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Why 4,998 died in U.S. jails before their day in court

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Why 4,998 died in U.S. jails before their day in court

Harvey Hill wouldn’t leave John Finnegan’s front yard. He stood in the pouring rain, laughing at the sky, alarming his former boss’ wife. Finnegan dialed 911.

“He needs a mental evaluation,” the landscaper recalls telling the arriving officer. Instead, Hill was charged with trespassing and jailed on suspicion of a misdemeanor offense that could bring a $500 fine.

It was a death sentence.

The next day, May 6, 2018, Hill’s condition worsened. He flew into a rage at the Madison County Detention Center in Canton, Mississippi, throwing a checkerboard and striking a guard with a lunch tray.

Three guards tackled the 36-year-old, pepper sprayed him and kicked him repeatedly in the head. After handcuffing him, two guards slammed Hill into a concrete wall, previously unpublished jail surveillance video shows. They led him to a shower, away from the cameras, and beat him again, still handcuffed, a state investigation found. The guards said Hill was combative, exhibiting surprising strength that required force.

Video showed Hill writhing in pain in the infirmary, where he was assessed by a licensed practical nurse but not given medication. Mississippi law dictates that a doctor or higher credentialed nurse make decisions on medical interventions. But Hill was sent straight to an isolation cell, where a guard pinned him to the floor, removed his handcuffs, and left him lying on the cement. Hill crawled to the toilet. Then he stopped moving.

No one checked him for 46 minutes. When they did, he didn’t have a pulse. Within hours, he was dead. And he had a lot of company.

Hill’s is one of 7,571 inmate deaths Reuters documented in an unprecedented examination of mortality in more than 500 U.S. jails from 2008 to 2019. Death rates have soared in those lockups, rising 35% over the decade ending last year. Casualties like Hill are typical: held on minor charges and dying without ever getting their day in court. At least two-thirds of the dead inmates identified by Reuters, 4,998 people, were never convicted of the charges on which they were being held.

Unlike state and federal prisons, which hold people convicted of serious crimes, jails are locally run lockups meant to detain people awaiting arraignment or trial, or those serving short sentences. The toll of jail inmates who die without a case resolution subverts a fundamental tenet of the U.S. criminal justice system: innocent until proven guilty.

“A lot of people are dying and they’ve never been sentenced, and that’s obviously a huge problem,” said Nils Melzer, the United Nations’ special rapporteur on torture and other inhuman punishment, after reviewing the Reuters findings. “You have to provide due process in all of these cases, you have to provide humane detention conditions in all of these cases and you have to provide medical care in all of these cases.”

The U.S. Constitution grants inmates core rights, but those provisions are hard to enforce. The Fourteenth Amendment guarantees fair treatment to pre-trial detainees, but “fair” is open to interpretation by judges and juries. The U.S. Supreme Court has ruled that the Eighth Amendment’s ban on cruel punishment forbids “deliberate indifference to serious medical needs of prisoners,” but proving deliberate negligence is difficult. The Sixth Amendment assures speedy trials, but does not define speedy.

The Reuters GFN revealed a confluence of factors that can turn short jail stays into death sentences. Many jails are not subject to any enforceable standards for their operation or the healthcare they provide. They typically get little if any oversight. And bail requirements trap poorer inmates in pre-trial detention for long periods. Meanwhile, inmate populations have grown sicker, more damaged by mental illness and plagued by addictions.

The 7,571 deaths identified by Reuters reflect those stresses. Most succumbed to illness, sometimes wanting for quality healthcare. More than 2,000 took their own lives amid mental breakdowns, including some 1,500 awaiting trial or indictment. A growing number – more than 1 in 10 last year – died from the acute effects of drugs and alcohol. Nearly 300 died after languishing behind bars, unconvicted, for a year or more.

As with much of the U.S. criminal justice system, the toll behind bars falls disproportionately on Black Americans, such as Hill. White inmates accounted for roughly half the fatalities. African Americans accounted for at least 28%, more than twice their share of the U.S. population, a disparity on par with the high incarceration rate of Blacks. Reuters was not able to identify the race of 9% of inmates who died.

Jail deaths typically draw attention locally but escape scrutiny from outside authorities, a gap in oversight that points to a national problem: America’s system for counting and monitoring jail deaths is broken.

A broken system of federal oversight

America’s 3,000-plus jails are typically run by county sheriffs or local police. They often are under-equipped and understaffed, starved for funds by local officials who see them as budgetary burdens. A rising share have contracted their healthcare to private companies.

Yet there are no enforceable national standards to ensure jails meet constitutional requirements for inmate health and safety. Only 28 states have adopted their own standards to fill the gap. And much of the oversight that does exist is limited by a curtain of secrecy.

The Justice Department’s Bureau of Justice Statistics has collected inmate mortality data for two decades – but statistics for individual jails are withheld from the public, government officials and oversight agencies under a 1984 law limiting the release of BJS data. Agency officials say that discretion is critical because it encourages sheriffs and police to report their deaths data each year.

The secrecy has a cost: Local policy makers can’t learn if their jails’ death rates are higher than those in similar communities. Groups that advocate for inmates’ rights can’t get jail-by-jail mortality data to support court cases. The Justice Department’s own lawyers, charged with taking legal action when corrections facilities violate constitutional standards, can’t readily identify jails where high death counts warrant federal investigation.

“If there’s a high death rate, that means there’s a problem,” said Julie Abbate, former deputy chief of the Justice Department’s Special Litigation Section, which enforces civil rights in jails. Publicizing those rates “would make it a lot harder to hide a bad jail.”

The Justice Department does issue broad statistical reports on statewide or national trends. But even those fatality numbers don’t always tell the full story.

Some jails fail to inform BJS of deaths. Some report them inaccurately, listing homicides or suicides as accidents or illnesses, Reuters found. Justice Department consultant Steve Martin, who has inspected more than 500 U.S. prisons and jails, said that in all the cases he’s investigated, he recalls only one homicide being reported accurately. The others were categorized as “medical, respiratory failure, or whatever,” he said.

