Double Disadvantage: Unemployment and Illness Teresa A. Sullivan The Problem

When George Floyd died at the hands of Minneapolis police, he had been laid off from his job at a restaurant closed by COVID-​ 19. Massive job loss is a second-​ order epidemic that followed the COVID-​ 19 epidemic because worksites closed. And just as with the disease itself, the epidemic of unemployment disproportionately affected African-​American workers. The exact counts of job loss and displacement cannot be described as precisely as the hospitalizations and deaths, but clues to their magnitude can be found in US government employment statistics. These statistics must be examined carefully for what they show and for what they conceal. Even with incomplete statistics, however, the high unemployment of African Americans reveals a broader picture of racial inequality and health disparities. The COVID-​ 19 epidemic ended months of politicians’ jubilation over a booming economy, but in fact the boom had been unequally shared and the bust intensified inequities existing before the pandemic. African Americans had relatively high unemployment levels even during the boom, and the economic dislocation caused by the pandemic made their employment situations worse. Historically, African Americans have suffered the highest unemployment rates in America, followed by Hispanic/​Latinx populations (who may be of any race, including Black) and then by majority Whites and Asian 49

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The African-American Double Disadvantage

Americans. By 20 April 2020, with over 40,683 COVID-​19 deaths already recorded and emergency orders in place nearly everywhere in the United States, the Black unemployment rate was 16.7% and the overall rate was 14.7%. The May 2020 unemployment rates were released on 5 June 2020, and by that date the number of deaths from COVID-​ 19 had reached 95,608. Politicians were quick to trumpet a 1.4% drop in the overall unemployment rate. Less frequently noted was that the Black unemployment rate increased from 16.7% to 16.8%. This disastrous loss of work for 3.3 million Black workers intensified financial inequalities. Unemployment is a serious issue for any family, but especially for African-​ American families because they have few income sources besides wages and salaries. They have little financial cushion because their median net worth is only $17,600. (This compares with $171,000 for White families.) Employment loss is also a serious issue for the society, because fringe benefits and payroll taxes constitute a major funding source for what remains of the American safety net. Not only is employer-​ sponsored insurance the best health care coverage most Americans have, but payroll taxes underwrite unemployment insurance and much of Social Security and Medicare. Whenever a job is lost—​but especially when a job is lost during a health crisis—​ an entire family is likely to lose health care. Without health insurance, ordinary health care costs in addition to COVID-​ 19 are more likely to affect African-​American families.

The Research Evidence

Evidence from the US Bureau of Labor Statistics indicates the extent of the African-​American disadvantage. Even before the epidemic, when the economy was booming, African-​American workers suffered from high unemployment. When the overall unemployment rate reached its recent historic low of 3.1% in January 2020, the measured unemployment among African-​ American workers was nearly twice that, at 6.0%; for adult men the comparison was 2.9% versus 5.6%. For several decades, the African-​American unemployment rate has typically been

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measured at nearly twice that of the White population, and it has also been higher than the unemployment rates for Hispanic/​ Latinx workers and Asian-​ American workers. The reason for the higher unemployment has commonly been explained by where African Americans find jobs in the economy and by their human capital endowments. Yet both types of common explanations fall short. Industry

In general, African Americans tend to be clustered in different industries to White workers. Approximately one in every eight African Americans would need to change industries to have the same distribution as White workers. When the pandemic was acknowledged in February–​ March 2020, African-​ American workers were overrepresented in the industries that were among the hardest-​hit by layoffs: Retail (17.1% overall unemployment); transportation and utilities (13.5% overall unemployment); and leisure and hospitality (39.3% overall unemployment). These industries also had lower-​ than-​ average wages and they were among the least likely industries to provide employer-​sponsored health insurance. They were hard-​hit because during the shutdown consumers were less able to frequent shops, restaurants, public transit, or hotels. Although many African Americans were deemed “essential workers” because of their work in the food supply chain, public transportation, or sanitation services, the decline in business volume still led to lost jobs. While nearly 30% of White workers were able to work from home, fewer than 20% of African-​American workers could do the same. Non-​essential workers who could work from home were often able to remain employed, but many of them worked in financial services, information, and other professional services—​fields in which African-​American workers tend to be underrepresented. Small Employing Firms

Some evidence suggests that African-​American workers are more likely to be employed by small firms such as restaurants. Workers in small firms find it harder to organize to seek

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benefits collectively, and small firms are often exempted from legislation that protects workers. When there was an employer mandate for Obamacare, for example, small firms were exempted from the requirement. When thousands of small firms closed during the pandemic, their newly unemployed workers sometimes found themselves ineligible for benefits such as unemployment compensation. It appears likely that many of these small employers will not be able to restart their businesses even after pandemic restrictions end. Education and Age

On average, African Americans are less well-​educated than White workers, and this affects their ability to work at more economically secure jobs. About 36% of White workers have a college degree compared with 26.6% of African-​American workers. During the pandemic people who held a college degree were more likely to maintain their employment. The unemployment rate for workers with a college degree was 8.4%, or five to six points below the national average. African Americans as a group are younger than White Americans, a demographic outcome that has resulted over a long period of time from differential mortality and particularly from differential fertility. The median age for African-​ American workers is 39.5 years compared with 42.7 years for Whites. About 17% of African-​American workers are aged 25 or younger compared with 14.6% of the total labor force. By contrast, 30.7% of African-​American workers are over the age of 55 compared with 36.7% of the total labor force. Young people historically have higher unemployment as they look for initial jobs and change jobs to find a better fit in the labor market. In addition, many entry-​level jobs provide temporary, part-​time, or seasonal work. These jobs often offer fewer benefits and are quickly shed in economic downturns. Young people populate the gig economy, which has been subject to catastrophic job loss during the pandemic. Being younger is thus a risk factor for all workers during periods of higher unemployment. It has differentially affected African Americans because as a group they are younger and once hired they lack seniority. Even when employers

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scrupulously followed a layoff policy that did not seem to take race into account, such as a policy that laid off workers according to reverse seniority, African-​American workers were among the first to be laid off. The unemployment rate for African-​American teenagers has been especially high for years. In May 2020, the unemployment rate for African-​American teenagers was 37%, compared with 24% in the previous May. Teenage unemployment has been discounted as a problem on the premise that teenagers have not yet finished their schooling, are less likely to seek a full-​ time job, and are not yet supporting a family. Aside from the fact that such assumptions are often not true, their high teenage unemployment makes African-​ American teenagers less likely to gain needed work experience, work references, and supplemental income than their White peers. The Effect of Racism

The structural differences in type of jobs and the demographic differences between African Americans and others ultimately do not suffice to explain away the differential unemployment. In one study done with data from 2005–​ 2007, a period characterized by relative prosperity, even after controlling for sex, age, education, place of birth, and metropolitan residence—​all factors that might be considered associated with differential unemployment—​ Black workers were 4.7 times more likely to be unemployed than White workers. Such a large differential implies a systemic exclusion of Black workers from the most secure jobs. Black women were clustered in service jobs that were vulnerable to sudden dislocations. The COVID-​ 19 pandemic and succeeding recession have exacerbated a pattern that prevailed even in prosperity.

Recommendations and Solutions

1. Provide health care that does not rely on work. Vulnerability to job loss translates for families into vulnerability for health care and housing. Particularly during a pandemic, health care is a social good as well

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as an individual benefit. People who go untreated for reasons of cost may be increasing the societal costs if they spread a contagion. For many families, their health insurance is tied to work, and losing their jobs means that they also lose their access to health care. Separating the work–​health care nexus is an important policy step for public health and for family well-​being. The current options, including privately purchased health insurance, are generally unaffordable. COBRA is available for unemployed workers, but the Kaiser Family Foundation estimates an average annual family cost of $20,000 plus a 2% service fee for COBRA. This sum amounts to one third of the median income for African-​ American families in 2019. Job loss is a qualifying event for special enrollment in an Obamacare plan, but even the cheapest bronze plan averages around $310 per month. For a family that has lost its income, the additional $3,700 a year may be unaffordable. A single-​payer health system, of the type found in Canada and most European countries, avoids magnifying the effects of work-​related income loss with unaffordable health care costs. While a new health system is politically difficult to accomplish, subsidizing COBRA to make it more affordable for the newly unemployed would be a stop-​gap measure. Some states have also opened special enrollment periods for the unemployed in their state-​ run health insurance exchanges. 2. Provide paid leave to workers. A second step would be universal paid leave. About two-​thirds (66%) of all workers have access to paid leave, compared with 62.6% of African-​American workers. While this might seem to be a benefit for the employed and not the unemployed, the two are related. Workers without sick leave may continue to come to work even with symptoms, endangering their co-​workers and perhaps customers, because they fear being fired if they claim illness. With paid leave acknowledged as a right, workers who are ill could seek treatment without fear of unemployment. Workers with an ill family member could observe the expected quarantine period without fearing job loss.

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Some portion of sick leave eligibility should be paid, so that economic distress does not further discourage the worker from using sick leave. Paying for sick leave is a challenge for employers, especially for small employers who might need to hire additional workers to take care of the work. In the pandemic situation, in which many small employers have simply closed and have had no income themselves, government help is needed to support the payroll. At least some employers did use their resources to continue pay or benefits for furloughed workers, but not enough were able to do so. 3. Expand unemployment insurance and recognize that insurance filings underestimate unemployment. While there has been a dramatic increase in applications for unemployment compensation, and both the states and Congress have tried to shore up the system, it is nevertheless true that unemployment compensation statistics alone obscure the position of African-​American workers. One step forward would be requiring racial/​ ethnic identification in the filing process, so that weekly numbers could be reported with additional detail. The machinery for applying for unemployment insurance is creaky and badly needs updating. New Jersey’s governor Phil Murphy called for programmers in common business-​oriented language (COBOL) to help fix their back-​office problems in the unemployment insurance division. COBOL was developed in 1959. Many states reported backlogs and delays, and workers required multiple attempts to successfully complete an application. One study showed that only 46% of unemployed service workers had successfully applied for benefits. Unemployment compensation does not cover all workers or all industries, and African-​American workers have the lowest coverage of all racial groups. Many African-​ American workers have been ineligible for unemployment insurance because they work in an excluded industry, their wages are too low, they don’t have enough seniority (“covered quarters”) or quarterly earnings in their current job, or they are entrants to the

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labor force. Small employers are also often exempted from coverage. Labor force entrants, who are excluded, might be disproportionately African American because of the younger age structure of the African-​American population. 4. Tell the truth about educational opportunities. Various pundits have used the pandemic as an opportunity to broadcast the message that traditional schooling is less important now, and that young people should seek a trade or a certificate from an online provider. Far less publicized is that many trade schools and online providers are inadequately regulated and leave students with little more than debt to show for their efforts. The publicity is asymmetric, with millions spent on marketing and very little spent on consumer protection. Moreover, the unemployment data show that a college degree has protected some workers from unemployment. The closing of school systems has also demonstrated that the digital divide remains a persistent issue. Aside from the interrupted supply chain, which makes the purchase of computers and peripheral equipment difficult, many of the unemployed have not had the resources to pursue an expensive distance education. Providers such as community colleges are more accessible and reasonably priced, but they do not have large marketing budgets. Bringing their services to the attention of the unemployed would be a useful step toward providing greater employability. 5. Report more fully on measures of underutilization as well as unemployment. Alternative measures of labor underutilization, termed U1–​U6, offer a fuller picture of the labor market situation of American workers. The broadest measure, U6, includes not only the unemployed but also those who have stopped looking for work (such as the 500,000 discouraged workers) and those who are working part-​time for economic reasons. Besides the 21 million unemployed Americans in May 2020, another 10.6 million workers were classified as part-​time for economic reasons. These are workers who want more work and are working part-​time because of a

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partial layoff or slack work. U6 rose from 8.7% in March 2020 to 21.2% in May 2020. On each of these indicators, African-​American workers are more disadvantaged than the labor force as a whole, but the relevant statistics are not routinely available. Based on 2019 data, when one such compilation was available, the African-​American rate on U6 was 11% versus 7.2% for the entire labor force. In May 2020, U6 was 21.2% for the entire labor force, but the rate for African Americans is unpublished. More timely reporting of race-​specific employment data would help clarify the relative economic status of African-​American workers. 6. Enforce equal employment legislation. The decline in enforcement energy in both the federal government and in some states emboldens employers to evade equal employment requirements. Greater diligence in enforcement could lead to a more level playing field for African Americans. Ensuring more presence of Black board members, executives, and others in visible leadership positions would also reassure Black applicants that a firm is committed to career possibilities for them.

Key Resources

Aratani, Lauren and Dominic Rushe. 2020. “African Americans Bear the Brunt of COVID-​19’s Economic Impact.” The Guardian, 28 April. Available at www.theguardian.com/​us-​news/​2020/​apr/​28/​ african-​americans-​unemployment-​covid-​19-​economic-​impact. Brundage, Vernon, Jr. 2020. “Labor Market Activity of Blacks in the United States.” US Bureau of Labor Statistics. Available at www.bls. gov/​spotlight/​2020/​african-​american-​history-​month/​home.htm. Emeka, Amon. 2018. “Where Race Matters Most:  Measuring the Strength of Association between Race and Unemployment Across the 50 United States.” Social Indicators Research, 136(2): 557–​573. Hipple, Liz. 2019. “U.S. Economic Policies That Are Pro-​Work and Pro-​Worker.” Washington Center for Equitable Growth, 2 January. Available at https://​equitablegrowth.org/​u-​s-​economic-​policies-​ that-​are-​pro-​work-​and-​pro-​worker/​. Kalev, Alexandra. 2020. “Research:  U.S. Unemployment Rising Faster for Women and People of Color.” Harvard Business Review, 20 April. Available at https://​hbr.org/​2020/​04/​research-​u-​s-​ unemployment-​rising-​faster-​for-​women-​and-​people-​of-​color.

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Nichols, Austin and Margaret Simms. 2012. “Racial and Ethnic Differences in Receipt of Unemployment Insurance Benefits During the Great Recession.” The Urban Institute, 23 July. Available at www. urban.org/ ​ r esearch/ ​ p ublication/ ​ r acial- ​ a nd- ​ e thnic-​ d ifferences-​ receipt-​unemployment-​insurance-​benefits-​during-​great-​recession. The Economist. 2020.“American Inequality Meets COVID-​ 19.” 18 April. Available at www.economist.com/​united-​states/​2020/​04/​ 18/​american-​inequality-​meets-​covid-​19. US Bureau of Labor Statistics. 2020. “The Employment Situation.” USDL-​20–​1140, 5 June. Available at www.bls.gov/​news.release/​ empsit.nr0.htm. US Bureau of Labor Statistics. 2020. “Unemployment Rate Rises to Record High 14.7 percent in April 2020.” The Economics Daily, 13 May. Available at www.bls.gov/​opub/​ted/​2020/​unemployment-​ rate-​rises-​to-​record-​high-​14-​point-​7-​percent-​in-​april-​2020.htm. Ward, Marguerite. 2020. “Black Women are the Hardest Hit by the Coronavirus Unemployment Crisis, New Survey Data Shows.” Business Insider, 14 April. Zipperer, Ben and Josh Bivens. 2020. “3.5 Million Workers Likely Lost Their Employer-​Provided Health Insurance in the Past Two Weeks.” Economic Policy Institute, 2 April. Available at www.epi.org/​blog/​ 3-​5-​million-​workers-​likely-​lost-​their-​employer-​provided-​health-​ insurance-​in-​the-​past-​two-​weeks/​.

About the Author

Teresa A. Sullivan, PhD is University Professor of Sociology at the University of Virginia. A labor force demographer, she teaches undergraduate courses that explore the intersection of work conditions with demographic backgrounds. Her most recent book is Census 2020: Understanding the Issues (Springer, 2020). She earned her bachelor’s degree at Michigan State University and her PhD at the University of Chicago.

6 Residential Crowding among Meat Processing Workers Stephanie A. Bohon and Rachel Ponder The Problem

According to the Census Bureau, more than 6% of US residents live in crowded housing. Residential crowding can be defined in a variety of ways, but a common measure of crowding is living more than one person to a room. Those living in crowded housing vary considerably by income, immigrant status, and race. Typically, those who live in crowded houses are poor, immigrants, and people of color—​ often all three—​with Latinx immigrants three times more likely to be crowded than other US residents, according to recent government data. Residential crowding negatively impacts learning outcomes, sleep patterns, and mental health. Living crowded also places residents at high risk for infectious disease transmission, because when people share close quarters, they have a difficult time staying isolated from other household members, according to the Centers for Disease Control and Prevention (CDC). The COVID-​19 pandemic escalates the risk associated with residential crowding, because essential workers who contract COVID-​19 at work and go home to crowded houses are likely to transmit the disease to other members of their household. Work sites where contracting COVID-​ 19 is especially likely include beef, pork, and poultry processing facilities—​ facilities that are considered critical infrastructure according to an Executive Order issued in April 2020—​where meat industry workers across the country are deemed essential under a federal mandate. Unfortunately, food processing 59

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workers also comprise a segment of the US workforce that disproportionately lives in crowded conditions. The deadly combination of high work-​related COVID-​19 risk and densely packed living quarters means that those who are likely to get COVID-​19 on the job are also at a high risk for spreading the disease to children, spouses, and other members of their household.

The Research Evidence Meat Processing Workers have a High COVID-​19 Risk

In April 2020, 115 US meat processing facilities in 19 states collectively reported nearly 5,000 COVID-​19 cases and 20 deaths among workers, according to the CDC. At least 32 plants were forced to close or reduce operations. The Texas State Health Department reported that COVID-​19 infection rates in rural counties with meat processing facilities were ten times those of the state’s largest cities, and clusters of COVID-​19 outbreaks have been linked to meatpacking in Europe, Australia, and South America. Researchers at Yale’s Human Nature Lab see these trends as evidence that meat processing facilities are hot spots for COVID-​19 infections. Why do meat processing plants pose a particularly high risk for COVID-​ 19? The University of Nebraska’s Global Center for Health Security points to the nature of the work, where many employees work in close proximity. According to the CDC, it is common for 1,000 workers to share a single shift. The fast pace of the butchery assembly line results in employees breathing hard and having trouble keeping their masks in place. Both the Global Center for Health Security and the CDC also point out that many meat processing workers are immigrants with limited English proficiency who may not be getting sufficient information about safety practices. Furthermore, the Pew Hispanic Center estimates that 27% of all meat cutters and 12% of all food preparers are unauthorized immigrants without health insurance or access to government assistance. Thus, public health officials are concerned that many meat processing workers who contract

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COVID-​19 may not get tested and may continue to work despite showing symptoms. Researcher at the University of California-​ Davis believe that the low temperatures in meat processing facilities may also be contributing to the high rates of COVID-​19 seen among food workers. Cold air may allow the virus to survive longer. Refrigeration systems that circulate the air may also pose a risk. Researchers at Texas A&M’s Aerosol Technology Laboratory suspect that fans in meat processing facilities may move the COVID-​19 virus much further than the six-​feet distance that some plants have spaced workers. Food Processing Workers Often Live in Crowded Homes

According to data from the American Community Survey, about 12% of food processing workers live crowded, double the rate of crowding in the general population. These rates vary widely by race and immigrant status. About 18% of Latinx food workers and nearly one in four Asian food workers live crowded in the counties where most US meat is processed, and a 2015 study in Social Problems established that unauthorized immigrants—​a substantial share of meat processing workers—​ are at even greater risk of residential crowding than other immigrants. Residential Crowding Contributes to the Rapid Spread of COVID-​19

Analyses by the Furman Center for Real Estate and Urban Policy show that COVID-​19 spreads quickly in neighborhoods where people live in crowded conditions and residents work away from home. These are the living conditions of many meat processing workers.

