Exchange with an Expert: Dr. Monik C. Jiménez, SM, Sc

Monik C. Jiménez, SM, Sc is an epidemiologist and an Assistant Professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School. Her work is centrally focused on the role of carceral control in creating and perpetuating racial/ethnic inequities in health. Her work aims to center the voices of directly impacted community members and she works with community advocacy groups to design, disseminate and conduct research focused on community identified needs.

  1. Could you give a brief overview of your work related to incarceration and homelessness and health, and how you got involved in it?

I started working within the space of incarceration and homelessness through a community partner called Justice 4 Housing. I was doing work during the pandemic on the impact of Covid-19 on incarcerated people, and I partnered with a couple of organizations to develop a community-led survey on conditions of confinement. That’s how I met Leslie Credle, who worked with the organization Families for Justice as Healing. She had recently come home from incarceration, and we worked on this project together. We published the work, and it was a great experience. But one of the things I think is critically important when working with community organizations and members is building reciprocal relationships. So, towards the end of that project, I told her “if there’s any way my expertise can provide support for the work you’re doing, keep me in mind. I’m happy to discuss what that might look like, and to support your work with data or from a public health perspective.” And she then shared with me that she was starting her own nonprofit, called Justice 4 Housing. It’s focused on eliminating discrimination in housing for people who have criminal records. She told me she knew she would need data for this, and that we should figure out ways to work together. After this initial project, I started working with Justice 4 Housing on their SHARP (Stable Housing and Reintegration Program), which is a high-intensity wrap-around housing stabilization program. The goal of that work is to provide housing vouchers for people who are coming home from incarceration and to provide them with very robust wraparound services and to eventually get them into stable housing.

  1. You’ve been really engaged with community organizations throughout your academic career, so can you talk about the importance of that and share any advice for effectively bridging the gap between academia and the general public/specific vulnerable populations?

I think our approach in academia can often be very extractive in working with community-based organizations. Many times, the approach is to come in and say “this is an important topic in your community, and I really want to study it with you.” But I prefer the approach of embedding myself within the communities that I want to work with and learning what matters to them just by listening. I’m going to show up. I’m going to volunteer. I’m going to do all the things that academia quite frankly does not care about, but that are meaningful to building relationships. I’ve been very clear with the people that I work with early on, so they know I’m not coming with the frame of research and publishing, but I’m coming to serve. If we get to the research and publishing, great. But if that never aligns with their goals, I still believe in what they’re doing and I’m still learning things that will influence my research.

One of the most important things that I’ve learned is that the relationship is what’s most important. That’s what comes first, which can make it really challenging to do academic work because communities have their own goals and agendas and needs, and they don’t necessarily align with the grant system or the time it takes to publish things. Sometimes I want to do a scientific paper on a subject that’s going to take some time, and I have to think of which things are important to the community so I can disseminate the science in a way that is meaningful. There are those challenges around what is valued in academia versus what’s valued in our communities, as well as what feeds me as a scientist and a person. I think as public health practitioners, and as people in academia, we’re the ones that need to fix how we value community-based work, not the other way around.

  1. What are some policies that would best help to reduce the number of people caught in this cycle of incarceration and homelessness?

I think a lot of people are unaware of how structurally the bi-directional relationship between incarceration and homelessness is embedded within our society, and the barriers to obtaining stable housing for people who have experienced incarceration. A lot of policing is subjective, and people’s biases feed into perpetuating structural racism which leads certain groups of people into the carceral system, and then systematically excludes them from safe housing. And it systematically moves people back into incarceration, because if you do not have stable housing, you are at a higher risk of interacting with the police and being incarcerated. I think it’s the structural piece of that discrimination that codifies those barriers to housing that a lot of people don’t realize.

The only way to deal with that is through policy changes that are explicitly designed to eliminate inequities, because if they are not specifically designed to address inequities, they will simply perpetuate them. Key examples include any policy that discriminates against people with a violent offense on their record. That will systematically exclude Black and brown men, because they carry more violent charges than their white counterparts because of the way that our criminal punishment system is set up. It’s really important to be critical of policies like these that use race-neutral language but are embedding structural racism within them.

I also think we fail to see the whole person. When somebody is released from incarceration in his 50s after serving 35 years, we see this adult man with a violent offense coming out of prison, but we fail to realize this person hasn’t had the opportunity to make the normal milestones of adulthood. They’ve never had the opportunity to open a bank account or sign a lease or file taxes – things that we learn over time. We as a society do a really poor job of providing re-entry services tailored to people’s needs. And we have many people who have cycled through the system frequently, which creates extreme trauma. If we think about someone with a substance use disorder: Are they receiving the right treatment? Is it treatment they can utilize that’s culturally relevant? Do they have a safe place to live? These nuances can be more adequately be addressed when people with lived experience are at the table. That’s why the SHARP program with Justice 4 Housing is so unique, because the case managers and organization leaders are directly impacted women, which allows people to build a healthy social network with other people who have been through similar experiences.

  1. Are there any health effects of incarceration and homelessness that people may find surprising?

Thinking about health broadly, incarceration and homelessness systematically impact the communities at large by affecting things like the accrual of intergenerational wealth. When we have segments of the population that are heavily policed, that are cycling in and out of homelessness and the carceral system, the opportunity for stable housing is limited, let alone home ownership. For most people, owning a home is their primary investment. Thus, there are multi-layered impacts that incarceration makes within families by impairing that accumulation of wealth that can set up the future and health outcomes for the next generations.

I also think a lot of people don’t know that if somebody is incarcerated and their children are put into child services, one of the stipulations of getting your children back is having stable housing. Imagine you’re meeting all your metrics and trying to find a place you can afford to live in Boston. I’m faculty at Harvard Medical School and I live outside of Boston because the cost is outrageous. So imagine your inability to pay rent to be what is keeping you from having your children. The impact of being within the Department of Children and Family system is highly traumatizing for children, and this system that effectively breaks apart families has long-term effects over generations, especially around mental health.