Disability, Race, and Health Beyond the Carceral State

Benjamin A. Barsky*, Craig Konnoth*, Michael Ashley Stein† April, 2024

Embodied Injustice: Race, Disability, and Health. By Mary Crossley. Cambridge; New York: Cambridge University Press. 2022. Pp. xi, 246. $34.99.

Introduction

In Embodied Injustice: Race, Disability, and Health (“Embodied Injustice”), Professor Mary Crossley¹ argues that “attending to race-and-disability intersections (at both individual and social movement levels) is critically important to achieving progress toward health equity” (p. 8). Ableism and racism permeate core socio-legal institutions in the United States, leading people with disabilities (PWD) and Black people to experience worse health outcomes than other groups (p. 12). These groups continue to experience unethical and sometimes even abusive treatment in hospitals and other sites of health care delivery.² In other areas of law and policy, such as housing, education, and policing, PWD and Black people also experience conditions that threaten health and wellbeing.³ Embodied Injustice calls for intersectional grassroots efforts to address these harms.

Our Review focuses on the role that criminal law enforcement plays in exacerbating health inequities experienced by PWD and Black people. Criminal law enforcement acts directly on the bodies of PWD and Black people. It also interacts with and reinforces other mechanisms—health care, education, and housing—that Crossley identifies as determinants of such inequities (pp. 12–13). We argue that addressing these harms requires that we not only extricate criminal authority from these areas of law and policy but that we also rethink the operation of criminal law enforcement itself through the prism of grassroots intersectionality. In doing so, we offer a concrete example of Embodied Injustice’s vision that supports Crossley’s analysis.

Part I sets up the disability-race-health theoretical backdrop that undergirds the book and our analysis. Part II examines three case studies that Embodied Injustice uses to advance its intersectional health justice framework: motherhood, Medicaid, and mistrust in medicine. Within each case study, we emphasize how criminal law enforcement exacerbates inequities in health. Part III discusses areas beyond medicine that Crossley identifies as vectors of inequity, including housing, education, and the carceral system; notably, PWD and Black people also interact with the carceral system in the education and housing contexts. Part IV draws on some still-preliminary qualitative research on alternative emergency response programs (“Alternative Responses”), many of which have emerged from intersectional grassroots efforts of PWD and Black people to address health inequities created by criminal law enforcement. Even a brief examination of these programs allows us to reflect upon health and safety in ways consistent with Embodied Injustice’s vision for intersectional health justice.

I. Constructing and Reconstructing Theories of Disability, Race, and Health

Embodied Injustice’s thesis centers on how perceived biological inferiority is used as a rationale for exclusion and oppression. Historically, disability has been understood in biological terms, “as an innate, biological, or psychological trait to be cured or rehabilitated.”⁴ Race, too, has been understood in biological terms, as “reflect[ing] inherent differences that explain groups’ disparate social outcomes and justify racial subordination.”⁵ These biological understandings were reflected, for example, in eugenic policies that reached their apogee in decisions like Buck v. Bell,⁶ where Justice Oliver Wendell Holmes justified involuntary sterilization: “It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.”⁷ Such policies targeted both PWD and Black people. Buck has not been overruled, and biological misunderstandings of disability and race remain robust to this day.⁸

Thankfully, biologically deterministic theories are slowly yet promisingly being scrutinized and replaced by frameworks that ascribe health to social, political, and cultural determinants (pp. 46–49, 52–55). The social model of disability takes a largely exogenous approach by ascribing “disadvantages experienced by disabled people as flowing from social systems and structures” (p. 52) rather than from biologically inherent characteristics. Additionally, significant historical events—including the United Nations Educational, Scientific and Cultural Organization’s Statement on Race and the Human Genome Project—have helped create “a path for understanding race as a political and social fact: race as socially constructed, not biologically destined” (p. 47).

