Health Policy Chapter 9

The relationship between law enforcement and low-income Communities of Color particularly black communities is deeply rooted in American History

• Policing as a means of social control of poor (and most often) Black people follows a long-path from slavery to Reconstruction-era

• Black Codes (laws that limited the freedom and economic opportunity of Black people, often enforced by police) to Jim Crow laws to “stop and frisk” policies in urban, predominantly Black neighborhoods

Rise of mass incarceration in the 1970s

In an ostensible effort to crack down on a growing crime in the 1970s (which included concerns about rising drug trade), the federal government initiated the “War on Drugs” a highly punitive approach to the sale and possession of illegal drugs as well as other tough on crime” laws and policies

The War on Drugs was initiated by the Nixon administration in 1971 but was amplified in the 1980s by the Reagan administration. From 1980 to 1984, the federal budget for drug enforcement increased from $8 million to $95 million, penalties for possession of marijuana were raised, and federal mandatory minimum sentences were established

From 1980 to 1984, the federal budget for drug enforcement increased from $8 million to $95 million penalties for possession of marijuana were raised and federal mandatory minimum sentences were established

Reagan led Congress in criminalizing drug users, especially African American drug users, by concentrating and stiffening penalties for the possession of the crystalline rock form of cocaine, known as “crack” rather than the crystallized methamphetamine that White House officials recognized was as much of a problem among low-income white Americans

Stop and Frisk-

Sometimes searching individuals based soley on reasonable suspicion of criminal activity in neighborhoods

Example: At the height of its stop-and-frisk approach to “controlling” crime, New York City made nearly 700,000 stops in 2011

Lawsuits brought by the Center for Constitutional Rights in 1999 and again in 2008, claiming that the policy violated the federal Constitution’s Fourth and Fourteenth Amendments (pertaining to search and seizure and equal protection of the laws, respectively), led to court-ordered quarterly audits

What were the two purposes of the audit?

To monitor why the police were making stops and to track the stops by race and ethnicity

What is the broken windows theory?

In which the police seek to prevent crime by addressing disorder and less serious crime problems

Example: New York City Police Commissioner William Bratton in the 1990s, said that once a neighborhood begins to tolerate low-level crime, more serious crimes will follow; hence the theory goes, when people see broken windows in the buildings, more deterioration and disorder will follow

The Broken Windows Theory is a criminological theory that suggests that visible signs of disorder and neglect in a community (like broken windows, graffiti, litter, and vandalism) can encourage further crime and antisocial behavior.

-While evidence of the effectiveness in reducing crime is mixed, most researchers agree that “aggressive order maintenance strategies that target individual disorderly behaviors do not generate significant crime reductions

Less than 5% of all arrests each year are for violent offenses; most are for low-level felonies and misdemeanors

Black people are more than twice as likely to be arrested than White people

A study in Wisconsin found that White individuals charged with misdemeanors are 75% more likely than Black individuals’ to have charges dropped or to serve no time in jail

Roughly 1,000 people each year are killed by the police. Black people are disproportionately likely to be killed in these interactions; they are more than twice as likely to be killed by police as White Americans

How do these police stops impact black communities?

For example, one study of young men in New York City found that those “who reported more police contact also reported trauma and anxiety symptoms, associations tied to how many stops they reported, the intrusiveness of the encounters, and their perceptions of police fairness. Police stops are also correlated with higher rates of hypertension and diabetes in communities in which these stops are relatively common

A 2021 study in California found that exposure to fatal police violence increased the risk of pre-term birth

• Acute stress from police violence combined with higher ,levels of chronic stress among black women, likely explained the correlation to adverse birth outcomes

• Another study found that there are spillover effects from learning about police killings for the mental health of Black Americans, but not for White Americans

• Finally police presence in communities of color may affect access to services, including health care for immigrants. Fear of deportation may induce undocumented immigrants to forego health care and other services to avoid the possibility of encountering law enforcement

What do scholars suggest to better law enforcement and what are teh underlying issues?

