How to Address Disparities? Recognize Incarceration as a Major Threat to Health.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Elizabeth Barnert, MD, MPH, MS, a pediatrician and clinical instructor in the UCLA Department of Pediatrics, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Barnert is an RWJF Clinical Scholar at UCLA.
While there is much to be done to improve equity and access to health care for all Americans, I believe that the most important strides in health we can make will occur by directly addressing the social and environmental determinants of health. Racial/ethnic and economic inequities strongly play out in the criminal justice system. This has important implications for health. Incarceration itself is a determinant of health.
Breaking cycles of incarceration has the potential to dramatically improve the health of entire communities, setting individuals and families on trajectories that are healthier, safer, more fulfilling, and more productive. To address incarceration, America must recognize that the patterns of mass incarceration prevalent in many disadvantaged communities perpetuate poor health outcomes, further widen social inequities, and often lead to further incarcerations within and across generations. Currently, 1 in 28 U.S. children, and 1 in 9 African American children, have a parent who is incarcerated. Two-thirds of these parents are incarcerated for non-violent offenses. By virtue of having an incarcerated parent, these children are at much higher risk of themselves becoming incarcerated at least once during their life course.
Creating a robust education and employment infrastructure may be the key in transcending pathways to incarceration. Presently, more African American young adult males who have not completed high school are incarcerated than employed. Investing to make education a feasible and worthwhile alternative to activities that lead to incarceration is critical. Adopting effective prevention and treatment programs that strategically address risk factors for incarceration in families and communities is also urgently needed.
More fundamentally, implementing policies that alleviate childhood poverty must be pursued. Reducing childhood poverty is already known to be achievable and worthwhile, and at this point requires only political will—the same political will that has successfully reduced poverty among the elderly over the last 50 years.
Finally, policies that support diversion of non-violent offenders away from the criminal justice system—keeping parents and their children out of jail—are important. Many American communities and policy-makers vastly underestimate the detrimental population health effects of incarceration and fail to identify offenses that can be effectively addressed by incarceration alternatives.
Promoting a culture of health that includes all people requires that we think hard about how we treat our most vulnerable. To me, prisoners and former prisoners—and in particular, juvenile offenders—are among the most vulnerable individuals in our country. Embracing a culture of health for all requires us to meaningfully address incarceration and recognize it for what it is—a major threat to health.