Thorny questions at the boundary of disability-race theories have arisen over time. For example, a debate rages among scientists and bioethicists about how to define racial identity in bioscientific research.⁹ Crossley suggests that “[a] person’s ancestry . . . may predict their genetic makeup (and its health implications), but their racial identity does not” (p. 47). Others have argued that even relying on a person’s genetic ancestry may be problematic, as it may “be serving as a proxy for differences in environmental effects, including the effects of discrimination.”¹⁰ Similarly, in the disability context, two of us have endorsed using neuroscientific evidence of behavioral impairments to prevent the imposition of punitive practices like the death penalty and solitary confinement.¹¹ Although members of the international disability rights community have attacked reliance on bioscientific evidence in the criminal context as instantiating biomedical notions of disability,¹² the use of such evidence is directed at preventing harmful and oppressive social practices.

Crossley analyzes biological versus social constructions of disability and race throughout her book, showing how biological constructions essentialize and oppress PWD and Black people in health care contexts. She also demonstrates how oppression is better understood through analysis of social conditions. We use Crossley’s analysis to show how the criminal legal system has reinforced biological frameworks and contributed to the social oppression that explains and worsens health inequities.

II. Three Facets of Intersectional Health Justice

Embodied Injustice uses three case studies to illustrate how medicine and health care institutions can harm PWD and Black people: motherhood, Medicaid, and mistrust in medicine. Each offers a rich account of how laws, policies, and practices have been determinants of morbidity and mortality among these populations. American health care has also internalized carceral logics and techniques, enhancing the inequities Embodied Injustice describes.

A. Motherhood

The chapter on motherhood makes the case that “[t]he practice and politics of motherhood presents an intersectional roller derby of sorts, where multiple aspects of a woman’s identity collide repeatedly” (p. 103). Historically and to this day, women with disabilities and Black women have suffered discrimination, stigmatization, and other forms of subjugation.¹³ These problems will be exacerbated for both groups by the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization,¹⁴ which overturned Roe v. Wade¹⁵ and ended the constitutional right to terminate pregnancy.¹⁶ Compounding the impact of Dobbs, the United States lags behind peer countries on key reproductive health metrics, including maternal and child mortality.¹⁷

The eugenic legacy of disability being an inherent deficit—as expressed in Buck—underlies practices in these areas. Thirty-one states and the District of Columbia allow the involuntary sterilization of PWD.¹⁸ Although these laws appear to afford due process, “judges may sympathize with family members, without seriously considering less invasive alternatives and critically assessing sterilization’s impact on the disabled person” (p. 109). Black women likewise have continued to be subject to eugenical practices.¹⁹ For example, Dorothy Roberts observes that well after the Second World War, mothers on Medicaid in South Carolina were forced to agree to postpartum sterilization if they wanted the only obstetrician in their area who accepted Medicaid to deliver their baby.²⁰ Research also shows that Black women continue to face a higher likelihood of sterilization than White women,²¹ which, “[g]iven the history of abusive sterilization practices, . . . merits further scrutiny” (p. 111). As Melissa Murray argues that these practices are part of a much larger program to control the bodies—and derivatively, the threatening and non-normative biology—of PWD and Black people.²² Criminal law exacerbates this program of reproductive control. Since Dobbs, more than a dozen states have criminalized abortion delivery services.²³

Beyond the context of abortion, criminal law enforcement reinforces the subjugation of Black mothers and mothers with disabilities well after childbirth.²⁴ Crossley describes how an entire legal infrastructure—most notably via the child welfare system—has worked to “disrupt[] maternal bonds” and separate Black mothers from their children, “produc[ing] enduring effects on both parent and child” (p. 125). As Roberts explains, our child welfare system “is deeply entangled with cops, criminal courts, and prisons, forming an integrated arm of the US carceral regime.”²⁵ It relies on groundless and racist assumptions of Black family dysfunction to legitimize its surveillance and enforcement tactics.²⁶