Other jails find other ways to keep deaths off the books, such as “releasing” inmates who have been hospitalized in grave condition, perhaps from a suicide attempt or a medical crisis, so they’re not on the jail’s roster when they die. Sheriffs sometimes characterize these as “compassionate releases” that allow inmates’ families a chance to spend their final hours together without law enforcement supervision.

In all, Reuters identified at least 59 cases across 39 jails in which inmate deaths were not reported to government agencies or included in tallies provided to the news organization.

The Justice Department has grown more secretive about the fatality data under the Trump administration. While BJS never has released jail-by-jail mortality figures, it traditionally has published aggregated statistics every two years or so. The 2016 report wasn’t issued until this year.

And, a Justice spokesman said, there are “no plans” to issue any future reports containing even aggregated data on inmate deaths in jails or prisons.

The report delays are “an outrage,” said Representative Bobby Scott, a Virginia Democrat who co-authored the original reporting law in 2000 with a Republican colleague. Scott said secrecy was never the goal. He co-authored a 2014 update, which restricts federal grant money when jails don’t report deaths and shifts data collection to a different Justice Department agency that would not be restricted from releasing jail-by-jail data. The updated law has yet to be implemented.

“The whole point,” Scott said, “is we suspect a lot of the deaths are preventable with certain protocols – better suicide protocols, better healthcare, better guard-to-prisoner ratios. You’ve got to have information at the jail level. You have no way of really targeting corrective action if you don’t.”

Because the government won’t release jail-by-jail death data, Reuters compiled its own. The news organization tracked jail deaths over the dozen years from 2008 to 2019 to create the largest such database outside of the Justice Department. Reporters filed more than 1,500 records requests to obtain information about deaths in 523 U.S. jails – every jail with an average population of 750 or more inmates, and the 10 largest jails or jail systems in nearly every state. Together, those jails hold an average of some 450,000 inmates a day, or about three out of every five nationwide.

“You’ve got to have information at the jail level. You have no way of really targeting corrective action if you don’t.”

Reuters is making the full data it gathered available to the public.

One finding: Since the last Justice Department report, for 2016, the death rate in big jails has continued to climb, leaving it up 8% in 2019, the highest point in the 12-year period of 2008-2019 examined by Reuters. In that time, the suicide rate declined as many facilities launched suicide awareness and response initiatives. But the death rate from drug and alcohol overdoses rose about 72% amid the opioid epidemic.

The data also reveals scores of big jails with high death tolls, including two dozen with death rates double the national average.

Such data “would have actually been very helpful for enforcement purposes,” said Jonathan Smith, who ran the Justice Department’s Special Litigation Section from 2010 to 2015.

Rare scrutiny, reform

Detailed insight into jail deaths can save lives.

In 2016, the Justice Department began investigating the Hampton Roads Regional Jail in Portsmouth, Virginia, after state Attorney General Mark Herring and local civil rights groups called for a probe following several inmate deaths. Reuters found the jail, which serves five jurisdictions, averaged 3.5 deaths per thousand inmates over the years 2009 to 2019, more than double the national average of 1.5 deaths.

In December 2018, the Justice Department said the 900-bed jail violated inmates’ rights by failing to provide adequate medical and mental healthcare. The regional authority that manages the jail agreed to a “consent decree,” enforced by a federal judge, to ensure improved treatment of prisoners.

Inmate deaths dropped after the agreement, which required increased staffing, better training and enhanced medical services. The jail reported two fatalities in 2019 and one through this May, down from an average of five a year in the prior four years.

That was one of the Justice Department’s last jail investigations. From 2008 to 2018, the department opened 19 investigations into jails, three during President Trump’s tenure.

Yet since 2018, it hasn’t opened any. A memo circulated in November 2018 by then-Attorney General Jeff Sessions put hurdles in the way of entering consent decrees for overhauling jails. In a telephone interview, Sessions told Reuters the policy he set forth adhered to Supreme Court standards on when consent decrees could be entered, allowing them when “appropriate” and “justified.”

In the absence of federal oversight, states have a patchwork of guidelines.

Seventeen states have no rules or oversight mechanisms for local jails, according to Reuters research and a pending study by Michele Deitch, a corrections specialist at the Lyndon B. Johnson School of Public Affairs at the University of Texas. In five other low-population states, all detention facilities are run by state corrections agencies. The other 28 have some form of standards, such as assessing inmates’ health on arrival or checking on suicidal inmates at prescribed intervals. Yet those standards often are minimal, and in at least six of the states, the agencies that write them lack enforcement power or the authority to refer substandard jails for investigation.

Deitch said these gaps make comprehensive nationwide statistics all the more important. “You can’t have good policy without good data,” she said. “Data tells us what is going right and what’s going wrong.”

The Fossil

Without jail-by-jail mortality data, even jails with extraordinary death rates can escape official intervention for years, and local officials can remain blind to the seriousness of problems their facilities face. One example is the Marion County Jail in Indiana, a decrepit 65-year-old facility nicknamed “The Fossil” within the sheriff’s department.

Overfilled and understaffed, the Marion County jail had at least 45 deaths from 2009-2019. Yet local officials rejected pleas from two consecutive sheriffs for additional funding to bolster staffing and build a new facility.

Reuters found that the jail is among the two dozen with an average death rate, 3.5 deaths per 1,000 inmates, at least double the national average from 2009 to 2019. And its record was troubling on one of the most challenging problems plaguing jails: suicide, which accounted for more than a quarter of all U.S. jail deaths.

Thomas Shane Miles, a married father of two, struggled for years with mental illness and opioid addiction when he was arrested in 2016 on a misdemeanor drug possession warrant. On his second day in jail, he flung himself down a stairway and swallowed the contents of a chemical ice pack.

Put on suicide watch, Miles was given a “suicide smock” – a heavy hospital-style gown closed with Velcro – and placed in a monitored cell. The jail’s policies, as well as American Bar Association guidelines, dictate that suicidal inmates be monitored continuously.

