Reactive, as they are, to eruptions of police brutality or perceived excesses of mass incarceration, these reformist postures have nevertheless failed to meaningfully contest the staggering immensity of the carceral enterprise or reckon with the many ways that, as Gilmore has written elsewhere, “the scope of prison touches every aspect of ordinary life” in America. In recent decades, the United States has systematically divested from social welfare and public health programs while pouring money and resources into the carceral system, turning prisons and policing into what Gilmore called in her pathbreaking 2007 study Golden Gulag, “catchall solutions to social problems.” Accepting the basic legitimacy and, by implication, the inevitability of a system that responds to human need with cops and cages, the reformist agendas that still dominate liberal discourse on policing and prisons have predictably achieved very little aside from the steady metastasis of carceralism into ever more aspects of social life.

The expansion of carceral solutions generates not just direct exposure to violence but also increases ambient vulnerability to premature death—an essential principle of the movement for police and prison abolition. Ronica Mukerjee and Carlos Martinez’s enlightening health-focused abolitionist collection All this Safety is Killing Us: Health Justice Beyond, Prisons, Police, and Borders takes this understanding as its point of departure. Consistent with Gilmore’s assessment, their crucial insight is not so much that policing and prisons can be violent—an obvious fact—but rather that they are profoundly and systematically deleterious to health along innumerable vectors.

Policing is also a pervasive physical threat in the United States. Every year, some 75,000 people experience police-inflicted injuries severe enough to require hospital treatment. Black people remain more than three times as likely as white people to be killed in police encounters. Even isolated interactions with police—ranging from personally experiencing police violence to simply living in a heavily policed neighborhood or facing the threat of deportation—are associated with increased risks of post-traumatic stress disorder, high blood pressure, and other health harms, which likewise fall disproportionately on marginalized communities.

Unlike much punditry on the subject, All This Safety is Killing Us catalogues carceralism’s realities by including contributions from sources that are grounded in the experiences of those most affected by policing and prisons. One vivid chapter authored by abolitionist Aminah Elster and colleagues is devoted to the severely dehumanizing and often invisible suffering caused by widespread medical neglect and harm within carceral institutions, excerpting a series of interviews conducted with women who have experienced medical abuse in the California prison system.

“When I was taken out for the hysterectomy… the doctor didn’t explain anything,” one person, who was given unnecessary surgery, recalled. “When it was explained to me later that what they did was wrong, I didn’t know it was wrong. I trusted them.” It is one of the book’s central refrains, how easily the people and institutions that claim to heal can function as instruments of harm.

Although often viewed as a relic of the past, this sort of involuntary sterilization—what Fannie Lou Hammer used to call the “Mississippi appendectomy”—remains legal in most states to this day, a contemporary eugenic program that now largely targets people with disabilities. These instances of racial violence in healthcare and policing are not aberrations. Situating the recent intensification of abortion criminalization alongside the country’s long history of medical experimentation on vulnerable populations and the still-common practice of shackling incarcerated patients in the hospital, Mukerjee and Martinez’s volume makes a convincing case for how carceralism remains an insidious element in American medicine.

A chapter authored by several resident OB-GYNs, i.e., physicians in obstetrics and gynecology, focuses on the routinely racialized and often nonconsensual practice of drug testing pregnant patients, providing a healthcare-focused illustration of issues that the legal scholar Dorothy Roberts brought to public consciousness with her monumental 1997 work Killing the Black Body. That book, which dealt broadly with the criminalization of Black women’s reproductive decisions throughout American history, opened with a story of collaboration between healthcare workers and police in Charleston, South Carolina, where, in an effort to arrest pregnant women who were using drugs, “police tracked down expectant mothers in the city’s poorest neighborhoods” and “invaded the maternity ward to haul away patients in handcuffs and leg irons, hours after giving birth.”

All This Safety is Killing Us links this analysis more directly to the healthcare system itself, drawing particular attention to mandatory reporting requirements. These laws, which exist in all 50 states, compel doctors, nurses, social workers, and others to report patients and their families to local welfare agencies in cases of suspected abuse or neglect. Such reports can directly contribute to the national family-separation epidemic that Roberts studied in her most recent book, Torn Apart. That system terrorizes a vast number of families by removing a staggering 200,000 children from their homes every year, in most cases for reasons that can be traced to the deprivations of racialized American poverty. In recent months, reporting has revealed yet another travesty of medicalized persecution: healthcare facilities around the country have been caught referring peripartum patients to those same family policing agencies when they or their newborns test positive for controlled substances that were prescribed to them in the hospital.

Predictably, police presence in hospitals introduces all the ordinary risks of policing into the medical setting. Hospitals and healthcare workers frequently assist police in the criminalization of patients, often sharing health information and property with police, granting police access to clinical care areas, calling police on patients in crisis, and conducting non-consensual medical tests or procedures at the request of police to aid in criminal investigations. Although data is hard to come by, police violence in healthcare spaces is also not rare. Several years ago, at one public hospital in Los Angeles, police shootings killed two patients.