Recommendations and Solutions

Residential crowding has long afflicted immigrants and low-​ income households, and COVID-​ 19 poses a new deadly risk for those living in crowded conditions. Food processing industry workers are disproportionately likely to live in

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crowded houses, and that fact is alarming, since the nature of work in US meat processing facilities makes these sites high-​ risk for COVID-​19 transmission. To reduce crowding, we need policies to generate more affordable and secure housing, improve wages, and reduce poverty in consort with widespread immigration reform. However, these major reforms are unlikely to happen any time soon, if at all, and they are certainly not going to be put in place in time to save lives lost to COVID-​19. However, there are smaller-​scale federal, state, and workplace policies that could be established immediately that would protect workers from the spread of COVID-​19 today. 1. Implement workplace controls. • Meat processors should slow down assembly lines to reduce heavy breathing and allow workers time to adjust their masks. • Meat processors should clean and adjust fans to limit the recirculation of infected air. Many work places, including meat processing facilities, have implemented new safety protocols in the wake of the COVID-​19 pandemic, including requiring that workers wear masks, spacing workers six feet apart, and erecting protective barriers between workers. However, the special dangers of COVID-​19 transmission posed by meat processing facilities require these additional safety measures, according to industry experts. 2. Discourage sick and exposed workers from working. • Pass legislation to require meat processors to provide paid sick leave and guaranteed pay for those caring for sick family members. A report by the Joint Economic Committee of Congress shows that, among food workers, only 27% had paid sick leave in 2010, although Maryland, New Jersey, Rhode Island, and Washington have mandated sick leave since then. For many workers, if they do not work, they do not get paid. According to a survey commissioned by the international job placement firm Robert Half, more than 90% of US workers go to work when they are sick. While some of this behavior is cultural, 25% of

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US workers receive no paid sick leave. It is telling that when Starbucks Corporation provided their workers with the option of staying home at regular pay or working for $3 more an hour, most opted to work for more money despite the risk of death. Low-​ wage workers, like food processing workers, have no option but working in order to survive. • Federal legislators should amend the current coronavirus emergency legislation to keep meat processors from opting out of paid sick leave requirements. It may seem counter-​ productive to send sick workers home to the site where crowding virtually guarantees the spread of the virus, but doing so reduces the risk that those sick in one household will spread the disease to other households on the work site. Unfortunately, the paid sick and family leave provisions in the coronavirus emergency legislation that has been enacted by the US legislature at the time of this writing was scaled back so that this bill is unlikely to help food processing workers. Ten days of paid sick leave are available only to those who work at companies with fewer than 500 employees—​effectively eliminating this requirement for those working for the largest meat processors—​ and companies with fewer than 50 workers can easily opt out of the requirement. • Meat processors need to eliminate workplace incentives to work while sick. Some companies are actually offering incentives for sick workers to stay on the job. Poultry producer Sanderson Farms offered employees an additional $1 an hour to stay on the job during the pandemic, but only workers who failed to miss a single day of work during the pay period were eligible for the bonus. This inducement to work even when experiencing possible COVID-​ 19 symptoms was announced on 31 March 2020; two days later, Sanderson cut poultry production at its Moultrie, Georgia facility after more than a dozen workers tested positive for COVID-​ 19. Although workers should get hazard pay for working in dangerous conditions,

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these pay increases should not be structured in a way that further endangers workers’ health. • States should require that medical costs and lost wages of sick workers be covered through workers’ compensation. Workers’ compensation laws cover “occupational diseases” but many state laws specifically exclude “ordinary diseases of life” such as the common cold or influenza. As a consequence, COVID-​19 falls into a gray area that needs to be legally clarified. • Meat producers should be required by legislation to provide medical coverage for essential workers. Some state legislators have debated requiring firms to extend medical insurance coverage to essential workers. Since meat processors are considered essential workers under a Trump administration Executive Order that enjoins meat processors to remain open if possible, this type of legislation can protect some workers on a state-​by-​state  basis. 3. Increase workplace oversight. • State legislators should vote against and, if necessary, governors should veto legislation that provides prosecutorial immunity and liability waivers for meat processors that endanger workers. In response to the coronavirus pandemic, legislators in several states introduced legislation that allows businesses that employ essential workers, including meat processors, to avoid lawsuits if workers fall ill or die. Such legislation reduces incentives for meat processors to ensure that workplace safety guidelines are scrupulously followed. • States and the US Department of Agriculture (USDA) should require closed meat processing plants to demonstrate compliance with state and federal safety guidance before reopening. The United States has done a remarkably poor job of ensuring domestic workplace safety, and government oversight of meat and poultry processing has become even more lax under the Trump administration. The Occupational Safety and Health Administration has fewer

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inspectors operating now than ever in its history, and a 2018 overhaul of USDA requirements reduced the oversight of meat inspectors. Meat processing plants that have closed because of widespread infections among workers should demonstrate that steps have been taken to avoid future outbreaks. • Ensure that safety practices are understood. The federal government should mandate that meat processing employers are ensuring that workplace safety regulations are understood and followed by all workers. Immigrants—​ especially those who are unauthorized—​ already have precarious working conditions in the meat processing industry. Many researchers have documented that immigrants who do not speak English often do not understand US workplace safety guidelines. A recent CDC study of COVID-​19 outbreaks in 119 meat processing plants noted that one affected facility had workers speaking 40 different languages. They cite language barriers that create a failure to understand safety measures as a contributing factor in COVID-​19 spread. 4. Expand use of the H-​2A program. The Department of Labor should expand the H-​2A visa program to include meat processing workers. Although comprehensive immigration reform is desperately needed, in the short run the Department of Labor’s H-​ 2A program—​ which allows employers to temporarily hire foreign workers for agricultural jobs—​ should be seen as a reasonable means for keeping meat processing facilities staffed to replace workers who need to stay home to avoid spreading COVID-​ 19. The H-​ 2A program is typically used to supply temporary labor for planting, cultivating, and harvesting, but it could be expanded to fill temporary needs for food processing. Impelled by the coronavirus crisis, the Department of Labor has increased the amount of time H-​2A workers can stay in the United States from one to three years. H-​2A offers a particularly good immediate solution to filling labor shortages in food processing due to illness by requiring that employers provide good wages and free housing.

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Housing requirements for H-​2A workers must meet a minimum space requirement, which means that those workers will be in safer living conditions than many other immigrants, especially those who are unauthorized.

Key Resources

Braunschweiger, Amy and Matt McConnell. 2019. “Interview:  How the US is Making Meatpacking Jobs Even More Dangerous.” Human Rights Watch, 4 September. Available at www.hrw.org/​ news/​2019/​09/​04/​interview-​how-​us-​making-​meatpacking-​jobs-​ even-​more-​dangerous#. Cohn, D’Vera and Jeffrey S. Passel. 2018. “A Record 65 Million Americans Live in Multigenerational Households.” Pew Research Center, 5 April. Available at www.pewresearch.org/​fact-​tank/​2018/​ 04/​05/​a-​record-​64-​million-​americans-​live-​in-​multigenerational-​ households/​. Dyal, Jonathan W. et al. 2020. “COVID-​19 Among Workers in Meat and Poultry Processing Facilities—​19 States, April 2020.” Centers for Disease Control and Prevention, 8 May. Available at www.cdc. gov/​mmwr/​volumes/​69/​wr/​mm6918e3.htm?s_​cid=mm6918e3_​ x. Food Empowerment Project. 2014. “Slaughterhouse Workers.” Food Empowerment Project. Available at https://​ foodispower.org/​ human-​labor-​slavery/​slaughterhouse-​workers/​. Gautié, Jérôme and John Schmitt, eds. 2009. Low Wage Work in the Wealthy World. New York: Russell Sage. Solari, Claudia D. 2019. “America’s Housing is Getting More Crowded:  How Will that Affect Children?” The Urban Institute, 24 April. Available at www.urban.org/​ urban-​ wire/​ americas-​housing-​getting-​more-​crowded-​how-​will-​affect-​children. Stephens, Alexander and William D. Lopez. 2020. “Governments and Corporations have Deemed Immigrant Workers Expendable During the Pandemic.” Jacobin. Available at www.jacobinmag.com/​2020/​ 05/​meat-​processing-​plants-​trump-​coronavirus-​covid-​meatpacking. Wald, Sarah D. 2011. “Visible Farmers/​Invisible Workers:  Locating Immigrant Labor in Food Studies.” Food, Culture, and Society, 14(4): 567–​586. World Health Organization. 2018. “WHO Housing and Health Guidelines.” World Health Organization. Available at www.ncbi. nlm.nih.gov/​books/​NBK535289/​.

About the Authors

Stephanie A. Bohon, PhD is a Professor and Head of Sociology and Co-​Director of the Center for the Study of Social Justice at the University of Tennessee in Knoxville. She is a Past President of the Southern Demographic Association

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and President-​Elect of the Southern Sociological Society. She is an immigration and race scholar whose research focuses on housing and transportation issues faced by Latinx people living in the US Southeast. Rachel Ponder, MS is a doctoral student in Sociology at the University of Tennessee in Knoxville specializing in criminology and political economy. Her work focuses on theoretical issues of justice, especially as it relates to genocide, assimilation, and population displacement.

III

Part 

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7 Experiencing Homelessness in the Time of COVID-​19 Cynthia Puddu The Problem

The increasing rates of homelessness in the United States and Canada have been a growing social and health concern for several decades. On any given night, it is estimated that over 500,000 individuals in the United States and 35,000 individuals in Canada experience homelessness. It is well documented that individuals experiencing homelessness have higher morbidity and mortality rates than the general population. The social and health disparities that individuals experiencing homelessness encounter are known to many in the homeless-​ serving sectors. However, these extant disparities have increased, and become exposed because of the COVID-​ 19 pandemic. The COVID-​ 19 pandemic has increased the risk of individuals becoming homeless due to the economic instability it has created and, once homeless, there is an increased risk of contracting COVID-​ 19. If individuals do contract the virus, the risk of severe outcomes is heightened due to the higher rate of underlying medical conditions such as cardiovascular disease and diabetes in homeless populations. Currently, the primary public health measures to help curb the spread of COVID-​19 are to mandate stay-​at-​home orders and social distancing. When stay-​at-​home orders are announced, there is an underlying assumption that individuals have a home. This is not the case for the hundreds of thousands of individuals experiencing homelessness in Canada and the US. These individuals use various spaces to stay safe, such as overnight emergency shelters, daytime drop-​in centers, or sleeping in tent encampments. Many of these environments increase the risk of contracting and transmitting COVID-​19. 70

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Homeless shelters and drop-​in centers are generally crowded spaces, which makes physical distancing difficult. When physical and social distancing measures to reduce the spread of the virus are introduced to shelters, there are fewer spaces available; therefore, more individuals may end up in unsafe situations on the streets. This can make people experiencing homelessness even more vulnerable to COVID-​19 because it is more difficult to self-​isolate, maintain proper hand hygiene, and access testing when on the streets. Along with the increased risk of contracting COVID-​19 and severe outcomes related to the disease, the economic ramifications of public health measures employed to reduce the spread of the virus have increased the probability of becoming homeless. Lack of affordable housing options due to rising rental costs and stagnating wages have led to housing instability and influenced the rise of homelessness in the past several decades. The economic realities of COVID-​ 19 have increased the risk of housing instability for millions of individuals across Canada and the United States. Modeling conducted by Dr Brendan O’Flaherty at Columbia University indicated that increased unemployment rates could lead to approximately 250,000 more individuals experiencing homelessness in the US by the end of 2020. Tim Richter, president and CEO of the Canadian Alliance to End Homelessness, also warned Members of Parliament in Canada of an increased risk of homelessness due to the economic downturn created by COVID-​19. The possibility of more individuals and families losing their homes will increase the burden on homeless-​serving agencies who are already under great stress as a result of the COVID-​19 pandemic.

Research Evidence

The rapid spread and highly infectious nature of the COVID-​ 19 virus have been especially concerning for vulnerable populations that find themselves in congregate settings. In many large cities across Canada and the United States, individuals experiencing homelessness tend to converge in locations such as drop-​in centers, overnight homeless shelters,

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and tent encampments. These are settings where individuals are generally in very close quarters with limited supplies for hand hygiene, vastly increasing the risk of contracting and spreading the virus. While comprehensive statistics on the number of positive COVID-​19 cases and rate of spread within homeless populations are limited due to the rapidly changing nature of the pandemic, several reports have documented numbers of positive cases in emergency homeless shelters and drop-​in centers. A Centers for Disease Control (CDC) report by Emily Mosites and colleagues on the prevalence of COVID-​ 19 infection in shelters in Seattle, Boston, and San Francisco found a high prevalence of cases amongst clients who access these shelters. Early in the pandemic, 1,192 clients were tested over a two-​week period, with a 17% positive rate in Seattle, 36% positive rate in Boston, and 66% positive rate in San Francisco. A separate CDC report by Tobolowsky and colleagues identified how rapidly the virus was able to spread within three separate but affiliated homeless shelters in the public health region of Seattle and King County. After two rounds of testing at all three sites over 12 days, 195 tests were administered to residents of the shelters and 38 tests to staff, with an 18% positive rate amongst residents and a 21% positive rate amongst staff. The authors identified that continued use of multiple shelters, congregate sleeping arrangements, and difficulty in enforcing physical distancing due to overcrowding were possible contributors to the spread of the virus. This report also highlights that the risk of transmission is not only high for individuals who access services at these shelters, but also for the staff who work at these organizations. In Canada, COVID-​19 cases in the homeless community remain relatively low, with small outbreaks being reported in Calgary, Toronto, and Montreal. However, because social distancing is difficult to enforce in this community, homeless-​serving organizations are still quite concerned that the ability to control outbreaks will be difficult as the pandemic progresses. A major consequence of this pandemic is an increase in the numbers of individuals experiencing homelessness. Before the pandemic, approximately 20.8 million households in the US and 1.7 million households in Canada were severely

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cost-​burdened—​meaning they spent more than 30% of their incomes on rent and utilities. With more than 27 million job losses across Canada and the US after two months of lockdowns during the pandemic, and millions more projected to lose their jobs, many individuals will not be able to afford monthly rents or mortgage payments. The possibility of increased risk of evictions or housing foreclosures as a result of these job losses during the pandemic will significantly add to the homeless crisis. While financial aid through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Canada Emergency Response Benefit (CERB) has been made available, these measures are not sufficient to address the long-​term economic impacts of the COVID-​19 crisis.

Recommendations and Solutions

1. Decrease the spread of COVID-​19 among homeless populations. • Provide universal access to testing for all individuals experiencing homelessness. Because of the highly infectious nature of the COVID-​19 virus, identifying positive cases is of utmost importance in reducing the spread of the virus in homeless communities. Relying solely on testing of symptomatic individuals is not adequate to identify all potential cases of COVID-​ 19. Researchers in Boston and Seattle have shown that testing of both symptomatic and asymptomatic residents and staff at homeless shelters was essential in helping to identify and isolate all positive cases, thereby curbing the spread of the virus. Testing capacity is an issue in many municipalities. However, because the virus can spread more rapidly in congregate settings such as homeless shelters, municipalities must provide testing to all individuals that access services at homeless shelters, whether they are symptomatic or not. • Provide safe spaces for individuals to self-​ isolate after having tested positive for COVID-​19. Isolating

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individuals who have the virus is extremely difficult when individuals do not have a home. The COVID-​ 19 pandemic has highlighted the need to find housing for hundreds of thousands of individuals around the world. In the short term, it is essential to provide safe spaces for individuals to self-​isolate if they are symptomatic and/​ or test positive for COVID-​ 19. The CDC has recommended that individuals who test positive for COVID-​19 be provided with temporary accommodation that includes separate rooms with bathrooms for each individual. Several communities across Canada and the US have successfully used empty hotels and larger spaces such as conference centers as temporary shelters for individuals to isolate after testing positive. While the impact of these temporary shelters on the spread of the virus has not been measured in depth, researchers in the UK have created predictive models comparing no intervention to providing accommodation for positive cases. Lewer and colleagues’ modeling predicts that providing supportive accommodation for positive cases in the homeless community has the potential to significantly limit the spread of the virus, thereby reducing hospital admissions and deaths of individuals experiencing homelessness. Where possible, municipalities must partner with homeless-​ serving agencies to provide adequate temporary shelters to help people isolate if they test positive for COVID-​19. 2. Address economic instability contributing to homelessness. While short-​ term solutions may be successful in decreasing the spread of the virus, they are temporary solutions that are difficult to sustain. More importantly, these measures do not address the systemic issues that have caused people to become homeless in the first place. Given the economic realities of this pandemic, there is a very high risk that more individuals will become homeless. Because of this, the ability to create safe, affordable housing for all individuals must be addressed during this pandemic and in the long term. In order to create change, we need to focus on

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the fact that homelessness will not decrease if we do not address the systemic inequalities that have been increasing for several decades. In order to do this, we must adopt a human rights-​based approach to housing. This is an approach that legislates a right to adequate housing for all individuals. According to a recent report of the UN Office of the High Commissioner for Human Rights, this approach can include increased eviction protection measures, rapid rehousing for newly homeless individuals, and most importantly a move away from the commodification and financialization of housing. • Increase eviction protection measures. Eviction due to an inability to pay rent is a common cause of homelessness. The economic impacts of public health measures have increased the risk of being evicted as many individuals have a significantly reduced income. Because of this, it is imperative that regional governments and municipalities prohibit evictions due to an inability to pay rent because of the COVID-​ 19 pandemic. Early in the pandemic, governments in the US and Canada announced moratoriums on residential evictions; however, these moratoriums ended within months of the initial public health lockdowns and the inability to pay rent may last beyond 2020 for many individuals. According to Leilani Farha, the UN Special Rapporteur on the right to adequate housing, this moratorium on evictions should extend beyond the current pandemic crisis and be included in right-​to-​housing legislation as forced evictions are a violation of international human rights law. To decrease the risk of evictions, immediate rent freezes for the duration of the pandemic and a reasonable time after must be implemented. Lack of rental income because of rental freezes can become a burden for residential landlords. The financial relief packages that have been made available in Canada and the US do not include financial relief for residential landlords. To assist landlords with the financial burden of rental freezes, the UN Special Rapporteur

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also recommended that governments should provide compensation to landlords as part of financial relief packages. While evictions increase the risk of homelessness for renters, many homeowners run the risk of foreclosure on their homes if they are unable to keep up with mortgage payments. To assist these homeowners during the pandemic, mortgage forgiveness policies must be implemented during the pandemic and for a reasonable time beyond. Along with rent freezes, mortgage forgiveness and compensation for landlords, economic relief packages must provide monthly supports for individuals who have lost their incomes because of the pandemic. Economic relief packages have been made available to citizens through the CARES Act in the US and the CERB in Canada. However, these are short-​term assistance programs that will not help individuals suffering long-​term job losses because of the pandemic. The CERB in Canada and the extended unemployment insurance benefits in the US have specific eligibility requirements that make them only available to individuals that had been previously employed. These programs also do not cover all types of employment such as jobs in the gig economy, nor do they assist essential workers such as grocery store employees whose income may not cover the cost of maintaining housing and other necessities of life. The implementation of these programs has also proved difficult in the United States. Because of the high volume of applications for unemployment insurance, many individuals have faced long waits to apply and delays in processing applications, leading to a lack of income for many months. • Implement a universal basic income (UBI). In order to provide fast, barrier-​free income relief to all citizens, scholars and activists suggest implementing a UBI that would provide all citizens the income needed to maintain housing and other necessities of life. The COVID-​19 pandemic is an opportune time to

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implement a UBI on a large scale, at least on a short-​ term emergency basis, to deal with the economic ramifications of COVID-​19. Rather than extending current relief measures that contain barriers for many citizens, money from those programs can be moved to fund an emergency UBI that would provide unconditional income to all citizens. The emergency UBI funds can be rolled out in the same fashion as the one-​time Economic Impact Payments that were implemented early in the pandemic. An emergency UBI would significantly lower the risk of foreclosures and evictions and ensure individuals do not lose their housing as a result of the COVID-​19 pandemic. If successful, the emergency UBI could clear the path to apply a UBI as a long-​term solution to housing instability. • Ensure the rapid rehousing of newly homeless individuals. With the increased risk of evictions during the pandemic and the high rate of transmission in homeless shelters, rehousing individuals who are newly homeless is an important strategy to help reduce the spread of the virus. While there are several strategies used to help house individuals who are experiencing homelessness, using a rapid rehousing approach may be most useful to assist individuals who have lost their homes because of the economic downturn of the pandemic. Rapid rehousing is an approach that provides short-​term help with housing expenses, such as rent assistance and moving costs, in order to get individuals into permanent housing as quickly as possible. The Urban Institute found that rapid rehousing programs presented low barriers to new housing and had low rates of return to homeless shelters. Several municipalities around Canada and the US have successfully used rapid rerehousing programs in their efforts to curb the rate of virus spread in the community and to assist individuals with finding permanent housing. Therefore, funding for rapid rehousing programs should be included as part of federal COVID-​19 relief packages.

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• Move away from the financialization of housing. While rapid rehousing can help individuals in quickly finding housing, it does not address the issue of housing affordability that exists in Canada and the US. Because housing has become commodified, many households experience high rates of residential instability once they leave rental assistance programs such as rapid rehousing. According to Manuel Aalber, the financialization and commodification of housing is a consequence of government policies that have shifted the responsibilities of housing away from government and toward a market-​ based system with less regulation and intervention. Financialization affects homeowners and household debt along with the rental market. Across the world, financialized investors have been purchasing social housing properties and other rental properties as forms of investments. Social housing is also becoming financialized, with social housing associations participating in financial markets. When housing is commodified, the purpose of housing as a human right is not considered and we lose sight of people and their well-​being.

