The United States is facing an epidemic of incarceration -- people in jail or prisons -- demanding national attention and a systemic response. Ernest Drucker, my colleague and a professor of epidemiology as well as family and community medicine, classifies incarceration as an epidemic because it is a situation with widespread and rapid onset over 35 years, it affects a disproportionately large number of people within a population, and its spread and adverse effects are felt even by those who are not incarcerated. Like other epidemics, incarceration is contagious and has the potential to benefit from preventive approaches. An example of that contagion is, as Drucker has demonstrated, that exposure to prior cases increases transmission risk. In particular, the children of incarcerated people have lower life expectancy and are six to seven times more likely to be imprisoned themselves.
A public health concern warrants a public health response. We need to address the conditions for its spread, prevent its adverse impacts on children and families, and identify more effective ways to stop our "school to prison pipeline" by creating the conditions for positive trajectories for every member of the most vulnerable communities.
While the statistics may be familiar, they are no less disturbing:
- From 1980 to 2008, the number of people incarcerated in America quadrupled -- from roughly 500,000 to 2.3 million people.
- African Americans are incarcerated at nearly six times the rate of whites, according to the NAACP.
- African-American males have a one-in-three lifetime risk of being incarcerated for at least one year.
- The U.S. Bureau of Justice reports that an estimated 77 percent of 405,000 prisoners released in 30 states in 2005 were arrested again by 2010.
- Inmates have AIDS diagnoses at five times the rate of the general population and hepatitis C at nine to 10 times the rate of the general population, according to the U.S. Centers for Disease Control.
According to the Institute of Medicine, public health is defined as "the actions we must take collectively to improve and protect the populations' health and well being." Prevention research within public health seeks to create the best possible health at the population level.
Activating basic prevention research could immediately have a tremendous impact. One obvious example is reduction of disease transmission in prison, which would help keep neighborhoods and individuals healthy after discharge. Free of disease, these healthy individuals would more effectively contribute to family life, raise healthy and optimistic children, work, and contribute to the community.
Among the key elements of President Obama's "My Brother's Keeper Task Force" is his recommendation to deploy prevention science to address incarceration risk. The president's life course approach calls for age-appropriate interventions from the earliest years to establish a trajectory of healthy outcomes throughout life and across populations. If young people enter school ready to learn, if they read at grade level a few years later, if they graduate from high school prepared for college and careers, and if they enter the workforce with robust skills and knowledge to secure and retain employment, we will surely see a decline in the number of young men whose multiple interactions with criminal justice begin at a very early age.
Because public health understands the movement from cause to intervention to delivery to continuation, it can help create those cradle-to-college-to-career conditions. Beyond education, public health scholars also explore other elements that can serve as primary prevention, including mental health, violence reduction, prevention of substance use and abuse, stable housing, medical care, and nutrition.
To focus attention on solutions, leaders from public health schools are meeting in New York this week to consider the persistent societal, economic, and human rights problems that result from incarceration and the toll it continues to take on healthy populations, on individuals at risk for incarceration, and on our communities. We will remove the walls that separate our areas of specialty and consider how experts studying the complex systems that collude to worsen this epidemic can instead collaborate on sustainable solutions. We will partner with criminal justice experts to learn how the system can be reformed, leading to less violence and to better health.
Incarceration consumes an extraordinary amount of government funding, much of which would be better spent strengthening the systems that serve as effective prevention. About $70 billion are spent on corrections yearly in the United States, reflecting a 127 percent increase between 1987 and 2007, according to the NAACP. Funding for education increased 21 percent in that same time period.
We cannot afford to let this epidemic continue unabated. To ensure that knowledge and resources are targeted appropriately, public health must take a seat at the table.