The Impact on Public Health & Mass Incarceration
Attorney General Jeff Sessions has emerged as the most malignant figure in the Trump administration. His role in the burgeoning Russian investigation aside, Sessions’ efforts to aggressively renew the War on Drugs has grave consequences for the overall health of our nation and the disparities therein. Sessions has already demonstrated concerning and regressive stances on various issues of public health, including gun control, LGBTQ rights, sexual assault, abortion, and protections for individuals with disabilities.
On May 12, Sessions released a policy memo overturning Former Attorney General Eric Holder’s efforts to reduce sentencing for lower-level drug offenders. In this memo, Sessions calls for thousands of U.S. attorneys across the nation to “charge and pursue the most serious, readily provable offense,” limiting the ability of prosecutors to use their discretion in cases where mandatory minimums would be triggered. This move builds upon his decision to reverse the federal ban against using private prisons for federal inmates and his ongoing review of police reform efforts.
Civil rights organizations continue to speak out against the efforts of the Justice Department. Eric Holder describes Sessions’ policy change as “cookie cutter.” He argues it will exacerbate unfairly long sentences without a benefit in public safety or reduction in federal spending.
The development of an apartheid-like criminal justice system is methodically described by Michelle Alexander in her 2010 book The New Jim Crow. In short, over the past 35 years, the number of incarcerated individuals has risen to over 2.2 million with serious racial disparities. She notes that the majority of illegal drug users are White. The majority of the incarcerated are African-American or Hispanic-American. In fact, White students were found to use cocaine at a rate 7x higher, crack cocaine 8x higher, and heroin 7x higher than African-American students.
The disproportionate incarceration of minorities in the United States has serious implications for social justice, but it also represents a public health crisis that will worsen under the Trump administration. Incarcerated individuals suffer higher rates of medical disease, across the spectrum, including substance use disorders, infectious disease, and chronic disease.
Special attention should be given to substance use disorders. The Trump Administration has already stood in the way of adequately addressing the opioid crisis in several ways. Most recently, Secretary of Health and Human Services, Dr. Tom Price, dangerously disregarded the evidence-based use of medication-assisted treatment by incorrectly claiming that it is akin to substituting one opioid for another.
The quality of healthcare delivered in correctional facilities is also of great concern. Many correctional facilities do not meet the same accreditation standards that regular hospitals uphold. Moreover, Sessions seeks to increase the use of private prisons. There have been hundreds of lawsuits filed against private, for-profit prisons claiming substandard care. There is indeed evidence that such arrangements are associated with higher mortality.
Moreover, private prisons are even worse in terms of perpetuating racial disparities. African-American males are overrepresented in private prisons compared to public prisons. To run a profit, these prisons try to keep healthcare costs as low as possible. Young, relatively healthy, African-American men are viewed as high-profit compared to older, more unhealthy White men. Perhaps it is unsurprising that a man who was denied federal judgeship because of statements in support of the Ku Klux Klan would seek to commodify African-Americans as Attorney General.
Whether in a public or private prison, multiple studies also indicate that the health implications of incarceration propagate throughout the community. Children with incarcerated parents have higher rates of poverty, grow up to have higher rates of disease in adulthood, and incarceration is associated with greater racial disparity in infant mortality. More broadly, individuals with felony convictions and their families often face loss of federal housing and food stamps, Medicaid termination, and difficulty finding employment. Finally, creating incentives to arrest and prosecute more individuals would likely increase aggressive policing tactics, which has been associated with higher rates of mortality for minorities. The further decimation and disregard of minority communities keeps with the overall tenor of the Trump administration.
The evidence shows that the health consequences of an individual’s imprisonment extend beyond that individual and beyond the time of incarceration. The data we have from the past 50+ years demonstrate health consequences for entire communities with real racial disparities in arrests, prosecutions and sentencing lengths. The evidence fails to show that returning to aggressive policing and prosecution for minor drug offenses would improve public safety yet alone public health. There is simply no merit for Mr. Sessions’ failed approach.
The chaotic nature of the Trump administration only serves to mask the concerted assault on public health by his appointees. While there is a high degree of awareness and outrage by the public and the medical community regarding the AHCA, these lesser known efforts by the Justice Department must be a focus of coordinated response.
It is rare to find areas of bipartisan agreement in Washington, but it seems like opposing Mr. Sessions’ plans may be an opportunity for unity. The medical community has historically played a significant role in the establishment of our punitive, racially unjust criminal justice system. Now, we must speak out and organize against its perpetuation.