Ultimately, to ensure we reduce the social and health inequities that have been exacerbated during this pandemic, we need to ensure that housing is treated as a human right and that everyone has access to safe, affordable housing. This can be done by introducing progressive laws that legislate housing as a human right. For example, the Government of Canada passed the National Housing Strategy Act, which legislated that housing be recognized as a human right. However, for national right-​to-​housing legislation to be effective, it must be legislated at provincial or state and municipal levels of government. This will ensure that rights-​based approaches to policy-​and decision-​making regarding housing are used. In order to create change in the long term, we need to recognize that homelessness will not decrease if we do not address the systemic inequalities that have been created by the ruling class. If the financialization of housing as one

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of the causes of structural barriers to homelessness is not addressed, we will continue to see the number of individuals experiencing homelessness rise. If we continue to prioritize a market economy in housing rather than treating housing as a human right, we will continue to increase inequities that have been created by the neoliberal market economy. Just as Canada has successfully done with health care, we must move toward treating housing as a human right rather than a priviledge in order to curb the crisis of homelessness across Canada and the United States. Key Resources

Aalbers, Manuel B. 2016. The Financialization of Housing: A Political Economy Approach. New York: Routledge. Aurand, Andrew, Dan Emmanuel, and Daniel Threet. 2020. The Need for Emergency Rental Assistance during the Covid-​19 and Economic Crisis. Washington, DC: National Low Income Housing Coalition. Available at https://​nlihc.org/​sites/​default/​files/​Need-​for-​Rental-​ Assistance-​During-​the-​COVID-​19-​and-​Economic-​Crisis.pdf. Basic Income Earth Network (BIEN). Available at https://​basicincome. org/​. The BIEN offers information and education to the wider public about basic income as idea, institution, and public policy practice. BIEN is associated with an academic journal, Basic Income Studies. Centers for Disease Control and Prevention. 2020. “Interim Guidance for Homeless Service Providers to Plan and Respond to Coronavirus Disease 2019 (COVID-​ 19).” Centers for Disease Control and Prevention. Available at www.cdc.gov/​coronavirus/​2019-​ncov/​ downloads/​COVID19_​Homeless-​H.pdf. Culhane, Dennis, Dan Treglia, Kenneth Steif, Randall Kuhn, and Thomas Byrne. 2020. “Estimated Emergency and Observational/​ Quarantine Capacity Need for the US Homeless Population Related to COVID-​ 19 Exposure by County; Projected Hospitalizations, Intensive Care Units and Mortality.” School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA. Unpublished manuscript, available at http://​works.bepress.com/​dennis_​culhane/​237/​. Cunningham, Mary K., Sarah Gillespie, and Jacqueline Anderson. 2015. Rapid Re-​Housing: What the Research Says. Washington, DC: Urban Institute. Available at www.urban.org/​sites/​default/​files/​publication/​54201/​2000265-​Rapid-​Re-​housing-​What-​the-​Research-​Says. pdf. Farha, Leilani. 2020. COVID-​ 19 Guidance Note:  Prohibition of Evictions. Geneva: Office of the United Nations High Commissioner for Human Rights (OHCHR). Available at www.ohchr.org/​ Documents/​Issues/​Housing/​SR_​housing_​COVID-​19_​guidance_​ evictions.pdf. Lewer, Dan, Isobel Braithwaite, Miriam Bullock, Max T. Eyre, and Robert W. Aldridge. 2020. “COVID-​ 19 and Homelessness in

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England:  A Modelling Study of the COVID-​19 Pandemic among People Experiencing Homelessness, and the Impact of a Residential Intervention to Isolate Vulnerable People and Care for People with Symptoms.” MedRxiv. doi:10.1101/​2020.05.04.20079301. Tobolowsky, Farrell A., Elysia Gonzales, Julie L. Self, Carol Y. Rao, Ryan Keating, Grace E. Marx, Temet M. McMichael, Margaret D. Lukoff, Jeffrey S. Duchin, Karin Huster, Jody Rauch, Hedda McLendon, Matthew Hanson, Dave Nichols, Sargis Pogosjans, Meaghan Fagalde, Jennifer Lenahan, Emily Maier, Holly Whitney, Nancy Sugg, Helen Chu, Julia Rogers, Emily Mosites, and Meagan Kay. 2020. “COVID-​19 Outbreak Among Three Affiliated Homeless Service Sites—​King County, Washington, 2020.” MMWR. Morbidity and Mortality Weekly Report, 69(17): 523–​526. Tsai, Jack and Michal Wilson. 2020. “COVID-​19: A Potential Public Health Problem for Homeless Populations.” The Lancet Public Health, 5(4): e186–​187. UN Office of the High Commissioner for Human Rights (OHCHR). 2020. Protecting the Right to Housing in the Context of the COVID-​19 Outbreak. Geneva: Office of the United Nations High Commissioner for Human Rights (OHCHR). Available at www.ohchr.org/​EN/​ Issues/​Housing/​Pages/​COVID19RightToHousing.aspx.

About the Author

Cynthia Puddu, PhD is an Assistant Professor in the Faculty of Health and Community Studies at MacEwan University in Edmonton, Alberta. Her research examines the experiences of homeless youth in downtown Edmonton and how higher-​ level sociopolitical systems such as neoliberalism and settler colonialism shape those experiences. Using institutional ethnography and community-​ based participatory research methods, she works closely with homeless youth in Edmonton, sharing their stories of difficulty and success. Cynthia is interested in using her research to work as an ally and advocate for populations that have been historically silenced.

8 The LGBT Medical and Political Crisis in the Wake of COVID-​19 DaShanne Stokes The Problem

The American lesbian, gay, bisexual, and transgender (LGBT) community is in a medical and political crisis. Prior to the coronavirus (COVID-​19) pandemic, politics and widespread discrimination lead to significant disparities in LGBT medical rights and health care outcomes. These pre-​existing LGBT health care disparities have since become exacerbated by the pandemic. Often overlooked in larger discussions about LGBT people and the pandemic is a larger social problem; LGBT health care disparities amplified by the pandemic are set to magnify LGBT social and political inequality on a national scale. In addition, the pandemic has contracted space in public discourse and media coverage—​ which is needed to advance LGBT equality—​creating new opportunities for exploitation to advance anti-​LGBT political agendas. Prior to the advent of COVID-​19, many LGBT people faced the detrimental effects of widespread discrimination. Before the pandemic, a majority of LGBT Americans also found themselves living in states without legal protection from job discrimination. LGBT people can be evicted from their homes or denied the right to adopt children for the “crime” of being who they are. Many LGBT people report being the targets of hate speech and hate crimes, to the point that many live in a constant state of fear of being attacked or murdered for walking down the street or engaging in public displays of affection with their loved ones. Research from the Williams Institute found that LGBT people are twice as likely to have experienced lifetime homelessness and earn as 81

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much as 32% less than their heterosexual counterparts. LGBT people continue to be denied basic services, such as the ability to purchase catering services, to order a wedding cake, or to hire wedding photographers. In recent years, there has also been a steady wave of attempts to legitimize anti-​ LGBT discrimination through claims of “religious freedom” to deny LGBT people their constitutionally protected right to equal treatment under the law. Situated in and reflecting this larger discriminatory context, the LGBT community also face significant health care disparities. Before the pandemic, many LGBT people had difficulty finding LGBT-​safe health care providers and faced an absence of federal laws prohibiting health care discrimination based on gender identity and sexual orientation. A majority of LGBT adults also have medical conditions like asthma, heart disease, HIV, and diabetes that, according to the Centers for Disease Control, make them especially susceptible to the deadly coronavirus. While there is no evidence that LGBT people are any more likely to catch the coronavirus than the general population, LGBT people face unique circumstances that affect them disproportionately and that can exacerbate the individual and broadscale impact of the coronavirus. LGBT people, for example, report lower levels of self-​rated health than their heterosexual counterparts. LGBT people are 50% more likely to use tobacco than the general population. About 65% of LGBT adults have pre-​existing medical conditions like diabetes, asthma, heart disease, or HIV. Members of the LGBT community are at higher risk for homelessness, poor mental health, suicidal ideation, and mental health disorders like depression and anxiety. With the growing impact of the novel coronavirus, the LGBT community faces new threats and a contraction of critically needed resources and space in which scholars, advocates, citizens, and policy-​ makers can discuss and effect social change.

Research Evidence

A growing body of research reveals that the coronavirus pandemic is exacerbating pre-​ existing LGBT health care

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disparities. Research briefs show that LGBT people are experiencing disproportionately higher rates of wage reduction (30%), job loss (18%), and difficulty finding food (33%) during the pandemic. LGBT people are also experiencing increased difficulties in accessing health care; 14% report difficulties obtaining routine medications, 24% report difficulty accessing medical care, and 59% are avoiding visiting their doctors and dentists for routine medical care. Older LGBT people view themselves as being especially at risk due to COVID-​19. A research brief on LGBT Tennesseans, for example, found that 83% agreed that COVID-​19 is a significant threat to their health and 70% view it as a significant threat to their lives. According to the American Medical Association and separate research conducted by OutRight Action International, which holds United Nations consultative status, the pandemic has led to LGBT people delaying care-​seeking due to concerns with discriminatory treatment. LGBT people, who are disproportionately affected by HIV and AIDS, have reported encountering problems obtaining HIV medications, HIV prophylaxis preventatives (PrEP), and HIV care. Reports further reveal interruptions in hormone treatments and gender-​ affirming care and indefinite postponements of potentially lifesaving gender-​ affirmation surgeries among transgender individuals. Public health messages about the coronavirus have also focused heavily on the elderly to the exclusion of at-​risk populations like those in the LGBT community. While health experts believe that donor antibodies of those who have recovered from the coronavirus can help others resist the virus, discriminatory bans against gay and bisexual men who have recovered from the coronavirus remain in effect and prevent them from donating blood and plasma without first going through a three-​month period of sexual abstinence. While anti-​ LGBT discrimination is well documented and research documenting the health consequences of the coronavirus on the LGBT community is growing, rarely considered in public debate is how the coronavirus is contracting critically needed resources, like time, money, and space—​such as in venues for social discourse and debate—​ with which to advocate for LGBT rights. With significantly poorer heath, less social and political support, and typically

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lower income, the pandemic is having the effect of decreasing resources many LGBT people need to support or participate in LGBT advocacy. For example, funds that might otherwise go toward investing in LGBT rights organizations and pro-​ LBGT political candidates are being diverted to coronavirus medical treatment, to create a personal financial safety net, and to support affected friends and family members. With the LGBT community’s few resources becoming fewer, and with many self-​isolating or practicing social distancing, many LGBT individuals are not as able to participate as they otherwise would in LGBT rights protests and annual national pride events that occur in major cities. This contraction in advocacy potential is significant because advocacy and pride events help to build and maintain a critically needed collective identity around which to mobilize and advance LGBT causes. This shrinkage of critically needed resources and participation in advocacy is amplified by the contraction of space in public discourse and media coverage in which to publicize, debate, and advance LGBT causes. Broad news coverage of the pandemic pushes the unique needs and vulnerabilities of the LGBT community out of sight and out of mind. This media coverage of COVID-​19 further has the effect of insulating the position of those who most ardently oppose LGBT rights and who benefit from homophobia in national institutions like government, the economy, marriage, and education. Extensive coronavirus media coverage has also created a new opportunity and cover for anti-​ LGBT politicians to attack LGBT people while no one is looking. While the nation reeled from the first wave of COVID-​19, for example, the Trump administration took steps toward finalizing a rule to rewrite Affordable Care Act Section 1557 provision so as to enable health care providers to discriminate against those in need on the basis of their sexual orientation or gender identity under the pretext of “religious freedom.”

Recommendations and Solutions

Response to the LGBT coronavirus crisis requires coordinated and systemic efforts to mobilize community members,

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health care providers, media outlets, and policy-​makers alike. Specific social action and policy recommendations include the following. 1. Pass federal legislation and enact policies that protect LGBT people and all citizens regardless of their sexual orientation or gender identity. Congress must pass the Equality Act, a bill that extends the 1964 Civil Rights Act to ban discrimination in housing, credit, education, adoption, jury service, and basic services based on gender identity and sexual orientation. The president must also reinstate protections for LGBT people and prohibit discrimination based on sexual orientation and gender identity like the Affordable Care Act Section 1557 prohibition of discrimination against LGBT people in health insurance coverage and medical care. State and federal policies that allow discrimination based on gender identity and sexual orientation help to create the LGBT community’s health disparities and increase the community’s vulnerability to the coronavirus and the recession growing in its wake. Additionally, laws and policies that allow anti-​LGBT discrimination are inherently unconstitutional as they violate the Equal Protection clause of the 14th Amendment, which holds that a governmental body cannot deny citizens equal protection under the law. Systematic reviews should also be conducted on all legislation, both enacted and proposed, to ensure accountability to the Constitution and equal protection of LGBT people. America cannot be a nation of laws unless its laws protect all its citizens equally. 2. Include LGBT individuals and LGBT leaders in policy decisions. The voices and lived experiences of LGBT people are central to appreciating how the coronavirus affects the LGBT community. Failing to include LGBT people in discussions about their own health care and other needs decisions sends the signal that LGBT people should be ignored and treated like second-​class citizens. This ensures the continuation of unfair and dangerous policies and practices and the continued marginalization

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of LGBT people. Electing more LGBT leaders, hiring more LGBT people to work in the White House and on Congressional staff, training current White House and Congressional staff on LGBT issues, bringing on members of the LGBT community as policy advisors, and political officials working more closely with organizations like the Victory Fund, which works to increase the number of LGBT people in all levels of government, are concrete steps to remedy this issue. 3. Include LGBT needs in public health response, research, and coronavirus relief packages. Public health officials must guarantee that the needs of the LGBT community are actively considered and included in public health response to the coronavirus. Doctors and researchers must develop new research that uncovers how the coronavirus impacts LGBT people individually and collectively, and to develop best practices to reduce the virus’ impact. Congress must also include language that guarantees LGBT rights and protections in future coronavirus relief packages. Relief packages must also include funding specifically earmarked for organizations and facilities that provide health care, housing, job placement, loans and economic assistance, educational assistance, counseling, and other forms of critically needed resource assistance to the LGBT community. With the LGBT community’s increased vulnerability and with insufficient coronavirus tests available, the availability of masks and tests must be increased, and concentrated efforts must be made to ensure that tests and masks are available to LGBT individuals. LGBT people also need information about the coronavirus tailored to the unique needs and circumstances of the LGBT community as well as dedicated communications on the benefits of social distancing. 4. Media outlets must cover LGBT issues during the pandemic. The impact of the coronavirus has left America, and indeed the world, in a state of collective shock. Understandably, media outlets have shifted much of their coverage to meet the demand of a public clamoring for news about the latest developments. This

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shift of public attention, and in turn of public discourse, has created an exploitable opportunity for anti-​LGBT political officials and organizations to ram through anti-​ LGBT legislation and policies while collective attention is distracted. This is evidenced, as noted above, by the Trump administration’s attack on LGBT rights during the pandemic. The failure of the news media to adequately cover LGBT issues and needs, including those related to the coronavirus, has the compounded effect of shifting social debate away from LGBT issues and needs. This in turn insulates and advances the unearned privilege of those who oppose LGBT rights. Left unchecked, this lends to a cycle in which less LGBT issue coverage may contribute to worsening LGBT health and social justice outcomes, potentially increasing the effects of COVID-​19 on an already at-​risk population. Media outlets, writers, and journalists must make a concerted effort, such as by setting a minimum percentage of LGBT news stories covered every day, to ensure continued coverage of issues bearing on LGBT rights, including but not limited to the virus’ impact on LGBT individuals. A 2017 Gallup poll found that about 5% of Americans identify as LGBT. Media outlets setting a minimum 5% of stories dedicated to LGBT people and issues would help ensure proportionate LGBT media coverage. 5. Social justice organizations must find new ways to lobby elected officials, engage the LGBT community, and develop a long-​term strategy for success. LGBT social justice organizations face a predicament like none they have ever witnessed. Bans on public gatherings, organizations and businesses going under or moving online as the workforce has become partially remote, and social distancing have effectively erased the ability of many LGBT social justice organizations to engage in traditional lobbying and organizing methods like field canvassing, in-​ person protests, in-​ person fundraising events, in-​ person strategizing and coordination, and in-​ person meetings to lobby political leaders. It is imperative that LGBT social justice organizations

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develop new means of maintaining and building the active participation of their bases and to lobby elected officials. A good starting point is to draw upon existing research to determine the effectiveness of various online and telephone-​ based lobbying and organizing and to sponsor new research in these areas. LGBT organizations must also be willing to embrace new methods of organizing and community engagement that go beyond their current methods. This may include, for example, holding pride events on YouTube, Facebook, or Twitter, hosting online meetings and events that incentivize active participation from LGBT individuals, organizing “Twitter storms,” in which a short period of increased tweeting can draw media attention to LGBT issues, organizing mass letter-​ writing campaigns and mass calling of elected officials at strategic moments, and more. While many people hold out hope that the pandemic will subside, it is imperative to think ahead to the possibility that additional pandemic waves will hit America, such as in the winter months during flu season, for years to come. Even if the pandemic subsides over the next one to three years, the LGBT community’s loss of life, time, resources, manpower, and more are likely to be felt for much longer. A full recovery may well take decades, if it happens at all. There simply are no guarantees. As such, LGBT social justice organizations should not remain content to be in hibernation or in limited operations during the pandemic, as some are doing, but should instead begin formulating short-​and long-​ term strategies to ensure their continued operations and abilities to effectively mobilize individuals, lobby politicians, and advocate for LGBT causes. 6. Address the root causes of anti-​LGBT discrimination. Any social actions or policy decisions that fail to address the root causes of discrimination against LGBT people are doomed to perpetuate the very problems they seek to address. Furthermore, LGBT discrimination does not exist in a vacuum. It instead intersects with, overlaps with, and contributes to the perpetuation of discrimination

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against women, people of color, people with disabilities, and other marginalized groups—​ all of which count LGBT people among their ranks. To understand discrimination against LGBT people, new research on the root causes of homophobia is critically needed, and such research should consider the multiple forms in which homophobia intersects with and contributes to other forms of discrimination. To address the causes of homophobia, we also need dedicated funding to develop and implement educational programs at the local, state, and national levels to disabuse people of the false and negative stereotypes about LGBT people that they have been led to believe.

Key Resources

Badgett, M.V. Lee, Soon Kyu Choi, and Bianca D.M. Wilson. 2019. LGBT Poverty in the United States:  A Study of Differences Between Sexual Orientation and Gender Identity Groups. Los Angeles, CA:  Williams Institute. Available at https://​ williamsinstitute.law. ucla.edu/​wp-​content/​uploads/​National-​LGBT-​Poverty-​Oct-​2019. pdf?mod=article_​inline. Department of Justice. 2018. “FBI Releases 2018 Hate Crime Statistics.” Department of Justice. Available at www.justice.gov/​ hatecrimes/​hate-​crime-​statistics. Eadens, Savannah. 2020. “LGBTQ People May Be ‘Particularly Vulnerable’ to Coronavirus Pandemic. Here’s Why.” USA Today, 18 March. Available at www.usatoday.com/​ story/​ news/​ nation/​ 2020/​03/​18/​lgbtq-​coronavirus-​community-​vulnerable-​COVID-​ 19-​pandemic/​2863813001/​. Fredriksen-​ Goldsen, Karen I., Jane M. Simoni, Hyun-​ Jun Kim, Kere Lehavot, Karina L. Walters, Joyce Yang, Charles P. Hoy-​ Ellis, and Anna Muraco. 2014. “The Health Equity Promotion Model:  Reconceptualization of Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Disparities.” American Journal of Orthopsychiatry, 84(6): 653–​663. Kristen, Elizabeth and Davis Nahmias. 2019. “The Writing on the Wall: The Future of LGBT Employment Antidiscrimination Law in the Age of Trump.” Berkeley Journal of Employment and Labor Law, 39(1): 89–​116. McKay, Tara, Jeff Henne, Gilbert Gonzales, Rebecca Quarles, and Sergio Garcia. 2020. The Impact of COVID-​19 on LGBTQ Americans. Vanderbilt University and the Henne Group. Available at http://​ nebula.wsimg.com/​b54504dc6c2f87e6373845bbec49b161?AccessKeyId=2FD98D6638BC9C7F6742&disposition=0&alloworigin=1.

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McKay, Tara. 2020. Older LGBTQ Tennesseans and COVID-​19. LGBT Policy Lab, Vanderbilt University. Available at http://​nebula.wsimg. com/ ​ 4 d5c0ceacd14ecb3296d8b97da2f054d?AccessKeyId=2FD98D6638BC9C7F6742&disposition=0&alloworigin=1. Mize, Trenton D. 2016. “Sexual Orientation in the Labor Market.” American Sociological Review, 81(6): 1132–​1160. National Center for Transgender Equality. 2020. “The Coronavirus (COVID-​19) Guide.” National Center for Transgender Equality. Available at https://​transequality.org/​COVID19. OutRight Action International. 2020. Vulnerability Amplified:  The Impact of the COVID-​ 19 Pandemic on LGBTIQ People. New York:  OutRight Action International. Available at https://​ outrightinternational.org/​sites/​default/​files/​COVIDsReportDesign_​ FINAL_​LR_​0.pdf. Sherrel, Devon. 2019. “‘A Fresh Look’: Title VII’s New Promise For LGBT Discrimination Protection Post-​Hively.” Emory Law Journal, 68(6): 1101–​1144.

About the Author

DaShanne Stokes, PhD is a Lecturer in Sociology at the University of Massachusetts, Amherst and a Research Associate at the University of Pittsburgh. He researches politics, LGBT issues, and race, specifically how different forms of power are coded, misrecognized, and reproduced. Dr Stokes is a bisexual scholar, political commentator, and nationally recognized social justice advocate and activist. Connect with Dr Stokes online at www.dashannestokes.com.

