“Mass incarceration is on the rise;” “budgets for public hospitals are declining;” “poor Black and Brown people are increasingly treated in jails, not hospitals.” Such assertions abound in media coverage of criminal courts and emergency rooms. They participate in a broader narrative that highlights the ever-expanding punitive power of the criminal justice apparatus as well as the ongoing retrenchment of welfare infrastructures in the United States, often tracing these dynamics to 1980s Reaganomics.
In Redistributing the Poor: Jails, Hospitals, and the Crisis of Law and Fiscal Austerity, Armando Lara-Millán provides a much-needed counterpoint to these sprawling generalizations. Drawing on an innovative mix of ethnographic and historical methods, he examines the specific transformations that have reshaped California’s county jails and public hospitals over the past 20 years.
Overall, the author argues against the “retrenchment-criminalization thesis,” namely the conventional narrative emphasizing the retrenchment of public healthcare and its internalization within criminal justice institutions. Instead, he emphasizes the complex set of administrative constraints that lead public hospitals and county jails to hierarchize, control, and redistribute poor Black and Brown populations.
Lara-Millán finds that county jails and public hospitals face surprisingly similar quandaries. After decades of budgetary austerity, there are never enough resources to take care of all the populations that enter their doors (coerced or voluntarily). Both jails and hospitals navigate constantly changing financial opportunities and constraints. Both sets of officials face increasing legal requirements protecting the rights of their “clients.” In both cases, employees fear litigation and public backlash.
Though some of these constraints may appear to be positive developments—in particular the growing legal apparatus protecting the rights of incarcerated populations and patients—Lara-Millán shows how they come with problematic consequences on the ground. Specifically, he documents how both jails and emergency rooms end up enforcing systems of triage based on automated and human assessments of criminal and medical risk in order to prioritize the allotment of beds.
Throughout the chapters, Lara-Millán provides a deeply compelling analysis of how two specific interventions—risk-assessment tools and opioid medications—serve as stopgap measures in overcrowded jails and emergency rooms seeking to triage overwhelming flows of people needing care. Overall, officials implement risk-based triage and opioid administration in surprisingly similar ways. This convergence of jails and hospitals leads to what Lara-Millán analyzes as the ongoing “redistribution” of poor Black and Brown people who get shuffled back and forth between the two sets of institutions in a seemingly never-ending cycle.
Redistributing the Poor is an essential book for readers interested in public institutions, criminal justice, and the concrete effects of fiscal austerity and legal demand. Well-written and compelling, it does not shy away from complexity, and convincingly maps out the systemic contradictions that shape public institutions. In the lineage of classics such as Jonathan Simon’s [1993] Poor Discipline and David Garland’s [2002] The Culture of Control, as well as more recent monographs such as Forrest Stuart’s [2016] Down, Out, and Under Arrest and Issa Kohler-Hausmann’s [2018] Misdemeanorland, Redistributing the Poor changes our understanding of how public institutions can unwittingly perpetuate inequalityFootnote 1.
One area that could have been further explored is the role of material infrastructures and sociotechnical systems in implementing and automating some of the broader dynamics identified in the book. For instance, Lara-Millán mentions that officers use risk-assessment systems to make decisions about the kind of cells and care incarcerated populations receive. He does not provide much information about these tools, except in passing, mentioning that some of these instruments are built by a company called “Northpointe” [30, 66].
Yet Northpointe (now Equivant) itself plays an important role beyond the case of prisons. Indeed, for the past five years, Northpointe has been at the center of a major public controversy regarding one of its products, a risk-assessment tool for correctional facilities called COMPAS, for “Correctional Offender Management Profiling for Alternative Sanctions.” In an article entitled “Machine Bias,” investigative journalist Julia Angwin and her colleagues [2016] found that the tool was biased against BlacksFootnote 2. Northpointe disagreed, critiquing the methodology used by Angwin. Computer scientists entered the fray, offering different measurements of algorithmic fairness [Corbett-Davis et al. 2016Footnote 3]. In 2017, a Wisconsin Supreme Court case (Loomis v. Wisconsin) further argued that COMPAS violated defendants’ right to due process. Since then, many computer science and critical data scholars have used the example of COMPAS in talking about what Safiya Umoja Noble [2018] calls “algorithms of oppressionFootnote 4.” Most of these previous studies of Northpointe’s tools remain somewhat abstract, examining algorithmic bias without placing it in the deeper content of COMPAS’s role within criminal justice institutions.
This is exactly where Lara-Millán’s acute ethnographic eye provides an essential complement. In addition to sociologists and legal scholars, one hopes that computer scientists and critical data scholars will read Redistributing the Poor, which shows the concrete ways that public institutions, digital classification systems, and social dynamics interact in reproducing and amplifying inequality in the 21st century.
