The United States has the highest rate of incarceration in the world. Serious efforts to change this require a focus on more than just the criminal justice system. As Ta-Nehisi Coates writes in this month's Atlantic magazine, "It is not possible to truly reform our justice system without reforming the institutional structures, the communities, and the politics that surround it."
In a study published earlier this year in the American Journal of Public Health, lead author Mark L. Hatzenbuehler, my colleague and associate professor of Sociomedical Sciences at Columbia University's Mailman School of Public Health, examined whether residence in neighborhoods with high levels of incarceration is associated with psychiatric problems among non-incarcerated people. The study found that people living in neighborhoods with high prison admission rates were more likely to meet criteria for depression and generalized anxiety disorder than were those living in neighborhoods with low prison admission rates. This suggests, the study concludes, "the public mental health impact of mass incarceration extends beyond those who are incarcerated."
A report published in November by the Vera Institute of Justice, "On Life Support: Public Health in the Age of Mass Incarceration," underscores the collateral damage of mass incarceration on communities. The Vera report looks into census tract data for a number of cities, including New York, and notes the correlation between incarceration and disease concentration in the same neighborhoods. In New York, these areas also have high rates of HIV infection and other sexually transmitted diseases, as well as asthma and assault-related hospitalization.
Some communities are disproportionately affected by this epidemic of incarceration. The Justice Mapping Center and the Spatial Information Design Lab at Columbia University's Graduate School of Architecture, Preservation and Planning introduced the concept of "million dollar blocks": neighborhoods where states are spending in excess of a million dollars a year to incarcerate the residents of single city blocks. Their resulting maps of those blocks in five U.S. cities "suggest that the criminal justice system has become the predominant government institution in these communities and that public investment in this system has resulted in significant costs to other elements of our civic infrastructure - education, housing, health, and family."
High rates of incarceration, costly in terms of disease and dollars, are largely driven by non-violent drug offenses. As President Obama stated in a speech to the NAACP in July, "In far too many cases, the punishment simply does not fit the crime. If you're a low-level drug dealer, or you violate your parole, you owe some debt to society. You have to be held accountable and make amends. But you don't owe 20 years. You don't owe a life sentence. That's disproportionate to the price that should be paid."
The cost to society is disproportionate as well. The U.S. spends $80 billion every year on incarceration, money that would be better spent on solutions to improve life in these communities in rather exceptional ways. As President Obama pointed out, "for $80 billion, we could double the salary of every high school teacher in America." Before the epidemic infects more Americans and their communities, it's time to apply prevention science to mass incarceration. That science involves four areas of focus: first, the causes of incarceration risk in populations and the most effective approaches to prevention; second, how best to intervene to prevent the condition; third, how best to take the proven prevention techniques and deliver them on a broad scale; and fourth, how to apply the most effective approaches to preserving the good health of communities in the first place.
As the rate of incarceration has quadrupled over the last four decades, so has the damage it has caused entire communities. With America incarcerating more people than the top 35 European countries combined, that represents enormous collateral damage. While addressing problems inherent in our system of criminal justice, we must also redirect investment and energy to prevent this epidemic of incarceration and support the health of communities.