In the tradition of abolitionist analysis and of radical politics more broadly, the diverse contributions to All This Safety is Killing Us, which range from essays to artwork, present these carceral tendencies in health as representative of a war being waged against marginalized populations. In an interview focused largely on his experiences with anti-carceral disability organizing in San Francisco, where I work as a resident physician, the author and activist Leroy Moore makes this point explicitly. Recounting a bevy of police murders of people with disabilities as well as the anti-homeless violence that has accompanied gentrification in the Bay Area, he urges a more comprehensive understanding of American legacies of disposability, a collective inheritance of what he calls the “soft eugenics that slowly kill us.”

“When institutions put out their version of what is healthy,” he says, “we gotta realize that health from their standpoint is not going to be healthy for the Black community or the disabled community.” It is an awareness that echoes previous generations of radical health activism and suggests a path forward for those interested in health justice today.

In Body and Soul, the sociologist Alondra Nelson speaks of how liberatory movements have long recognized that health and its withholding can be both instruments of violence and sites of radical struggle. As one Black Panther announcement celebrating the 1971 establishment of a “People’s Free Medical Clinic” in Berkeley put it: “We will be subjected to institutionalized genocide whether it comes from inadequate housing, the barrel of a pig’s shotgun, or from inadequate medical attention.” Moore takes a similar position, appreciating that when it comes to the slow devastation wrought by what the abolitionist Mariama Kaba once called “death-making institutions,” it ultimately matters little whether violence is meted out by the police, the hospital, or both working in concert. Then, as now, the challenge is in building the political consciousness and systems of care necessary to move towards a healthier social order.

All This Safety is Killing Us posits that this process begins with the cultivation of uncompromising solidarity. In the book’s first chapter, Ronald Leftwich, who leads restorative justice programming at the prison where he is incarcerated on a life sentence without the possibility of parole, writes of how he reached this understanding through his own experiences “as a survivor and perpetrator of deadly violence.” Recounting cycles of abuse and trauma in his own life, he shares how he arrived at what he sees as the central principle of abolitionist health justice, a form of care that insists “everyone matters, and no one is expendable.” These practices of care resist the violent logics of disposability so deeply embedded in the nation’s existing healthcare and carceral systems. It is a fitting encapsulation of the abolitionist demand for a truly healthy society, a proclamation that we might someday live in a world reflective of Gilmore’s recognition that “where life is precious, life is precious.”

The urgent questions before us have much more to do with building the political conditions under which a healthcare revolution is possible than with once again demonstrating truths that have already been so well-established. As Gilmore herself has warned, quoting the late great Barbara Harlow, there is no small danger in advocates who become “so overwhelmed by discovering the production of knowledge that they have forgotten about ‘just knowing something.’”

Mukerjee and Martinez wisely dedicate the focus of their volume to how clinicians, activists, scholars, and community members, both inside and outside prison, can organize in their own immediate surroundings to build systems of health and healing that meet people’s needs with far more humanity than existing carceral structures. Dispensing with the fantasy that a healthy post-carceral society can be built “in one fell swoop,” All This Safety is Killing Us responds to America’s carceral turn with refreshing clarity, emphasizing how abolitionist insights can be put to work—not only as policy prescriptions, but, more importantly, as practices in everyday life.

As liberal efforts for (siloed and circumscribed) reforms in healthcare and mass incarceration have stalled dramatically, with few results to speak of, the book’s vision of solidarity and organizing suggests the contours of a movement beyond the stagnant policy-first framings that currently define healthcare discourse. All This Safety is Killing Us finds inspiration in local healthcare-focused abolitionist campaigns across the country, from Atlanta’s “Communities Over Cages” to the Los Angeles rallying cry of “Care First, Jail Last.” Such efforts are aimed at reducing the carceral footprint and redirecting resources to meet community health needs. On the whole, the collection embraces the abolitionist methodology that Alex Vitale, the sociologist and author of The End of Policing, once articulated as “the systematic questioning of the specific roles that police currently undertake, and attempting to develop evidence-based alternatives so that we can dial back our reliance on them.”

Eschewing advocacy that centers national or even local electoral politics—there are no hopes hung in this book on the next victory of a Democrat, or even promises of Medicare for All—the solutions on offer here are more modest and, as an enlivening result, more demanding of those who would endorse them. A political throughline that ties together many of the book’s disparate chapters is the preoccupation with “overcoming the chasm between strategies aimed at short-term survival and longer-term social change,” as Martinez and two co-authors put it in an entry on building an abolitionist health praxis, one of the book’s strongest contributions. The abolition envisioned here is not one centered on having the right political views. It is much more deeply reliant on building a collective willingness to participate in anti-carceral politics with an eye to horizons of possibility that, in the words of the visionary abolitionist Rose Braz, are “not just an end goal but a strategy today.” ♦