There’s a popular action movie trope in which the heroic protagonist, temporarily believed to be the bad guy, must covertly treat an injury instead of going to a hospital and risking being tracked or discovered. The circumstances driving these suboptimal health care choices are always extraordinary. Think of Rambo stitching himself up in the woods or Sarah Connor dealing with a wound from the T-1000’s blade. Things need to have really flown off the rails for a hospital to be off limits.
But a new study suggests that concerns about being tracked by the criminal justice system can lead people to avoid medical institutions even in the absence of extraordinary circumstances. And it’s not just a person’s health that can be put at risk. Fears about surveillance may also have a negative effect on financial and educational outcomes.
The study, conducted by Sarah Brayne, a Ph.D. student at Princeton, examines whether contact with the criminal justice system—anything ranging from incarceration to being stopped on the street by a police officer—leads people to opt out of certain institutions, a concept she calls “system avoidance.” Specifically, her question was whether police contact would increase system avoidance with regard to “surveilling institutions”—places like hospitals or banks that collect important personal information and give the sense you’re being “put into the system.”
A perfect storm of data collection and aggressive criminal justice policies can help to create a society that's toxic for social mobility.
Brayne analyzed two data sets: The National Longitudinal Study of Adolescent Health, which surveyed adolescents in 1994 and 1995, and then twice more between the ages of 18-26 and 24-34; and the 1997 National Longitudinal Survey of Youth, from which she examined four waves of data. Contact with the criminal justice system was divided into five categories: 1) no contact, 2) stopped and questioned, 3) arrested, 4) convicted, and 5) incarcerated. The surveilling institutions she examined included medical facilities, financial institutions, schools, and places of employment. As a comparison, Brayne examined contact with “non-surveilling” religious or civic institutions like churches and volunteer associations.
The results are revealing, disturbing, astounding—pick your adjective. Even after controlling for demographics, income, health, and behaviors like drug use or carrying a weapon, respondents who had any type of contact with the criminal justice system were 31 percent more likely than those who had no contact to not obtain medical care when they needed it. Even people who were merely stopped by police were 33 percent more likely to not seek medical care. On the other hand, contact with the criminal justice system was unrelated to engagement with non-surveilling institutions.
A similar patter emerged with regard to financial and educational institutions. Having contact with the criminal justice system was associated with a 19 percent increase in the odds of not having a bank account, and a 31 percent increase in the odds of not being enrolled in school.
The multiple time points in the surveys also allowed Brayne to slice the data a second way and look at how individuals modified their behavior over time as their contact with the criminal justice system changed. She found that transitioning from no contact to contact with the system was associated with 48 percent higher odds of not obtaining needed medical care, and 90 percent higher odds of going from having a bank account to not having a bank account. In contrast, changes in contact with the criminal justice system had no statistically significant effect on involvement with non-surveilling institutions.
The findings tell a convincing story about how fear of the criminal justice system can lead to negative health, financial, and educational outcomes. And because contact with the system is more frequent in low-income and minority communities, these negative outcomes ought to hit them disproportionately hard. A perfect storm of data collection and aggressive criminal justice policies can help to create a society that's toxic for social mobility.
One specific implication is that new laws establishing stricter requirements for voters could have a stronger impact on voter suppression. It’s possible that such requirements draw attention to the “being in the system” aspect of voting and make it seem more akin to engaging with a surveilling institution. That these laws would actually induce surveillance concerns that cause people to stay home may seem like a stretch, but there is already research suggesting that concerns about ballot secrecy—a distinct but not completely unrelated concern to surveillance—can depress voter turnout.
Despite the study’s extensive controls, it is possible that the findings have an alternative explanation that’s more pedestrian than fears of surveillance. The fact that getting arrested makes people less likely to have a bank account seems self-evident, for example. And although there are very few barriers to going to a hospital or opening a bank account, it’s plausible that what appears to be willful avoidance of surveilling institutions is actually driven by discrimination. But at the very least, there is probably causality in both directions—people choose to avoid surveilling institutions and are pushed away from them—and even with these potential alternative explanations the study still provides compelling evidence that surveillance concerns lead to negative health, financial, and educational outcomes for a disproportionately low-income population.
More broadly, the study is a reminder that policies are set by people who, for the most part, don’t have threatening contact with the criminal justice system or a reason to be suspicious of it.
In policy debates there’s a notion that support for a more intrusive intelligence apparatus comes from people who shortsightedly believe they have nothing to hide. But a more accurate characterization may be that support comes from people who know that nobody is coming to look for what they’re hiding. Brayne’s study shows that, among the many Americans who don’t have such a luxury, efforts to compensate for its absence may lead to a variety of negative outcomes.