Behavioral health disabilities are similarly used as evidence of parental unfitness within the carceral child welfare system.²⁷ Evidence shows that forty-two states and the District of Columbia legalize the policing of parenthood among mothers with disabilities and permit the termination of parental rights because of disability status.²⁸ That number has remained stable over time, highlighting the entrenchment of stigmatizing and ableist laws that too often make parenthood among PWD impossible.²⁹

B. Medicaid

As Embodied Injustice explains, Medicaid and its expansion have been of “distinctive importance” for PWD and Black people (p. 136). It has enhanced health service utilization, decreased out-of-pocket expenditures among PWD,³⁰ and helped address the coverage gap that has disproportionately affected Black people (p. 139). Inversely, efforts that include challenges to Medicaid expansion³¹ have impacted these groups. States avoiding Medicaid expansion are those “whose uninsured residents living in or near poverty . . . are disproportionately Black and Brown” (p. 136). These states also invest the least in home and community-based services, including case management and personal attendant services, that ensure PWD can live in community-based settings rather than in segregated congregate institutions.³²

Medicaid’s reach, and its disproportionate benefits for PWD and Black people, are also limited by the criminal legal system. The so-called Medicaid Inmate Exclusion Policy (MIEP), a provision buried in the Social Security Amendments of 1965, prohibits the use of federal funds for the financing of health services in jails, prisons, and other detention facilities.³³ Resultantly, underfunded and often ill-monitored local and state governments are entrusted with carceral health care financing and administration.³⁴ This arrangement puts incarcerated people with health vulnerabilities—disproportionately those who are PWD or Black people—at risk of neglect or deprivation. As of this writing, California, Montana, and Washington are the only states that have succeeded in bypassing the MIEP via § 1115 waivers.³⁵ All other similar waiver requests are still pending approval by the federal government.³⁶ Efforts to repeal the MIEP have also failed, despite the momentum to do so that occurred during the COVID-19 pandemic.³⁷

Evidence also suggests that access to Medicaid can burden PWD and Black people with histories of incarceration. For example, one study found that Medicaid-enrolled people seeking mental health services after release were at higher risk of reincarceration because of “violations of the technical conditions of probation or parole,” which can include complying with treatment plans and passing alcohol and drug urinalysis screenings.³⁸ Additionally, policies that require Medicaid recipients to show proof of employment, otherwise known as “work requirements,” also intersect with criminal law enforcement to exclude recently incarcerated PWD and Black people. Evidence shows that a history of incarceration, which disproportionately affects these populations, is linked with employment instability after release.³⁹ Work requirements risk increasing uninsurance and worsening inequities given the labor-related difficulties that PWD and Black people experience upon release.

C. Mistrust

Powerful actors in medicine have exploited “Black bodies to further White goals” (p. 71). Examples range from nineteenth-century experimental surgeries on enslaved people (p. 72) to twentieth-century debacles like the Tuskegee Syphilis Study and the Kennedy Krieger Institute study (pp. 73–76). In the case of PWD, Saul Krugman’s research at the infamous and now-closed Willowbrook State School, where he distributed hepatitis-infected food to children with intellectual disabilities to study the virus and develop a vaccine, followed in these footsteps.⁴⁰ Other examples abound. For example, Harriet Washington recounts experiments conducted by University of Pennsylvania researchers at the Holmesburg Prison in Philadelphia, Pennsylvania.⁴¹ Those inside, most of whom were Black and many of whom were PWD, became guinea pigs for tests involving harmful and sometimes lethal substances, including pharmaceuticals, radioactive isotopes, and chemical warfare agents.⁴²

Crossley’s examples are historically situated, but the mistrust Embodied Injustice describes goes deeper because of the intimate relationship that exists between clinical and law enforcement actors (pp. 123–24). Police presence in hospitals in general, and emergency rooms in particular, compromises patient privacy and confidentiality, especially among PWD and Black people.⁴³ It can also lead clinicians to feel obligated to share information with police, including test results, diagnoses, and treatment details, even when clinicians have the right to refuse disclosure.⁴⁴ Even when the police intrude on private and confidential patient affairs, holding them to account is too often impossible because of permissive and police-friendly Fourth and Fifth Amendment doctrine.⁴⁵