On Day 6, Miles was given a jail uniform for a hearing and escorted down an underground hallway to a holding cell below the adjacent court building – a cell with no video monitor or clear sightlines for deputies. Left alone, he tore a strip of cloth from the collar, looped it over a door hinge and hung himself. He was found unconscious 30 minutes after entering the cell. An internal inquiry said the supervising officer logged his rounds after the fact, leaving it unclear when Miles was checked.

In a wrongful death suit that settled this September, Miles’ family argued that despite being identified as a suicide risk, he was given the means and opportunity to kill himself. The sheriff’s office denied misconduct and said it admitted no wrongdoing in the settlement; details were not disclosed.

Miles’ suicide was the jail’s seventh in just under 15 months. The Fossil’s suicide rate ranked it among the top 20 jails in the Reuters study.

In 2016, the sheriff called the suicide problem an “epidemic,” but county officials denied requests for more funding. While the county knew it had a suicide problem, there was no way to know how it compared. Like all other officials, Marion County’s leaders had no access to the Justice Department figures.

The sheriff’s jail-management mission often “came in second” in a budget system that pits it against the Indianapolis police department’s law enforcement duties, said Frank Mascari, who sits on the City-County Council. “We knew there were some deaths” at the jail, he said, “but we didn’t have the statistics” to know the rates were extraordinary.

From 2015 to 2017, the sheriff’s budget grew just over 1% a year, audit figures show. The inmate population rose 12% in that time, due to a rise in arrests and to state legislation dictating that some low-level felons serve their sentences in county jails, not state prisons.

“A lot of people are dying and they’ve never been sentenced, and that’s obviously a huge problem.”

The sheriff launched suicide-prevention efforts, hired social workers and trained deputies in spotting suicide warnings. From 2017 to 2019, the number of suicides dropped to two a year, but staffing remained critically low as deputies routinely left for better paying jail jobs in nearby suburbs.

Jail deaths remained stubbornly high despite the decline in suicides, reaching six last year, the heaviest toll in more than a decade, driven in part by drug and alcohol overdoses. Still, there has been no state or federal intervention.

In July 2018, Kyra Warner, 30, went quiet about 90 minutes after arriving at the jail. As her limbs twitched, cellmates called for help, telling nurses and deputies that Warner said she had been using methamphetamine and anti-anxiety drug Xanax.

Jail video shows Warner unable to walk on her own as deputies moved her to a monitored isolation cell, where they left her on the floor, still twitching. She lay unresponsive as they checked her periodically over two hours – until medical staff found no pulse. She died of an accidental overdose.

“The officers that are watching aren’t medically trained,” said Rich Waples, a lawyer handling the family’s ongoing wrongful death lawsuit against the sheriff and Wellpath, the company providing the jail’s healthcare. “If she’d gotten prompt care, they could have reversed the effects of those drugs.”

Jail officials denied wrongdoing and noted in their response to the suit that deputies checked on Warner numerous times, but added they are not medical professionals. Wellpath, also contesting the ongoing suit, denied any misconduct.

“We’re not built to be the largest mental health hospital in the state,” said Colonel James Martin, who oversees the jail. “We’re not built to be the largest detox facility in the state.” Yet the jail has “more detox beds than any single hospital in the state.”

The jail’s shortcomings have been documented, including a county-commissioned review in 2016 that found the Fossil “antiquated,” with inadequate staffing and design flaws that severely hamper inmate monitoring. In 2018, after another independent study highlighted the jail’s challenges, the county approved a new $580 million criminal justice complex, with dedicated facilities to treat mental illness and substance abuse. In 2022, the Fossil will be history.

Another flaw in the U.S. system for monitoring jail fatalities is misleading disclosure. The John E. Polk Correctional Facility in Florida’s Seminole County reported one death to the Justice Department in 2019. But at least one other death at the jail was not reported in its official filings.

On June 2, 2019, Thomas Harry Brill, 56, was found hanging by a bed sheet in his cell. Staff tried but failed to resuscitate him, the jail said. He was pronounced dead at a nearby hospital. Sheriff’s spokeswoman Kim Cannaday said he “was released out of our custody” before he died. “Therefore, it would not technically be considered an in-custody death.”

Brill’s sister, Tracy, was shocked to learn his death was excluded from the jail’s official count. “They’re trying to avoid responsibility,” she told Reuters. “They’re playing with the numbers. That’s just wrong.”

Brill graduated from Eastern Michigan University with a mathematics degree and lived on a sailboat for years, she said. He had been wrestling with mental illness when he flew from his home in San Diego to look at a boat in Florida. Out of money, he was found in a stolen car and arrested, but couldn’t afford bail. He died unconvicted of the charge. “He needed $500 to get out,” she said. “It was an awful, ridiculous waste that he died.”

A death in Mississippi

The Reuters death database also points to another benefit of collecting and publishing jail mortality rates: It can identify an unusual number of fatalities at jails that typically have few. One is Mississippi’s Madison County Detention Center, where Harvey Hill died after being beaten by guards.

The jail had occasional deaths, and in several years reported none. Yet in 2018, it had two deaths, including an inmate who died of complications from an ectopic pregnancy. Few other jails its size had multiple deaths that year.

Hill grew up in the poorest county in the poorest state in America. West, his town of 185 people, is intersected by a four-lane highway in Mississippi’s rural Holmes County. He did landscaping work an hour’s drive south in Canton, a city of 13,000 in the state’s wealthiest county, where 19th Century antebellum shophouses packed with antiques line a postcard-perfect downtown square.

“Harvey needed to be in a mental hospital.”

REUTERS/Linda So

When he was 18, Hill was arrested on charges of sexual battery and robbery. He pleaded guilty and served 14 years in prison. Friends and family say he began piecing together his life after his 2015 release, taking landscaping jobs with business owner Finnegan. “He was an incredible worker,” said Finnegan.

Through the winter of 2017 into the spring, Hill showed signs of mental illness, displayed flashes of paranoia and complained of insomnia, said Finnegan. After he let him go in 2018, Hill started showing up at his home, claiming his old boss owed him millions of dollars. “Harvey, if I had taken your millions, I wouldn’t be landscaping. I would be on an island,” Finnegan recounts telling him.