9 Inequality in Isolation Educating Students with Disabilities during COVID-​19 Nora C.R. Broege and Charity Anderson The Problem

COVID-​19 has forced all facets of daily life to shift. This has been particularly difficult for institutions like schools that depend on in-​person, daily instruction. Across the United States, students, their families, schools, and districts have had to scramble to ensure instruction continues. With little precedent, responses have varied greatly, leaving the potential for unequal provision. In particular, the national patchwork of responses to the pandemic has exacerbated the uneven provision of special education in the US, potentially increasing the achievement gap between students with disabilities and their general-​education peers, and contributing to academic and social regression. Students with disabilities (SWD) in the US are guaranteed rights under various federal and state laws, including the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973 (Section 504), and the Individuals with Disabilities Education Act (IDEA). The latter mandates that a “free appropriate public education” and related accommodations, supports, interventions, and services be provided to SWD. Federal and state legislatures and courts have repeatedly found such rights under IDEA to be mandatory and non-​ negotiable, even when difficult or expensive to provide. At the end of April 2020, the US Department of Education sent a report to Congress reaffirming the rights of SWD to have equal access to education during the COVID-​19 pandemic. The report stated that the Department would not request waiver authority to 91

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give school districts the option to forgo critical provisions of IDEA. IDEA, however, does not address how schools should respond during crises like COVID-​ 19, leaving states and districts to decide how to deliver special education to SWD. Some districts initially refrained, only changing course when the federal government dictated so, from providing online instruction to any students during the closure, thus skirting the requirement to provide special-​education services during the same period. Other districts, including over 30 in New Jersey, asked parents to sign waivers releasing any claims of liability under IDEA as a condition of their children receiving special-​education services during COVID-​19—​a violation of state and federal law. Other districts have elected to provide distance instruction and services. COVID-​19 has necessitated that education be delivered in new ways dependent on internet platforms. The impact of the COVID-​19 crisis on all students is significant, as it alters their learning trajectories, but the impact on SWD is greater and will alter their learning and development even more. Anecdotal evidence from the news media, educators, and families suggests that providing special education as required by students’ Individualized Education Plans (IEPs) during the pandemic presents a unique set of challenges, as many of the services that SWD require—​such as modified instruction, a one-​to-​one paraprofessional, or various kinds of therapies—​have proven difficult to provide virtually and some accommodations—​such as assistive technology—​have proven incompatible with online educational platforms. Pre-​COVID, special education in America was characterized by gross inequity, with racial and socioeconomic disparities in identification and achievement among SWD. Even during the best of times, the accommodations, supports, interventions, and services that SWD receive are uneven; this can be further complicated by varied school district funding formulas, instructional quality, and the type, availability, and quality of special-​education services. COVID-​19 potentially exacerbates these disparities for our country’s most vulnerable students, thus begging the question: How do we ensure that SWD are provided an equitable education during a pandemic?

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Research Evidence

According to the National Education Association, 7 million 6-​to 21-​ year-​ olds enrolled in public schools received services under IDEA. Guidance from the US Department of Education, published in March, confirmed that IDEA guidelines should not stand in the way of continuing to provide educational services during virtual schooling. This mandate was prompted, in part, by some states’ decision to forego virtual learning to protect districts from potential lawsuits from SWD families or rely on a standard, abridged curricula for all SWD rather than following the details of each student’s IEP. In Pennsylvania, some services for SWD halted because districts couldn’t figure out how to translate, for example, occupation or speech therapies. These facts are particularly concerning given the educational obstacles SWD already have to overcome. According to the National Assessment of Education Progress data, SWD graduation rates are roughly 20% lower than mainstream students and SWD continue to perform below the “basic” achievement level. Considering these deficits, the effects of school disruptions on SWD could certainly yield even larger gaps. For example, in states like New Jersey, this gap persists with SWD graduation rates lagging behind the state average by more than 20 percentage points (67% and 91%, respectively). New Jersey presents an interesting case study as it accounts for a large proportion of SWD, classifying 12% of its public school student population, and has one of the lowest inclusion rates in the US, at 46% according to the state’s Special Education Summary Reports. Coupled with the state having the second-​ highest rate of COVID-​19 cases and deaths, according to the Centers for Disease Control, a discussion of educating SWD during the pandemic could provide important insight on how best to serve these students, in general, as well as during any future disruptions. District-​level disparities may also exacerbate inequities in special education. For one, higher-​resourced districts whose families are more likely to have access to technology have had an easier time transitioning to at-​ home instruction.

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These families are also most likely to live in districts that can provide additional staff and resource supports to SWD. For example, in one high-​resource New Jersey district—​whose median exceeds $200,000 compared to the state’s average of $82,000—​ SWD are still able to access the support of instructional aids during online instruction, and thereby receive supplemental help. This is in addition to the special-​ education services students are also receiving. To the contrary, in some low-​income districts a lack of technological access prevents students from the benefit of an instructional aid helping with instruction and assignments. Many families in these communities, as well as rural communities, do not have internet access: 35% of low-​socioeconomic-​status households with school-​aged children in the US do not have high-​speed internet; when measured by race and ethnicity, the gap is greater for African-​ American and Hispanic families. This suggests that there is a lack of standardization with respect to the translation of services from in-​class to online, which could certainly contribute to academic achievement gaps. Of greater concern is both the US Department of Education and school districts’ messaging around educating SWD during COVID-​ 19—​ in particular, asking families of SWD to sign release/​waiver forms, as opposed to consent forms, in order to access the services guaranteed by law to their child(ren). The language in the forms varied, from short and general to long and jargon-​filled, as did the rights being waived, from foregoing full services to liability on the part of the teacher, school, or district. In states like Washington, California, and New Jersey, these waivers were sent to SWD families. After some pushback, both state and federal officials (e.g., the New Jersey Governor’s Office as well as the US Department of Education) decried these forms as illegal, but we cannot fully understand the impact such forms have had on families. Asking families to waive or release their rights rather than consent to receive services presents another potential barrier for SWD and their families to overcome—​inequality of rights to legal recourse and circumstances with respect to schools and districts.

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Recommendations and Solutions

It is likely that SWD, an already vulnerable student group, are at even greater risk of inadequate services, academic failure, and social regression during the pandemic, and that low-​ income SWD, SWD of color, and/​ or SWD who are also English-​language learners (ELLs) may be at a particular disadvantage. The current realities of COVID-​19, shelter-​in-​ place laws, and virtual schooling have exacerbated inequities in our educational system and widened the achievement gap between SWDs and their general-​education peers. However, there appear to be some ways we can mitigate COVID-​19-​ related challenges that impact the education of SWD, among them the following. What State and Local Departments of Education Can Do

1. Provide free and appropriate education. The US Department of Education’s Office for Civil Rights (OCR) and the Office for Special Education and Rehabilitative Services (OSERS) released guidance to states amid the COVID-​19 pandemic explaining that educators can use distance learning opportunities to serve all students, including SWD, and comply with IDEA, Section 504, and Title II of the ADA. The Department made clear that districts should provide special education virtually, rather than providing no education at all for fear of litigation. Free and appropriate public education (FAPE) may include, as appropriate, special education and related services delivered through instruction provided virtually, online, or telephonically. Many modifications and services may be effectively provided online, which might include extensions of time for assignments, videos with captioning or embedded sign language interpretation, accessible reading materials, and many speech and language services through video conferencing. What’s more, students with IEPs are also entitled to education alongside non-​disabled peers in the least restrictive environment (LRE) appropriate for their needs.

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2. Plan to offer compensatory services. IDEA allows, in some instances, for SWD to receive services retroactively. Local educational agencies (LEAs) (i.e., public boards of education) and schools should determine which needed services cannot be adequately or appropriately provided during COVID-​19 distance learning and begin to plan for the provision of compensatory services, or extended school year services, as soon as possible. 3. Provide/​ subsidize internet and technology access for SWD and instructional aides. In the absence of a nationwide mandate requiring states to provide appropriate technology and internet access for remote learning, individual districts must make efforts to bridge the current digital divide—​such as ensuring students’ technology needs are met and/​or providing students and instructional aides WiFi access via hotspots or paying for internet access, where available, for Title I-​ eligible families. 4. Offer formal help to parents. Parents should have access to assistance beyond their child’s teacher. A help desk, available in multiple formats (e.g., virtual/​ online, video conferencing, email, texts, or phone calls) and languages, can provide support to parents during the day and evening. This is particularly important for ELL families who may have difficulty helping their children log onto “classroom” sites because the instructional resources available are not translated or rely too much on technical language. 5. Provide additional supports for special educators. A common denominator among school districts is a lack of preparation; very few appear to have had a plan or resources in place to smoothly transition to distance learning. More supports are needed for special-​ education teachers during virtual schooling—​ especially, when necessary, translators and instructional aids. Teachers can spend hours scouring the internet for tips and tricks. Districts, particularly their offices of teaching and learning, can alleviate some of that burden by providing special educators with research-​based best practices for teaching remotely, and can direct teachers

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to the best online resources for lesson planning, as well as apps, games, and websites to support their students’ learning. Professionals, such as teachers and instructional aides, that support students in online or blended learning environments often have much to learn about the most effective ways to support student learning with technology; this is particularly crucial for special educators and paraprofessionals whose students may contend with additional barriers to technology (i.e., attention issues, motor skill deficits, etc.).

What Schools Can Do

6. Acknowledge that SWD require and are legally entitled to services. Outside of a global health pandemic, SWD require additional resources and services on a daily basis to ensure they have access to a quality education. When presented with the daunting task of transitioning and translating these services during an academic disruption, school districts should acknowledge this and support an ongoing, realistic dialogue that notes this, rather than behaving as if the transition of educational services is similar, in policy and practice, to those afforded to the general-​education population. 7. Provide support to parents. Since parents/​ caregivers now also function as special educators, generating more supplemental/​informational resources (e.g., training in virtual learning platforms) for families during “normal” times could help when they need to pinch-​ hit for teachers during times of crisis. Many parents who have not experienced online or blended learning may be inadequately prepared without detailed informational guides or ongoing support. It is also crucial that all resources are translated into the appropriate language to serve the disproportionate number of non-​native-​ speaking SWD families.

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What Educators Can Do



8. Review IEP goals. Educators must review students’ IEPs and identify the goals that can be adapted most quickly to distance learning to ensure SWD receive the supports necessary to help them succeed. It is imperative that educators review each student’s IEP to determine who they will need to collaborate with (e.g., social workers, school psychologists, speech therapists) to best meet students’ goals. 9. Streamline lessons and assignments. Some SWD struggle with time and task management, which can complicate the demands of virtual schooling. Given this, SWD should not be expected to navigate multiple online platforms and assignment repositories. If a special educator and a general educator both need to look over an assignment, the student should not have to submit it in two different locations. Or, if available, instructional aids should be tasked with helping SWD navigate online portals to ensure students are completing and posting assignments on time. Educators should bear in mind the principles of universal design for learning (UDL), offering SWD flexibility in the ways they can access material, engage with it, and share what they have learned. 10. Communicate with families. Regular and meaningful communication with families is incumbent on educators; contact can occur in multiple ways (e.g., video conferencing, email, texts, or phone calls). Where necessary, translators should be available to facilitate communication with ELL families. Many parents need support to effectively navigate technology and lessons, and to meet their child’s academic and social needs. Educators should establish a consistent schedule of communication, and patterns of contact should be predictable in the same way that interaction with educators in school is predictable. Districts, schools, or educators might also consider sharing a weekly email or text with helpful information that can be communicated to parents as a group rather than

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individually—​for instance, strategies to increase student success or online resources to support instructional content. Communication should also be clear, concise, jargon-​free, free of judgment, and accessible for all families. This includes sparing SWD and their families from anxieties and stressors related to waivers/​release forms that include reference to lawsuits or the threat of legal action. 11. Maintain flexibility. Educators should be able to deviate from curricula and choose which skills to really pay close attention to, given the constraints of virtual schools. General-​education teachers may need to adjust their expectations for SWD during an academic disruption and defer to their special-​ education peers. This is particularly important with respect to submitting work and navigating multiple internet platforms, which is often required of SWD. General educators should not require duplicate submissions or additional work and instead should work in partnership with their colleagues.

Key Resources

Americans with Disabilities Act. 2010. Title II Regulations. Available at www.ada.gov/​regs2010/​titleII_​2010/​titleII_​2010_​regulations. htm. Cooc, North and Elisheba W. Kiru. 2018. “Disproportionality in Special Education: A Synthesis of International Research and Trends.” The Journal of Special Education, 52(3): 163–​173. Council for Exceptional Children. Available at www.cec.sped.org/​. Elder, Todd E., David N. Figlio, Scott A. Imberman, Claudia L. Persico. 2019. “School Segregation and Racial Gaps in Special Education Identification.” NBER Working Paper No. 25829. Available at www. nber.org/​papers/​w25829. Levine, Hallie. 2020. “Parents and Schools Are Struggling to Care for Kids with Special Needs.” The New York Times, 31 March. Available at www.nytimes.com/​2020/​03/​31/​parenting/​kids-​special-​needs-​ coronavirus.html. Losen, Daniel. J. and Gary Orfield, eds. 2002. Racial Equity in Special Education. Cambridge, MA: Harvard Education Press. Morgan, Paul L., George Farkas, Michael Cook, Natasha M. Strassfeld, Marianne M. Hillemeier, Wik Hung Pun, and Deborah L. Schussler. 2017. “Are Black Children Disproportionately Overrepresented in Special Education? A Best-​ Evidence Synthesis.” Exceptional Children, 83(2): 181–​198.

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National Council on Disability. 2018. IDEA Series: The Segregation of Students with Disabilities. Washington, DC:  National Council on Disability. Available at https://​ncd.gov/​sites/​default/​files/​NCD_​ Segregation-​SWD_​508.pdf. Schifter, Laura A., Todd Grindal, Gabriel Schwartz, and Thomas Hehir. 2019. “Students from Low-​Income Families and Special Education.” The Century Foundation, 17 January. Available at https://​tcf.org/​ content/​report/​students-​low-​income-​families-​special-​education/​ ?agreed=1. US Department of Education. 2020. “COVID-​ 19 (“Coronavirus”) Information and Resources for Schools and School Personnel.” US Department of Education. Available at www.ed.gov/​coronavirus. US Department of Education. 2004. Individuals with Disabilities Education Act (IDEA). Available at https://​sites.ed.gov/​idea/​. US Department of Labor. 1973. Section 504 of the Rehabilitation Act of 1973 (Section 504). Available at www.dol.gov/​ agencies/ ​ o asam/ ​ c enters- ​ o f fices/ ​ c ivil- ​ r ights- ​ c enter/ ​ s tatutes/​ section-​504-​rehabilitation-​act-​of-​1973. Voulgarides, Catherine Kramarczuk, Edward Fergus, and Kathleen A. King Thorius. 2017. “Pursuing Equity: Disproportionality in Special Education and the Reframing of Technical Solutions to Address Systemic Inequities.” Review of Research in Education, 41: 61–​87.

About the Authors

Nora Broege, PhD is a Postdoctoral Fellow at the Joseph C. Cornwall Center for Metropolitan Studies at Rutgers University –​Newark. Her research interests include racial/​ ethnic inequality, sociology of education, and quantitative methods. Charity Anderson, PhD is a Senior Research Associate at the Joseph C. Cornwall Center for Metropolitan Studies at Rutgers University –​Newark and Director of the Clemente Veterans’ Initiative (CVI) Newark. She is a former high school special-​education teacher in New York City Public Schools. Her research interests include urban education, poverty and inequality, and transformative education for disenfranchised adults and youth.

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10 Birth in the US amid COVID-​19 Shannon K. Carter and Bhoomi K. Thakore

The Problem

The COVID-​ 19 pandemic has exposed and exacerbated existing social problems inherent in the US maternity care system. The US spends more money on hospital-​ based maternity care than any other nation in the world, yet has poorer and more disparate birth outcomes than most industrialized nations. The current system relies on what Robbie Davis-​Floyd termed a “technocratic model of birth,” defined as a system of maternity care that treats birth as a medical event that requires hospitalization, and where birth is actively managed with technological interventions rather than treating it as a normal physiological process. This model prioritizes information gained from technological devices and medical tests over pregnant people’s voices, which removes agency from birthing patients and fosters unequal outcomes. It subordinates providers such as midwives and doulas who are shown to have positive effects on birth outcomes. It produces disparate outcomes for pregnant people of color who have less access to high-​quality facilities and receive unequal treatment from health care providers, resulting in higher risk of preterm births, unnecessary surgical births, and even death for the baby and the patients themselves. Pandemics such as COVID-​ 19 bring to light inherent problems with basing maternity care within an institution created to treat people who are sick. Many pregnant people are worried about becoming exposed to the novel coronavirus SARS-​CoV-​2 in the hospital while giving birth, and many health care systems are overburdened by the influx of patients 102

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needing treatment for COVID-​19. In recent months, US hospitals have implemented policies during labor, delivery, and recovery to attempt to mitigate the potential spread of COVID-​ 19, many of which have been applied unequally, worsened people’s birth experiences, and contributed to other health problems such as unnecessary caesarean births, breastfeeding disruptions, and postpartum depression. Whereas some maternity wards have an abundance of personal protective equipment (PPE) and require mandatory COVID-​19 testing, many wards in overburdened hospitals lack adequate equipment to ensure safety of health care workers and patients. Pregnant people in Black and Latinx communities are forced to navigate health care systems that are disproportionately overburdened, and they are at higher risk of exposure to the coronavirus during pregnancy or birth due to their social location and employment. In addition, medical racism, embedded in medical institutions and enacted by health care providers, creates a lower quality of care for people of color and further contributes to unequal birth outcomes. In the US maternity care system, a midwifery model of care exists alongside the technocratic model, yet midwives and other maternity care workers such as doulas—​ whose presence is correlated with improved outcomes—​ are not fully integrated members in most maternity care teams. The COVID-​ 19 pandemic, like other emergencies such as Hurricane Katrina, generate increased demand for midwifery care and community-​based births in freestanding birth centers or at home. The lack of structural support for community-​based birth inhibits midwives’ abilities to meet this increased demand, especially in communities that are already underserved, including those that are poor, rural, have high minority populations, and have high incidence of COVID-​19.

Research Evidence

Much research evidence demonstrates overutilization of medical technologies and unequal access to care, treatment,

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and outcomes within the US maternity care system, which are exacerbated during emergencies. The National Vital Statistic System (NVSS), a comprehensive data set created by the CDC’s National Center for Health Statistics that records vital statistics, shows vast inequalities in birth outcomes. The maternal mortality rate for Black women is three to four times that of White women, and the mortality rate of Black infants is nearly 2.5 times that of White infants. Outcomes are only marginally better for American Indian and Alaska Native populations. As Black and Native American populations have been hit hardest with COVID-​19 infection and mortality, disparities will likely increase during the pandemic. Ethnographic data show how these disparities are created in maternity car caree through overreliance and unequal use of medical technologies and implicit bias, factors that became more apparent during the coronavirus pandemic. Dána-​Ain Davis illustrates how preterm labor, a significant cause of infant and maternal complications and mortality, is complicated by implicit bias among care providers. Myths of “obstetrical hardiness”—​a perception that African-​American women can give birth more easily and with less pain than White women—​enable providers to minimize Black women’s symptoms. These biases are exacerbated amid COVID-​19, with increased remote prenatal care appointments, which require providers to rely on their patients’ accounts rather than medical testing. Such biases contribute to the deaths of Black maternity patients like Amber Isaac, who felt her health concerns were being ignored during a prenatal appointment held via telehealth due to COVID-​19, and died right after giving birth by caesarean in a Bronx, New York hospital a month before her due date. Although complete data regarding the long-​ term impacts of COVID-​19 on birth outcomes will only become available after the pandemic is over, news reports of hospital practices confirm disproportionate access and use of medical technologies and PPE across hospitals and among groups of patients. For example, while hospitals in affluent areas require everyone, including birthing patients, to wear facemasks and undergo COVID-​19 testing, some hospitals serving minority and low-​income patients are unable to even

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test their health care providers, putting patients at potential risk of exposure. Meanwhile, a hospital in Albuquerque, New Mexico implemented a secret policy to separate asymptomatic patients identified as Native American (based on physical appearance and zip code) from their babies after birth until their COVID-​19 test results came back, a process that often took up to three days and was not applied to White patients. While the US CDC recommends that new mothers with the coronavirus self-​quarantine for 10–​ 14 days, and maintain hygiene when interacting with their newborns, the World Health Organization (WHO) and many maternal and infant health experts argue that the benefits of breastfeeding and skin-​to-​skin contact outweigh the risks of infant viral exposure in most cases. The potential lasting effects from maternal-​ infant separation amid COVID-​ 19, such as heightened postpartum depression and anxiety and disruption of breastfeeding and parent–​infant bonding, are highly racialized and institutionalized.

