The Public Health Consequences of Criminal Justice Policy

Incarceration, law enforcement and public health

Published on August 22, 2013 by Chelsea Davis

Two announcements made this week signal a shift in criminal justice policy aimed toward reducing mass incarceration. Though not focused on systemic overhaul, the shifts represent an understanding that a more economic, effective, and equal system is not only necessary in order to maintain public safety, but possible through policy change.

Although there was little explicit recognition of the public health consequences of incarceration in Attorney General Eric Holder’s speech to the American Bar Association or Judge Shira Scheindlin’s ruling in Floyd vs. the City of New York, these calls for a shift in criminal justice will indubitably have public health consequences, particularly because of their focus on reducing racial disparities.

On August 12th, Mr. Holder asserted that “incarceration is used to punish, deter, and rehabilitate—not merely to warehouse and forget.” He recognized how the cycle of poverty, criminality, and incarceration exacerbates the problems the system is meant to alleviate.

Reform will include:

  • increased federal prosecutorial discretion
  • anti-violence strategies
  • resource allocation to “hot spots”
  • increased funding for the Community Oriented Policing Services (COPS)
  • a Task Force on youth violence prevention
  • increased support to victims services
  • updated compassionate release frameworks
  • research on the use of drug and community service diversion programs and alternatives to incarceration
  • funding for better indigent defense
  • the appointment of a Prevention and Reentry Coordinator in every district
  •  commitment to evidence based programs

The largest part of the plan involves rethinking mandatory minimum sentences, a policy that greatly contributed to the growth of the U.S. prison system over the past four decades.

Holder assures that low-level, nonviolent drug offenders who have no ties to gangs or cartels will no longer be charged with offenses that impose such sentences. It is unclear how large the impact of this singular policy shift will be with regards to reducing the numbers of people in prison, but the admission that minorities face harsher punishments than their peers, destabilizing particular communities, is a signal that the shifts in policy are being recommended for the right reasons.

In New York, Judge Scheindlin ruled in Floyd, et al. vs. the City of New York, et al. that New York City’s use of stop and frisk violates the constitutional rights of minority citizens. Stops were carried out in a racially discriminatory manner, failing to satisfy the constitutional requirements made clear in Terry v. Ohio in 1968. Since 2004, the NYPD have stopped almost five million people, about 85% of whom were black or Hispanic, yet only 6 percent of stops result in arrest and 2% yield contraband.

Judge Scheindlin appointed an outside federal monitor to oversee the necessary changes in the NYPD. Mayor Bloomberg reacted by claiming “…the judge conveyed a disturbing disregard for the good intentions of our officers…,” and “…murders in NYC are 50% below the level they were 12 years ago—something no one thought possible back then.”  NYC mayoral candidates reacted publicly as well with most democrats praising the decision, including Christine Quinn who has shown support for Police Commissioner Ray Kelly in the past.

Both of these criminal justice policy shifts will impact public safety.

Mr. Holder made clear that current sentencing policy further destabilizes communities, and the same is true for stop and frisk. As police are often the first government entity youth come into contact with in neighborhoods with high stop rates, these discriminatory practices breed distrust for police and increase legal cynicism, a factor actually contributing to crime.

What is less known and little publicized will be the policy shifts’ positive impact on public health and the benefits to public safety they will bring.

Overcrowding in prison exacerbates and results in unhealthy prison conditions, increasing the chances of infectious disease epidemics and reducing the ability to care for chronic disease. In California, as a result of extreme overcrowding and a fungal infection outbreak, thousands of prisoners are ordered to be released, potentially posing a threat to public safety.

According to Yale sociologist Christopher Wildeman, imprisonment is associated with decreased life expectancy and increased disparities in overall population health in the U.S. Rates of incarceration are so high that it is not only those in the criminal justice system whose health is damaged. Research on AIDS, women’s mental health, children’s health, and divestment from public health into incarceration shows spillover effects as well.

Today’s penal system is not only impacted by racial disparities but perpetuates them.

Mr. Holder aims to target the failing drug war specifically, a large contributing factor to the epidemic of incarceration. More community-based alternatives to incarceration programs and the elimination of mandatory minimums for non-violent drug offenders may mean fewer incarcerations. As a result, the 14.5 percent of men and 31 percent of women in jail settings with serious mental illness (70% of whom have a co-occurring substance-use disorder and most of whom are such offenders), will spend less time behind bars.

People with psychiatric needs are more likely to be violently victimized and have high rates of recidivism. Shorter jail and prison stays coupled with alternatives can only increase treatment opportunities.

Health impacts of stop and frisk extend beyond indirectly furthering crime and police distrust. Because police contact is concentrated in disadvantaged neighborhoods, disparities in health are again exacerbated.

Systemic discrimination increases risk for several disorders including stress, depression, high blood pressure, cardiovascular disease, and some even claim racial profiling is a social determinant of health. Stops themselves are often stressful and physically invasive resulting in bodily harm, trauma, and negatively impacting adolescent health in particular.

What is still gravely necessary, yet untouched by Holder’s proposed policies or New York City’s necessary policing overhaul, are national attention on the collateral consequences of incarceration. Though reducing the numbers of people sent to prison and the length of stay in prison is important for reducing mass incarceration, alleviating the structural stigma and myriad of restrictions associated with the prison label is vital for truly fixing a now officially broken system.

Edited by Joshua Brooks

Chelsea Davis
Chelsea Davis is the Coordinator of the Mass Incarceration and Public Health Initiative at Columbia University, Mailman School of Public Health. She received her MPH from the Department of Sociomedical Sciences, concentrating in the History and Ethics of Public Health and Medicine in 2012. Chelsea has also researched the intersection of both the criminal justice and public health systems at the Vera Institute of Justice, Center of Immigration Justice and Substance Use and Mental Health Program, and the NYC DOHMH Bureau of Mental Health. She has written about mental health of asylum seekers and immigration court, therapeutic jurisprudence, alternatives to incarceration, and prison conditions. Her master’s thesis examined the historical development of drug and mental health courts as well as their impacts on both criminal justice and public health. Chelsea’s previous work experience includes literacy AmeriCorps and the Vanderbilt University Institute for Global Health. She will also be teaching public health anthropology with the Bard Prison Initiative in the fall of 2013. Follow her on twitter @msChelseaDavis. Email her at

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