Scholars who study law enforcement in low-income communities of color suggest that policy and practice reforms should include more sophisticated crime analysis to

• Prevent discriminatory rime control approaches

• Better engagement with residents through policing strategies

• Just procedures for police-resident interactions

• Problem-solving around crime prevention that does not rely on surveillance and aggressive enforcement

The top 5 countries with exponential growth of mass incarceration in the United States

1. United States

2. El Salvador

3. Rwanda

4. Brazil

5. Russia

Roughly 2.2 million people are incarcerated in federal and state prisons, juvenile detention facilities, and jails each year

-More than half a million of those are locked up in jails without having been convicted of a crime

As highlighted previously, a disproportionate number of the people affected by America’s mass incarceration are racial and ethnic minorities

Overall incarceration rates peaked in 2009 but have been slowly declining in some parts of the country. However, incarceration rates for women, which have grown steadily since the 1980s have not dropped at the same pace as those for men. Growth in the number of women in prison appears to result from the crackdown on drug and minor offenses in low-income neighborhoods discussed earlier in the chapter

LGBTQ+

In 2019 the National Survey on Drug Use and Health reported that gay, lesbian, and bisexual adults were 2.25 times as likely to be arrested as straight people in the past 12 months

-Until the U.S Supreme Court struck them down in Lawrence v. Texas in 2003. state sodomy laws were enforced as a way to criminalize sexual activity between same-sex partners

Prision Industrial Complex

An economy, particularly in small towns, built on incarceration. As funding from the federal government was funneled to federal agencies and states for the War on Drugs and enhanced law enforcement and as more people were arrested and prosecuted, there was a need for more prison beds.

Privatization in the jail economy

While some view privatization as beneficial to reliving tight state budgets, others see incarceration as a financial boon to private industry. Privatization, they argue creates perverse economic incentives to keep prison beds full and runs counter to criminal justice reform. An additional consequence of the growth in the prison industry is that many communities become dependent on prisons for employment

Motives for expanding incarceration

One of the primary motives for expanding incarceration and hence building more prisons was to reduce violent crime. Yet a recent study that randomly assigned and then compared criminal defendants to judges who were “more harsh or lenient in their sentencing” found that those who were more or less likely to be convicted of a violent crime within five years and that the benefit of “incapacitating” a person to prevent them from committing crime while in prison was marginal. Furthermore, states that have decreased their prison populations have not seen an increase in crime rates

Inferno: An Anatomy of American punishment

In his recent book law, professor Robert Ferguson argues that America doesn’t punish its criminals. it demonizes them. It turns them from men into monsters so that it then may feel justified

one study estimated that in 2009 the cumulative probability by age 30 to 34 that a Black man would spend time in prison was nearly 7-% compared to 15% for a white man

Fifty percent of incarcerated white people and 60% of incarcerated Black people have not completed high school

Unhoused people are 11 times more likely to be incarcerated than house people

Criminal Justice Fines

Depending on the state, failure to pay court debt can lead to jail time in several ways: It is considered a probation violation, it is a penalty for “willful failure to pray criminal justice debt,” and /or it may lead to arrest and pre-detention until a hearing on the ability to pay is held. Since the majority of people who are incarcerated are already poor, accumulating this kind of debt along with the threat of additional jail time can easily lead to a cycle of poverty and reincarceration

Definition of Stigma

Stigma is the process whereby “elements of labeling, stereotyping, separation, status loss, and discrimination co-occur together in a power situation that allows the components of stigma to unfold

Collateral Consequences of a criminal record

Refer to the penalties and disabilities that occur automatically as a result of conviction, apart from the sentence itself. These include a range of disadvantages, disenfranchisement; ineligibility for public benefits, housing scholarships, and student loans; being barred from obtaining occupational licenses and employment; loss of child custody and the inability to adopt a child; and felon registration requirements

American Bar notes": “If promulgated and administered indiscriminately, a regime of collateral consequences may frustrate the chance of successful re-entry into the community, and thereby encourage recidivism

More than one-third of prison inmates suffer from at least one disability (not including substance use disorders), including 19.5% of prisoners who have developmental or intellectual disabilities. Incarcerated individuals are four to six times more likely than the general public to report Down syndrome, autism, dementia, learning disorders, and intellectual disabilities

Although there is not extensive research directly linking the experience of incarceration to specific health outcomes, one study found that incarceration is associated with increased C0-eactive protein and risk for depression, especially for people who spent longer period in prison. CRP is associated with chronic stress, leading to inflammation and reduced immune response, putting a person at higher risk of heart disease and death