Recommendations and Solutions

1. Address the privatization of birth and health care in the US. Ultimately, there is a need for more advocates for patients during the birthing process, particularly amid COVID-​19 and other similar emergencies. In recent months, many health care facilities have made changes to their services that have not led to safer or more satisfying births. For example, the Kaiser Permanente Medical Group of Northern California began offering inductions to pregnant people in their late third trimester, as a way for them to avoid the risks associated with a peak in the virus transmission and an overwhelmed hospital. A hospital in Canada encouraged laboring patients to get an epidural, to prepare in advance for a possible emergency caesarean in an already resource-​ strapped facility. As Elisabeth Rosenthal and others have established, the increased privatization of health care has prioritized treatments over cures, all for profit. Health care facilities are strategic in maximizing the number

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of “billable” items associated with treating a patient, which are neither transparent nor standardized, and overcharging for simple items, such as $15 for a dose of Tylenol. In this current health care system, the uninsured and underinsured will continue to suffer the most. Health care associated with the birthing experience is no different, and is further exacerbated amid COVID-​19. Prioritizing medical interventions, often beginning with the encouragement by health care providers to use an epidural anesthesia for pain management independent of the patient’s wishes, and the quick-​trigger decision to administer Pitocin for the sole purpose of speeding up active labor—​both of which are more likely to lead to what Wendy Simonds and colleagues refer to as a “cascade of interventions”—​is more profitable and thus a more desirable episode of care. These industry practices are largely due to the lack of federal oversight, which itself is a result of effective lobbying by the health care and pharmaceutical industries. Therefore, it is necessary to limit the influence of large lobbying groups such as these on the political process. The US must also move away from a privatized health care system in which such practices are possible. At minimum, this would require more regulatory oversight of these private companies. Ideally, a universal health care system would allow for the pregnant patient to remain the priority, rather than the medical interventions that could lead to death and other long-​term complications for parents and newborns. 2. Integrate a midwifery model of care into hospital settings. As established, experiences of birth in the US are influenced by a variety of social factors, most notably one’s social location. These inequalities have merely been heightened during the COVID-​ 19 pandemic. Integration of a midwifery model of care into hospital settings would allow for a more holistic approach to the birthing process, rather than one that is mitigated by medical doctors (MDs) and prioritizes medical interventions over the experiences of the laboring patient. Use of midwifery care in hospitals corresponds with lower rates of labor induction, caesarean and preterm

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births, and low birth weight, and higher breastfeeding rates—​ all of which disproportionally affect patients from minoritized racial groups. Integration of midwives in all hospital-​ based maternity care can also address many issues that community-​based midwifery services alone cannot, such as in cases of high-​risk pregnancies. 3. Expand access to community-​based midwifery services. Alongside integration in hospitals, increased access to community-​ based midwifery services can alleviate some of the problems associated with hospital birth in the United States. Greater availability and utilization of community-​based midwifery care corresponds with improved birth outcomes, including higher rates of spontaneous vaginal birth, vaginal birth after caesarean, and breastfeeding, and lower rates of preterm birth, low birth weight, and neonatal mortality. Studies show similar trends for White, Hispanic, and Black infants, indicating that expanded access to community-​ based midwifery services could particularly improve Black infant and maternal mortality rates. Yet, access to midwifery services is lowest in states where more Black babies are born, partly as a result of state laws that ban Certified Professional Midwives (CPMs), but not Certified Nurse Midwives (CNMs), from practicing. Legislation that provides licensure for CPMs in all states and incentives to pay for midwifery education for individuals who practice in underserved areas would expand access to community-​based midwifery to the communities that would benefit the most. 4. Identify medical racism and inequality in health care institutions. At the institutional level, hospitals and health care facilities, particularly those serving predominantly non-​White communities, must be tasked with conducting audits to examine their own internal rates of death and other complications for patients giving birth in their facilities during this pandemic. If a facility has disproportionate rates of death and other major complications by race/​ethnicity, then that facility must do a thorough investigation of what happened during those episodes of care. Such investigations would very

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likely identify negligence on the part of specific health care providers (e.g., doctors, nurses, social workers), who individually must be dealt with. Not only would these audits highlight how discrimination operates in these spaces, but it would also begin the work of identifying the kinds of efforts necessary to ensure that such injustices stop happening. 5. Invest in access to obstetric and pediatric care for underserved communities. Access to obstetric care has been greatly affected amid COVID-​ 19, with many providers now conducting appointments via telehealth. There are also increased barriers for the utilization of other maternity care services, including those provided by childbirth educators, doulas, and lactation consultants, whose presence is shown to have disproportionate improvement in birth and breastfeeding outcomes for underprivileged populations. However, this creates challenges for those who do not have easy access to the resources for telehealth, including reliable internet and phone connections. There must be concerted efforts to improve access to these now-​fundamental utilities, not only for telehealth but also for all demands that require virtual connection during social distancing protocols (e.g., employment, distance education). This includes investing in the necessary infrastructure, as well as those resources for affordability and accessibility. There have also been reports that well-​child visits have decreased during the current pandemic, and more children are now becoming overdue on routine care, including vaccinations. Any delay in well-​child checks, particularly for the vaccination schedule between age 0 and 2, will disproportionately affect poor children and children from minoritized racial groups who already have challenges related to health care access, continuity of care, and other social and environmental factors that affect their health outcomes. In the US, working-​class people of color are more likely to contract COVID-​19 due to overrepresentation in service-​sector employment. Pregnant people in these jobs are thus also more susceptible. These populations deserve extra

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attention in all factors, including health care and access. It will become increasingly necessary to invest in health care facilities, especially maternity care and pediatrics, that serve under-​resourced communities. 6. Improve access to postpartum resources amid COVID-​ 19 social distancing. The effects of the pandemic can also heighten symptoms of postpartum depression. Virtual health care may cause providers to miss important signs of distress. For new parents, a limited number of support people are allowed to visit patients during labor and after delivery, and social distancing protocols interfere with home visitors during those important early days and weeks at home. Parents are recommended to maintain social distancing for their children, which essentially means keeping them at home. Those with older children are also likely dealing with disruptions in their routines (for example, with closed schools, daycares, and other activities), which can interfere with time to bond with the new baby. Not to mention the added stress of being pregnant and trying to avoid infection, then raising children to also avoid infection, or dealing with an infection in their family. These dynamics can be addressed in part by focusing on access to mezzo-​ level connections, including the various postpartum parents’ groups and services that are often already available through health care facilities. Free access and availability of such services would help those families for whom the associated travel and costs are prohibitive. 7. Research long-​ term effects of COVID-​ 19 on birth experiences. Since the start of the COVID-​19 pandemic, there have been concerted efforts to collect public health data to study the health outcomes on pregnant women. Early evidence identified some instances of infants becoming severely ill with COVID-​19, but in general the current research indicates that most infants born to infected mothers do not become infected, and those who do tend to develop mild symptoms. The US CDC states that transmission between mother and child during birth is unlikely, but newborns are at risk

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if they interact with an infected caregiver. Transmission of the virus through breast milk is also unlikely—​in fact, breastfeeding provides antibodies that may protect infants from COVID-​ 19 infection as well as other infectious diseases, and has particularly beneficial health outcomes among marginalized populations. To further understand the long-​term health effects, these efforts for data collection must be continued and prioritized at the national level, particularly the well-​ established disparate experiences for non-​ White communities as they relate to experiences of birth. 8. Actively work toward progressive and informed legislation. True public health intervention is needed. Fundamentally, this means more testing and contact-​ tracing. Widespread tests for COVID-​ 19 and PPE need to be readily available to all health care workers and maternity patients, including community-​ based midwives, and hospitals offering maternity services in low-​ income and minority areas. Measures also need to be implemented to keep patients with suspected or confirmed infection from infecting other patients. Facemasks in public spaces are necessary to stop the spread. Specific to the experiences of birth, it is important to maintain regular access to care for everyone, particularly those who do not have it and need it. At the time of writing, both Democrats and Republicans in the House and Senate are designing legislative packages that focus on both COVID-​19 and police reform as it relates to excessive force disproportionate to non-​ Whites. Any specific policy changes can and should be packaged along with upcoming legislation, and should be drafted by, or at least consulted with, key public health experts and epidemiologists who utilize data for solutions. Further, all efforts must acknowledge these disparate experiences by race, gender, socioeconomic status, and other social identities.

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Key Resources

Bridges, Khiara. 2011. Reproducing Race: An Ethnography of Pregnancy as a Site of Racialization. Berkeley, CA: University of California  Press. Davis, Dána-​Ain. 2019. Reproductive Injustice: Racism, Pregnancy, and Premature Birth. New York: New York University Press. Davis-​Floyd, Robbie, Kim Gutschow, and David A. Schwartz. 2020. “Pregnancy, Birth and the COVID-​19 Pandemic in the United States.” Medical Anthropology. doi: 10.1080/​01459740.2020.1761804. Knight, Marian, Kathryn Bunch, Nicola Vousden, Edward Morris, Nigel Simpson, Christopher Gale, Patrick O’Brien, Maria Quigley, Peter Brocklehurst, and Jennifer J. Kurinczuk. 2020. “Characteristics and Outcomes of Pregnant Women Hospitalised with Confirmed SARS-​CoV-​ 2 Infection in the UK:  A National Cohort Study Using the UK Obstetric Surveillance System (UKOSS).” medRxiv 2020.05.08.20089268. doi: 10.1101/​2020.05.08.20089268. Maternal Health Task Force, Harvard Chan Center of Excellence in Maternal and Child Health. 2020. “Maternal Health in the United States.” Maternal Health Task Force. Available at www.mhtf.org/​ topics/​maternal-​health-​in-​the-​united-​states/​. Rosenthal, Elisabeth. 2017. An American Sickness:  How Healthcare Became Big Business and How You Can Take It Back. New York: Penguin Press. Simonds, Wendy, Barbara Katz Rothman, and Bari Meltzer Norman. 2007. Laboring On:  Birth in Transition in the United States. New York: Routledge. Singh, Gopal K. 2010. Maternal Mortality in the United States, 1935–​ 2007:  Substantial Racial/​ Ethnic, Socioeconomic, and Geographic Disparities Persist. Washington, DC: US Department of Health and Human Services, Health Resources and Services Administration. Tomori, Cecília, Karleen Gribble, Aunchalee E.L. Palmquist, Mija-​ Tesse Ververs, and Marielle S. Gross. 2020. “When Separation is Not the Answer: Breastfeeding Mothers and Infants affected by COVID-​ 19.” Maternal & Child Nutrition. doi: 10.1111/​mcn.13033. Vedam, Saraswathi, Kathrin Stoll, Marian MacDorman, Eugene Declercq, Renee Cramer, Melissa Cheyney, Timothy Fisher, Emma Butt, Y. Tony Yang, and Holly Powell Kennedy. 2018. “Mapping Integration of Midwives across the United States: Impact on Access, Equity, and Outcomes.” PloS One, 13(2): e0192523.

About the Authors

Shannon K. Carter, PhD is Associate Professor of Sociology and Associate Chair of the Sociology Department at the University of Central Florida. Her primary research areas are sociology of reproduction, social inequalities, and sociology of health and medicine. Her research examines social inequalities in reproductive health, revealing reproductive constraints and perspectives of underserved populations, including Black women and transgender individuals, and stigmatized practices

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like breastmilk sharing and breastfeeding in public. Her book, Sharing Milk: Intimacy, Materiality and Bio-​Communities of Practice in the 21st Century, co-​authored with Beatriz M. Reyes-​Foster, is scheduled to be released in October 2020 (Bristol University Press). Bhoomi K. Thakore, PhD is Assistant Professor in the Department of Sociology at the University of Central Florida. Her areas of expertise include racial inequality, media studies, and diversity in STEM. Thakore’s works include the book South Asians on the U.S. Screen:  Just Like Everyone Else? (Lexington Books, 2016), and the co-​edited volume (with Jason A. Smith), Race and Contention in 21st Century U.S. Media (Routledge, 2016). She has also published a variety of journal articles and book chapters on these topics. Currently, she serves on the Board of Directors for the Society for the Study of Social Problems (SSSP).

11 Access to Mental Health Care during and after COVID-​19 Andrea N. Hunt The Problem

The National Institute of Mental Health estimates that nearly one in five adults in the United States have a mental illness. One in six youth (ages 6–​17) have a mental illness. Mental illnesses are left untreated for many people including youth because of the cost and the availability of appropriate services. Data suggest that less than half of adults (43%) with mental illness received mental health services in the past year. This percentage is slightly lower for young adults (18–​25 years old), who are less likely to receive mental health services compared to other adults. For youth, access to treatment is more nuanced than for adults because youth often access services in school or through parents/​caregivers who agree to take them to community-​based or private practice settings. Other disparities exist, with women and girls more likely to receive mental health services than men and boys, and Whites more likely to receive services than other racial or ethnic groups. Further data from the Kaiser Family Foundation found that nearly 17 million adults and 3 million adolescents had a major depressive episode in the last year with nearly a third of the adults feeling worried, nervous, or anxious on a regular basis. These data along with the public attention on suicide rates among youth and the growing numbers of college-​aged students inundating student counseling centers across the nation illustrate the extent of the mental health crisis pre-​COVID-​19. With the pandemic, mental health professionals and advocates are projecting a more severe mental health crisis, 113

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with increases in depressive episodes and anxiety resulting from isolation, job loss, and income security, and new barriers arising for people with mental illnesses and substance use disorders as they access services. Experts caution against “deaths of despair” such as suicide, overdose, and substance use disorders that are likely to also increase. The mental health crisis is further exacerbated by the comorbidities that often exist among clients with mental illnesses and chronic lung disease, asthma, serious heart conditions, diabetes, and other chronic health illnesses that are risk factors for COVID-​19. The COVID-​19 pandemic has created an increased need for mental health care in a system that was already not working well for many vulnerable, minoritized, and marginalized groups. Telemental health quickly became the solution to mental health treatment in both outpatient and inpatient settings during the COVID-​ 19 pandemic. As a relatively new form of care, telemental health is also referred to as telehealth, telebehavioral health, telepsychology, and virtual care. Accompanying the growth of telemental health has been an increase in mental health apps available for download as well. While telemental health seems like the obvious solution to access to mental health care during the pandemic, there are additional considerations in the implementation of new therapeutic deliveries that include the availability of technology and policy changes.

Research Evidence

More recent data from the Kaiser Family Foundation found that nearly half of adults (45%) in the United States reported that their mental health had been negatively affected due to worry and stress over COVID-​19. This includes people who did not previously need mental health services, stable clients who may see a need for increased services because of COVID-​19, and clients who were actively utilizing services that were disrupted to some degree by COVID-​19. For many children and adolescents, school closures created a disruption in mental health services. The National Survey of Drug Use and Health found that 13% of adolescents received some type

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of mental health services in a school setting in the last year from school counselors, social workers, or community-​based providers that come into schools. Based on the Centers for Disease Control guidelines, many mental health providers changed from in-​person services to telemental health as COVID-​19 spread. Telemental health entered the popular lexicon for the public, many clients, counselors in training, and mental health providers with COVID-​ 19. Counselor education programs, as a whole, do not provide extensive training in telemental health. As a result, many mental health providers do not have experience in this area and may have only used web-​ based tools to screen for mental health conditions, risk factors, and previous victimization. Providers working with more specialized populations such as veterans are more likely to have experience with telemental health, with research in the past decade supporting care management practices and the effectiveness of cognitive processing therapy for post-​ traumatic stress disorder. For clients in underserved areas, such as rural and tribal communities, local mental health care is limited and telemental health has been a promising alternative to in-​ person services. There is also a growing body of research providing guidance for the delivery of trauma-​ focused cognitive behavioral therapy using telemental health. This research addresses both individual and community-​ level trauma that results from public health emergencies and continues to exist in post-​ disaster settings. Research has found that telemental health can increase mindfulness, well-​being, and satisfaction among some clients. Telemental health services for clients with a history of trauma, interpersonal violence, or substance use disorders may need a more structured approach than mindfulness to help increase their present control. Counseling with clients who have more serious mental health issues or who have experienced trauma requires specialized knowledge and experience, and these clients often need more time with counselors than do other clients. These clients may also benefit from professional wraparound services to develop coping mechanisms for the recovery process. It is difficult to retain these clients through telemental health if there is not

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a positive affective bond and therapeutic alliance—​ usually obtained through persistent proximity to one another, which helps strengthen the counselor/​client relationship.

Recommendations and Solutions

Barriers to mental health care existed prior to COVID-​19, with many advocates working tirelessly to increase access to services. COVID-​19 brought additional attention to these issues. There are several different potential recommendations and solutions for mental health care during and after COVID-​ 19 that can address the ongoing mental health crisis. The following serve as a call to action for practitioners, advocates, and activists on the institutional, organizational, and interactional levels. 1. Lobby for changes in mental health access and delivery. This is more important now than ever. Much of the current lobbying focuses on telemental services being reimbursed to providers in the same way as in-​person visits, Health Insurance Portability and Accountability Act of 1996 (HIPPA) penalties, and licensure for providers using telemental health. The CARES Act gave the Secretary of Health and Human Services the authority to waive Medicare telemental health reimbursement restrictions based on geographic and originating sites of services. This means that clients can use telemental health services in their homes without having to travel to a qualifying “originating site” for Medicare reimbursement. The Department of Health and Human Services waived HIPAA penalties for using non-​HIPAA-​compliant videoconferencing software, which allows for the use of Skype, Facetime, Facebook Messenger video chat, Google Hangouts, and Zoom for telemental health. The Centers for Medicare and Medicaid Services temporarily waived requirements that out-​of-​state providers be licensed in the state where their client resides, which allows for the provision of telemental health services across state lines.

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The Mental Health Access Improvement Act (S. 286/​ H.R. 945) was introduced in both the House of Representatives and the Senate to amend Title XVIII of the Social Security Act. This legislation would provide coverage for services by marriage and family therapists and mental health counselors under part B of the Medicare program and authorize them to develop discharge plans for post-​hospital services. Currently, licensed mental health counselors cannot be reimbursed by Medicare, which limits access to services for many older and disabled adults using Medicare. The Bipartisan Policy Center’s Rural Health Care Taskforce that includes former members of Congress, public health experts, and policy analysts is in support of the Mental Health Access Improvement Act, citing the need for additional mental health providers in rural communities. In rural areas, inpatient services are quite limited and mental health counselors are often the only available providers, yet, they cannot accept Medicare. S. 286/​H.R. 945 would alleviate the access gap in rural and underserved communities. 2. Access to technologies for telemental health. Many mental health advocacy groups, professional associations, and providers are keenly aware of issues around access—​ specifically, that many vulnerable clients are facing obstacles because they lack the needed video technology for telemental health or live in areas without reliable internet service. The US Department of Agriculture suggests that 80% of the households in the United States that lack reliable and affordable high-​speed internet are in rural areas. COVID-​19 has brought needed attention to the digital divide, which many people thought was a relic of the 1990s and early 2000s. Local, state, and federal efforts should focus on expanding broadband or high-​speed internet access in rural and underserved communities. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) can help with expanding telemental health services. The CARES Act provides a $425 million appropriation for use by the Substance Abuse

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and Mental Health Services Administration and includes several provisions for expanding coverage and availability of telemental health for clients using Medicare, private insurance, and other federally funded programs. The American Psychological Association sent a letter to the Centers for Medicare and Medicaid Services at the US Department of Health and Human Services urging them to change requirements so that people receiving Medicaid and Medicare could access therapy, evaluations, and management of services via telephone. Since then, the Centers for Medicare and Medicaid Services loosened the requirements during COVID-​ 19 since it is a public health emergency and telemental health coverage has expanded to the telephone. Additional options for adults beyond the typical telemental health or telephone services include the use of apps for coaching, virtual chat bots that provide cognitive behavioral therapy, and app-​ based on-​demand programs that match clients to a licensed therapist. For students who relied on school-​ based services or who lack sufficient technology, one model is to provide WiFi-​enabled tablets or computers that are already networked or rely on school-​provided hotspots. This allows students access to telemental health services with school-​ based counselors and social workers or coordinated care through community agencies and mental health providers. 3. Include the leading mental health organizations in disaster preparedness strategies. Response strategies to the pandemic rightfully focused on medical care and flattening the curve through different physical distancing protocols. The response strategies need to include plans to sustain and expand mental health care during this public health emergency. Leading mental health organizations are currently providing guidance to clients and providers around self-​care and advocating for increased mental health access. These organizations can also give direction for organizing community outreach, patient psychoeducation, policy recommendations, and overall strategies. Inpatient and long-​term care facilities

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need contingency plans to prevent the contraction and spread of COVID-​19 and mental health organizations are vital to developing preparedness strategies for public health emergencies. Some of the leading mental health associations and organizations include, but are not limited to: • American Psychological Association • American Medical Association • National Alliance on Mental Health • American Psychiatric Nurses Association • American Counseling Association • National Board for Certified Counselors 4. Sustain the well-​ being of mental health providers. Research indicates high burnout rates among frontline workers, including nurses and physicians, during COVID-​ 19. While this research has not specifically examined the burnout for mental health providers, there is ample literature on the effects of vicarious trauma (also known as compassion fatigue, secondary traumatic stress, and secondary victimization) on mental health providers. Vicarious trauma can affect job performance, interpersonal relationships, and the physical and mental health of counselors. In addition to seeing clients impacted by COVID-​ 19, mental health providers are also dealing with individual and community-​level issues related to the pandemic. The following are recommendations to sustain the well-​being of mental health providers. • Adjust staffing procedures and schedules when possible to allow for flexibility and the monitoring of stress. • Encourage self-​care and psychosocial support. • Provide additional training in telemental health for providers with less experience. • Model the commitment to mental health by creating an environment with open communication.

