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.