Police presence affects the patient-physician relationship for PWDs and Black people far beyond emergency rooms. Some states require clinicians to call the police if patients behave in specific ways, including when pregnant people are found to be addicted to opioids.⁴⁶ These laws can deter people from seeking health care when they need it the most.⁴⁷ Criminal law enforcement also invades many aspects of medicine apart from reproductive health care.⁴⁸ These domains include behavioral health care, through the Drug Enforcement Administration’s monitoring and surveillance of controlled substance prescribing;⁴⁹ infectious disease medicine, through the criminalization of sexually transmitted diseases;⁵⁰ and pediatrics, through prohibitions on the provision of gender-affirming treatment.⁵¹ As Teneille Brown writes: “Everywhere you look, it seems, cops . . . blur the provision of health care with the prosecution of crime.”⁵²

III. Intermediary Determinants of Health

Embodied Injustice’s case studies show how the medical system, in tandem with criminal law enforcement mechanisms, has led to unnecessary and preventable harm among PWD and Black people. The rest of the book explicates how other “[i]ntermediary determinants” of health (p. 153)—including the criminal legal system, housing, and education—have exacerbated health inequities among these groups.⁵³ We also emphasize that housing and educational systems are enmeshed with the criminal legal system in ways that exacerbate health-related harm.

A. Criminal Legal System

Although we have analyzed the cross-cutting role that criminal law enforcement plays in exacerbating health inequity, Crossley herself considers the criminal legal system’s impact on health. The book frames this discussion around the rise of “law and order” rhetoric that gained traction during the latter part of the twentieth century and coincided with a shift from investments in social and welfare programs during the Great Society era (p. 194). This phenomenon resulted in an increased and generalized reliance on police, jails, and prisons to respond to problems as diverse as mental health crises, controlled substance addiction, and school disciplinary matters.⁵⁴

Embodied Injustice provides a helpful intersectional analysis: “[A]lthough mass incarceration is most often described as locking up Black and Brown bodies, critical disability scholars argue that the intersection of race, class, and disability better deﬁnes the bodies subjected to mass incarceration” (p. 171). As has been extensively documented, PWD and Black people experience higher rates of police violence than other groups (p. 170 n.92). They are overrepresented in jails, prisons, and other detention facilities (pp. 170–72). Once confined within these institutions, they, more than any other population, are subjected to punitive practices like solitary confinement.⁵⁵

Injustice does not stop there. Upon reentry, PWD and Black people disproportionately experience barriers that hinder their ability to reintegrate into their communities and avoid repeated encounters with the criminal legal system.⁵⁶ The MIEP plays a crucial role in this context. Scholars persuasively hypothesize that this provision has contributed to the high rates of drug overdose that occur after people are released into the community.⁵⁷ The COVID-19 pandemic also reinforced inequities experienced by people with histories of incarceration. For example, researchers have found that White incarcerated people benefited most from “the largest, most rapid . . . decrease in prison population in US history” that occurred early in the COVID-19 pandemic, in part because of disparities in average sentence length by race.⁵⁸ This finding aligns with the more general idea that the COVID-19 pandemic deepened preexisting vulnerabilities among PWD in institutional settings (p. 179).

B. Housing

Crossley critiques how the unavailability of affordable, accessible, and inclusive housing affects the health of Black people and PWD (pp. 159–61). Segregation, part and parcel of “the legacy of historically racist restrictive covenants, discriminatory zoning, mortgage discrimination, and redlining” (p. 156), is a well-documented driver of health inequities experienced by Black people (pp. 157–58). Furthermore, despite the deinstitutionalization movement initiated in the 1950s that shifted the focus of behavioral health care from inpatient to outpatient settings (p. 157), many PWD have become de facto excluded from the community at large: “[S]ome neighborhoods become identified as locations of congregate housing for people with cognitive or psychiatric disabilities” (p. 158).