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Key Resources

American Psychiatric Association. 2020. “Practice Guidance for COVID-​19.” American Psychiatric Association, 14 July. Available at www.psychiatry.org/​psychiatrists/​covid-​19-​coronavirus/​ practice-​guidance-​for-​covid-​19. Gale, John, Jaclyn Janis, Andrew Coburn, and Hanna Rochford. 2019. Behavioral Health in Rural America:  Challenges and Opportunities. Rural Policy Research Institute. Available at www.rupri.org/​wp-​content/​uploads/​ Behavioral-H ​ ealth-i​ n-R ​ ural-A ​ merica-C ​ hallenges-​and-​Opportunities. Golberstein, Ezra, Hefei Wen, and Benjamin F. Miller. 2020. “Coronavirus Disease 2019 (COVID-​ 19) and Mental Health for Children and Adolescents.” JAMA Pediatrics. doi:10.1001/​ jamapediatrics.2020.1456. Langarizadeh, Mostafa, Mohsen S. Tabatabaei, Kamran Tavakol, Majid Naghipour, Alireza Rostami, and Fatemeh Moghbeli. 2017. “Telemental Health Care, an Effective Alternative to Conventional Mental Care:  A Systematic Review.” Acta Informatica Medica, 25(4): 240–​246. Li, Wen, Yuan Yang, Zi-​Han Liu, Yan-​Jie Zhao, Qinge Zhang, Ling Zhang, Teris Cheung, and Yu-​Tao Xiang. 2020. “Progression of Mental Health Services during the COVID-​19 Outbreak in China.” International Journal of Biological Sciences, 16(10): 1732–​1738. National Action Alliance for Suicide Prevention. 2020. “National Response to COVID-​ 19.” National Action Alliance for Suicide Prevention. Available at https://​theactionalliance.org/​covid19. Panchal, Nirmita, Rabah Kamal, Kendal Orgera, Cynthia Cox, Rachel Garfield, Liz Hamel, Cailey Muñana, and Priya Chidambaram. 2020. “The Implications of COVID-​19 for Mental Health and Substance Use.” Kaiser Family Foundation, 21 April. Available at www.kff.org/​ coronavirus-​covid-​19/​issue-​brief/​the-​implications-​of-​covid-​19-​for-​ mental-​health-​and-​substance-​use/​. Pfefferbaum, Betty and Carol S. North. 2020. “Mental Health and the Covid-​19 Pandemic.” The New England Journal of Medicine. doi: 10.1056/​NEJMp2008017. World Health Organization. 2020. Mental Health and Psychosocial Considerations during the COVID-​ 19 Outbreak. Geneva:  World Health Organization. Available at www.who.int/​ docs/​ default-​ source/​coronaviruse/​mental-​health-​considerations. Yao, Hao, Jian-​Hua Chen, and Yi-​Feng Xu. 2020. “Patients with Mental Health Disorders in the COVID-​19 Epidemic.” The Lancet, 7: E21.

About the Author

Andrea N. Hunt, PhD is an Associate Professor of Sociology and Family Studies and the Director of the Mitchell-​West Center for Social Inclusion at the University of North Alabama. Her teaching, research, and community efforts cover a range of interrelated topics including identity, inequality, and intersectional trauma-​informed practices. Dr Hunt is a public

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sociologist and court-​appointed special advocate. She works regularly with local judges, probation officers, mental health professionals, social workers, youth in juvenile detention, K-​ 12 teachers, and adults in recovery. She is currently pursuing a degree in clinical mental health counseling to better support and advocate for her community.

12 Vaccine Opposition in the COVID-​19  Age Jennifer Roebuck Bulanda, Shelby Frye, and Valerie Thompson

The Problem

Hope of ending the COVID-​19 pandemic rests mainly on development of an effective vaccine. Availability of a vaccine is only part of the solution, though; Americans’ decisions to receive or forego the vaccine will determine its ultimate success. If too few people immunize, outbreaks will continue. Such outbreaks pose serious health risks to those who cannot vaccinate and translate into continued economic and health care costs, which those in higher-​ risk and disadvantaged groups disproportionately shoulder. Although a vaccine is not currently available, there are already troubling signs about Americans’ willingness to embrace one. The convergence of the anti-​vaccination movement with the public’s growing distrust of social institutions—​ including government, medicine, and the media—​ poses major challenges for COVID-​19 immunization efforts. Vaccine opposition was a growing social problem before COVID-​ 19, and abundant misinformation, economic uncertainty, politicization of the pandemic, and anxiety about government overreach following pandemic-​ related restrictions have exacerbated existing anti-​ vaccination sentiment. Even during the earliest phases of the US COVID-​ 19 crisis, unfounded reports circulated online suggesting the vaccine would be unsafe, an attempt at surveillance, and/​ or a dangerous yielding of personal freedom. The New York Times reported that by April 2020, the most widespread falsehood about the pandemic—​viewed and shared millions of times in a matter of weeks—​involved speculation that Bill 122

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Gates had helped create COVID-​19 to profit from it and implant a surveillance device into Americans via an eventual vaccine. The viral “Plandemic” video circulating in May 2020 suggested that vaccinations Americans have received in the past make them more susceptible to COVID-​19 by weakening their immune systems. In addition, some anti-​ vaccination groups see concerns about pandemic-​ related government restrictions as an opportunity to expand their movements and recruit adherents. During the first wave of the outbreak, anti-​vaccination groups were behind some of the protests for ending stay-​at-​home orders and reopening the economy. These events demonstrate concerted efforts to influence Americans’ views of a COVID-​19 vaccine before one is even available. They also suggest that not only is the pandemic affecting views on vaccination, but that these changing views will pose an important barrier to ending the crisis. Anti-​ vaccination efforts have flourished in part because researchers, policy-​ makers, and health officials have not developed effective multi-​ pronged strategies to counter vaccine misinformation, to understand and respond to diverse reasons for vaccine resistance, and to develop digital communication strategies that leverage social networks. Pro-​ vaccine messaging has relied on the assumption that providing accurate information will be an effective solution, but scholars must recognize that anti-​ vaccination groups often summarily discount or distort rigorous empirical evidence. The novel nature of COVID-​19 further complicates efforts to disseminate reliable information about vaccination. Little research exists on the virus, and as new studies emerge, they sometimes contradict or change experts’ earlier recommendations. This can undermine the public’s trust in officials’ advice. Therefore, multifaceted advocacy efforts that move beyond merely sharing research evidence are necessary to increase Americans’ acceptance of an eventual COVID-​19 vaccine.

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Research Evidence

Even before COVID-​ 19, an increasing proportion of Americans were foregoing vaccination. In 2019, the World Health Organization listed vaccine hesitancy as one of the top ten global public health challenges. A 2019 Gallup poll found that 84% of parents considered vaccinating their children to be extremely or very important, down from 94% in 2001. Previous viral outbreaks have not attenuated increasing vaccine opposition. The US Centers for Disease Control and Prevention (CDC) reported that even during the high-​severity 2017–​2018 flu season, only about 37% of adults received the flu vaccine, a decline of over 6 percentage points from the previous flu season. Similarly, Ward’s study of vaccination during the 2009 H1N1 flu pandemic found that the outbreak did not result in stemming trends toward increasing vaccine refusal. Data collected around the initial peak of the US COVID-​ 19 crisis show Americans were already reluctant about a potential vaccine. In May 2020, a Pew Research poll found that 27% of Americans would not get a COVID-​19 vaccine if it were already available, and a separate AP/​NORC poll found that only about half of respondents planned to get a coronavirus vaccine if it were to become available in the future. Of the quarter of Americans who indicated little or no interest in a coronavirus vaccine in a Reuters/​Ipsos poll, 40% believed the risks of the vaccine would be greater than the risks of the disease itself. Existing research suggests there is no single, monolithic anti-​ vaccination movement. Instead, those who oppose vaccination are a heterogeneous group with a diverse set of concerns and motivations. In addition, a study by Violette and Pullagura suggests that conceptualizing immunization as a binary choice of accepting or refusing vaccines misses the tremendous heterogeneity that characterizes vaccine reluctance. Safety concerns are the most common reason for both vaccine hesitancy and opposition. These concerns increased after a now-​retracted and discredited 1998 study purported a link between vaccines and autism, and the damage has persisted to date. A 2019 Gallup poll shows that 10% of US adults believe vaccines cause autism and another 46%

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are unsure. Other concerns include distrust of government, preference for alternative medicine, and suspicion of health care professionals’ and pharmaceutical manufacturers’ motives. Increasing anti-​ vaccination sentiment has garnered the attention of the medical community but yielded few concrete solutions. Salmon and colleagues’ recent review suggests physicians do not feel they have the necessary resources to communicate effectively about vaccination with their patients, and lack of reimbursement for lengthy discussions with patients disincentivizes such conversations. According to Stahl and colleagues, the internet and social media have opened new conduits for misinformation about vaccination to spread unchecked, and anti-​ vaccination groups have harnessed these opportunities far more effectively than pro-​ vaccine groups. Indeed, a recent Gallup poll shows that 79% of Americans report hearing a great deal or a fair amount about the potential disadvantages of vaccination in 2019 versus only 39% in 2001. The COVID-​19 crisis may intensify these barriers to addressing vaccine opposition due in part to voluminous information circulating about the pandemic and physicians’ unfamiliarity with a coronavirus vaccine.

Recommendations and Solutions

Policy-​ makers and public health experts must not assume Americans will widely embrace a COVID-​ 19 vaccine if it becomes available. In addition, simply distributing accurate, research-​based information about the vaccine will not effectively counter the widespread and media-​ savvy misinformation campaigns from anti-​vaccination movements. Instead, officials must carefully and proactively work to counteract misinformation, address vaccine hesitancy, and prevent inequities in vaccination. We recommend the following strategies to guide these efforts. 1. Start by understanding the complex reasons for vaccine hesitancy/​opposition, and then create multi-​pronged education and advocacy campaigns that respond to

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these. Before attempting to devise solutions, health officials and policy-​ makers must understand the underlying reasons for vaccine opposition. Ward’s recent study of vaccination decisions after the 2009 H1N1 flu pandemic shows that many people who refused the H1N1 vaccine did so to advance broader political and/​or cultural agendas and not because they opposed vaccination generally. Similar concerns may affect COVID-​19 vaccination decisions. Even early in the pandemic, Americans expressed plans to refuse an eventual vaccine for diverse reasons, such as concerns about erosion of personal liberty and opposition to government oversight, adherence to natural living philosophies that consider vaccination unnatural and therefore harmful, conspiracy theories that powerful individuals seek to enact nefarious plans via a vaccine (e.g., surveillance, population reduction), and suspicion about the profit motive of pharmaceutical companies and the medical establishment. In order to effectively increase vaccine compliance, advocates must first understand both personal concerns and broader social movements that may collectively drive objections to a COVID-​19 vaccine. Given the diverse reasons for vaccine opposition, singular messaging on the issue will be insufficient and ineffective. Differing reasons for vaccine resistance require designing multiple responses. Research suggests that scare tactics (e.g., citing death rates) are generally unsuccessful. Campaigns to encourage vaccination should instead use the language and values that characterize specific anti-​ vaccination groups. For example, when addressing groups’ concerns that vaccination is unnatural, Reich and Levinovitz suggest advocates should emphasize that vaccines produce natural immunity through the body’s own immune system. The accelerated development of the COVID-​ 19 vaccine is likely to intensify others’ concerns about vaccine safety. In a May 2020 AP/​NORC poll, 70% of those who respond that they would not get a COVID-​ 19 vaccine indicate that concerns about side effects drive

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their decision. Emphasizing the extensive guidelines and required testing before the vaccine receives approval and underscoring its backing from the Federal Drug Administration could help convince these groups of the vaccine’s safety. In addition, easy-​to-​understand material (e.g., videos, articles, infographics) that describes the stages of vaccine trials and mechanisms through which the vaccines work, and which offers a window into the laboratories testing the vaccine and interviews with the scientists conducting the studies, will help demystify a process that can feel abstract and frightening to some. It is also important to recognize that research on attitudes toward COVID-​19 vaccination is in its infancy, and new sources of misinformation and reasons for skepticism will likely emerge as the pandemic progresses. Jennifer Reich, author of a book examining parents’ decisions about vaccinating their children, suggests the need for listening to the voices of the general public when developing pro-​vaccine campaigns. Focus groups and interviews with laypeople can help policy-​makers and public health experts better understand individuals’ evolving concerns and determine the best ways to communicate with them. 2. Leverage trusted figures and relationships. Studies show that people are more likely to believe information delivered from a trusted source. Partnering with community-​based organizations and respected figures such as local educators and religious leaders who can provide information and advocate for vaccination will likely be more successful than relying on federal agencies/​ officials with which individuals have no personal relationship. Medical professionals offer another opportunity for partnership. Although trust in the medical establishment has declined over the past decade, people still have a high degree of faith in their personal health care providers. According to the 2018 Wellcome Global Monitor, 88% of North Americans trust their nurses and doctors more than anyone else. There are several ways in which medical professionals can more strongly influence their patients’ vaccination

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decisions. Medical professionals should receive training on having effective conversations about vaccination. A recent New York Times article on ways to combat vaccine hesitancy points to motivational interviewing, a technique that encourages providers to ask patients what information they need to make a decision rather than using a hierarchical approach to pressure patients to vaccinate. In these conversations, doctors should utilize personal stories about why they vaccinate, rather than just data, to better connect with their patients. Physicians must also show their patients that they want to understand the source of their hesitancy to vaccinate, which further develops trust, rather than summarily dismiss it. Policy could encourage these conversations by mandating that insurance companies pay doctors for the time they spend counseling patients about vaccination. 3. Prioritize prevention of inequities in COVID-​ 19 vaccination by increasing access to health care providers, vaccination, and reliable medical information. Misinformation about vaccination may disproportionately affect some Americans. Those with lower levels of education have lower health literacy and less access to reliable information from medical experts and may, therefore, be more affected by COVID-​ 19 misinformation. In addition, conspiracy theories and misinformation about vaccines may be especially consequential for racial and ethnic minority communities, as discrimination and maltreatment by the medical system and other institutions have reasonably led to distrust. According to a recent Pew poll, only half of Black Americans, as compared to 75% of White and Hispanic Americans, say they would get a COVID-​ 19 vaccine. A 2015 study of race-​ethnic disparities in vaccination rates by Lu and colleagues suggest the importance of recognizing this legitimate distrust and having trusted community leaders disseminate information and participate in advocacy efforts. Even if pro-​vaccine messaging resolves disparities in the desire to vaccinate, people cannot comply with public health recommendations to vaccinate if they do not have

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access. The lack of universal health care in the US means members of race-​ethnic minority groups and those with lower socioeconomic status are less likely to have health insurance or a regular source of physician care. Policies mandating no-​cost COVID-​19 vaccination for those without health insurance and no cost-​sharing for those with insurance will be vitally important in increasing vaccination rates. Legislators should implement such policy at the federal level in order to prevent piecemeal adoption by states. The Task Force on Community Preventive Services, a nonpartisan panel of public health experts, recommends ensuring easy access to vaccination by providing transportation options and vaccination access in non-​ health care settings throughout the community, such as in schools. These strategies can help reduce disparities in access, but strategies that address institutional racism in the health care system must supplement them. Lu and colleagues’ research finds that policies establishing intensive standardized immunization practices by health care providers increase vaccination rates and reduce disparities in vaccination. Such implementation involves reducing variability in physicians’ recommendations for vaccination between patient populations, thereby supporting consistent, equitable treatment. They suggest the physician–​ patient relationship must be a focal point; bettering this partnership by integrating culturally relevant communication into patient outreach to underserved populations will be imperative to addressing the factors that significantly impact individual decision and desire to receive the vaccine. 4. Work to depoliticize the issue. Although anti-​ vaccination movements span the political spectrum, the growing partnership of these movements with conservative political groups opposed to expansion of government oversight/​control during the COVID-​19 crisis suggest a vaccine may become highly politicized, similar to the way compliance with wearing facemasks became a political statement in the early stages of the pandemic. A May 2020 Reuters poll found that twice

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as many Republicans were uninterested in a COVID-​ 19 vaccine as Democrats. President Trump and other conservative politicians, who have suggested that COVID-​ 19 is a hoax instigated by Democrats to influence the 2020 presidential election and who have questioned the legitimacy of public health experts like Dr Anthony Fauci, have encouraged this division. If a COVID-​19 vaccination campaign is to succeed among some groups, it will need the backing of conservative politicians. Advocacy efforts should carefully consider ways to depoliticize immunization choices, such as recruiting well-​known figures from across the political spectrum—​ including both politicians and individuals with no links to government—​ to participate in pro-​ vaccination campaigns. Advocacy material should also frame vaccination choices in ways that utilize the values of different political groups. For example, emphasizing that vaccination can help with economic recovery by ending the pandemic and framing vaccination as a personal choice displaying civic duty and patriotic commitment to the country may better resonate with conservative groups. 5. Recognize the power of social media. Social media facilitates the quick and easy spread of misinformation. Anti-​vaccination groups far outnumber pro-​vaccination groups, and they are increasingly media-​savvy. When misinformation appears on social media platforms such as Twitter and Facebook, more people share it than attempt to debunk it, which can make belief in misinformation seem much more common than is actually the case. Social media companies have started to address misinformation on their platforms by removing it or adding disclaimers that the information may be untrue, but this alone will not be enough to counteract anti-​ vaccination campaigns. In their study of the challenges and opportunities of internet sources for vaccination, Stahl and colleagues recommend the development of a digital action plan that involves designing and implementing innovative communication strategies. This plan may include the use of digital communication teams to

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assist local health agencies in crafting and delivering tailored messages through social media. These messages should provide accurate, clear information about the vaccine, be accessible to the general public, and address multiple underlying concerns. In addition, advocacy efforts should encourage people to share these messages widely. Research indicates that information shared by someone within an individual’s social network is more persuasive than information shared by outsiders, even if they are experts. To facilitate this, advocates can provide the general public with simple how-​ to instructions for sharing vaccine information and best practices for debunking misinformation on social media. Stephan Lewandowsky and John Cook’s recent handbook on addressing conspiracy theories cautions individuals to show empathy, steer clear of ridicule, and avoid trying to win an argument during social media interactions. It is better to address falsehoods others share on social media by linking to medically accurate information than to simply ignore misinformation. Encouraging people to effectively share pro-​ vaccine messaging on social media will help others see that vaccine acceptance is more common than refusal and will aid in establishing COVID-​19 vaccination as a normative expectation. 6. Begin work immediately. Waiting to design and enact public health campaigns until a vaccine is available allows misinformation and anti-​vaccination messaging to gain a foothold that will be difficult to combat later. Research by Jolley and Douglas suggests that efforts at debunking misinformation are less effective than “prebunking” efforts. They recommend a dual strategy of explicitly warning people about attempts to mislead them—​a technique that helps people develop resilience to misinformation before they encounter it—​ and preemptively rebutting this misinformation. The key is to start now. As we have discussed in this chapter, increasing compliance with vaccination will require building coalitions that leverage trust, creating effective and accessible messaging, tailoring education efforts to different groups’ concerns, developing innovative digital

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communication strategies to counter misinformation, and instituting policies that make vaccination equally accessible to all Americans. Doing this well will require substantial time and effort.

Key Resources

DeRoo, Sarah Schaffer, Natalie J. Pudalov, and Linda Y. Fu. 2020. “Planning for a COVID-​19 Vaccination Program.” Journal of the American Medical Association. doi:10.1001/​jama.2020.8711. DiResta, Renée. 2018. “Of Virality and Viruses:  The Anti-​ Vaccine Movement and Social Media.” NAPSNet Special Reports, 8 November. Available at https://​nautilus.org/​napsnet/​napsnet-​ special-​reports/​of-​virality-​and-​viruses-​the-​anti-​vaccine-​movement-​ and-​social-​media/​. Harnish, Amelia. 2020. “Fighting Vaccine Hesitancy, One Parent at a Time.” The New York Times, 19 April. Available at www.nytimes. com/​2020/​04/​19/​parenting/​measles-​vaccine-​hesitancy.html. Jolley, Daniel and Karen M. Douglas. 2017. “Prevention is Better Than Cure:  Addressing Anti-​ Vaccine Conspiracy Theories.” Journal of Applied Social Psychology, 47(8): 459–​469. Lanzarotta, Tess. 2019. “How to Beat Anti-​ Vaxxers at Their Own Game.” The Washington Post, 10 December. Available at www.washingtonpost.com/​outlook/​2019/​12/​10/​how-​beat-​anti-​vaxxers-​ their-​own-​game/​. Lu, Peng-​jun, Alissa O’Halloran, Walter W. Williams, Megan C. Lindley, Susan Farrall, and Carolyn B. Bridges. 2015. “Racial and Ethnic Disparities in Vaccination Coverage among Adult Populations in the U.S.” Vaccine, 49(6) (Suppl. 4): S412–​S425. Reich, Jennifer A. 2018. Calling the Shots: Why Parents Reject Vaccines. New York: New York University Press. Reich, Jennifer and Alan Levinovitz. 2020. “Anti-​Vaxxers Will Fight the Eventual Coronavirus Vaccine. Here’s How to Stop Them.” The Washington Post, 29 April. Available at www.washingtonpost. com/ ​ o utlook/​ 2 020/​ 0 4/​ 2 9/​ a nti-​ v axxers-​ w ill-​ f ight-​ e ventual-​ coronavirus-​vaccine-​heres-​how-​stop-​them/​. Salmon, Daniel A., Matthew Z. Dudley, Jason M. Glanz, and Saad B. Omer. 2015. “Vaccine Hesitancy: Causes, Consequences, and a Call to Action.” Vaccine, 49(6) (Suppl. 4): S391–​S398. Ward, Jeremy K. (2016). “Rethinking the Antivaccine Movement Concept: A Case Study of Public Criticism of the Swine Flu Vaccine’s Safety in France.” Social Science & Medicine, 159: 48–​57. Yaqub, Ohid, Castle-​ Clarke, Sophie, Sevdalis, Nick, and Joanna Chataway. 2014. “Attitudes to Vaccination:  A Critical Review.” Social Science & Medicine, 112: 1–​11.

