542419 research-article2014
JMHXXX10.1177/1557988314542419American Journal of Men’s HealthTreadwell et al.
Editorial
Miles to Go: The Prison Expressway, Health Research, and Health Activism
American Journal of Men’s Health 2014, Vol. 8(6) 449–456 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988314542419 jmh.sagepub.com
Henrie M. Treadwell, PhD1, Kasim S. Ortiz, MS2, and James R. McCoy3
Introduction On February 27, 2014, President Barack Obama delivered a speech commencing a new White House Initiative titled, “My Brother’s Keeper.” President Obama remarked, “We need to encourage fathers to stick around, and remove the barriers to marriage, and talk openly about things like responsibility and faith and community” (The White House, 2014). Earlier in his speech the President proclaimed, If you’re African American, there’s about a one in two chance you grow up without a father in your house—one in two. If you’re Latino, you have about a one in four chance. We know that boys who grow up without a father are more likely to be poor, more likely to underperform in school. (The White House, 2014)
The contention of these two statements explains largely an ill-directed narrative of individual responsibility, poor policy development in addressing social inequities that shape the health of men of color comprehensively and an unwillingness to recognize the institutionalized realities that prevent men of color from “sticking around.” Such political rhetoric is at minimum thwarting to social progress concerning men’s health and the influence of mass incarceration wherein this rhetoric of “sticking around” is not fully understood through a lens that highlights the systemic epidemic of mass incarceration that challenges full opportunity for many to “stick around.” One major area of concern for the President is the impact mass incarceration has had on the life trajectory of men, particularly men of color. In this commentary, we detail how mass incarceration has compromised the health of all Americans, outline what we describe as a prison expressway, and raise concern for greater public health response to address the needs of those that are incarcerated and/or formerly incarcerated.
100 per 100,000 people were incarcerated in the mid1970s to roughly 500 per 100,000 people by the mid2000s (Wakefield & Uggen, 2010). According to the Justice Department’s Bureau of Justice Statistics 2012 advance count, there was a prison population of 1,571,031 persons at yearend (Carson & Sabol, 2012). With these figures being in decline for the second consecutive year, understanding the factors that facilitate in successful reentry requires an upstream approach that considers those contextual factors that create populations most vulnerable to incarceration. Rates of incarceration and interaction with the criminal justice systems are largely predicated on various racial biases embedded with the criminal justice system (Wright, 1987). The overall impact of mass incarceration is detrimental to the quality of life for not only formerly incarcerated persons but equally jeopardizes quality of life for all Americans. For example, growing tax spending for privatization of incarcerated populations is benefiting some communities while depleting resources from others (Fulcher, 2012). It has been demonstrated that states with growing private prisons are also compromising employment opportunities for communities that host private prisons (Genter, Hooks, & Mosher, 2013). Relative to health effects resulting from mass incarceration, those consistently engaged with the criminal justice system have demonstrated higher rates of sexually transmitted infections and mental health complications when compared with the general population. Such health affects in-turn jeopardizes the health of family members of incarcerated persons and community members in which those might be returning to (Travis, Western, & Redburn, 2014). Concerted efforts have centered on redressing the “school to prison” pipeline (Ladson-Billings, 2009), yet this framing insufficiently describes the connection between incarceration and population-level health. Rather, mass incarceration 1
Morehouse School of Medicine, Atlanta, GA, USA Vanderbilt University, Nashville, TN, USA 3 American University, Washington, DC, USA 2
A Prison Expressway? The portion of the U.S. population imprisoned has skyrocketed since the 1970s, disproportionately affecting men and particularly men of color, wherein approximately
Corresponding Author: Kasim S. Ortiz, Department of Sociology, Vanderbilt University, PMB 351811, Nashville, TN 37235-1811, USA. Email: [email protected]
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Figure 1. Exiting the prison expressway. Addressing mass incarceration in African American and Latino boys and men.