Trauma that impacts prisoners the most

1st:Family drug use- 57%

2nd:Hit by parents-46%

3rd:Witnessed death-42%

Parent lost custody:40%

The ACA’s expansion of Medicaid to low-income single adults made it possible for this population to access health insurance, often for the first time. However, because the ACA’s Medicaid expansion is optional for states, individuals who live in states that did not adopt the expansion still have no access to affordable health insurance and likely no regular source of health care

Furthermore federal law bars inmates from obtaining Medicaid coverage

• First, the costs of medical care are borne by state correctional budgets rather than federal and state governments. This discourages states from investing in prison health care

• Second, it furthers enshrines inequities in health care access by SES, race, and ethnicity

• Third it thwarts successful rentry by fostering “logistical hurdles” to continuity of care

In 1976, the Supreme Court held in Estelle v. Gamble that the provision of health care is mandated in correctional facilities, since incarcerated individuals are effectively wards of the state and unable to seek on their own. The court said that “deliberate indifference to serious medical needs of prisoners” violates the Eight amendment to the U.S. Consititution which forbids infliction of cruel and unusual punishment

Hepatitis C

• Hepatitis C affects roughly a quarter of the prison population

• Direct-aging anti-removal agents cure more than 90%of hepatitis C infections and are considered the standard of care for treatment. however DAAs cost between $20,000 and $84,000 per year

Reproductive health in prisons

• A report by the National Women’s Law Center that graded states on their provision of reproductive health care in correctional facilities found that 21 states received a D or F. Most states did not have policies on routine exams, treatment of women with high risk pregnancies, nutrition, or HIV screening

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Formerly incarcerated individuals, particularly those with a history of using opioids such as heroin and fentanyl, are at high risk of overdose upon leaving prison. Most inmates with opioid addiction must withdraw without medication-assisted treatment (MAT) or supportive counseling. Upon leaving prison, formerly incarcerated people often start using drugs again, and if they use at the level they did prior to being in prison, they are likely to overdose as their body can no longer tolerate the higher dose.

For example, women with incarcerated partners are at increased risk for social isolation and depression,85 and children who have an incarcerated parent are susceptible to feelings of shame and stigma and are at higher risk for stress-related illness

4 Approaches to reduce incarceration

1) Improving both health care in prisons and the continuity and quality of care post-incarceration

2) Linking legal services and health care for criminal justice-involved individuals and their families though medical legal-partnerships

3) Diversion programs that keep people out of the criminal justice system by connecting them with community-based care and supports

4) Policy changes, including police reform, reducing collateral consequences, and decarceration (reducing prison populations)

Medical-legal partnerships-partner health care providers and legal advocates with the goal of addressing social and legal drivers of health for individuals, communities, and populations

One MLP model is to partner Transitions Clinic and other medical providers with legal advocates to provide free legal assistance to formerly incarcerated patients and their families to support successful re-entry.

Drug courts target defendants with substance use disorders and employ a multidisciplinary team approach that includes social workers, treatment service professionals, community corrections staff, judges, prosecutors, and defense attorneys. These courts assess defendants’ risks and needs, offer treatment and rehabilitation services, implement graduated sanctions and incentives (usually in lieu of incarceration), and monitor and supervise progress (such as drug testing).

Cities across the country are debating ways to reform (or eliminate altogether) police departments. There are two types of proposals. First, some propose defunding the police by substantially reducing police department budgets and then redirecting that funding toward the social safety net and community investment (e.g., affordable housing, mental health care, drug treatment).

Second, those calling for abolition argue that police departments are an “inherently racist tool of social control” and cannot legitimately be reformed. They propose replacing policing with a model in which empowered communities work to solve their own problems

restorative justice—a response to crime that focuses on repairing the harm and restoring the well-being of those involved through a process of reconciliation

There have also been some federal bipartisan efforts at criminal justice reform, including the First Step Act, which made important strides by among other provisions:

Shortening mandatory minimum sentences for nonviolent federal drug offenses

Expanding the “drug safety-valve,” which allows judges more discretion in sentencing for drug offenses

Applying retroactively the Fair Sentencing Act of 2010, which reduced the sentencing disparity between crack and powder cocaine to address racial inequities

Improving the conditions in federal prisons by prohibiting the shackling of pregnant women, increasing credit for good behavior, and requiring prisons to offer programming to reduce recidivism

First, it was a compromise bill that watered down or eliminated many other policy reforms that were originally proposed. Second, the law only applies to federal prisons.