Calling out the horrors of mass incarceration

Addressing a uniquely American problem.

The US incarcerates more people than any other country in the world. There are currently two million people in prisons and jails in this country. Yet mass incarceration, for all the lives it touches, does not affect all lives equally. Black men are six times likelier than white men to be incarcerated. Latino men are 2.5 times likelier to be incarcerated than white men. These numbers reflect a system that arguably does not simply punish those who have committed crimes in proportion to their offenses. Rather, it reflects a deeply biased system that has created a crisis in this country.

During the pandemic, there was much conversation about prisons as sites of viral spread, with close quarters and often unsanitary conditions placing incarcerated populations at risk. From the perspective of public health, these conversations were welcome and necessary. Yet they were also cause for some frustration. They felt like what they were: exceptions to a rule, one in which we rarely if ever discuss mass incarceration’s implications for health—for both the health of prisoners and the health of the communities of which they are part. It should not take a pandemic for us to have conversations about incarceration and health. Given the scope of incarceration in the US, and how it disproportionately affects certain communities, incarceration constitutes, for many populations, a ubiquitous exposure, deeply shaping health. For those who are not directly affected by mass incarceration, it is nevertheless a key influence, as a driver of health inequities and as an injustice in which we, collectively, are implicated.

Public health has long engaged with the challenge of incarceration. (In my own work, I have often written about incarceration in the context of trying to create healthier populations.) Next Wednesday, September 28, the Boston University School of Public Health will continue this engagement by hosting a conversation, “Abolition, Incarceration, and the Public’s Health” (details and registration here). In advance of the event, I thought I would share some thoughts on incarceration, its implications for health, and steps we can take to do better by incarcerated populations and their communities. 

It is perhaps worth starting by saying precisely what it means to be incarcerated. Incarceration represents one of the most intrusive actions the state can take in relation to the bodies of its citizens. The incarcerated are relocated to a setting that is generally far less healthy than the one they used to inhabit, and they are kept there often for years on end. During that time, they are subject to a range of risks to their physical and mental health, to say nothing of the pain of being separated from family and friends on the outside. They are placed in this situation by a justice system that aspires to an ideal of fairness yet often falls short. That some people should be in prison is beyond doubt. That far too many are there, with clear racial disparities in incarceration rates, is also, I think, beyond any reasonable doubt. Incarceration, then, presents a challenge that is both moral and sociological. The moral challenge is inextricably linked to the injustice that underlies much incarceration. The sociological challenge reflects the age-old balance societies have tried to strike between crime, punishment, and finding compassion-informed avenues for rehabilitation and redemption. Even as we accept the need for some incarceration as part of this balance, it seems to me that public health has a responsibility to argue against mass incarceration, against a carceral state, making the case in a way that reflects the realities of crime but also insists on a more humane way of addressing the elements of human nature that generate infraction.

I would suggest that there are two key arguments against mass incarceration in the US: the empiric argument and the moral argument. First, the empiric argument. This argument rests on the data I have already shared about the scope of American mass incarceration and its disproportionate toll on communities of color. It also rests on the fact that prisons and jails tend to be dangerous places, where prisoners face many threats to their health—from risk of violence, to transmissible disease, to the severe toll incarceration can take on mental health. It is also a fact that mass incarceration poses challenges not just to prisoners themselves, but to their communities. About 2.7 million American children have a parent who is incarcerated. This includes 11.4 percent of Black children, 3.5 percent of Hispanic children, and 1.8 percent of white children. Lack of a two-parent household can do much to undermine life outcomes. High incarceration rates in a community can also affect communities by undermining mental health. A 2015 study found populations living in neighborhoods with high rates of incarceration were likelier to have a major depressive disorder or generalized anxiety disorder.

The empiric argument also rests on the facts of the historical legacy that informs incarceration in America. As Ava DuVernay observed in her film 13th, the 13th amendment, which abolished slavery in the US, says no one in the country can be held involuntarily “except as a punishment for crime.” This exception has arguably informed a status quo which, shaped by racist attitudes within law enforcement, the criminal justice system, and at the policy level has led to the disproportionate burden of incarceration that has fallen on Black communities. This status quo is inseparable from the Drug War, which has done much to drive up incarceration rates among communities of color.

The second argument against mass incarceration is the moral argument. It lies not in statistics but in the human beings whose lives they reflect—in communities disrupted, in health kept out of reach. And it is in the injustice we have let creep into our justice system. Certainly, societies have a right to prosecute crime and to administer punishment, ideally with an eye towards rehabilitation. But when this system becomes unduly punitive, as ours has become, it is itself deserving of judgement and correction. It is a system which not only incarcerates but disenfranchises many prisoners. It dispenses punishments that do not always fit crimes, with money and privilege able to buy much in the way of lighter sentencing and poor offenders receiving harsh sentences, often for nonviolent drug offences. This is a system which goes well beyond the remit of a sensible, fair approach to addressing crime. What is more, it actively impedes our ability to develop such approaches, by taking us far from a compassionate, imaginative perspective that could truly support justice.

In making the case against an incarceration system that arguably goes beyond punitive to appear, in many cases, genuinely vengeful, it is important to take a moment to address what is perhaps the ultimate expression of a gratuitously punitive approach: capital punishment. In a system which routinely dehumanizes those it affects, in which the state wields power over prisoners’ bodies, often with terrible consequences for their health, capital punishment, by destroying these bodies, reflects a violation of health in the most fundamental way. We should be very clear in saying that no state should ever take away the lives of its citizens. Capital punishment is the state denying the prisoner the chance to ever be healthy again, as it exacts a measure of what it calls justice, but which is in fact an often sloppily applied process in which the innocent are at times killed along with the guilty. In addition to all it does to undermine health, capital punishment also undermines the healthcare profession, to the extent that doctors and drug companies have participated in giving the state the means to carry out executions and have used the language of medicine to euphemize what happens when a prisoner is put to death. For these reasons, our conversations about the injustice of mass incarceration must include the injustice of capital punishment, and our reform efforts must prioritize the end of this practice.         

Mass incarceration perpetuates many of our worst impulses as a society. It is biased when it should be impartial. It can be vengeful when it should advance justice. It makes us sicker when it should rehabilitate citizens. Creating a healthier world means engaging with the challenge of mass incarceration through a bold reimagining of what justice can be. This does not necessarily mean doing away with prisons, but it does mean doing what we can to make prisons into places that truly support rehabilitation and health. It means ending the Drug War, including the long sentences that keep so many behind bars for nonviolent offenses. It means addressing the racial biases that have shaped the carceral system at every turn, with roots in the legacy of slavery. And it can indeed mean an abolitionist approach, as we work towards a world where prisons are replaced by centers of true rehabilitation. I realize “abolition” may be a challenging word in the context of this conversation, yet it reflects the boldness necessary for envisioning a better future even if this future is more a product of reform than of radicalism. These steps all have a role to play as we engage in the work of creating a better, more just status quo around this issue.