September 15 2015

The justice system in the United States is designed to punish — and rehabilitate if possible — people who have committed crimes as a tool to secure public safety. The system is supposed to be fair and promote justice. Many years ago we made our criminal justice policies tougher, but in a way that turned out to be neither just nor equitable.

Since then, we’ve realized our justice system is also terrible for your health.

As a nation, we have tried to lock our problems away and are now seeing the harmful impacts of mass incarceration on our society at-large. We have the largest prison population in the world by a large margin — with more than 2.3 million people locked up. More than 60 percent of prisoners are people of color. We have nearly 750,000 black men behind bars, which is more than the total prison populations in India, Japan, England, Germany, Argentina, Canada, Finland, Lebanon and Israel combined. Nearly one-third of federal prisoners are Hispanic, and the number of women in prison is rising 50 percent faster than men. Sixteen states put more people behind bars than in college housing. Since 1980, we’ve seen a nearly 800 percent increase in the federal prison population.

This is not by accident. Policies matter and they start wielding influence before a child is even born. Inadequate prenatal care, childhood exposure to lead and other toxins in the home, poverty and other early childhood trauma all predispose underserved children to poor performance in school. Minor behavior patterns — especially among kids of color — can result in school suspensions as early as preschool. Our failure to invest in protections for vulnerable children, including school-based behavioral therapy, family counseling and other needed services, has resulted in false labeling: Kids are diagnosed with attention deficit hyperactivity disorder or described as maladapted, problem children.

This practice starts the school-to-prison pipeline. In the 1980s we started a metaphorical “war on drugs,” which became a war on people: We began focusing on incarceration rather than treatment for a range of minor drug offenses, along with disparate prosecutions for the use of crack cocaine compared to powder cocaine. The passing of the Controlled Substances Act inadvertently targeted blacks by making mandatory sentencing for crack possession 100 times stricter than for powder cocaine, the latter of which was favored by whites. Today prisons are overcrowded with people who have mental illness, drug addictions and little education, and they generally receive inadequate therapy for their conditions. Half of all people in prison are parents, with their families suffering the consequences. The average prison sentence is nearly 10 years, and prisoners are often inappropriately cared for while there. Once they’re released, few options exist when they return to their community, further reducing the likelihood of their successful rehabilitation and reentry.

We can begin to address the problem if we look at the factors that influence health from an early age. We spend more than $80 billion in our prison system, while more than half of all federal prisoners are serving time for drug offenses. That’s money that’s not being spent on health, education and other social services.

But what if we focused on prevention and medical intervention, especially for nonviolent offenses? We’re seeing success stories in states and communities that are changing the way we think about justice. In California, Proposition 47 established a new sentencing policy that changed the classification of most nonviolent property and drug crimes from felonies to misdemeanors, and is said to have kept 120,000 children in schools rather than on the streets and given more than 4,000 people a second chance — both of which equate to new opportunities for jobs, housing and better health. New York has reduced its prison populations by nearly 25 percent in less than 15 years, but the move has resulted in no increase in crime rates. In Michigan, the governor’s plan to allocate resources to address what they see as the root causes of criminal behavior — such as child neglect, substance use, truancy, and mental health issues — focuses on preventing crimes rather than simply reacting to them.

The end goal should be to create a healthier nation by creating healthy and safe communities. Mass incarceration does not get us there. What does is thinking about the social determinants that keep us healthy and prevent the crimes that make us sick. There are many strategies to do this, including: Investing in early childhood interventions to increase learning and support development; ensuring universal health care coverage, which would provide opportunities to improve health at an early age and reduce the risk of health-related criminal behavior; providing comprehensive, school-based physical and mental health services; and replacing zero-tolerance policies in schools with trauma-informed restorative justice practices.

Our penal system also needs to change. Nonviolent people with behavioral health needs, such as substance abuse and mental health problems, should be placed in care that gives them appropriate treatment and supervision, rather than prisons where they are too often not rehabilitated. And we can do much more to ensure all individuals in prison receive adequate health care for, which enhances their ability to successfully reintegrate into the community once they have served their time. And by investing more in urban communities to improve the safety and economic viability of the community and its residents, we can reduce the need for prisons even while improve the options for those reentering society.

Ensuring justice and equity in our criminal justice system strengthens our ability to build healthy communities and create a healthier nation. Rehabilitating with treatment rather than incarceration will saves lives and saves money. The facts make it crystal clear: We should end our culture of punishment and replace it with a culture of prevention.

Watch this video about how our justice system impacts health.

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