Hill kept returning. In May 2018, Finnegan called the Madison Police Department. If he wanted Hill removed, he had to press charges, Finnegan said he was told, so he did. “That’s not something I really wanted to do,” he said. “Harvey needed to be in a mental hospital.”

At the station, Finnegan told the officer he’d drop the charges and take Hill to a mental health facility if they could find a room. Instead Hill was booked into Madison County’s jail that Friday morning. “I’ll pick you up on Monday,” said Finnegan. “And we’ll get you some help.”

The Madison Police Department said there were “no remarkable or extraordinary events related to his arrest.” Mississippi has no standards or oversight for jails.

In their response to a family lawsuit, the guards said their actions were proper under jail policy. Michael Wolf, an attorney for one of the guards, James Ingram, told Reuters that Hill bit and then tried to head butt an officer, “and continued to resist and exhibited unusual strength. The control techniques were consistent with the County use of force continuum.” The other guard named in litigation, James Buford, declined to comment.

The family believes the force was unjustified. “Harvey Hill was in handcuffs and beaten to death,” said Derek Sells, a lawyer representing the family. “Someone needs to be held responsible.”

Hill’s death was one of four Reuters identified at the jail over the 12-year period. After he died, the jail filled out a form for the BJS with Hill’s name and details including his race, age and charges. The box for “homicide” was left unchecked. Two years later, no “cause of death” has been sent to the BJS, the jail said, citing an ongoing investigation by the Mississippi Bureau of Investigation. No one has been charged.

The family said the jail lied about his death. “They just told us that Harvey had passed and he had had a heart attack,” said Katrina Nettles, his younger sister. The jail did not respond to requests for comment. Its medical contractor, Quality Correctional Health Care, and the nurse who treated Hill denied wrongdoing in litigation.

An autopsy ruled Hill’s death a homicide, however. The report showed that abrasions speckled his head and chest. Severe internal bleeding swelled his neck. His liver had been lacerated.

The state medical examiner, citing a backlog, didn’t release the findings to the family until this June, 25 months after he died and 13 months after the statute of limitations had expired for litigation involving assault. The family filed its ongoing lawsuit last February, before receiving the autopsy.

Told by Reuters of the autopsy’s grim findings, Finnegan bent forward and choked back tears. “God Almighty,” he said, dragging a hand over his face. “Harvey was a friend.”

The Reuters examination of deaths in U.S. local jails represents the largest collection and publication of inmate mortality data undertaken outside the federal government.

The news organization filed more than 1,500 public records requests to collect data on inmate populations and deaths from more than 500 local jails. That universe includes the 10 largest jails in each state, as well as any jail in the country with an average daily population of 750 or more inmates.

In all, the Reuters data captures about 60% of the total inmate population in the nation’s 3,000-plus jails. Similarly, Reuters data accounts for about 60% of all inmate deaths nationwide, based on the latest national data collected by the U.S. Bureau of Justice Statistics. BJS issues national-level and state-level data on jail deaths, but no statistics for individual jails. The Reuters investigation is the first to provide individual jail death data on a national scale.

Reuters calculated annual death rates at more than 500 jails by dividing the total number of deaths in a given year by the average daily population in the same year – the same formula used by BJS and other experts in criminal justice statistics.

States and local law enforcement agencies have varying definitions for what constitutes a jail death. Reuters counted all deaths that occurred in a jail, as well as deaths of inmates who were hospitalized for injuries or conditions incurred at the jail. When inmates are in life-threatening condition, some jails release them and do not count their subsequent death as an inmate fatality. Reuters, like many jurisdictions across the country, included those cases in its tally of jail deaths.

Reuters received responses from more than 95% of the jurisdictions from which it sought public records. Not all jails were able to provide accurate data on inmate populations for every year covered by the GFN, particularly the earlier years. Data was not available on race for about 9% of inmates who died and for conviction status for about 17% of fatalities. In cases where data was available for adjacent years, Reuters used that information to estimate inmate populations for the years in which no data was provided – a statistical method also used by BJS.

Reuters also used court records and news accounts to identify deaths that were not documented in jails’ responses and, in many other cases, to augment information jails did provide. Several dozen unreported deaths were identified in this manner and added to the Reuters tally. Court records and other official records, such as autopsy reports, also were used when available to fill in data that some jails declined to provide, such as cause of death or age.

Reuters also collected information on how healthcare services are provided in each jail, identifying those that relied on private companies to manage and deliver that care. Reuters only considered jails to have privatized or contracted care if they relied on a company to manage and staff the facility’s entire healthcare operation. If a jail contracted with individual practitioners for discreet medical services or hired staffing agencies to provide clinicians, Reuters still considered that care to be publicly managed, just as it would if the jail was running its own healthcare operation or relying on a public health agency.

The data captures jails in 44 states plus the District of Columbia. It does not include six other states – five where all detention facilities are managed by unified state corrections agencies (Connecticut, Delaware, Hawaii, Rhode Island and Vermont), and Alaska, which uses a hybrid model that also relies largely on a network of state-run facilities.

Fashion

The truth about fast fashion: can you tell how ethical your clothing is by its price?

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What is the true cost of a Zara hoodie? In April 2019, David Hachfeld of the Swiss NGO Public Eye, along with a team of researchers and the Clean Clothes Campaign, attempted to find out. They chose to analyse a black, oversized top from Zara’s flagship Join Life sustainability line, which was printed with lyrics made famous by Aretha Franklin: “R-E-S-P-E-C-T: find out what it means to me”. It was an apt choice, because the idea was to work out whether any respect had been paid to the workers involved in the garment’s production, and how much of the hoodie’s average retail price, €26.66 (£22.70), went into their pockets.

This was no simple assignment. It took several people six months, involved badgering Zara’s parent company, Inditex, over email, slowly getting limited information in return, and interviewing dozens of sources on the ground in Izmir, Turkey, where the garment was made. The researchers analysed financial results and trading data, and consulted with experts in pricing and production. It was, Hachfeld says on the phone, with dry understatement, “quite a huge project”.

