Though hundreds of people die in jails and prisons across the United States every year, nobody knows the exact number. 

That ignorance is despite the strict monitoring of incarcerated people’s movement and the extensive record-keeping of their personal and biographical information. Since 2013, federal law mandates that counties and cities report all deaths in custody. But with little oversight and no enforcement mechanism to ensure local jurisdictions track and properly report this data, the exact number of people who die while incarcerated in this country remains unknown.

That’s a deadly problem to have, according to Roger A. Mitchell Jr. and Jay D. Aronson, authors of the recently published book, “Death in Custody: How America Ignores the Truth and What We Can Do About It.”

Mitchell is a forensic pathologist and professor at the Howard University College of Medicine. He was previously the chief medical examiner for Washington D.C.

Aronson is the founder and director of the Center for Human Rights Science at Carnegie Mellon University, where he is also a history professor.

Together, Mitchell and Aronson describe and contextualize the crisis of deaths in custody, leaning on infamous recent examples such as the death of 28-year-old Sandra Bland in a Texas jail. They also profile investigative journalists and academic researchers who have focused their attention on trying to count and make sense of these deaths.

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After probing the topic through six deeply researched and historically-rooted chapters, they reach a series of conclusions about how we can begin to address the crisis. Their recommendations include adding a mandatory check box to the U.S. Standard Death Certificate to note if someone dies in custody. There are already similar checkboxes for smoking, transportation-related deaths, and deaths during or after childbirth. They credit these boxes with giving researchers critical information about public health, which can spur life-saving changes such as seatbelt laws. 

Mitchell and Aronson also call on the Centers for Disease Control and Prevention and the Department of Justice not only to undertake a “centralized and coordinated effort” to grasp the number of deaths in custody, but also to urgently address the root causes.

“The principles found in science and medicine must be applied to our social diseases if we are to save lives and mitigate suffering,” they write.

Despite their proclivity toward science, they also dig deep into literature, music and the history of journalism to understand the magnitude of the problem of deaths in custody.

They ask, and implicitly answer: by “knowing better” — properly understanding how many people die in custody — “can we also do better?”

Jay D.. Aronson wrote “Death in Custody: : How America Ignores the Truth and What We Can Do About It” with Roger A. Mitchell Jr.

Arizona Luminaria spoke with Aronson (Mitchell was unavailable) about why so many people are dying in custody, what can and should be done about it, and his connection to the topic. The following conversation with Aronson has been edited for length and clarity.

Arizona Luminaria: Just last night (Sept. 26) we learned that Aaron Moore, a 36-year old man, died in the Pima County jail. So far this year, he is one of at least eight people to die inside the jail. Reporting on and investigating such deaths can be emotionally impacting, and I wonder what your personal and emotional involvement and investment is in the topic of deaths in custody. 

Jay Aronson: The emotional side for me is actually very complicated because I come at this as a human rights person. I had been doing work on the identification of missing people after conflict and disaster, casualty recording and estimation, and the use of video to reconstruct human rights violations. I had learned techniques to blunt the emotional aspects, without ever forgetting that I was reporting on sets of individual people who had been killed in some tragic circumstance, people who had families and emotional lives and who weren’t just numbers. So I had been doing this kind of delicate dance of not becoming emotionally invested in each investigation that I was involved in, but also not dehumanizing the people. And when I wrote about events, or when I talked about events, I always made the point that there are humans behind all those numbers. 

When I started doing this work [on the book] it was much harder for me because this isn’t some far off place. This is the United States and the type of person who is supposedly being protected by this system that sucks people in and grinds them up and often kills them, is me. I am the beneficiary of the system. And so it’s been very difficult for me to process that emotionally these deaths are happening in my name, I am partly responsible for them, even though I’m not directly responsible, but as a straight white male, with kids and a family and property and wealth, I’m the person being protected. 

