Mark Fleming

MARK D. FLEMING, University of California, Berkeley, California, was awarded a grant in April 2018 to aid research on “Managing the ‘Hot Spots’: Health Care, Policing, and the Governance of Poverty.” This project examined the relationship between medicine and carcerality in the United States through an ethnographic study of medical “hot spotting,” a health care intervention targeting the 1% most costly emergency room patients with intensive health and social services. Originally developed as a policing tool for identifying crime “hot spots,” the hot spotting practice of surveillance and resource allocation has been repurposed for the management of chronic illness in the urban poor, with the aim of reducing the overall costs of managing this population. The patients targeted for medical hot spotting are mostly people who have four or more chronic illnesses along with a nexus of conditions closely connected to concentrated urban poverty and structural violence including substance use, mental illness, and homelessness. Many of these patients also have histories with the criminal justice system and are intensively managed across multiple criminal, medical, and social services sectors. Police and medical hot spotting overlap substantially in terms of the techniques of surveillance and the targeted population: people living in sites of racialized poverty. This project asks, does the expansion of medical hot spotting represent a convergence with or divergence from the established, ongoing punitive and criminalized management of poverty? Is this strategy part of the medicalization of poverty, where chronic disease diagnoses become the primary grounds of poverty alleviation? By studying the entanglement of medical and carceral techniques in the management of high-cost emergency room patients, this project contributed an understanding of how states configure care and coercion in the governance of poverty today.