Matters of Mass Incarceration

I’m from the Rio Grande Valley, where it isn’t uncommon to know someone serving time in prison. I'd even say it’s far more common to know someone who's served time than otherwise not to. Our area resides on the border between Texas and northern Mexico. It’s a region with many public health concerns ranging from a disturbingly high rate of childhood obesity to lack of basic access to quality health care. Underlying these issues are the conditions of poverty, illiteracy, and lack of economic opportunity. For many young people, dealing illicit drugs or joining the ranks of the neighboring Mexican drug cartels are enticing options for pulling themselves out of generational poverty. They inevitably cycle through the system as convicted felons for nonviolent, drug-related crimes. (For more, watch my 2013 short film Rio) As a young boy, I never reflected on what life was like for my peers; to be isolated from everyone and everything they’ve ever known. Through most of my life, I never felt sympathy for the prisoner. I never considered how their family suffered, much less how our community was affected by the incarceration of our neighbors. I was socialized to forget about the criminal once he/she was imprisoned. Friends whom once shared the hallways at school became vague memories. This is the paradigm that allowed the United States to become the most incarcerated country in human history.

I learned about Reagan’s war on drugs when I was a second-year undergraduate.
Over-policing. Mandatory minimum sentences. The prison-industrial complex. Mass Incarceration.
Criminal justice reformation is scaling the wall of priority for public health workers, human rights activists, and public servants alike. Michelle Alexander taught me more about the issue with her book, The New Jim Crow - Mass Incarceration in the Age of Colorblindness. She describes the inequalities in the criminal justice system that disproportionately impact people and communities of color. Recently, Vice produced a powerful piece covering mass incarceration and President Obama’s visit to a Federal Correctional Institution. While much of this work focuses on the incarcerated populations specifically, a study by The American Journal of Public Health published earlier this year, looked at how living in neighborhoods with high incarceration rates affects one’s health. Specifically, the study looked at the odds of developing psychiatric illnesses like major depressive disorder (MDD) and generalized anxiety disorder (GAD) if one lives in an area with high incarceration rates. (Read the study here ; May have to purchase) High incarceration rates were defined as roughly 5 prison admissions per 1000 adults in the community. After controlling for age, gender, "race", and income, the study showed that the odds of meeting criteria for a current diagnosis of MDD are 2.9 times higher for residents in communities with high incarceration rates (2.1 time higher for GAD). This is a glimpse of how mass incarceration extends beyond the walls of our prisons; an indication for public health urgency, action and further investigation. It's time for us to examine how the culture of mass incarceration developed and what we can do ameliorate the poor outcomes generated by it; how the war on drugs impacts our patients and our communities' mental and physical health. Dostoyevsky helped us measure the degree of civilization in our society by entering the prison. Now it seems we can make the same assessment by entering the 'hood.

Considerations:
-What do you think of the study? 
-Should physicians be more vocal regarding criminal justice reformation and it’s public health implications?
-When performing a social history, do you regularly ask about patients’ friends/families/neighbors who are imprisoned?
-Have you rotated or visited a prison during your training? What was that like?
-What is your group doing in terms of advocacy and action?
-Do you know someone in prison? 
-What is the war on drugs?
-What is the prison-industrial complex?

Recommended readings:
-The Collateral Damage of Mass Incarceration: Risk of Psychiatric Morbidity Among Nonincarcerated Residents of High-Incarceration Neighborhoods
-The New Jim Crow - Mass Incarceration in the Age of Colorblindness by Michelle Alexander
-Chasing the Scream: The First and Last Days of the War on Drugs by Johann Hari