One evening this February in Binghamton, New York, Jackie Wood walked into a meeting of Justice and Unity for the Southern Tier (JUST)—a grassroots organization dedicated to ending mass incarceration—and placed a box on the table. Inside the box were her brother’s ashes. “We have to do something,” she said.

On January 8, Jackie’s brother, Robert Card, was brought into the Broome County jail on a drug court violation. Card had a brain tumor and, once in the jail, with no access to anti-seizure medication, began to experience multiple seizures, falling down and hitting his head. Correctional Medical Services, the private company contracted by Broome County to provide medical services in the jail, prescribed him Tylenol. Thirteen days after being locked up, Rob Card was taken out of the jail on a stretcher and placed on life support at the local hospital. He was pronounced dead at noon the next day. According to JUST, Card was the ninth person to die at the jail since 2011. In New York, as in many states, counties are required to report local jail deaths. But if, like Card, they actually die in a hospital, they are not counted.

Across the country, investment in jails, and disinvestment in health care and other social services, has had devastating consequences for people’s lives. On the Friday before he died, Rob Card called a close friend. “The jail,” he said, “is killing me.”

Binghamton is a small industrial city at the confluence of the Chenango and Susquehanna rivers in Broome County, near the Pennsylvania border. Once a center of industry and technology, it has experienced a massive loss of industrial jobs in the last few decades. Binghamton’s population today is little more than half of what it was in the 1950s. Broome County is mostly white and very poor, with a below average median household income and an above average poverty rate. Binghamton is also a university town, home to Binghamton University, a global research center with an undergraduate enrollment of nearly 18,000.

When the current sheriff of Broome County, David Harder, joined the force in 1964, the county had a population of around 212,000, and the jail had a capacity for fewer than 100 people. Today, around 200,000 people live in Broome County, and the jail can hold close to 600 people—which it does regularly. From 1964 to the present, the population of the city of Binghamton declined from around 75,000 to about 45,000 as industry left the county, leaving poisoned air and water for those who remained. In short, the social and economic geography of Broome County has changed through a period of deurbanization and deindustrialization. And while local, state, and national governments have taken away pieces of the social safety net, the county has invested more and more in police and incarceration.

Rural upstate New York has some of the highest jail incarceration rates in the state, and Broome County has the highest. In July of this year, Broome County's jail incarceration rate was 384 per 100,000 people between the ages of 15 and 64. This is in contrast to New York City (incarceration rate 120 per 100,000), which, since the early 1990s, has seen a decline in the number of people in jail.

Advocates and activists in New York City are now discussing how to end incarceration on Rikers Island and how ambitiously they can decrease the city’s jail population. Upstate counties, on the other hand, in many cases under pressure from the state of New York, have been building and expanding jails for decades. This trend has previously been noted by Binghamton University sociologist Bill Martin, who has written about jail deaths in Broome County. The problems remain, and people in the Southern Tier continue to organize against the violence of incarceration.

One bright, early autumn day last September, at the invitation of members of JUST, I drove up through the Catskills to Binghamton to attend a daylong meeting of advocates from around upstate New York. There were almost 30 people of widely varying ages in attendance. Most had either been incarcerated themselves or had loved ones who were currently or formerly incarcerated in county jails in the region.

By the end of the day, the attendees had agreed on “principles of advocacy” to guide their organizing. They agreed to work toward the abolition of cash bail and to advocate for healthy solutions to the social and economic problems facing upstate counties. The group also concluded that more community health care was needed—especially for mental health and substance use treatment—and that such treatment should not be located in a jail. “One of the greatest challenges we face,” read a document summarizing the meeting, “is the drive by Sheriffs, and county and state legislators to locate new health and treatment services in county jails. . . . We oppose all reforms that invest in and further empower police, jails, courts, and prosecutors—this includes renovations for ‘bigger and better’ jails.”

This opposition comes after decades of jail expansion in upstate New York. In the 1990s and early 2000s, upstate counties built thousands of new jail beds across the landscape of rural New York. As one upstate sheriff pointed out, investing in expanded jail capacity generally leads to more people in jail. In 2015, Broome County expanded its jail at a cost of $6.8 million, converting a gymnasium into housing for incarcerated women, and adding a 16-bed medical unit. The sheriff also hired 13 additional deputies as part of the expansion, a cost that will now be added to the jail’s annual operating budget. In constant dollars, the budget of the sheriff’s office has grown 20 percent since 2005, while the county’s population has fallen by 4 percent.

The advocates I spoke with in Binghamton told me they see additional funding for programs in the jail as reinforcing a wider shift from meaningful care and services to local incarceration. As Andy Pragacz, a Binghamton University graduate student and member of JUST told me: “We oppose all new money for jails.” Pragacz, who grew up in Binghamton, went on to describe Broome County’s need for better health care, more jobs, drug treatment, and robust social services like daycare. “That political project,” he said, “is imperiled by resource concentration in jails.”