For those with greatest vulnerability, like PWD and Black people, housing determinants are also shaped by policing and criminal law enforcement. In his ethnography of Skid Row in Los Angeles, California, Forrest Stuart finds that law enforcement officials leverage “the coercive power of the criminal legal system in an explicit effort to correct the attitudes, behaviors, and lifestyle choices” of individuals in the throes of homelessness.⁵⁹ This exercise of power has worsened health outcomes. For example, recent research reveals how the continual coercive displacement of unhoused individuals who inject drugs increases the risk of drug overdose and bacterial infection mortality and decreases life expectancy.⁶⁰ That research also finds that these efforts could be associated with one-quarter of deaths among unhoused individuals who inject drugs by 2028.⁶¹

C. Education

The educational system is another site where PWD and Black people are disproportionately at risk of health-related harm. One reason relates to “[s]chools’ use of extreme and exclusionary discipline”: “[c]hildren who are Black or disabled (or both) disproportionately face exclusion when schools rely on excessive disciplinary measures or place ‘difficult’ students in ‘alternative’ schools” (p. 165). This problem heightens the risk that youth will be subjected to law enforcement scrutiny. For example, one report found that Black students and those with “educational disabilities” who are removed from the classroom or disciplined by other means face a higher likelihood of incarceration.⁶²

While Embodied Injustice refers to disciplinary measures, Crossley does not explicitly connect the education system with criminal law enforcement. Yet the education system is often the first encounter with the criminal legal system for marginalized groups.⁶³ Although law enforcement presence in schools was rare during the first half of the twentieth century, between 20,000 and 30,000 officers work full time in these settings today.⁶⁴ Research also shows that law enforcement officers are more common in schools with large numbers of Black students, and that their presence disproportionally affects students with disabilities.⁶⁵ Consequently, members of these groups are arrested at school more often than their peers.⁶⁶ Such findings buttress conceptual accounts of the school-to-prison pipeline that has plagued middle and high school education for decades.⁶⁷

IV. Alternative Emergency Response Programs

Embodied Injustice emphasizes that the health-related harms that Black people and PWD experience arise from socially constructed phenomena rather than innate, biological deficiencies. Crossley calls for intersectional grassroots coalitions and movement building to address these harms. Preliminary qualitative research on Alternative Responses—which localities across the country created in response to mass protest demands following George Floyd’s murder—illustrates the potential of such movement building.⁶⁸ More particularly, by responding to cross-coalitional demands for health-affirming, non-police public safety responses, Alternative Responses not only have the potential to decrease criminal legal involvement among PWD and Black people but they can also attend to the very same intermediate determinants of health that Embodied Injustice emphasizes.

Intersectional Grassroots Activism. Alternative Responses represent a salient case study of Embodied Injustice’s vision for intersectional health justice—particularly, its call to center alliances between and across social movements (pp. 238–40). Consider the experience of Oakland, California, as an illustration. Decades of activism preceded the city’s eventual creation of the Mobile Assistance Community Responders of Oakland (MACRO).⁶⁹ As explained below, this movement has been composed by diverse racial and disability justice organizations. Although these organizations have had platforms that are distinct in many respects, they have shared the commitment to building sustainable and dignity-affirming public health and safety systems for historically marginalized communities.

Oakland’s long history of racial justice activism is well documented, notably as the birthplace of the Black Panther Party (BPP).⁷⁰ In some circles, the BPP may be known for its antistate activism, which, as Sami Schalk describes, has ushered images in the public’s mind of “Black men wearing black berets and carrying guns.”⁷¹ But this imagery overshadows the BPP’s deeply-held commitment to realizing the right to health and health care. The BPP’s “vision hewed closely to the fundamentally radical idea that achieving health for all demands a more just and equitable world.”⁷² Today, organizations such as the Anti-Police Terror Project (APTP), Critical Resistance, Neighbors for Racial Justice, and Root & Rebound have carried forward this vision.⁷³ These organizations have fought, for example, for disentangling policing from health care, decarcerating prisons and jails, creating pathways to reparations, and supporting formerly incarcerated people.⁷⁴