Their research suggested that the biggest chunk of the hoodie’s retail price – an estimated €10.26 – went back into Zara, to cover retail space and staff wages. The next biggest slice, after VAT at €4.44, was profit for Inditex/Zara, at €4.20. Their research suggested that the textile factory in Izmir received just €1.53 for cutting the material, sewing, packing and attaching the labels, with €1.10 of that being paid to the garment workers for the 30-minute job of putting the hoodie together. The report concluded that workers could not have received anything like a living wage, which the Clean Clothes Campaign defined, at the time the report was released, as a gross hourly wage of €6.19.

When the research was covered by the media at the time, Zara said the report was “based on erroneous premises and inaccurate reporting”, that the €7.76 sourcing price was wrong and that the workers were “paid more than the amounts mentioned in Public Eye’s report”. But at the time and when I contacted Zara for this article, the company declined to set out in greater detail where the research was inaccurate.

Workers in a small garment factory in Istanbul
Workers in a small garment factory in Istanbul. Photograph: NurPhoto/Getty Images

What is clear is that trying to find out the true production cost of a garment is a tortuous and potentially fruitless process – even when assessing a major high street retailer’s flagship “sustainability” line.

Hachfeld points out that Zara is by no means uniquely opaque. It is doing more than many clothing brands and has long-term commitments in place to work towards living wages. “They are launching initiatives and consultations with trade unions. But the question remains: when will they deliver on it?” he says. Vanishingly few retailers guarantee living wages across their vast, complex supply chains. According to the not-for-profit group Fashion Revolution, only two of the world’s 250 largest fashion brands (OVS and Patagonia) disclose how many of their workers are paid a living wage – despite the kind of resources that make billionaires of founders. Forbes estimates that Zara’s founder, Amancio Ortega, is worth $77bn (£55bn) and that H&M’s founder, Stefan Persson, is worth $21.3bn; the Sunday Times puts the wealth of Boohoo’s co-founder, Mahmud Kamani, at £1.4bn.

Throughout fashion, the numbers just don’t add up. High-street clothing has been getting cheaper and cheaper for decades. A major reason why, according to Gordon Renouf, the CEO of the fashion ethics comparison app Good on You, is that so many western brands have “moved from onshore production 40 years ago to larger offshore production”. Often, the countries they have chosen have “much lower wage costs, weaker labour movements and laxer environmental regulations”. Of course, we know all this, but we have also become accustomed to reaping the benefits. Our perception of what clothing should cost – and how much of it we need – has shifted.

In 1970, for example, the average British household spent 7% of its annual income on clothing. This had fallen to 5.9% by 2020. Even though we are spending less proportionally, we tend to own more clothes. According to the UN, the average consumer buys 60% more pieces of clothing – with half the lifespan – than they did 15 years ago. Meanwhile, fashion is getting cheaper: super-fast brands such as Shein (which sells tie-dye crop tops for £1.49) and Alibaba (vest tops for $2.20), have boomed online, making high-street brands look slow-moving and expensive by comparison.

But the correlation between price and ethics is knotty, to say the least. The conversation about sustainable fashion tends to be dominated by expensive designer brands: at Stella McCartney, for example, a wool-cotton jumper costs £925; at Another Tomorrow, each $520 sustainable viscose carbon-offset scarf neck blouse features a QR code in the label that outlines every stage of its “provenance journey”.

On the high street, many who proudly opt out of shopping at Primark or Boohoo for ethical reasons may be unaware that most reassuringly mid-priced brands don’t guarantee workers living wages or produce clothing without using environmentally harmful materials. A garment’s price is often more about aspiration and customer expectation than the cost of production. Hachfeld points out that the Zara hoodie was priced higher in Switzerland (CHF 45.90; €39.57), where Zara is positioned as a mid-range brand, than in Spain (€25.95), where it is perceived as more mainstream and affordable.

Another Tomorrow scar-neck blouse.
‘Provenance journey’ … Another Tomorrow scarf neck blouse.

Online, debates about the price of clothing can get heated. The sustainable-fashion writer Aja Barber, for example, uses the phrase “exploitation prices” to refer to very cheap clothes, such as the 8p bikini offered by the Boohoo brand Pretty Little Thing last autumn. “Either the company or the garment worker is taking the hit, and most likely it’s not the company, because that wouldn’t be a profitable business model,” she says.

Barber has a personal threshold in mind when she buys an item. “Any time a dress is under £50, you really need to break down the labour on it,” she says. “Think about what you get paid hourly – think, could a person make this dress in three hours?” She doesn’t base this calculation on local wages in the global south, either, which are so much lower “because of years of colonialism and oppression”. She buys new clothes infrequently and tries to avoid polyester, which is made with fossil fuels and generally used in garments to make them cheaper.

Barber gets annoyed by the accusations of snobbery that ripple through social media when anyone criticises super-cheap brands. Largely, she says, these comments come from middle-class people “who want to participate in the system and not feel bad about it”. In her view, fast fashion is propped up not by those with very low disposable incomes, but by middle-class overconsumption.

The only way to tell if a garment has been ethically produced is by combing through the details on the manufacturer’s website (although many brands give little or no information) and checking out its rating on Good on You, which compares fashion brands on the basis of their impact on the planet, people and animals. Even among brands that have launched with sustainability as their USP, greenwashing is rife. Renouf warns against those that talk vaguely about being “natural” and “fair”, or bang on about recycled packaging, without giving details about, say, the materials they use or whether they engage with unions in their factories.

For the fashion retailer Sam Mabley, the idea that fashion can be ethical only if it is expensive is a myth. Mabley runs a sustainable fashion store in Bristol; he thought it was a shame that he was selling so many ethical T-shirts at around the £30 price point. Usually, he says, such T-shirts are created in small batches, by “cool indie brands who do printed designs – a lot of the work is in the design”. He decided to invert that business model, ramping up the scale in order to get bigger discounts from suppliers and creating plain, organic cotton, ethically produced Ts in black and white for £7.99. With just a month of social media promotion, he secured 4,000 orders.

A model wears a Yes Friends T-shirt by Sam Mabley
‘Buying power’ … a Yes Friends T-shirt by Sam Mabley.