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About the Authors

Jennifer Roebuck Bulanda is an Associate Professor in the Department of Sociology and Gerontology at Miami University. Her research focuses on family demography, health disparities, and the influence of family relationships on well-​being across the life course. She teaches courses on social forces and aging, demography, introductory sociology, and medical sociology. Shelby Frye has a BA in Sociology, Political Science, and Women’s, Gender, and Sexuality Studies from Miami University. Her research interests include gendered language, women in politics, and criminology. Her past research projects have examined the effects of team-​based learning in introduction-​to-​sociology courses, the effects of media on perceptions of Supreme Court Justice Kavanaugh, and public opinion of mandatory reporting laws on college campuses. Valerie Thompson is pursuing a BA in Microbiology, Public Health, and Premedical Studies with minors in Medical Sociology and Spanish at Miami University. Her research interests include health outcomes of race-​ ethnic minority groups, social determinants of health, and epidemiology. Her career aspirations are in medicine and public health, with plans to focus on the intersection of health and social justice as a physician-​scholar in the social sciences and humanities.

13 The Social Problems of COVID-​19 Joel Best As the chapters in this volume reveal, the COVID-​ 19 pandemic is related to a wide array of what are routinely described as social problems; they describe ways the disease makes many existing problems worse, even as it creates some new ones. These chapters focus narrowly on their various topics. This chapter adopts a broader perspective that seeks to synthesize sociologists’ thinking about the epidemic; it offers a theoretical framework for thinking about the many social problems of COVID-​19. Sociologists sometimes use the term social problems loosely, to refer to any aspects of anything considered harmful to society. In this paper, I am going to adopt a tighter definition—​to focus on the processes by which people identify these troubling conditions. This approach is sometimes called constructionist because it explores how people construct social problems. (A classic statement of this approach is found in Malcolm Spector and John I. Kitsuse’s 1977 book Constructing Social Problems.) This paper seeks to locate COVID-​19 within a constructionist theoretical framework. It begins by classifying the principal types of COVID-​19 social problems, and then examines the key stages in the process of constructing these problems. But first, a disclaimer. I wrote this paper in late May 2020, only about four months after most Americans became aware that COVID-​ 19 posed a serious threat, and about three after social distancing policies became widespread. Like all the other chapters in this volume, mine is an attempt to do sociology “on the fly.” It is too early to know all the ways our thinking about COVID-​19 will evolve, let alone to have done thorough sociological research and analysis on the topic. 134

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Instead, this is a rough draft, an effort to guide thinking for future studies of the epidemic. To begin, we need to appreciate that COVID-​19 is not a single social problem. Rather, it involves a constellation of a great many interrelated topics that people consider social problems. • COVID-​ 19 is of course the name for a coronavirus pandemic that originated in late 2019 and spread across most of the globe by early 2020. Think of this as COVID-​19 the disease. It is being much studied by biologists and physicians, who are interested in how the coronavirus behaves, and how it can be effectively treated. And, since it is transmitted by social contact, sociologists, too, are interested in aspects of this disease. • The strategy public health authorities recommend for containing such epidemic diseases is to minimize contact with people who might be infected. This led to COVID-​ 19 policies, usually described as social distancing. As their very name suggests, these policies are of interest to sociologists because they involve altering established patterns of social behavior. Implementing these policies also had devastating effects on the economy—​drastically increasing unemployment and shrinking economic activity so as to launch a recession. In turn, this led to conflict between those advocating continuing social distancing, and the people calling for reopening the society as quickly as possible. Notice that the term COVID-​19 policies names not one social problem, but a large set of phenomena considered social problems. Both COVID-​19 the disease and COVID-​19 policies are quite unusual, in that both had unusually harsh effects. In part, this is because their onset was sudden; just a few weeks passed between the discovery of the disease, its global spread, and the adoption of social distancing policies in many places, which also meant that the consequences of both the disease and the policies were widespread. Worse, those consequences were severe; many people were infected, substantial numbers died from the disease, and countless others had their economic

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and social lives disrupted. Moreover, the consequences are likely to be lasting, at least until a vaccine is available, and quite possibly even longer. This makes COVID-​ 19 virtually unique. To be sure, hurricanes and other disasters strike suddenly, but their impact is confined to relatively small geographic areas. Similarly, economic crises, wars, and ecological problems sometimes have widespread, even global, effects, but these usually develop much less suddenly. Few problems emerge as suddenly, affect so many people, have such severe consequences, and have such lasting effects. This explains why COVID-​19 has received so much attention, and why there has been so much uncertainty about how long the crisis will last, or what its effects might be. Precisely because the disease and the policies have such wide-​ ranging effects, there are still other categories of COVID-​19 social problems. • COVID-​ 19 created challenges for social institutions. Most obviously, it tested the ability of public health officials to manage a serious epidemic disease, and challenged the capacities of the medical system to provide the needed care. It also became clear that nursing homes, jails, and prisons—​settings that force lots of people, many with health problems, into close proximity—​ were particularly hard-​ hit by infections. Meanwhile, many educational institutions—​at all levels from preschools to research universities—​either halted instruction or moved it online. Many houses of worship also had to halt in-​ person services and substitute worshiping via electronic media. A large number of workplaces closed, asked employees to work from home, or drastically restricted their accessibility to the public. And there were worries about the effects on all sorts of businesses, with speculation that some sectors might never recover. Further, government’s ability to inspire trust in its policies was questioned; this was exacerbated by a variety of claims that political leaders behaved irresponsibly so as to make the disease’s impact much worse than it had to be. So, there were many different concerns about COVID-​19 institutional issues; in fact,

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it is difficult to identify a social institution that did not change its practices to respond to the crisis. • Similarly, COVID-​ 19’s place in the social structure received a good deal of attention. In his 2009 book The Burdens of Disease, historian J.N. Hays argued that epidemics almost invariably hit a society’s most vulnerable members hardest. COVID-​ 19 is no exception; the risks of finding it difficult to abide by social distancing recommendations, of becoming infected, of not receiving adequate medical treatment, of requiring hospitalization, and of dying were higher for those who are poor, infirm, or aged. In addition, media coverage carried countless feature stories about how the disease or the policies were affecting the lives of medical personnel and other emergency responders, workers still employed, workers now unemployed, those dealing with disabilities, teachers and students, families, those living alone and those stuck in tight quarters, city-​ dwellers and rural residents, and virtually every other imaginable category of people. The effects on communities of all sorts were also addressed. Of course, patterns reflecting such differences are often topics of sociological research, and we can imagine that there will eventually be many studies of COVID-​19 structural issues. • A fifth category of social problems concerns the meanings people assign to the pandemic. Pollsters of course began tracking the public’s attitudes toward the disease (early polling showed substantial majorities [two-​ thirds or more] of respondents were worried about becoming infected) and the policies (about a third saw the need to reopen the economy as more pressing than the threat of infection). Even in its early months, there were rumors, contemporary legends, and conspiracy theories about COVID-​19’s causes, or the dark forces manipulating it for various purposes—​a pattern the folklorist Andrea Kitta documented in other epidemics in her 2019 book The Kiss of Death:  Contagion, Contamination, and Folklore. We can classify the public’s concerns as COVID-​19 cultural issues.

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Because constructionists consider social problems to be social processes, it is important to try and trace their development. Here, I will use a model I develop in my book, Social Problems (4th edn, 2021), which depicts the process in terms of six stages:  Claims-​ making, media coverage, public reactions, policy-​making, social problems work, and policy outcomes. Claims-​making refers to people calling attention to some troubling condition and arguing that something ought to be done about it. Oftentimes, sociologists describe this as the work of activists and social movements. However, because COVID-​19 emerged and spread as rapidly as it did, many of the most visible claims came from experts—​public health and other medical authorities, and government officials (including President Trump and Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases—​ the two figures whose statements probably received the most coverage in early 2020). In addition, many troubling features of the disease and the resulting policies were first brought to public attention through members of the news media. Of course, social media offered another forum through which claims could spread. Although there were some efforts to draw like-​minded people together using hashtags, and although existing social movement organizations often took positions on aspects of the disease or the policies, as of this writing, no social movement organization or activist has emerged as the leading voice on COVID-​19. Precisely because people are constructing so many social problems as involving COVID-​ 19, it is possible that there will never be one or two leaders emerging to take ownership of the coronavirus problem. Making a claim is an iffy business; most claims fail to have much impact. Obviously, the claims by public health authorities that social distancing was necessary to combat COVID-​19 led to new policies. However, it is hard for people to sort through the cacophony of other claims dealing with COVID-​19’s many aspects and warning about their likely effects on the society and the economy. In all likelihood, most of those will fail to command serious, continued attention, but it is too soon to know which will and won’t succeed. The second stage in the social problems process is media coverage. People making claims usually rely upon the media

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to relay their claims to the public and policy-​ makers; in ordinary times, there are many claims competing for the media’s attention. But COVID-​19 has created a different situation. Even within a few weeks of the first cases having been identified in the United States, COVID-​19 began to nearly monopolize coverage in the major news media. Many of the topics that ordinarily receive soft news coverage had largely vanished; all major sporting events had been cancelled; there were no new movies opening in what were now closed theaters. The principal categories of hard news coverage were refocused—​business news increasingly centered on the damage to the economy, and political coverage on how officials were addressing the epidemic. In most election years, the campaign receives a substantial amount of coverage, but at least during the spring of 2020, COVID-​19 seemed to overshadow other issues. The media’s focus became all COVID-​19, all the time. The effect of concentrating media coverage on COVID-​ 19 meant that there was a constant search for new angles on the epidemic, its consequences, and its prospects. Journalists covered the waterfront; they wrote about COVID-​19 the disease, COVID-​19 policies, and COVID-​19’s institutional, structural, and cultural issues. There were daily bulletins about total numbers of infections and deaths. The public statements of officials were reported, and there were human interest stories about the hardships of being sick, medical professionals’ struggles to provide care, and ordinary people trying to cope with the restrictions of social distancing. All manner of commentators weighed in, pointing out who wasn’t receiving the help they needed, or arguing that this or that should have been done in the past or needed to be done in the future. If, as social problems theorists argue, the study of people making claims is at the center of the study of social problems, there was an exhausting range of claims originating with or being covered by the media. The social problems process’ third stage is public reaction. Often it is hard to gauge how people are responding to social problems claims. Most often, we rely on polling to give us a sense of the public’s attitudes. To be sure, the COVID-​ 19 crisis attracted the attention of pollsters, but as both the

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disease and the issues related to it continue to evolve, we can’t predict how attitudes might change. Another measure of public sentiment were public demonstrations calling for ending restrictions and reopening the economy; these received considerable media attention. These protests seemed to reflect the current political divisions; many of the protesters seemed to echo the views of President Trump, whose public statements often worried about the economic havoc caused by social distancing. Some advocated conspiracy theories, such as the claim that COVID-​19 originated in a Chinese laboratory. (Such claims are not new; they appear in fiction, such as Stephen King’s 1978 novel The Stand, in which an epidemic is caused by an accident at a biological weapons lab, but also in rumors about AIDS and Ebola originating in laboratories.) Certainly, some people resisted or were willing to ignore social distancing recommendations, but the real issue is how long it will take for pre-​ epidemic levels of social activity to resume. Polls suggested that substantial majorities of people remained concerned about the risks of both becoming infected themselves and spreading the infection to others (especially among family and household members). Imagine that, say, a restaurant reopens. No doubt some people will be willing, even eager, to eat there. But it is also likely that other folks will be more risk-​adverse, reluctant to risk the exposure. Until the risks of COVID-​19 diminish, it is unlikely that public gatherings will return to their pre-​epidemic levels. Policies can guide behavior, but they cannot force everyone to follow the guidelines; public reactions make a difference. Which brings us to the fourth stage in the social problems process:  Policy-​ making. COVID-​ 19 has been interesting because it has forced policy-​makers to make a host of fairly quick decisions in the first months—​ about the level of preparations needed to address the prospective epidemic, about marshaling medical resources once the epidemic began, about implementing social distancing restrictions, about addressing the economic crisis caused by massive unemployment and severe reductions in economic activity, and about how and when to lift social distancing restrictions. Not surprisingly, since the media routinely devote much of

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their attention to government activities, these topics received a good deal of media attention. It is less clear what the future will hold. Barring one or more additional severe outbreaks of disease, it may be that the greatest shocks to the medical, economic, and social systems occurred during the crisis’ first few months. As attention shifts to managing COVID-​19 while reopening social institutions, policy-​makers will probably find themselves under less urgent pressure. One question will be which of the many calls for change, ranging from relatively minor adjustments in official procedures to sweeping visions for transforming society to make it more just, will be addressed by policy-​makers in the years ahead. As of this writing, public conversations seem to be focused on restoring the social arrangements we had, rather than making significant institutional and structural changes. Most studies of social problems work—​the fifth stage—​ tend to involve close observations of how policies are implemented. Certainly there is social problems work with COVID-​19, most obviously among the medical professionals engaged in diagnosing and treating people with the disease, some of whom have written about their experiences. I have no idea whether any researchers—​perhaps sociologists already working in a medical setting—​have been able to study these processes directly. No doubt there will be other studies mining medical records to try to figure out how different sorts of patients fared during treatment. But because so much is in flux, this may well be the stage in the social problems process least studied by sociologists. Finally, we come to policy outcomes. In this final stage of the social problems process, policies become the focus for new claims. This began almost immediately in the case of COVID-​19; as early as January 2020, there were critiques that not enough was being done to ensure that there would be sufficient stockpiles of ventilators, masks, and other medical equipment that would be needed when the epidemic reached the US, and that there was not enough effort to produce and distribute antibody tests. As soon as the first dramatic weekly increase in people filing unemployment claims revealed that social distancing would cause significant economic damage, there were complaints that the cure was worse than the

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disease, and that society should reopen. When the federal funds intended to help preserve the economy began being released, critics charged that the money was failing to reach those who most needed help. And so on. Politicians from the president on down, as well as commentators and advocates of all stripes, debated the merits of various policies, and these arguments have continued throughout the emergence of the various COVID-​19 problems, and will undoubtedly continue in the months and years ahead. In sum, COVID-​19 poses significant challenges to the US and the world. Although some optimists initially insisted that the American economy would come “roaring back” after a brief interruption, by May 2020 most people anticipated that, even if an effective vaccine became available fairly soon, full recovery would be gradual and take a fairly long time. This chapter has argued that COVID-​19 is best understood as a collection of many social problems; it cannot be analyzed as a single issue, but needs to be understood in terms of the complex processes that shape the way all social problems emerge and evolve. Key Resources

Best, Joel. 2021. Social Problems, 4th edn. New York: Norton. Spector, Malcolm and John I. Kitsuse. 1977. Constructing Social Problems. Menlo Park, CA: Cummings.

Acknowledgments

Thanks to Kathleen Bogle and Brian Monahan for comments on an earlier draft. About the Author

Joel Best is a Professor of Sociology and Criminal Justice at the University of Delaware. He is a former editor of the journal Social Problems and a past president of the Society for the Study of Social Problems. His books on social problems theory include Threatened Children, Random Violence, Damned Lies and Statistics, The Student Loan Mess (with Eric Best), Kids Gone Wild (with Kathleen Bogle), and American Nightmares.

Afterword

This volume provides the public at large, scholars, students, and policy-​makers with sociological analyses of the impact of the COVID-​ 19 pandemic on a series of significant social problems. For the individual, nothing rises to the level of losing a loved one. The pandemic, however, has done more than wreak havoc on the lives of millions of people—​ disproportionately people of color and the poor. Consequently, COVID-​ 19 has reminded us of the deep and persistent underlying societal inequities that explain the disparate impact of this pandemic on different groups. Viruses do not discriminate, but we do. The chapters in this volume speak eloquently to this disparate impact and provide us with a deeper understanding of the changes required to avert similar, if not more devastating, consequences in the future. Meanwhile, the politically calculated response by elected officials to the pandemic calls into question whether it is enough to provide solutions based on rigorous scientific analyses. Politics, not science, tends to win when the two are pitted against one another—​and that, clearly, has implications for the work we do, how we do it, and for whom we do it. While problems often require short-​term responses to address the immediate suffering of millions, and they are prescribed in these chapters, long-​term solutions to these problems require fundamental social structural changes, addressed as well, either explicitly or implicitly, in this volume. The Agenda for Social Justice volumes and this latest title on COVID-​19 were conceived to target a different, broader audience than sociologists typically target, with analyses of social problems. But is it enough? Are there other, even more effective ways to reach even broader audiences, effect change, and become more relevant in the public arena of policy 143

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debates? The Society for the Study of Social Problems (SSSP) identifies itself as a social justice organization, but continues to grapple with what that means in practice. Should we, and indeed can we, as professional sociologists, play a more active role in bringing about the fundamental social change prescribed, if not demanded, by the type of analyses in this volume? Every year, for example, the SSSP gives $5,000 to a social justice organization in our annual meeting host city. Is that enough, or should the SSSP establish a long-​term relationship with these organizations, to support their work and to establish and maintain a presence in the communities served by these organizations? In a political climate such as this one, where even a pandemic is politicized for partisan purposes, do we really have a choice if we want to be more effective in fashioning a more just society? Clearly, there are impediments (costs) to playing more of an “activist” role, for both individuals and professional academic organizations. There is a risk to careers and legitimacy in publishing in outlets and in a language intended for consumption by a much broader, non-​academic audience—​and, in particular, for actors and organizations on the frontlines of social justice struggles. On the other hand, if we believe that this kind of work is essential and necessary, not only for society, but even for the relevancy of the discipline, we have to remove that risk (and initially be willing to assume) and reward that kind of work, instead of compartmentalizing and stigmatizing it and the people who produce it. These questions are not new, but the pandemic and the steady erosion of shared governance in academia, on which the pandemic is likely to have an accelerant effect, forces us to broach them again—​and with an even greater sense of urgency than they were in a 2004 symposium in the flagship journal of the SSSP, Social Problems, edited by Michael Burawoy, and a volume titled Public Sociology:  Fifteen Eminent Sociologists Debate Politics and the Profession in the Twenty-​First Century, edited by Andrew Abbott et al. in 2007. In both, scholars discussed the question of knowledge for what, principally as an exposition and response to Burawoy’s 2004 Presidential Address at the American Sociological Association’s (ASA) Annual Meeting.

