Sickle Cell Anaemia and Deaths in Custody in the UK and the USA

An unexplained death in custody represents an important focal point for public scrutiny of the criminal justice system, especially when excess deaths occur in those of minority ethnic descent. Sickle cell anaemia is a serious inherited blood disorder disproportionately affecting minority ethnic groups. Sickle cell trait is the genetic carrier state and not an illness. The evidence suggests that the treatment of sickle cell in the criminal justice system is twofold. Justice authorities have misused sickle cell trait to explain away ten sudden deaths, often associated with forced restraint, of AfricanCaribbean people in custody. Meanwhile, seven deaths have been attributable to lack of provision of health care for those prisoners suffering from the illness sickle cell anaemia. In this article, we examine critically the attraction that explanations based in reductionist versions of genetics have in discourses in the fields of both criminal justice and health. We approach this by considering a case where the two discourses meet. We document the manner in which sudden deaths of people of African-Caribbean descent are explained by the criminal justice authorities. We also look at the way in which sickle cell anaemia is reified as a marker of health issues affecting only people of AfricanCaribbean descent. The two discourses meet when the carrier status sickle cell trait is invoked as indicative of the alleged vulnerability of the male of African-Caribbean descent to death whilst being restrained when in the charge of police, prison, or army officers. We contrast these accounts with other accounts of the lack of sympathy and care for those living with the illness sickle cell anaemia within custody in the USA or the UK. This contrast represents two related points on the same racist and abusive continuum. We attempt to draw out the consequences of the pervasive nature of this discourse both for the treatment of people of AfricanCaribbean descent in the criminal justice system, and for the advancement of treatment and understanding of the condition sickle cell anaemia in the criminal justice system, in health services, and in wider society. The data are drawn from a 30-year timescale, but this merely helps to explain why the pattern has not been noted before, and why each occurrence can be The Howard Journal Vol 45 No 1. February 2006 ISSN 0265-5527, pp. 14–28