Precedent-creating disability justice activism has also occurred in the East Bay. The Center for Independent Living (CIL) in Berkeley, California, has played a leading role in the fight for the right of PWD to live in the community.⁷⁵ It famously helped to orchestrate the most important protest of the American disability rights movement. The protest involved a twenty-six-day sit-in at the San Francisco office of the United States Department of Health, Education, and Welfare.⁷⁶ The protesters demanded that then-Secretary Joseph Califano sign the regulations that would implement § 504 of the Rehabilitation Act of 1973, which prohibited all disability-based discrimination by recipients of federal funds.⁷⁷ The CIL remains engaged in disability justice advocacy, joined by organizations like the Homeless Action Center and the Homeless Advocacy Working Group.⁷⁸ These organizations work to ensure that PWD, many of whom are unhoused in and around Oakland, are connected to public benefit programs, receive legal representation, and enjoy safe and humane living conditions.⁷⁹

These strands of activism coalesced behind Oakland’s decision to create MACRO. City records and media reports indicate that in 2019, the city enlisted a community-based organization called Urban Strategies Council to determine the feasibility of an Alternative Response program.⁸⁰ The report emanating from that work integrated input and feedback from a cross section of advocacy-based community organizations in Oakland—including APTP, the CIL, and many others working at the nexus of racial and disability justice.⁸¹ After nine months of engagement with these organizations, the Urban Strategies Council recommended a program that would replace police in “mental health and non-criminal community crises.”⁸²

The Urban Strategies Council’s findings build on years of mobilization efforts to displace police in behavioral health crises. For example, the Oakland Power Projects, inspired by Critical Resistance research in Oakland in 2013, has offered residents trainings on how to avoid unnecessary contact with police during health-related crises.⁸³ These trainings emerge from recognition that “policing fails to meet people’s needs, and puts people in danger of arrest, imprisonment, and/or even death.”⁸⁴ Other organizations, namely the Anti-Police Terror Project through its MH First initiative, have created similar, community-led initiatives to decouple the provision of health care from law enforcement intervention.⁸⁵ These community-led programs have worked to offer concrete and achievable “alternatives to calling the police while simultaneously questioning the logic of police involvement in medical crises in the first place.”⁸⁶ Given the myriad of contexts in which criminal law enforcement shapes health care and social systems—including housing and education—limiting unnecessary police involvement is important to improve health and wellbeing. Similar initiatives likely exist in other localities that have decided to create Alternative Responses, but a comprehensive, systematic accounting of these efforts would go beyond the boundaries of this Review.

Curbing Criminal Law Enforcement. Alternative Responses have had success curbing police involvement in high-frequency, low-risk emergency calls involving people who are experiencing health-related difficulties, including behavioral health distress. This finding can be explained by the following institutional arrangement: A principle of emergency public safety services commands that if a situation presents a risk of danger or violence, then police must respond; Alternative Responses are ruled out.⁸⁷ To assess this risk, 9-1-1 communications personnel screen for issues like the presence of weapons, injuries, and threats of harm to self or others.⁸⁸ Typically, they will err on the side of caution and call on police versus Alternative Responses to make a public safety response.⁸⁹

Outside of situations that are considered dangerous, however, Alternative Responses have rather broad latitude to intervene. That latitude can apply to an array of incidents that are usually subject to law enforcement intervention, such as low-level controlled substance use, public disturbance, trespassing, and panhandling.⁹⁰ In most cases, these behaviors pose no threat to life and limb. This process is paradigmatic in how Alternative Responses have the potential to protect PWD and Black people from the inequitable health risks associated with criminal law enforcement.⁹¹