And so it’s been hard for me to deal with that: The deaths in jails are happening in my name. And so I’ve gotten more emotionally involved as I’ve learned more about the system and the history of the system. I never really intended to focus on the American criminal legal system. This project came about because I asked Roger a question about where the data on death in custody is, so that I could put the videos [of police killings] I was seeing in context. I just wanted to know how common or rare these events were. In the U.S., where we have the best vital records system in the world, I assumed that someone knew, and the data just wasn’t being shared. It was shocking to me that it wasn’t available.

Q. And that shock prompted the book? Or what effect did it have on you?

A. I wouldn’t say it was a radicalizing moment, because that would be making the point too sharply, but it got me interested in why we don’t have a database of people who die in law enforcement custody in a democracy. When the state kills, the least that it could do is keep track so that we can minimize unnecessary deaths. And that got me interested in the system more generally. I started reading about the history of the US criminal legal system. And what I found out was infuriating, and that’s what was radicalizing, the history of incarceration in this country, the history of policing in this country. It’s not an accident that we suck poor, vulnerable people in who are facing mental health crises or poverty, and we put them in situations that are potentially deadly, and when they die, or when they’re killed in our names, we don’t really care. None of that is accidental. These things don’t just keep happening by accident, they’re happening intentionally. 

And that not knowing how many people are dying is an act of producing ignorance, it’s not an absence of information or absence of the ability to know, it’s an active decision that we make — not to know. Realizing all of that forced me to take seriously who the people were, and how they ended up where they were, and why they were there and why they didn’t get the care they needed. And to ask what kind of country we live in where thousands and thousands of people could die at the hands of police and in jails. And that as a community of people, we don’t really care that much. And so I would say that it’s been a slow process of radicalization. 

I don’t think the system is reformable as it exists. You can’t really see me, but I am the least likely radical you’ve ever met. And when I teach political issues, I teach them in a pretty centrist kind of way, that we need to understand the complexity of the problem and no one political ideology can give us all the answers. And, you know, we have to take the best of every different approach. But in this context, I’m radically abolitionist now. Not that we need to tear down the system tomorrow. But we need to dramatically reduce the presence of policing, we need to dramatically limit the use of jails, we need to dramatically cut down the number of people who are incarcerated for long or any periods of time, and we need to replace it with a system of care and compassion and offer opportunities for growth and rehabilitation. And so that’s a very long winded way of saying that it eats at me every minute of every day now that I know what’s happening. 

Q. Can you describe how the check box for smoking or transportation helped people understand the dangers of tobacco use or driving? What can we learn from previous checkbox campaigns?

A. Checkboxes for smoking and transportation allow us to know exactly how many people die as a result of those causes. Particularly with transportation, we get very granular data about exactly what happens to someone in a transportation related death. If they are a passenger or a driver, we know that. If they are a pedestrian or bicyclist, we know that. This allows us to develop better public health strategies and policies to combat these occurrences. It’s also important to keep in mind that for every death that results from a particular cause, there is a tremendous amount of harm that gets done that might not even get noticed.

One of the things that’s so important about the part of the death certificate that allows the certifier to know whether the person was pregnant or had recently given birth is that it allows us to look at risks beyond those that are explicitly biological. If lots of women are being murdered during that phase of life, or dying by suicide during that phase of life, we can pick up on things that we might not ordinarily notice. It’s the same with death in custody. The majority of deaths in custody are not violent deaths at the hands of a law enforcement official, rather they are natural deaths that can still be attributed to the criminal legal system in that they likely would not have occurred if the person was not interacting with a criminal legal system in some way.

Q. You advocate for thinking about deaths in custody from a public health perspective. Why is that framing important?

A. I think that we need to move to a different understanding of what public safety means. But I don’t want my view that the system that we have is untenable and that we need to create a new system to get in the way. I don’t want imagining a better system to get in the way of recognizing that the system that we have now and will have for a very long time, is extremely harmful and continues to do harm. And I want to document that harm. And I want to reduce that harm in a public health way. I’m enough of a historian to know that the worlds that we imagine only partly come true, but I want to be part of the community that imagines a better future and works toward it. But I also want to be a realist and then capture the harm that’s happening now. So that we can’t say we didn’t know. 