He believes it would be fairly easy for fast-fashion brands to use their buying power to “drive change for millions of workers around the world” and guarantee their factories paid living wages, without drastically affecting their margins. He is not alone in this view: Jenny Hulme, the head of buying at the sustainable fashion mainstay People Tree, believes ethical production is necessary and possible in every part of the market. “If you order in big volumes, it does reduce price – if a company really wants to improve, it can,” she says.

The reality of high-street clothes shopping is still very far from this ideal. Apart from a few “sustainable” lines produced by the big fast-fashion brands – which I am loath to recommend, because of so many accusations of greenwashing – it is almost impossible to find new, ethical clothing at rock-bottom prices, because the business models that have enabled clothing to get this cheap rely on inexpensive, environmentally damaging fabrics and very low wages.

That may leave anyone wanting to dress ethically on a high-street purse feeling out of options, although Renouf points out that buying better is possible at every budget. That is why, he says, Good on You aims to “provide ratings for as many brands as possible, rather than simply promoting the most sustainable brands”. You could, for example, move from an ultra-rapid fashion brand to a more engaged high-street fast-fashion brand, which might not cost much more, but still could constitute progress.

Buying fewer, but better-quality, items might save you money overall and is the most consistent advice you will hear from fashion campaigners. “Buy the best quality that you can afford, perhaps in end-of-season sales or by buying a thick jumper in the middle of summer to wear the next winter,” says Hulme.

Stepping out of the trend cycle, and avoiding brands that trade on planned obsolescence, is another avenue to explore. For example, Patrick Grant, a judge on the BBC’s The Great British Sewing Bee, explains that his Community Clothing brand aims to give shoppers more bang for their buck by stocking basics rather than continually designing new collections (it also does without retail space and marketing). Working to slimmer margins means he can invest in good fabric, but keep prices fairly low: his £49 hoodies are made from 470g 100% loopback cotton, a thicker, more durable fabric than you might find for a similar price on the high street.

A blazer from ethical brand Lora Gene
A blazer from the ethical brand Lora Gene. Photograph: Lora Gene

For those who can afford mid-high street prices, researching small, sustainable brands might glean results. A quick look at the Zara website today shows silk dresses selling for as much as £199, with plenty of others at £49.99, while H&M-owned &OtherStories sells blazers for about £120; Barber points out that at these prices, shoppers could switch to ethical brands including Lora Gene, for which she has designed a collection, and Ninety Percent. (There is a dress I like the look of for £64 in the Ninety Percent sale; a mustard Lora Gene blazer is £139.)

If those prices are out of reach, swapping clothes, shopping secondhand, repairing and rethinking what you already have, and occasionally renting for special occasions can all be cheaper – even free – alternatives.

Voting with your wallet will only go so far, however, and won’t be possible for many people who are struggling, as the number of people in poverty in the UK soars to 15 million. Questioning the magical thinking of rock-bottom prices is not about blaming the consumer. Instead, you could write to MPs and CEOs and demand that they do something about living wages and the environmental cost of fashion. The responsibility lies with brands, and with the government, which should be held to account for a broken system.

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What Is Health at Every Size (HAES)? The Approach Focuses on Health vs. Weight

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What Is Health at Every Size (HAES)? The Approach Focuses on Health vs. Weight
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Whenever we go to the doctor’s office — whether it’s for an annual physical or a sore throat— one of the first things we do is step on a scale. For some of us, it’s a fraught moment: Will the number be higher or lower than last time? How will we feel about that? And folks in larger bodies, especially, may wonder: What will my doctor think about that?

In a paper published in 2014, researchers found that 21% of patients with BMIs in the “overweight” and “obese” ranges felt that their doctor “judged them about their weight” — and as a result, they were significantly less likely to trust their doctor or even to return for follow-up care. And research shows that this lack of trust is valid: Doctors are more likely to be biased against patients with high BMIs, and that this impacts the quality of the medical care they receive.

After analyzing audio recordings of 208 patient encounters by 39 primary care physicians, scientists found that doctors established less emotional rapport with their higher weight patients, according to a study published in a 2013 issue of the journal Obesity. Other studies have found that this lack of rapport makes doctors more likely to deem a higher-weight patient as “noncompliant” or “difficult,” often before the exam has even begun. And for women, gender non-conforming folks, people of color and people with low socioeconomic status, a doctor’s weight bias may intersect with other biases and potentially make the situation worse.

Medical weight stigma can have dire consequences. When patients delay healthcare because they’re worried about discrimination, they miss regular screening exams and are more likely to be much sicker by the time doctors do see them, which is one of the reasons why some people assume everyone in a larger body is unhealthy and observe correlations (but not causations) between higher body weight and chronic health conditions that benefit from good preventative healthcare.

At the same time, provider bias can lead doctors to under-treat or misdiagnose their larger patients in all sorts of ways. Patients in larger bodies with eating disorders tend to struggle longer and be sicker when they finally do get treatment, because doctors can ignore their symptoms — or even praise their disordered eating when it results in weight loss. Weight stigma also causes doctors to overlook problems that aren’t about weight. For example, in May 2018, a Canadian woman named Ellen Maud Bennett died only a few days after receiving a terminal cancer diagnosis; in her obituary, her family wrote that Bennett had sought medical care for her symptoms for years, but only ever received weight loss advice.

Because of this mounting evidence about the health consequences of medical anti-fat bias, some providers are starting to shift their medical practices to what’s known as the “Health at Every Size” approach, the purpose of which is to take the focus off a person’s weight, and instead look more holistically at their overall health. Of course, many doctors are still using scales and prescribing weight loss. But the Health at Every Size movement can be a model for health and wellness that you can adopt for yourself, too.


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While only a fifth of the 600 respondents in a 2012 survey perceived weight-related judgment from PCPs, they were significantly less likely to report high trust in these doctors.


So, what is Health at Every Size?

Most doctors today approach health through what’s known as the “weight-centric” model, where weight is viewed as one of, if not the, most important marker of health. In the weight-centric model, if the patient is in a larger body, many conditions are treated primarily through the prescription of weight loss. Health at Every Size, commonly known as HAES (pronounced “hays”), is an alternative approach, also sometimes referred to as a “weight-inclusive” model of healthcare.