Addressing Intermediary Determinants of Health. Alternative Responses can also address the very same intermediary determinants of health that Embodied Injustice focuses on. For instance, Alternative Responses respond to situations that involve unstably housed or unhoused individuals.⁹² Such situations can range in severity, from somebody needing a fresh set of clothes to somebody suffering an overdose who immediately requires the administration of Narcan.⁹³ Depending on the nature of these situations, Alternative Responses often have the capacity to assess housing-related needs and provide support. If people do not have a place to stay, Alternative Responses can bring them to a shelter, where they may be able to spend the night.⁹⁴ They can also contact housing support providers who can create onramps for short- and long-term housing.⁹⁵ This focus on housing, although highly and inevitably contingent on resources that are available in the community, exemplifies the utility of Alternative Responses beyond their criminal diversionary function.

Evidence also suggests that Alternative Responses can help address crisis situations involving youth. Although Alternative Response interventions are generally confined to public settings, their scope can extend into settings like schools, where they can provide resources to students and personnel.⁹⁶ This scope of response serves a dual purpose. It addresses the needs of educators and other staff who lack the training to address certain crisis situations. Additionally, it has the potential to mitigate, and even prevent, youth encounters with police. Alternative Responses’ work with youth also extends to various community settings, such as group homes and libraries.⁹⁷ The widened purview stands as a potentially promising strategy to address the disproportionate criminalization of youth with disabilities and Black youth.

Alternative Responses can help to tackle intermediary determinants of health beyond housing and education as well. Many have emergency medical technicians or paramedics on staff, meaning they can conduct on-the-spot health care assessments.⁹⁸ These assessments can be helpful for understanding and following up on people’s health-related needs.⁹⁹ Alternative Responses also have a record of creating connections with community-based health providers and services, such as food banks and other nutrition assistance programs, clothing services, and hygiene service providers.¹⁰⁰ These responses illustrate how Alternative Responses have the potential to meet the health-related needs of marginalized populations, including PWD and Black people, without needing to rely on other public safety agencies.

Conclusion

Embodied Injustice is a timely intervention that laudably places disability and race at the center of health justice discourse. Its analysis of the disability-race nexus is sharp and thorough, and it offers critically important reflections on why centering the experiences of PWD and Black people is necessary to ensure a healthier, more just society. We recommend it to any scholar, policymaker, or practitioner who hopes to acquire a foundational and up-to-date understanding of the complicated and fraught relationship between disability, race, and health.

We have also emphasized throughout this Review the ubiquitous and often pernicious role that criminal law plays in American health care and public health systems, as well as its disproportionate impacts on PWD and Black people. Criminal law interacts deeply and intimately with experiences of motherhood and pregnancy, public health insurance systems, and the patient-physician relationship. Its influence also extends beyond the health care system, pervading other areas of life that shape health, such as housing and education.

In that light, we agree with Crossley that achieving intersectional health justice goes beyond improving health outcomes and addressing intermediary determinants of health that disproportionately affect PWD and Black people. Such goals, although crucial, would alone yield a framework for law, policy, and practice that is too narrow. Using Alternative Responses as an illustrative case study, we have shown that intersectional health justice requires bold democratic action that flourishes from the bottom up. This work can help to disentangle the public’s health from criminal law enforcement and to realign medicine and social support systems toward actual care.

* Incoming Associate Professor of Law, University of California College of the Law, San Francisco; Research Fellow, Center for Public Health Law Research, Temple University Beasley School of Law; Annual Fellow, Harvard Law School Project on Disability, Harvard Law School; Initiative Fellow, Edmond & Lily Safra Center for Ethics, Harvard University; Ph.D. Candidate in Health Policy, Harvard University. Mr. Barsky acknowledges support from the Robert Wood Johnson Foundation Evidence for Action Program.

** Martha Lubin Karsh and Bruce A. Karsh Bicentennial Professor of Law, University of Virginia School of Law.

† Executive Director, Harvard Law School Project on Disability, Harvard Law School; Visiting Professor of Law, Harvard Law School.