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'Health Behind Locked Doors' course explores incarceration, institutionalization

Lecturer Jennifer Sarrett with her class prior to Emory’s transition to remote learning. When the pandemic forced the course’s format to change, Sarrett also adapted the content to discuss how health disparities were playing out in real time.

Spring semester began with Jennifer Sarrett teaching her “Health Behind Locked Doors” course with a planned emphasis on the physical and mental health concerns of people living in disability-related institutions as well as in prisons and jails.

The course was developed by Sarrett in Emory’s Center for the Study of Human Health, which encourages students and faculty to explore aspects of health from a variety of different fields. Sarrett, a lecturer in human health, led discussions that incorporated public health, history and philosophy to illustrate how institutionalization and disability often lead to poor health outcomes.

Halfway through the semester, the COVID-19 outbreak played out that lesson in real time. Early data show COVID-19 disproportionally impacts African Americans, while the highly contagious disease has spread rapidly in jails and prisons, as well as in residential group homes.

“It’s one thing to know the disabled are often the ones pushed aside in a triage situation,” Sarrett says. “It’s disheartening to see those people are still not included in emergency planning, even as we know better.” 

Gabi Davis, a human health and visual arts double major with plans to become a physician, gravitated to the course because she wanted to better understand the higher medical burden borne by African-American patients, especially in maternal care.

The course outlined how race and ethnicity are invariably linked to the circular relationship between developmental, intellectual and psychiatric disabilities and incarceration – in which disabilities can lead to imprisonment and incarceration can create disabilities. Those fault lines have again appeared in the current pandemic. 

“What’s happening now is we are seeing every level of being disadvantaged being exacerbated by this virus,” says Davis, who graduated May 11. “The virus isn’t targeting people based on race or socioeconomic status. It’s the way America has disadvantaged some people that is making them bear the brunt of this.”

Impact of disabilities

Sarrett developed the course after her previous work with children with autism as a special educator led her to pursue an academic career. Her doctoral research explored the personal, cultural and professional experiences of autism in Atlanta and Kerala, India.

As she continued research into the experience of autistic adults, one fact jumped out.

“I saw that people with autism and related disabilities are over-represented in the criminal justice system,” she says. “They are less likely to get justice as victims because of their developmental disability. And if a young man, especially a young black man, with autism has an encounter with police, there is a much greater likelihood of something going wrong.”

Jacob Klaus was well into his undergraduate business degree when he realized he was more interested in that kind of focus on people. He is now in the fourth-year of an approved five-year program to earn a human health degree on his way to medical school. 

He was volunteering as an advanced EMT for Emory Emergency Medical Services when the outbreak sent him out of the field and into his Atlanta apartment for the rest of the semester.

“Just thinking about the political dialogue now, it seems more people can see that if you can afford health care but your neighbor can’t, you both can be at risk,” Klaus says. “Not everyone who calls for help is heard in the same way.”

Sometimes, Sarrett says, they are not heard at all. People with disabilities are often left out of emergency planning. Those who are incarcerated tend to literally lack access to ways to be heard, even as rules remain in place that limit critical help for things as simple as soap or the time allowed to bathe. 

“Anything that involves scarce resources is terrifying for members of the disability community, who often are considered as contributing less to society and therefore less deserving of care,” she says. 

‘We are not powerless’

Sarrett will teach the course again this fall, though it is too early to tell how the ongoing outbreak will come up in class. It is likely to, though, based on junior Jimmy Zhang’s experience in the spring session.

 Zhang, a human health and biology major, completed the course from his Illinois home. He says he was more aware of social undercurrents in the news about the pandemic, where consideration for compassionate health care extends beyond the science and into the policy realm, especially for people in prisons, jails and residential institutions for those with disabilities.

“We forget about them but we are not powerless to change that,” Zhang says. “It’s very enriching to what I want to do as a family physician, to remember how important it is to consider someone’s full identity if you want to provide true care.”

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