Healthcare, Prisons, and Intersectional Reform

Does unequal access to health care lead people to prison? Does universal health care decrease the number of people being sent to prison? What type of remedies would provide more equal access to health care?

One of the most important parts of my overarching intellectual and political project is to analyze the ways in which inequitable social conditions lead people to prison in the United States and in Brazil and to examine how intersectional remedies might be used to address these institutionalized disparities. Part of this discriminatory matrix includes the fact that race, gender, and class based disparities make it difficult for members of poor communities of color to access health care in the US and in Brazil - even though it is a basic human right. Today, while interviewing members of an organization that provides health care for poor Afro Brazilians through religious practice (spiritual/holistic) and learning about the negligent health care that Afro-Brazilians receive, I came to see possibilities for health care remedies in a new light.

After a series of questions about Black access to universal health care, about the implementation of the national Black health care policy, and about the continued denial of reproductive autonomy to Black women through state-sponsored sterilization, I asked, on a whim: “Is sex work regulated under the national health care plans?” In response, the director of the organization told me, to my disbelief, that sex workers were involved in implementing universal health care through the expansive and progressive Brazilian AIDS program, under the Commission of Health. Like other organized marginalized groups, including Black movement activists, transgendered people, transsexuals, GLBTI people, and farmers (I am assuming landless farmers), sex workers work directly with the state to implement health care.

This information provokes many questions for me and challenges some of my positions on the viability of state reform. Under which conditions and on which issues does working ‘within’ the state become more effective than working without? Although my research on the Gender Responsive Strategies Commission [for women prisoners] has made me wary of this approach, how does placing a network of community organizations in positions of power bypass some of the problems associated with individual political representation? Which organizations get a ‘seat at the table?” Could such reform be considered intersectional in that members often occupy multiple identity positions (for example, members of the sex workers organization might also be queer women of color) or is this a thin version of identity politics? How does this type of reform help us to understand the problems associated with gender responsive prison reform in the US and gender conscious responses to violence in Brazil? Today’s organizers informed me that even under the hard-fought anti-sterilization law, Black women are still denied informed consent. Knowing that women of color continue to be subjected to health care violence, is expanding the [less?] repressive health care system less dangerous for women of color than expanding the [more?] repressive prison system, as my argument contests? What might be learned about intersectional remedies from comparing the health care contexts in Brazil and in the United States?