Part of the series “Viewpoints on Resilient and Equitable Responses to the Pandemic” from the Center for Urban and Regional Studies at The University of North Carolina at Chapel Hill.
The COVID-19 pandemic is causing people around the world to question how this virus will affect the many public and private systems that we all use. We hope this collection of viewpoints will elevate the visibility of creative state and local solutions to the underlying equity and resilience challenges that COVID-19 is highlighting and exacerbating. To do this we have asked experts at UNC to discuss effective and equitable responses to the pandemic on subjects ranging from low-wage hospitality work, retooling manufacturing processes, supply chain complications, housing, transportation, the environment, and food security, among others.
Carmen Gutierrez is an assistant professor in the department of public policy at The University of North Carolina at Chapel Hill. Her research explores issues at the intersection of social stratification, the criminal justice system, and health, with an emphasis on how inequalities arise across race, ethnicity and citizenship. In this episode, she will discuss the risk and implications of COVID-19 among people on probation and parole in the United States.
Transcript – Viewpoints on Resilient & Equitable Responses to the Pandemic. Carmen Gutierrez: Risk and Implications of COVID-19 among People on Probation and Parole in the US
The effects of COVID-19 among people involved with the US criminal legal system may be particularly devastating for individuals on community supervision. People on community supervision through probation or parole are a group that overlaps significantly with the population in jails and prisons, who have been shown to have disproportionately high levels of death caused by COVID-19. According to a recent study, the COVID-19 death rate in prisons is three times higher than in the general population. For people on community supervision, the chances of death upon exposure to COVID-19 may be even higher. Compared to those in jail and prison, people on community supervision have higher overall levels of mortality and generally worse access to health care. People on community supervision also likely face high levels of exposure to the virus as a result of their interactions with jails and prisons as well as home and work environments that suffer heavy burdens of COVID-19 cases.
There are also important reasons to expect that ongoing policy efforts intended to manage the spread of the virus in US jails and prisons could further exacerbate COVID-19’s impact on the community supervised population. Since the beginning of the pandemic, most of the largest clustered outbreaks of COVID-19 in the US have occurred in jails and prisons. In response to these outbreaks, jail and prison officials across the country began releasing inmates on an early basis and diverting people from incarceration altogether in attempts to contain the spread of the virus. While doing so likely lowered the potential number of cases in carceral institutions, these actions also significantly increased the size of the population on probation and parole and relocated the risks associated with COVID-19 to their homes and communities. Prior to the pandemic, approximately 4.4 million people, or one in 55 adults, were estimated to be on community supervision through probation or parole. Nearly 200,000 people were added to this population between March and October of 2020 through efforts to reduce the number of people in jail and prison during the pandemic. Research on COVID-19 among people involved with the criminal legal system, however, has generally focused on people in jail and prison, while the potential impacts of COVID-19 among people on community supervision have remained unknown.
To address this important and timely research gap, I worked with Evelyn Patterson, a professor of sociology at Vanderbilt University, to conduct a study investigating the extent to which people on community supervision are vulnerable to COVID-19 and have access to care during the pandemic. Because there is currently no data on actual COVID-19 cases and deaths among people on community supervision, we inferred vulnerability to COVID-19 in two ways. First, we examined health risks that the CDC associates with severe COVID-19 illness. And second, we examined the factors identified by the CDC that put people in need of taking extra precautions during the pandemic, such as having a disability, asthma, substance use disorder, and living in a rural area. We inferred access to care based on health insurance and analyzed levels of coverage across COVID-19 health risks and extra precautions factors. Because they make up around 80 percent of all people on probation and parole, we focused on the population of men on community supervision. For all outcomes, we compared results among men on community supervision to men without any kind of involvement with the criminal legal system. For the sake of simplicity, I’ll refer to this comparison group as men in the general population.
In terms of vulnerability to COVID-19 illness or death, we found that men on community supervision were more likely to suffer from conditions that the CDC associates with higher risk for severe COVID-19 illness. On average, approximately 64 percent of men on community supervision were at risk for severe COVID-19 illness compared to only 48 percent of men in the general population. We also found striking age differences in the risk for severe COVID-19 illness. For example, we found that men on community supervision who were between the ages of 26 and 34 shared a similar level of risk for severe COVID-19 illness as men in the general population who were between the ages of 50 and 64. For both these groups of men, approximately 58 percent are considered high risk for serious illness or death if exposed to COVID-19.
We also found that men on community supervision were more likely than men in the general population to be in groups that the CDC identifies as needing to take extra precautions against COVID-19. As a reminder, the groups we examined were people with substance use disorder, disability, asthma, and those who live in a rural area. Among community supervised men in these groups, we found that roughly 70 percent were at high risk for severe illness or death from COVID-19, if exposed to the virus.
In our evaluation of health insurance, we found that men on community supervision were about twice as likely to be uninsured as men in the general population. Fully one quarter of the group of community supervised men at high risk for severe COVID-19 illness were uninsured. High-risk men on community supervision who lived in rural areas had even higher levels of uninsurance, with about 31 percent being uninsured.
Together, these results highlight the greater levels of risk for serious illness or death from COVID-19 and the disproportionate lack of health insurance among men on probation and parole during the pandemic. These findings also have a number of important policy implications. Overall, they indicate that decarceration efforts alone are insufficient for addressing the COVID-19 crisis among people involved with the US criminal legal system. People on community supervision, like those in jail and prison, are highly vulnerable to serious illness or death upon exposure to COVID-19—much more so than the average person in the general population. Many of those at risk for severe COVID-19 illness lack health insurance coverage, potentially causing them to go without needed care during the pandemic. If exposed to the virus, people on community supervision during the pandemic will be more likely to end up in emergency departments or to die prematurely due to complications from COVID-19. These outcomes have significant human and material consequences for American society, but they can be better managed and even prevented entirely through improvements in access to health care. Providing all people involved with the US criminal legal system with universal emergency Medicaid during the pandemic is one plausible policy solution. As cost savings from reductions in emergency department use and premature mortality could offset the cost of expanding access to health care, states have significant budget incentives to increase health insurance coverage among people leaving jail and prison and those on community supervision during the pandemic.