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Viewing Mass Incarceration as a Public Health Issue

Tuesday, December 9th, 2014 @ 11:13AM

A recent editorial in the New York Times echoed a report by the Vera Institute on the need to understand and treat mass imprisonment as a public health issue.  Nearly 2.3 million people are locked behind bars in America’s jails and prisons on a given day.  Most of these are inmates in state prisons.  They are largely ill-educated, poor, and many suffer from mental illness, substance abuse or both.  They are the throwaways in a society that celebrates high achievers.  Our criminal justice system is no longer correctional—having largely abandoned most efforts to rehabilitate its prisoners.  Prisons are warehouses for many of society’s undesirables.  Little care is given to sanitary conditions and many facilities are incubators for illness and disease.

More than 11 million people circulate through jails systems in a given year.  Each year about 700,000 inmates are released from prisons.  Approximately 95 percent of all inmates are expected to be released at some point in the future.  Most of them will return to economically distressed communities with inadequate healthcare resources.  They will be scarred for life.  A prison sentence is almost always a lifelong badge of dishonor that reduces one’s ability to gain meaningful employment, have access to public housing and other public benefits, or find educational opportunities.  Often many returning citizens find themselves with little choice but to reengage in illegal activities that eventually return them to prison.

IncarcerationBut it is not just these tragic lives that are impacted by a system that readily gobbles up the poor and disenfranchised.  It is the communities where they live that often suffer as much as the incarcerated.  It is in these communities that sickness spreads beyond the prisons walls.  The Vera Institute report highlights how mass incarceration even extends its reach to infant mortality.  Research found that had the incarceration rate held steady at the 1973 level, the rate of infant mortality would have been 7.8 percent lower than it was in 2003.  It counts mass imprisonment as one of the social determinants of health that has exacerbated many health disparities.

Treating incarceration as a public health issue requires understanding its effects on multiple elements of society as well as society as a whole.  It also requires active engagement in prevention efforts on universal, selective and indicated levels, language recently adopted by the Institutes on Medicine (IOM) to replace the traditional terms of primary, secondary, and tertiary prevention.  Universal interventions are directed at entire populations (cities, towns, communities).  Selective interventions are directed at individuals or subgroups that are at greater than average risk.  I would count among these children with incarcerated parents, kids in special education, and first-time, low-level offenders.  Those in need of indicated prevention would be high-crime neighborhoods, repeat offenders, and chronic drug users.

The Vera Institute report describes opportunities through the Affordable Care Act (ACA) for states and localities to develop partnerships between health systems and criminal justice systems to reduce the negative health impacts of incarceration.  Another report by the Sentencing Project outlines specific areas where the ACA can be useful in reducing the impact of incarceration such as reaching more disadvantaged people who may be at-risk for incarceration, covering pre-trial detainees and people on probation, and providing resources to people with behavioral health problems that may help them to avoid being incarcerated.

In a 2010 report produced by the National Association of Social Workers (NASW), Mel Wilson, Manager for Social Justice and Human Rights, describes the considerable roles social workers have played in the United States criminal justice system dating to the beginning of the profession.  Using Scotland’s criminal justice system as a model, Wilson sees an opportunity for social workers to move beyond traditional roles of providing psychosocial services within the criminal justice system to a more active role in shaping policies that impact service delivery.  Many social workers embrace the public health model as a framework for service delivery.

I see these as exciting developments having spent numerous years studying the criminal justice system while completing my dissertation on the impact of incarceration of the employment and earnings of young fathers using data from the Fragile Families Study.  The idea of focusing attention and resources on getting in front of the problem of mass incarceration is something I have been advocating for years to many of my friends focused primarily on reentry.  The National Prevention Science Coalition to Improve Lives (NPSC) which organized a congressional briefing last week is working with the newly-formed bi-partisan Crime Prevention and Youth Development Caucus to advance policies in the House of Representatives, according to its website: “to encourage the federal government, particularly Congress, to work toward smart justice reform for at-risk youth and further efforts that encourage violence prevention and youth opportunity.”  I think that is a mission social workers can get behind.

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