Thoughts on the APHA Closing Session: In the End, It is All About Power

Nov 1, 2012, 10:50 AM, Posted by

Robert Otto Valdez, PhD, is the Robert Wood Johnson Foundation (RWJF) professor of family & community medicine and economics at the University of New Mexico. He serves as executive director of the RWJF Center for Health Policy at the University of New Mexico, a national program office for increasing diversity in health and health care leadership. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.


The 140th Annual Meeting of the American Public Health Association (APHA), the nation’s oldest gathering of public health professionals in the world, concluded yesterday as the San Francisco region celebrated the World Series victory of their beloved Giants.  Close to 13,000 public health professionals came together around the theme, Prevention and Wellness Across the Life Span.

The closing session focused on incarceration, justice, and health with a keynote speech by Angela Davis.  Our society has used mandatory sentencing and incarceration of Black and Latino young men and, more recently, immigrants as a form of social control that not only maintains the current social order but also contributes to the inequalities in health that result from inequitable society.

The kinds of mass incarceration costing some $70 to $100 billion a year has produced social inequalities that can be readily seen in the lives and families of the formerly incarcerated.  Bruce Western and Becky Pettit offered an insightful article in the Summer 2010 Daedalus that describes the creation of a group of social outcasts “who are joined by the shared experience of incarceration, crime, poverty, racial minority, and low education.”  These are all characteristics that contribute to social and economic disadvantage not only for those who were incarcerated but also their families.

This closing of the annual meeting reminds us all that prevention and wellness focused on the individual, as suggested in the theme, cannot ignore the institutional framework that keeps or increases the inequalities in our society.  We can pursue wellness and create greater prevention when we go well beyond an individual’s behavior or actions.  Our laws have pursued punishment as a means to produce “public safety” or create the illusion of such.  But public safety, just as community health, grows when people can create predictable orderly lives.  Unemployment, poor health, family instability, and laws or regulations and institutions that maintain an uneven playing field foster unpredictable circumstances in the lives of many people, especially those who have been incarcerated.

We must understand how prisons and now immigration detention centers (both increasingly operated by for-profit corporate interests rather than governments) over the last decade have embedded themselves in the structure of our society’s inequalities.  Too few in our society know that immigrants, many children, are detained under harsh conditions for long periods of time without being charged for a crime.  In 2011, the Department of Homeland Security held more than 429,000 immigrants in more than 250 facilities across the country even though the overwhelming majority of these individuals do not require detention to process deportations.

Nor does it make our society any safer.  Among those locked up include survivors of torture, victims of human trafficking, families with small children, individuals with serious medical conditions, and long-time law abiding members of our society who have contributed to our economy and culture.

Addressing the inequalities in our society that create unhealthy communities that are toxic for humans has become more complex over the last decades, requiring us to undo both the legal and policy structures that allow a few to reap benefits while the rest of society divides the scraps.  We must challenge the institutional interests that serve as the frame upon which is draped that cloak of invisibility that protects the status quo and power structure. 

In the end it is all about power; in a healthy republic, power is more evenly distributed so that people have a sense of community and equality of opportunity.  We must strive to create these in our economic and social policies as well as in our homes and neighborhoods.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.