The archipelago of concentration camps being filled by the Trump administration’s sadistic “interior enforcement” activities are a huge public health problem. There is a measles outbreak at the South Texas Family Residential Center (child prison) in Dilley, TX. According to recent reporting, ICE has simply stopped paying for medical care as the population of prisoners it oversees has doubled. Horrifying stories of medical abuse surface every day (one man was denied transplant medication; Rümeysa Öztürk, the Boston graduate student kidnapped by ICE and trafficked to Louisiana for writing an op-ed mildly critical of Israel, wrote of being denied her asthma medication). Conditions and techniques characteristic of War on Terror CIA “black sites” have been widely reported including at so-called Alligator Alcatraz. People are being increasingly menaced and detained while seeking medical care. 

Indeed, the “concentration camps” and the apparatus of violence they symbolize are an important public health issue – perhaps the most important public health issue right now. Trying to think them “through” public health recalls a recent historical example. When the Covid-19 pandemic started, something unprecedented in my lifetime happened: we started letting people out of prison and jail early. According to the Brennan Center, roughly 100,000 people (8% of the incarcerated population) were released from state and federal prisons and jails between March and June of 2020. There was a clear public health rationale for this. American prisons and jails were extremely high-risk settings for catastrophic disease spread; medical care in such settings is inadequate; carceral institutions are porous to the wider community and can drive epidemic spread outside the community. There was a clear and elegant public health demand attached to this project: “free them all for public health.” It seems only natural to revive this demand now, and especially appealing to those of us in public health who find ourselves horrified, whether for the first time or yet again, at the atrocities being committed before our eyes.

I want to think about this a little harder, because in the years since 2020 I’ve closely experienced the hard limits of making political demands in the language of public health. I want to do so by way of a consideration of historical analogies, with apologies and concessions to Nate, who planted this idea in my head (and whose writing on this you should keep an eye on). What work is the concentration camp analogy is doing in public health specifically? What does it reveal, and what does it conceal? I’m talking not about the strict definition of a concentration camp (which these ICE facilities clearly meet), but what it evokes in the cultural imagination – Nazi Germany. There are clear and obvious similarities; death and disease were rampant in the Konzentrationslager. But how do we use this analogy in the present? It’s clear that the Republicans are the Nazis, ICE are the SS… but who are the Democrats? Who are we? The concealing function of the analogy becomes clearer here. Using an analogy to a foreign country obscures the genetic lineage from our own past to the current abuses we see. And what we’re seeing is indeed continuous with the US project of incarceration and characteristics of US prisons. The litany of outrages is too long to fully enumerate here, so I offer instead some examples skimmed off the top of my head. Many prisons are situated upon toxic waste sites. Medical neglect is rampant, as is life-threatening exposure to extremes of heat and cold and to the effects of natural disasters. Shackling of pregnant prisoners during labor and delivery is common practice in this country. Even in its more routine aspects, our astronomically high incarceration rate (our reliance on incarceration as a social technology) means we lead the world in separation of families, psychological torture, and the destructon of human lives and souls.

Following this thinking, the current situation both is and isn’t a “public health issue” for the same reasons that the genocide in Gaza both is and isn’t a “public health issue.” There are identifiable public health correlates, obviously. Ultimately, though, what horrifies is not adjusted mortality rates or indices of disease spread. What horrifies is the unthinkable reality that living human beings just like us, with consciousness, with feelings, with souls, are being subjected to such brutal and dehumanizing experiences. Regardless of public health indices, and regardless of the public health rationale based on the threat that tolerating the subjection of prisoners to life-destroying conditions poses to “the rest of us,” the soul recoils at the degrading and dehumanizing treatment of other human beings, at sadism, at kidnapping, torture, and murder. Because that’s what we’re really talking about here: kidnapping, torture, and murder. 

Why do we want to talk about public health instead of talking about kidnapping, torture, and murder? That this is more comfortable and less “controversial” language for us is an indictment of our professional culture. Starting the argument from public health technicality is a way to take a moral position without assuming any of the risks such a position entails. Not just risks of retaliation or professional marginalization, which are real, but the psychological risks involved in admitting the responsibilities corresponding to a moral position. What does it mean to think of this not as a technical problem that can be solved at work but as an existential one? To admit that we don’t need to rediscover technical terms for what we already know – that kidnapping, torture, and murder are wrong and intolerable for any society that aspires to ideals of freedom and justice – is destabilizing.

This is why we need to broaden our arena of concern beyond public health. Just like the idea of “human rights,” a “public health response” is only as good as the moral politics supporting it. Those politics (socialist politics) consist of a principled commitment to equality, dignity, and justice, and a principled opposition to every form of inequality and violence, precisely because of the a priori moral unacceptability of inequality and violence – not just because of their deleterious public health effects. Every form of dehumanization degrades and violates the souls not just of the victims (who may be anyone, on any given day), but of all of us. Perpetrators and spectators alike. Processes of dehumanization and oppression resulting in public health problems are morally intolerable as such, not only when they cross some arbitrary threshold of statistically-determined preventable mortality. 

There is no case but the moral case. The public health data have precisely the moral valence that we give them and, crucially, that we are willing and prepared to act upon. The process of political development in public health is the process of developing just such a capacity for action – action that will be, by definition, not strictly related to public health in the majority of cases. The intellectual action consists of the movement from “free them all for public health” to, simply, “free them all.” Public health will follow.