Early one morning in March, Donald Williams climbed into a twelve-seat van and headed toward San Quentin State Prison. As he drove, he swilled coffee while the rising sun turned the sky a hopeful pink. At the prison gates, he was greeted by guards who remember when he was a drug-addicted recidivist who cycled in and out of prison. The prison vehicle carrying soon-to-be released inmates stopped just outside the gate and Williams gave the guard the name of his pickup. The guard called out: "Copeland!"
From the rear of the vehicle emerged a skinny 36-year-old with short-cropped hair and a cane. Charles Copeland wore a gray sweatshirt, gray sweatpants, and white tennis shoes that he bought for three books of stamps, the currency of prison. In his arms, he cradled a paper sack filled with medications and inhalers for his numerous ailments: lupus, asthma, depression, and a congenital heart problem that sometimes gives him chest pains.
Williams ushered Copeland into the back of the van, and they made small talk as they drove back to Oakland. Copeland, whose original incarceration was for selling heroin, told Williams he'd been imprisoned for three months because he didn't report to his parole officer the last time he got out. Williams spoke with familiarity about prison and parole, and feeling more at ease with Williams, Copeland asked to borrow a cell phone to call his grandmother. Williams obliged, and the elderly woman's surprise, worry, and frustration were audible from the headset.
Once back in Oakland, Williams deviated from his usual routine by pulling through a McDonald's drive-through to buy some breakfast for Copeland since inmates are released without a meal. The parolee took careful but appreciative bites of an Egg McMuffin, as Williams rolled on to the morning's next stop: Healthy Oakland, a community medical clinic that works with ex-offenders such as Copeland.
But Williams wasn't just offering Copeland a ride and a meal. This warm handoff from San Quentin to Healthy Oakland is part of a growing national effort to connect people released from jails and prisons to health care soon after release.
Healthy Oakland, which received its state medical clinic license last year, takes a public-health approach to public safety. This past fiscal year, the clinic received $1.2 million from the county to serve as a one-stop health and social services center for the poor. In addition to its clinic, the "Save a Life Wellness Center," visitors can get help signing up for housing, employment, food stamps, even tax preparation.
"If our charge is to make communities healthier, then we have to look at all of the indicators that are causing a community to be unhealthy," says Anita Siegel, acting director of the Alameda County Public Health Department. "And we know violence is one of them. And we also know that the reentry population is coming to Oakland. And if there are no jobs or resources available, then they could end up committing crimes — which will continue the cycle of producing communities that aren't healthy."
Health care and violence prevention may not seem related, but Alameda County is betting there's an important connection between the two. For the past half-decade, the county's Public Health Department has been active in a growing movement that addresses social issues such as poverty, education, and crime as a way of creating healthier communities.
The many connections between social issues and public health are clear, but the reasons for them — what exactly causes what and how — remain unclear. But for now, the Public Health Department and clinics such as Healthy Oakland aren't fixating on the why. They believe that providing a combination of social and health services is one way to chip away at core problems like violence and crime.
Community Oriented Correction Health Services, a nonprofit organization based in Oakland, is at the forefront of this effort. It has helped create programs across the country that bridge medical care between jails and the communities where ex-offenders return. "Given the economic climate and the growth in incarceration, we are rethinking public policy on public safety," noted program medical director Dr. Keith Barton, who also has practiced at Santa Rita Jail. "There are multiple interventions for ex-offenders and health care is one of them, with substance abuse treatment being an important subset of that."
Since many offenders have substance-abuse or mental-health problems connected to the crimes they've committed, corrections departments and criminal justice policymakers argue that investing in medical care during reentry is good for public safety. "A lot of offenders come back to the system because, although they were stabilized while incarcerated, when they leave, they decompensate once they go off their medication and they go back to the behavior that got them arrested in the first place," observed Captain Ron McCuan, a health analyst with the National Institute of Corrections. "That's why corrections is taking such a long look at the continuity of care, and connecting with public health."
Meanwhile, elected officials note that attending to parolee health makes obvious financial sense because it's more cost-effective to treat ex-offenders — who tend to be less healthy and have higher rates of infectious disease than the general public — before they wind up in the emergency room.
Still other proponents see health care services as a "carrot to bring people in to talk about their other issues that are germane to reentry," said Sherri Willis, Alameda County Public Health's public information officer. "It's a medical model, using health as a portal to reach people to give them other types of services."