The carceral state beyond bars: Pretrial surveillance as a structural determinant of health.

The expanding reach of the carceral state has led to a rise in surveillance-based reforms marketed as humane alternatives to incarceration. Electronic monitoring (EM), an increasingly common condition of pretrial release, is often portrayed as a non-punitive solution to mass incarceration. Drawing on 40 in-depth interviews with individuals on pretrial EM in Cook County, Illinois-home to one of the largest and most restrictive EM programs in the U.S.-this paper critically examines the health harms that EM imposes on legally innocent people. We identify three mechanisms through which EM operates as a structural determinant of health: (1) persistent psychological distress caused by constant surveillance and legal uncertainty, (2) restricted access to medical care due to stringent movement controls, and (3) the use of emergency healthcare as a coercive and surveillance-laden last resort. Rather than shrinking the carceral state, EM spatially redistributes its harms and embeds carceral control within homes and bodies. We conclude by advancing abolitionist public health frameworks and outlining non-carceral alternatives that center dignity, autonomy, care, and community-based support.