In the summer of 2014, Alexis Pleus, an engineer from Broome County, lost her son Jeff to a drug overdose. In her grief, she began speaking with others who had lost loved ones to organize Truth Pharm, a small, Binghamton-based nonprofit that works to reduce the stigma of substance abuse disorder and advocates for improved treatment. Pleus’s experiences advocating for her own children, as well as her work with Truth Pharm, have led her to view jail as compounding substance abuse disorder rather than solving it. “Based on my own experience,” she said, “and then reading story after story after story after story in these grief groups; they were all the same. You know, I hate telling my own story because it’s just a repeat of everybody’s story. They’re all the same, it’s terrible. Like, the family’s looking for help, desperate for help, trying to get help, and their kid gets arrested. It’s just this pattern.”

Broome County has the second highest opioid overdose death rate of any county in New York—double that for the state overall. Jail incarceration, according to Pleus, exacerbates the problem rather than treating it. “There’s this perception,” she said, “that if [people with substance use disorder] are in jail, they're safe. And I feel like that's part of the problem. I feel like if people understood more how dangerous jail is, either while they're there, or the fact that when they get out they're actually at a higher risk of overdosing than if they never went in, people would start to rise up and fight against the carceral system even more. But they don't, because they don't understand. . . . I didn't understand either.”

Pleus went on to tell me that many in local law enforcement, claiming expertise on the opioid epidemic, tell parents that if their children won’t seek treatment, they should go to jail. “They’re touted as experts. And they sit in front of audiences and say `you should have your kid arrested if they won’t get help.’ And they tout this as a positive path. So families literally think that this is a solution. And it’s not.”

I asked Pleus why she didn’t see jail as at least a possible, if imperfect, short-term solution to addiction. “There's no care there,” she said. “There's no treating what got them there in the first place. . . . Everything that jail does would actually perpetuate or make their condition worse. Alienating them. Making them feel different. Making them feel separate. Making them feel shame. All of those things are, a lot of the time, what caused the person to use in the first place, or causes them to continue to use.”

“Jail provides no tools, at all,” she said. “And I think that that's really the biggest issue. But then I fear saying something like that, because I fear somebody would say ‘Oh so what you're saying is that if we provided better care in jail. . . .’ I don't want that to happen either. I just think that we should be addressing things in our community first, in a healthier way. In both of the cases with my sons, before they got arrested, they wanted help. If that were readily available, they might not have ever been in that situation, they might not have ever been incarcerated, and you know, it didn't help either one of them in either situation. Locking them up is not a solution.”

Earlier this year, I spent an afternoon in a Broome County McDonald’s talking to Jackie Wood, Robert Card’s sister. Card, she told me, was a father and a skilled carpenter. “His work is all over Broome County,” she said. Card was the youngest of three children, Wood said, and her brother was just 48 when he died. “He was the baby,” she said. “Nobody should be treated that way. . . . I just want people to know that he was loved.”

Card’s death is not the first suspicious death at the Broome County jail. In 2012, an investigation by the New York State Commission of Correction found that the jail’s outside medical contractor—Correctional Medical Care—did not follow its own procedures in the death of a 40-year-old man. And in April, three nurses who once worked at the jail sued Correctional Medical Care, claiming they were forced to falsify medical records to save money and to secure the company’s accreditation.

After her brother’s death, Wood and her family became active in JUST, attending meetings, talking with other people about problems in the jail and about the problem of incarceration in Broome County. In March, JUST and Truth Pharm staged a rally in Binghamton, demanding an inquiry into Card’s death. The protesters then went into a meeting of the Broome County Legislature, where they confronted their elected officials, holding them responsible for what happens in the jail.

Finally, the 30 or so protesters—which included people formerly incarcerated in the jail as well as those whose loved ones had died there—gathered outside the county municipal building and remembered Card. Professor Bill Martin addressed the crowd. “We want an independent, outside investigation of [Card’s] death,” he said. “We want independent oversight of the Broome County Jail. . . . We want policy that recognizes substance abuse disorder as a disease, leading to treatment in and by the community, rather than . . . criminalization and incarceration.”

Kevin Revier, a Truth Pharm member, spoke of the jail’s medical abuses. “These are extreme cases of what is happening to people on a daily basis,” he said. “We talk to people who go in there, and they lose their insulin, they lose their inhalers, they lose their prescribed medication, and they go through hell. And there’s really no justice. These deaths are extreme cases of what’s happening on a daily basis.” “We can’t only remember the people who died,” Andy Pragasz said. “Everyone who is incarcerated comes out worse. We’ve all seen people come out. Are they better? Are they better for having spent time in there? No. They come out worse. They dispossess poor people of the little they have.”

Jackie Wood, holding her brother’s ashes, also spoke. “This has got to stop,” she said. “My brother has got to be the last one. No more families can go through this. Rob isn’t going to rest in peace until something is done. We are not going to rest in peace until something is done. I promised my brother, listening to his heartbeat while he was hooked to that damn machine . . . that I would not stop until I had my last breath. And now I see that I am not alone.”