HAES originated in the fat acceptance movement and was further popularized by Lindo Bacon, Ph.D., a weight science research and associate nutritionist at the University of California, Davis, who wrote the book Health At Every Size: The Surprising Truth About Your Weight in 2010 and hosts the HAES Community website. “Health at Every Size is the new peace movement,” writes Bacon. “It is an inclusive movement, recognizing that our social characteristics such as our size, race, national origin, sexuality, gender, disability status and other attributes, are assets and acknowledges and challenges the structural and systemic forces that impinge on living well. It also supports people of all sizes in adopting healthy behaviors.” (If you’re interested, more information about the history and philosophy of HAES is available from the Association for Size Diversity and Health.)

HAES-informed practitioners do not routinely weigh patients, or use weight to determine how healthy a person is. Instead, they look at other biomarkers, like blood pressure and cholesterol levels, to assess physiological health. And they consider how various social, economic and environmental factors in a person’s life impact their ability to pursue health. Translation: Instead of assuming you’re lazy or uninformed if you aren’t exercising or eating vegetables, a HAES-aligned doctor will ask about your schedule, responsibilities and priorities, to see what kind of barriers you face to adopting a regular workout routine. And they’ll take into consideration whether or not you live near a grocery store, have time to cook, or can otherwise easily access healthier food.

This doesn’t mean a HAES provider won’t ever encourage you to be more active or change your eating habits; it means they’ll only recommend changes that are attainable and realistic for you. And, most crucially, they won’t be telling you to do these things to lose weight. In the HAES model, weight loss is never a goal of treatment because your body is never viewed as a problem to be solved. You have the right to pursue health in the body you have, rather than waiting for that body to change in order to be deemed healthy.

But isn’t it unhealthy to be fat?

Contrary to popular belief, it’s not inherently unhealthy to be fat. Research shows that the relationship between weight and health is much less clear-cut than we’re often told. Weight may be a correlating factor in health conditions like diabetes and heart disease, but scientists haven’t been able to prove that a high body weight causes such diseases. In some cases it may contribute, or it may be simply another symptom of a different root cause. (Consider how smoking can cause both lung cancer and yellow teeth — but nobody assumes that yellow teeth cause lung cancer.)

In fact, weighing more can actually protect you against certain health problems, including osteoporosis and some kinds of cancer. Heart surgery patients with higher BMIs also tend to have better survival rates than their thinner counterparts. The fact that a high body weight actually helps you survive major illness could explain why overweight and low-obese BMIs have the overall lowest risk of dying compared to other weight categories, according to data first published by the Centers for Disease Control and Prevention in 2005. In short, it is absolutely possible to be fat and fit.

Even if you live in a larger body and do have health conditions often assumed to be weight-linked, there is good evidence that you can treat those problems and improve your health without pursuing weight loss. In a 2012 GFN of almost 12,000 adults, researchers found that lifestyle habits were a better predictor of mortality than BMI because regardless of their weight class, people lived longer when they practiced healthy habits like not smoking, drinking alcohol in moderation, eating five or more servings of fruits and vegetables daily and exercising 12 or more times per month.

That’s good news because despite how often doctors prescribe it, we don’t have a safe and durable way for most people to lose significant amounts of weight. That’s because our bodies are programmed to fight weight loss, for our own good. According to an evidence review of common commercial weight loss protocols first published in 2007, and later updated in 2013: People lose some weight in the first nine to 12 months of any diet, but over the next two to five years, they gain back all but an average of 2.1 pounds. And dieting and “weight cycling” in this way can increase your risk for disordered eating and other health problems.


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In a University of South Carolina study, all of the men and women followed over the course of 170 months benefited from the adoption of healthy habits, no matter their size.

How do I practice HAES — and how do I get my doctor on board?

Practicing Health at Every Size will look different for everyone, because that’s part of its beauty: You get to decide your own health priorities and can focus on the goals that are accessible and realistic for your life, rather than following a doctor’s “one size fits all” approach to health. But there is one universal tenet: Your weight is no longer part of the conversation. That might mean that you ditch your scale, stop dieting and exercising for weight loss, start to explore intuitive eating and joyful movement — or all of the above.

But while there is growing awareness of HAES in the medical community, it is not the default approach in most healthcare offices. To find doctors or other practitioners in your area who identify as HAES-aligned, you can start by checking the HAES provider directory. But if not, it may be possible to have a productive conversation with your current doctor about why you’d like to take the focus off your weight. One simple way to set this boundary is to decline to be weighed at the start of the visit.

You may worry that the doctor’s office won’t allow you to skip the routine weigh-in, but you have a right to refuse to be weighed, says Dana Sturtevent, R.D., a dietitian and co-founder of Be Nourished, a nonprofit organization in Portland, Oregon, which offers workshops, retreats and e-courses for healthcare providers on how to offer trauma-informed and weight-inclusive care. “This can be a very real and potentially vulnerable step towards self-care,” she says. If your doctor objects, you can ask: “How will this information be used?” There are times when a weight is medically necessary, such as when it’s needed to determine the correct dosing of certain medication. If that’s the case, you can ask to be weighed with your back turned to the scale so you can’t see the number. But if you’re told it’s routine or that they just need to write it down for insurance purposes, you can ask that they write “patient declined” instead.

It can also help to give your doctor a heads up that you would prefer not to discuss weight or weight loss at your appointment. If you feel anxious about bringing this up in the exam room, you can download this letter, created by HAES providers Louise Metz, MD., and Anna Lutz, R.D., to send ahead or give to the nurse who takes your vitals at the start of the appointment. Dr. Metz has also collaborated with health coaches Ragen Chastain and Tiana Dodson to create the HAES Health Sheets Library, which contains downloadable fact sheets on how to treat conditions commonly linked to weight from a HAES perspective.

If your doctor persists in a weight-focused approach to your care, remember that you have the right to switch providers. But more importantly: “Remember that you are not required to be a certain weight in order to be worth of love, respect, belonging or decent medical care,” says Sturtevent. “Your body is your body.”