And that’s another way of saying that I’m an idealist. And I’m also a realist. And so I have to balance those two perspectives in the work that I do. I think there are some abolitionists who would just reject the very idea of even counting deaths, because if we reduce the numbers of deaths that will allow us to say we fixed the problem. That’s not the perspective that I take. But I also think we should know. And I think that once people realize how many people die in custody, and have good numbers, I think it’ll turn a lot of people off to the system. 

Q. You mention that getting accurate numbers may help us maybe address the problem. Can you articulate for us what the problem is? Why are so many people dying in custody?

A. The fact that we don’t have the data and the fact that people are dying are intertwined. The biggest problem is that we don’t care about a huge swath of our population. They’re minoritized, they’re excluded. They’re seen as expendable. And they’re seen as not worthy of existence. And that creates the conditions that lead them to die. And it also explains why we don’t count. Because we count what we care about. And the fact that people with severe mental illnesses, instead of being given care, are being thrown in jail. And poverty, in this country we have a very strange response to certain kinds of poverty. For some people we’re willing to see that it’s not their fault. But for many poor people who are seen as criminal, the problem is that they’re seen as inherently damaged, morally damaged, rather than the products of a bad situation. 

In our society we have decided that certain people are capable of reform and rehabilitation and others aren’t. And when we’ve decided that someone isn’t worthy of rehabilitation, or should have a second chance, or is worthy of social support, then we’re willing to throw them away. They become social garbage, essentially. And really, our prisons and jails are the trash bin that we use to throw away what we consider people who aren’t worthy of being in society with the rest of us. And that’s maybe being a bit too blunt. But I teach a class on crime, policing and law. And that’s essentially the historical story that we tell. And I do it with documents, I do it with real historical research. That’s the reality. And so when you don’t care about a certain group of people, you don’t document the loss of those people. And so the problem is, in part, that we’re allowing far too many people to die in custody because we as a society have decided we don’t care about them. 

And my hope is that by actually counting that we can generate some care and concern. And at least the problem is no longer invisible. 

Q. Our local medical examiner began tallying, as well as posting on a public dashboard, deaths that occurred post custody, after someone was released from the jail. After pushback from the sheriff’s department, the county is no longer publicly posting the number of post-custody deaths. Do you think tracking post-custody deaths should be implemented on a national level? Or what other means do we have for tracking deaths related to incarceration but that don’t exactly occur in custody?

A. We see the checkbox as one source of data among many. Once you have the checkbox, you can’t just go home, John, and start covering education. We still need lots of eyes on the system. We think that this becomes one of many bits of data. We also need people like you if there is a checkbox who are actually checking on the medical examiners and coroners to make sure that they’re capturing death in custody correctly and doing the investigations on that issue. So there has to be a system of oversight in place. And also, we need people who are on panels to review cases to make sure that all the relevant information is being collected. It’s not like one day, we decided that we wanted to capture maternal mortality, and we were getting every mother, every person who had had a baby within a year. With a new database, it takes time, and it takes continuous oversight and continuous effort. We need clear guidelines about when a date of death is in custody, we need to establish what’s the amount of time after release that counts as custodial-related, what are the conditions in which someone actually dies outside of the jail, or outside of the law enforcement agencies control that actually count as death in custody, and then we need people to constantly be checking up to make sure that those rules are being followed. So we know that systems don’t work without oversight. 

There will always be events that are missed. And that through engagement with community, through engagement with the medical practitioners, through engagement with social service providers, we can actually find more of those deaths. And you still never have a complete record. But if we care, then we can do much better than we’re doing now.

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John Washington is an investigative journalist based in Tucson with a focus on immigration and borders, as well as criminal justice and literature. His first book, "The Dispossessed: A Story of Asylum...