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This public sociology, under which heading this volume fits, includes a variety of formats, such as op-​ eds in newspapers, articles in periodicals, blog posts, and books like Robert Bellah’s Habits of the Heart (published in 1985 by the University of California Press), intended to be read by non-​sociologists and non-​academics. As teachers, we engage in “public sociology” when we explain difficult concepts to people who are not members of our club and do not speak our language, and encourage and teach them how to think critically. In the Social Problems symposium, however, Burawoy argued that professional sociologists’ reach has to extend to the “trenches of civil society, where publics are more visible, thick, active, and local, or where indeed publics have yet to be constituted” (p. 104). In what today reads more like a prophesy than an observation and call for action at the time, Burawoy further maintained, Thus, sociology’s particular interest in its own perpetuation, in its own conditions of existence, ever more closely coincides with humanity’s interest in opposing the erosion of civil liberties, the violation of human rights, the degradation of the environment, the impoverishment of working classes, the spread of disease, the exclusion of ever greater numbers from the means of their existence, and deepening inequalities—​ all forces that threaten the viability and resilience of civil society at home and abroad. (p. 125)

The threat of “state despotism and market tyranny” that needed to be kept, in Burawoy’s words, “at bay,” is even more ominous and proximate today. But kept “at bay” how? In their introduction to the 2007 volume Public Sociology, Zussman and Misra observed that Burawoy’s plea for public sociology would require “rethinking and remaking our relationship to the university, our relationship to other disciplines, the way we train graduate students, the way we reward and honor colleagues, and (not least) the way we practice politics. And these are no small matters” (p. 7). To say that they are “no small matters” clearly is to understate the difficulty of the task—​a task made much more difficult by

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the corporatization of higher education. But that’s not even mildly coincidental or ironic, since the forces Burawoy and others wanted to counter in 2004 and 2007 are the same forces behind a neoliberal tide that has been eroding faculty power and academic freedom in colleges and universities for decades, with only sporadic and scant resistance by the professoriate. The faculty’s failure to defend its own turf, in turn, raises serious questions about scholars’ commitment, or at least ability, to confront, let alone defeat, forces that continue to increase economic and political inequality in the United States and the rest of the world. How do we make a case for helping other movements and causes when we have done such a dismal job against these very forces, now made all the more challenging by the COVID-​19 pandemic? The answer perhaps lies in not thinking in terms of how we can assist others, but rather in recognizing that we must be part of a larger movement and, consequently, thinking more in terms of what we can bring to the table as part of that movement, in an attempt to create a more just and equal society and world. Excellent analyses are not enough. The application of the solutions prescribed for the problems discussed in this volume depend on a different political climate—​one in which social justice and human rights, not neoliberalism and partisan politics, are the principal means and ends, and one in which the solutions adopted to solve the social problems discussed in this volume are selected on the basis of sound scientific research and data, and not the next election. The impact of the COVID-​ 19 pandemic has been devastating on higher education. There are steps the boards and presidents of these institutions will have to take, and are taking, for financial reasons, but it would be naïve to think that they will let this crisis go to waste. Even prior to the pandemic, business models utilized by institutions of higher education had, among other things, increased markedly the number of contingent or adjunct faculty, substituted corporate values for academic values, and shifted the conversation from critical thinking and collegiality to marketing, branding, and customer satisfaction. (Denigrated for decades by other institutions, the University of Phoenix may experience more

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emulation than ridicule in the decades ahead.) The proponents of this neoliberal approach contend, and have contended from the beginning, that universities need to be (in corporate parlance) more “flexible,” and “nimble,” and that significant faculty autonomy and responsibility impede needed changes and frustrate attempts to bring greater accountability to higher education. According to Larry Gerber in his book The Rise and Decline of Faculty Governance (published in 2014 by Johns Hopkins University Press), what led to this reversal was: the confluence of substantial cuts in funding for public colleges and universities, growing complaints about the increasing cost of tuition at both public and private institutions, greatly intensified demands from governing boards and politicians for new efficiencies and greater accountability … unprecedented competition from for-​ profit institutions of higher learning and the apparent potential of new technologies to transform traditional methods of teaching and research … (p. 1)

The same forces remain at play today, now joined by the effects of the pandemic. But as Christopher Newfield argues in Unmaking the Public University (published by Harvard University Press in 2011), conservatives have defunded higher education principally for cultural and ideological, not financial, reasons. Over the past 30 to 40 years we have observed the steady de-​ professionalization and impoverishment of professors, with, as noted above, the replacement of full-​time tenure-​ track professors with contingent or adjunct faculty, poorly paid, poorly protected, and easily exploited. Universities claim that they are forced to hire adjunct faculty to save money, but fail to point out that the money they save is being spent on hiring more administrators and paying them higher salaries; hiring consultants, public relations and marketing firms, and attorneys; putting up billboards to market their product; and placing large-​screen televisions in dormitory suites to attract more customers (aka “students”). But it is precisely this insecurity that employers, including universities and colleges,

148 Afterword

bank on for greater flexibility, lower labor costs, and a more docile workforce. This new model has depleted the tenured and tenure-​track ranks. Clearly tenure is disappearing and in the not-​so-​distant future may exist only in the top-​tier research institutions that will continue to compete for the most distinguished scholars in the world. This new model has not only stripped faculty of power. It has also ushered in a new culture. Corporatization, by definition, means a shift from academic to corporate values. The humanities and social sciences especially are asphyxiated by this kind of an environment and the natural and physical sciences potentially compromised morally and ethically by corporate money. But it is worth noting as well that it is from the humanities and the social sciences that most of the critiques of the existing economic, political, and social order emanate—​ voices that those in power would like to silence or at least reduce to a whisper. This neoliberal attack on higher education should have been the first machinery on which faculty should have thrown their bodies. Part of why they did not is that university and college faculty cannot do it in isolation. That requires being part of something bigger. This and the volumes of the Agenda for Social Justice, however, demonstrate that we have a great deal to offer to public policy debates. But in doing so, and more effectively, we have to see ourselves as part of a broader, international social movement fighting against a neoliberal agenda that produces the social problems we study as scholars, both in the United States and abroad, including the global South, where the consequences of neoliberalism have been especially brutal and inhumane. The question of knowledge for what is not principally a moral or ethical one, despite its moral and ethical underpinnings. It is a political one. The response to the COVID-​19 pandemic has not been principally a medical one, but rather a political one. The question is not whether we should be more public, but rather, what is the most effective way to be part of a broader and more concerted movement to build such a society? As members of this movement, we need to think intelligently and in collaboration and conversation with other social justice activists and organizations, about what we can bring to the

End Matter

149

table (uniquely) as academics and academic organizations. (I recall asking a union organizer once how academics could help in union efforts to organize immigrant workers. He said, principally, through research that they needed, adding, with a sly smile on his face, “You guys always have to form a committee, then a couple of subcommittees, before you make a decision. We don’t have that luxury.”) All of this will require redefining legitimate scholarship, rethinking he activities and manner in which organizations like ours engage politically, and organizing within the discipline, with other disciplines, and with partners outside of the academy fighting the same war (and “enemy”) on other fronts. In a different political climate, the pandemic would have taken fewer lives, the problems discussed in this volume would have been less severe, and the solutions would have relied on the best research that the chapters in this volume represent. But that climate has to be created and we, as scholars and teachers, can and should play a critical role in its creation by working ever more closely with other groups, organizations, and individuals committed as well to the eradication of the social inequities discussed in this volume, the promotion of human rights and civil liberties, the protection of the environment, and the advancement of science. This, in turn, will require of us something bordering on revolutionary, i.e., encouraging and rewarding social action scholarship and work in our discipline and institutions. We, as sociologists, must be more visible in the public arena, in concert with other anti-​neoliberalism activists. At the local level, members of the SSSP and other sociological organizations must break down the walls between town and gown and, more broadly, organizations like the SSSP and the ASA must work closely with national and international organizations working to create a more just and safer world. Héctor L. Delgado, Executive Officer, the Society for the Study of Social Problems; Professor Emeritus, University of La Verne Key Resources

Abbott, Andrew, Michael Burawoy, Patricia Hill Collins, Barbara Ehrenreich, Evelyn Nakano Glenn, Sharon Hays, Douglas Massey, Orlando Patterson, Frances Fox Piven, Lynn Smith-​Lovin, Judith

150 Afterword Stacey Arthur Stinchcombe, Alain Touraine, Immanuel Wallerstein, and William Julius Wilson. 2007. Public Sociology: Fifteen Eminent Sociologists Debate Politics and the Profession in the Twenty-​ First Century, 1st edn. Edited by Dan Clawson et al. Berkeley, CA: University of California Press. Burawoy, Michael, William Gamson, Charlotte Ryan, Stephen Pfohl, Diane Vaughan, Charles Derber, and Juliet Schor. 2004. “Public Sociologies:  A Symposium from Boston College.” Social Problems, 51(1): 103–​130. Gerber, Larry G. 2014. The Rise and Decline of Faculty Governance: Professionalization and the Modern American University. Baltimore, MD: Johns Hopkins University Press. Ginsberg, Benjamin. 2011. The Fall of the Faculty: The Rise of the All-​ Administrative University and Why it Matters. Oxford:  Oxford University Press. Newfield, Christopher. 2011. Unmaking the Public University:  The Forty-​Year Assault on the Middle Class. Cambridge, MA:  Harvard University Press (reprint edition). Scott, Debra Leigh. 2012. “How the American University was Killed, in Five Easy Steps.” The Homeless Adjunct, blogpost, 12 August. Available at https://​junctrebellion.wordpress.com/​2012/​08/​12/​ how-​the-​american-​university-​was-​killed-​in-​five-​easy-​steps/​

Index

A Affordable Care Act (ACA) 43, 84–85 African American unemployment 49–51 education and age factors 52 educational opportunities truths 56 equal employment legislation 57 industry 51 insurance policies 55 paid leave 54–55 providing non-work-reliant health care 53–54 and racism 53 small employing firms 51–52 underutilization measures, reporting of 56–57 unemployment levels 49–50 African Americans maternal mortality rate 103–104 and vaccination 128 American Civil Liberties Union 14 American Medical Association 83 American Psychological Association 117–118 American Sociological Association (ASA) 149

Americans with Disabilities Act (ADA) 91–92, 95 anti-LGBT discrimination 83– 84, 86–88 anti-neoliberalism 149 anti-union campaigns 40–41, 44–45 anti-vaccination movements 125, see also vaccine opposition depoliticization of 129–130 expansion of 122–123 heterogeneity 124–125 misinformation campaigns 125–132 use of social media 130–131 app-based on-demand programs 117–118 B birth amid COVID-19 102 community-based midwifery services, access to 107 maternity care system 102–103 medical racism and inequality in health care institutions, identification of 108 midwifery model of care 103 integration into hospital settings 106–107

151

152 Index obstetric and pediatric care for underserved communities, access to 108 postpartum resources amid social distancing, access to 109 privatization of birth and health care 105–106 progressive and informed legislation 110 researching long-term effects of COVID-19 on birth experiences 109–110 technocratic model 103 Brennan Center for Justice 20 Bureau of Justice Statistics (BJS) 25–27, 30 C Canada 72, 78–79 financialization of housing 78 homelessness in 70–72 housing legislation 78 maternal healthcare 105–106 rapid rehousing programs in 77 self-isolation spaces 73–74 work-related income loss 54 Canada Emergency Response Benefit (CERB) 72–73, 76 cash bail, elimination of 21 Centers for Disease Control and Prevention (CDC) 15–16, 72 on educating students with disabilities 93 guidelines for mental health providers 115 on intimate partner violence (IPV) 2 on LGBT healthcare 82

National Center for Health Statistics 103–104 recommendations for new mothers with coronavirus 104–105 recommendations on worker quarantine 45 on residential crowding 59–61 self-isolation recommendations 73–74 on vaccination 124 Centers for Medicare and Medicaid Services guidelines for telemental health 116 telemental health guidelines 117–118 Civil Rights Act 85 claims-making 138 COBOL program 55 COBRA program 42, 47, 54 community support infrastructure, and mutual aid networks 10 community-based midwifery services 106–107, 110 confined community, increasing access to testing among free testing 20 reduction of global transmission of the virus 20 testing and treatment options, access to 20 confinement alternatives 21 conspiracy theories 122–123, 140 Coronavirus Aid, Relief, and Economic Security (CARES) Act 43–47, 72–73, 76, 116–118

Index custodial settings 13, see also jails broader criminal justice system changes 21 confinement conditions. 16–17 deaths data 22 demographic breakdown data 22 health and health safety confined community, increasing access to testing among 19–20 correctional staff, increasing access and requiring testing among 20 mandatory quarantining 20–21 outdoor activities 21 physical distancing 21 potentially lifesaving supplies, increasing access to 20 recovered correction staff 21 sanitization and cleaning 21 immediate solutions for prisons and immigration detention centers decarceration 18–19 funds reallocation 19 suspension of new admissions 19 incarceration alternatives 31–32 infection rates data 22 infections, recoveries, and deaths data 15–16 law enforcement and jailers, discretionary power of 31 overcrowding 13–14, 17, 19

153 social distancing problems 13–14, 21, 28–29 social processes within and between 13–14 testing level data 22 vulnerabilities to COVID-19 16 D decarceration 18–19, 26–29, 32–33, see also custodial settings; jails immigrants in detention, releasing of 18–19 medically vulnerable, releasing of 18 older persons, releasing of 18 use of incarceration alternatives 18 decriminalization 31–33 detention centers 13, see also custodial settings COVID-19 data 16 facilities 13–14 disaster preparedness strategies, including leading mental health organizations in 118–119 diversion system 21 drop-in centers 70–72 E Economic Impact Payments 76–77 education distance learning opportunities 95 for SWD. see student with disabilities (SWD) virtual learning 93, 97 educational opportunities 56

154 Index electronic monitoring 21 emergency housing, funding for 7 emergency shelters 3, 70–72 Employee Free Choice Act 45 equal employment legislation 57 Equal Justice Initiative 17 Equality Act 85 essential businesses and survivor advocates, collaboration between 10–11 essential work/workers 36–38 African Americans 51, see also African American unemployment health risks levels 39–40 immigrants 37–38 low wages 39 medical insurance coverage by firms 64 and Occupational Safety and Health Administration 41 uneven distribution of 38 unions 40–41 F free and appropriate education, for students with disabilities 95 frontline workers 38 justice workers health safety 20 social distancing problems 14 transmission risks 14 low wages 39 funding from decarceration, reallocation of 19 disproportionate amount of 8

for housing 7 H H-2A visa program 65–66 health insurance employer-sponsored 37, 42– 43, 47, 50–51 loss of coverage 37 higher education 146–147 accountability 146–147 and conservatism 147 corporatization of 146, 148 HIPAA penalties 116 homelessness 70, see also housing COVID-19 spread, reduction of providing safe space for self-isolation 73 universal access to testing 73 economic instability contributing to 74–78 financialization of housing 78 increased eviction protection measures 75 rapid rehousing 77 hospital-based financial support programs 9 increase in 72–73 and intimate partner violence 4 and social distancing 70–72 hospital-based financial support programs, for homeless 9 housing eviction protection measures 75 funding for 7

Index housing support programs 7–8 as human right 78–79 insecurity, and intimate partner violence 4, 11 instability, and intimate partner violence 5–11 lease termination, advance notice to 6–7 long-term housing 4, 7–8 permanent housing 4 rapid re-housing approach 77 rent freezes 75–76 safe housing 3 I immigrants deportation fear 20 in detention 13–14 releasing of 18–19 essential workers 37–38 incarceration issues. see custodial settings; jails Individualized Education Plans (IEPs) 92, 95, 98 Individuals with Disabilities Education Act (IDEA) 91–93, 95–96 intimate partner violence (IPV) 2 criminal justice-based approaches 5–11 domestic violence hotlines 2–4 evidence of violence 6 first responders, integration of housing support and other social services 8–9 and housing insecurity 4, 11 and housing instability 5–11 housing resources for survivors of 4 housing support programs 7–8

155 interprofessional work and training 9 nuisance ordinances, and eviction of tenants 7 prevention, integration into neighborhood and community initiatives 9–11 publicly accessible information about services for survivors 10 punitive tenant laws 6–7 rates of 2–3 shelter-in-place orders, impact of 2–4 social distancing, impact of 2–3 survivor advocates and essential businesses, collaborations between 10–11 training in trauma-informed practices 9 types of 2 J jail populations data on 30–31 decrement of reduction of new admissions 31 state policymakers’ role 31–32 overcriminalization and miscounts 25–26 and public safety 27 jails 25, see also custodial settings custodial deaths reporting 30–31 data on COVID-19 spread in 27 from journalism 28

156 Index limitation 27 from private-sector researchers 28 from state agencies 28 data reporting and collection systems 30 legalization of 30–31 ending of expansion of 32 counties and jail oversight bodies’ role 32 elimination of federal funding sources 32 increase data transparency 29–31 information about health in 27 investments in 29–31 mass incarceration 25 origination and evolution of 25 public health crisis 26 rapid population reductions in 26 social problems 136–137 transparency issues 26–27 job loss 49–50, 54, see also unemployment L labor unions 40–41 strengthening rights of 45–46 unionization 45–46 unionization rates 40–41 laid off workers 52–53 Latinx communities 59, 102–103 LGBT 81 anti-LGBT discrimination addressing root causes of 88 health consequences of the coronavirus on 83–84

healthcare disparities 81–82 HIV/AIDS affected 83 individuals and leaders, inclusion in policy decisions 85 legislation and policies for protection of 85 media coverage 86 needs, inclusion in public health 86 and religious freedom 81–82, 84 social justice organizations, lobbying 87 and social media 87–88 LGBTQ+, and intimate partner violence 2 M Marshall Project (MP) 15 mass incarceration 25, see also custodial settings; jails and crime reduction 27 maternal mortality rate 103–104 maternal-infant separation amid COVID-19 104–105 maternity care system 102–104, see also birth amid COVID-19 maternity services in low-income and minority areas 110 meat processing workers 60 employer-sponsored medical insurance 64 inclusion in H-2A visa program 65–66 Workers Compensation coverage 64 meat processors coronovirus emergency legislation, amendment regarding sick leave requirements 63

Index guaranteed pay for sick family members 62 paid sick leave 62 prosecutorial immunity and liability waivers for 64 safety guidance compliance before reopening 65 safety protocols 62 understanding of safety practices 65 workplace control 62 workplace incentives to work while sick, elimination of 63–64 media coverage 137 of social problems 138–139 Medicaid 42–43, 47 medical racism 102–103, 108 Medicare 47, 50, 116–118 mental health 113 lobbying for changes in mental health access and delivery 116 mental health organizations, inclusion in disaster preparedness strategies 118–119 sustaining the well-being of mental health providers 119 technologies for telemental health, access to 117, see also telemental health Mental Health Access Improvement Act 117 mental health providers, well-being of 119 midwifery model of care 103, 106–107 moratoriums 75–76 mortgage forgiveness policies 76 mutual aid networks 10

157 N National Education Association 93 National Housing Strategy Act, Canada 78 National Institute of Mental Health 113 National Network to End Domestic Violence (NNEDV) 4 National Sheriffs’ Association 28–29 National Survey of Drug Use and Health 114–115 National Vital Statistic System (NVSS) 103–104 neoliberalism 146–148 new admissions custodial settings reduction of 31 suspension of 19 detention of non-citizens 19 parole and probation violations issuance 19 no-cost COVID-19 vaccination, mandate of 128–129 non-justice system alternatives 21 non-work-reliant health care 53–54 O Obamacare 51–52, 54 obstetric care, access to 107 Occupational Safety and Health Administration (OSHA) 41, 46–47, 64–65 P paid leave 54–55, 62

158 Index Pandemic Unemployment Assistance (PUA) 42 personal protective equipment (PPE) 102–105, 110 poverty level benefits 43 pretrial community supervision 21 pretrial detention 31–32 elimination of 21 judicial actors and prosecutors’ discretionary powers 31 private insurance, telemental health 117–118 Protecting the Right to Organized (PRO) Act 45 public sociology 145 Q quarantining 20–21 R race in custodial settings 25–26 and essential workers 37–38 and intimate partner violence 2 Rehabilitation Act of 1973, Section 504 91–92, 95 residential crowding 59, 61–62 contribution to rapid spread of COVID-19 61 discouraging sick and exposed workers from working 62 ensure that safety practices are understood 65 food processing workers 60– 61, see also meat processing workers; meat processors H-2A program expansion 65–66

implementation of workplace controls 62 increasing workplace oversight 64 reduction policies 62–66 risks 59 residential landlords, financial relief for 75–76 S scholars and teachers critical roles of 149 professionalization and impoverishment of 147–148 self-employed workers 42 shelters 77 construction, funding for 7 overnight emergency shelters 70–72 temporary shelters 73–74 single-payer health system 54 social contact 135 social distancing 135 access to postpartum resources amid 109 in custodial settings 13–14, 21, 28–29 and homelessness 70–72 impact on economy 141–142 and intimate partner violence 2–3 and LGBT individuals 83–84, 86–88 social justice activists and organizations 148 social media and claimsmaking 138 for drawing LGBT issues 87–88 and vaccine opposition 130

Index social problems 134 cultural issues 137 institutional issues 136–137 policies issues 135 structural issues 137 the disease 135 social problems process claimsmaking 138 media coverage 138–139 policymaking 140–141 public reaction 139–140 social problems work 141 Society for the Study of Social Problems (SSSP) 143–144, 149 solitary confinement 21 special education 91, see also students with disabilities (SWD) students with disabilities (SWD) 91, 95 additional supports for special educators 96 compensatory services plans 96 district-level disparities 93–94 educators’ role communication with families 98 flexibility maintenance 99 IEP goals review 98 lessons and assignments streamline 98 formal help to parents of 96 graduation rates 93 Individualized Education Plans (IEPs) 92 providing/subsidizing internet and technology access for 96

159 provision of free and appropriate education 95 release/waiver forms 94 schools’ role additional resources and services 97 parents/caregivers support 97 supervised release 21 T telehealth 104, 108 telemental health 113–115 benefits 115–116 counseling 115–116 lobbying for changes in mental health access and delivery 116 private insurance 117–118 technologies, access to 117 trauma-focused cognitive behavioral therapy 115–116 trauma 115–116, 119 trauma-informed practices, training in 9 Trump, Donald 138 U U1-U6, labor underutilization 56–57 unemployment 36, 38, 42, 49 of African Americans. see African American unemployment compensation 55–56 state level unemployment insurance programs 43–44 teenage unemployment 53 uneven distribution of economic impacts 42–43

160 Index unemployment insurance 37, 42–44, 46–47 Universal Basic Income (UBI) 76–77 Universal Design for Learning (UDL) 98 universal health care 128–129 Utah, Senate Bill 205 30–31 V vaccination 108–109, 122, 124 leverage trusted figures and relationships for 127 need for immediate campaigns for 131–132 prioritization of prevention of inequities 128 vaccine opposition 122, see anti-vaccination movement education and advocacy campaigns as response t 125–126 social media, recognizing the power of 130

understanding of 125–126 virtual health care 109 W women essential workers 37–38 homelessness 4 IPV see intimate partner violence (IPV) workplaces essential work see essential work/workers guidelines for record keeping and enforcement of requirements and policy violations 46 health and safety regulations 37, 46–47 safety 65 World Health Organization (WHO) 104–105, 124