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9 Amazon Fashion Brands You Need to Be Shopping

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9 Amazon Fashion Brands You Need to Be Shopping

You’re already well-acquainted with Amazon as your shopping preference for everything from household products to books, tech accessories to groceries. But since 2017 one of the world’s largest retail marketplaces has made a pointed effort to expand past their traditional stock. In less than four years, Amazon has introduced dozens of in-house fashion brands, making their mark on the style world in the process. (And with free speedy shipping on most Amazon Prime items, there’s never been an easier way to do a spot of last-minute shopping).

We’ve gathered the nine standout Amazon fashion brands you need to know below. Whether you’re looking to refresh your underwear drawer, update your closet with some trend-focused finds, or simply add a few wardrobe essentials, the mega-retailer is literally your one-stop destination.

Core 10

What it is: High-quality workout-wear with tons of amazing reviews

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If you’re looking for affordable activewear that performs just as well as brands three times the price, Core 10 is your answer (it comes in extended sizing as well). Sports bras, leggings, shorts, hoodies, and more—it’s got all your workout needs covered.

Highlights include a ’90s-fantastic collaboration with Reebok launched earlier this summer and a “Build your own” legging option. Shoppers can customize their perfect pair with three lengths and three waistband styles, resulting in one shopper saying that they’re the “best leggings [she’s] tried. Hands down.”

Wild Meadow

What it is: Basics with a ’90s feel that all cost less than $30

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Launched this spring, Wild Meadow brings that easy-breezy youthful ’90s vibe and all styles are offered up to a size XXL. The best part? Not a single item costs more than $30, which means you should stock up—ASAP.

In the market for a tie-dye cami dress? A tie-front cropped tee? Still hunting for that perfect slip dress that will take you from day to night with a simple shoe swap? Wild Meadow has you covered with all that and more.

Amazon Essentials

What it is: Non-basic basics that are budget-friendly

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The Amazon Essentials brand includes food, household items—and wardrobe basics. Essentials, yes, but they’re anything but boring. Expect to find everything from floral t-shirt dresses to cozy fleeces, yoga leggings to bathing suits.

It’s affordable—prices are pretty much all under $50, with most under $25—and available in plus sizes. An important-to-know factor that makes this label stand out is how many maternity options there are, should you be in the market. In short, you can curate your entire wardrobe virtually no matter your size, budget, or stage of life.

Goodthreads

What it is: Trend-driven closet essentials

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Goodthreads started as a menswear-only Amazon brand but quickly expanded into the womenswear market. This line has a lot of wardrobe essentials, like button-down shirts, chinos, and sundresses, but they’re a bit more fashion-focused than some of Amazon’s other basics go-tos (like Amazon Essentials).

Here, you’ll find cinched-waist midi dresses, tops with subtly ruffled sleeves, and colorfully striped button-downs. The biggest draw, though, is the denim, which is sold in six different silhouettes, showcasing an impressive number of length and wash options. The size range for Goodthreads is XS-XXL on most pieces.

There is

What it is: Everyday underwear and lingerie, plus great swim options

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Amazon’s own lingerie brand offers everything from underwire bras to slinky slips and lace-trimmed thongs. If you’re looking for underwear or sleepwear of any kind, this is your brand.

For casual everyday wear, Mae offers cotton briefs and bras, lacy bralettes, and future go-to t-shirt bras to name a few. If you’re looking for more of a special lingerie moment, consider their wide selection of sexy, flirty sets and separates. The brand has expanded into swim, shapewear, and pajamas, too.

Daily Ritual

What it is: Comfortable basics that go up to 7X

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Daily Ritual is your go-to for comfortable options that look presentable enough for stepping out with friends or running errands. The brand is known for its selection of casual essentials that are anything but basic, and most items are made of a super soft cotton jersey or fleece.

There’s a bit of everything, including puffer jackets for when temps get chilly, but the majority of the pieces focus on classic cotton tees, joggers, and the like. An impressive amount is offered in plus sizes up to 7X, providing real universal appeal. For the shopper who loves to dress simply, stay comfortable, and look put-together, this is the Amazon fashion brand for you.

The Drop

What it is: Limited-edition collections co-created with some of today’s biggest social stars

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Built on the concept of curated, limited-edition capsule collections that are only promised to be available for a quick 30 hours, The Drop is Amazon’s most coveted line. Each collab is designed and curated by a rotating list of bloggers and influencers uniquely catering to their individual style at affordable prices—it’s either pieces they want for their own wardrobe or have developed a signature look around.

Past influencers to participate include Charlotte Groeneveld of The Fashion Guitar, Leonie Hanne of Ohh Couture, Quigley Goode of Officially Quigley, and more. Depending on the influencer, The Drop could include everything from wrap dresses to faux leather pants; teddy bear shearling coats or shackets. You have 30 hours to order originally, but some styles (like the below) make a reappearance.

Cable Stitch

What it is: Classic knitwear silhouettes, updated

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The name literally says it all: Cable Stitch is the Amazon brand to go to if you love a good knitwear moment. Cardigans, pullovers, dresses…you name it. The range will appeal to minimalists and maximalists alike, with classic solid colors and brightly colored stripes in the mix.

When Amazon creates an entire line centered around knitwear, you know they’re going to go big or go home. You can shop an array of the more unconventional knits that are trending (like side-slit midis and puff-sleeve pullovers) as well as basics. Most pieces retail between $20 and $60, though some outliers will exist from season to season.

The Fix

What it is: Stand-out shoes and bags that can upgrade everything in your closet

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Accessory obsessed? You need to know about The Fix. Specializing in the little pieces that make or break a look, this is your shop for all the trendiest footwear and handbags you’ve been coveting since you first saw them explode on the street style scene.

At The Fix, you can shop heels, flats, sandals, and sneakers in a range of head-turning styles. There are certainly no basics here, with every style boasting at least one special detail that makes them stand out from the rest. Whether that’s an ankle strap or chunky heels covered in velvet, special details let you transform your look by swapping in a new accessory.

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