should be viewed as an expressway, a prison expressway. Such an illustrative portrayal situates exits from the expressway that includes opportunities. Far too often such opportunities are limited from full access and deter formerly incarcerated populations back onto the expressway. A school to prison pipeline does indeed exist that foments the life trajectories of many men of color, which has decreased in that young boys in earlier grades are being labeled for entering such pipeline (Ladson-Billings, 2009). The prison expressway perpetuates marginalization of men of color wherein heightened vulnerability for increasing likelihood of early police contact leads to social/community stigmatization (Travis et al., 2014) (see Figure 1). Incarceration consequences can linger far beyond periods of jailing such that incarceration can jeopardize future employment opportunities, civic engagement, health statuses, educational opportunities, greater potential for reentry into prisons, and as the President identified negatively disrupt families and communities (Wakefield & Uggen, 2010). Confronting the impact of mass incarceration requires attention to a myriad of issues such as postincarceration educational opportunities, civic engagement, health statuses (pre-/postincarceration), family disruption, and community disruption (e.g., federal spending for community development that is depleted from urbanized areas where many men of color reside but yet are not counted within Censuses because of incarceration; Drake, 2011; Wagner, 2011). To achieve this we
have to figure out better ways to help the incarcerated population obtain means for navigating the prison expressway to secure more meaningful lives or prevent such mass imprisonment from the onset. Affirming the consequential life chances described previously and ascribing to a prison expressway realization warrants public health researchers’, practitioners’, and health policymakers’ attentiveness to these areas to fully understand the health effects of mass incarceration at a population level. More important, a public health response must mobilize around these areas to decrease the growing epidemic of mass incarceration efficiently. How might the public health community respond to make progress toward ending the prison expressway? We detail three areas of emphasis for which we believe are possible target areas: (a) increase research and training to improve consciousness of mass incarceration, (b) integration of a public health critical race praxis to confront mass incarceration that produces an antiracist paradigm, and (c) greater health activism. Before outlining these foci, we first turn attention to detailing the President’s Initiative and then highlight a recent National of Academies of Science report on mass incarceration.
My Brother’s Keeper In May 2014, the My Brother’s Keepers Task Force Recommendations to the President was released. The
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Treadwell et al. primary focus is on increasing mentorship opportunities for young men of color in targeted areas to improve their livelihoods. This report outlined recommendations for the Initiative, ranging from cross-cutting recommendations to very specified targeted recommendations for milestones of focus areas to track progress. Cross-cutting recommendations and areas of opportunity identified include (a) Establishing National Indicators, which included closing gaps in data collection of invisible populations; (b) Incentives for Implementation of Evidence Based Effective Strategies; (c) Support Comprehensive, Cradle to College, and Career Strategies Rooted in Local Communities; (d) Recognize the Importance of Parents and Other Caring Adults. Other focus areas included school readiness and adequate access to high-quality early education, implementation of universal early health and developmental screening, improving high school graduation and college readiness, increased attentiveness to assisting men of color with completion of postsecondary education and/or training, and workforce and employment opportunities to name a few. Specific attention was provided to issues relative to men of color, the criminal justice system, and incarceration. These recommendations included (a) reducing violence in high-risk communities by integrating public health approaches, (b) encourage law enforcement and neighborhoods to work hand-in-hand, (c) reform the juvenile and criminal justice systems to keep youth on track, and (d) eliminate unnecessary barriers to reentry and encourage fair chance hiring options. Within these recommendations lies optimal opportunity to improve the life of men of color while simultaneously their subsequent communities and families, especially incarcerated populations. However, these recommendations have yet to be materialized into policy prescriptions for guaranteeing their success. The primary mechanism for achieving these goals is utilizing governmental and non-governmental entities (via primarily philanthropic groups) for developing critical indicators of life outcomes for men of color for mentoring efforts. One approach is to utilize the Federal Intergency Forum on Child and Family Statistics (Children’s Forum). Such efforts are useful as data gaps impeding a knowledge base to produce evidence based approaches for addressing life outcomes of men of color currently are lacking. However, it should be careful in the development of efforts to not perpetuate highly racialized perceptions of men of color being necessary for familial developments as the sole primary foci for improving the well being of communities of color. Moreover, it should be highly integrated within the My Brother’s Keeper Initiative a key focus on developing interagency policy initiatives that directly confront racism that shapes the livelihood of young men of color. This could be manifested in greater research funding for
studying men of color explicitly. While we recognize that the efforts proposed from the My Brother’s Keepers Initiative are plausible and a positive step in a good direction, we must also recognize that mentoring is only one means for improving the livelihoods of men of color. Equal vigorous efforts should be placed on changing policies that jeopardize the lives of men of color and other multifaceted approaches that do unite governmental and non-governmental responses.
The Cracks in the Road The recently published National Academies of Science report “The Growth of Incarceration in the United States: Exploring Causes and Consequences” outlines how the United States has turned into the current carceral nation state. The report explicitly outlines the culmination of increased violence prior to the 1970s and political transformation of U.S. race relations created the perfect storm in which racial attitudes were guised under a need for better social control to decrease crime (Travis et al., 2014). The authors of the report identify that increased incarceration might have contributed to decreased crime, the magnitude of this reduction is highly uncertain, and most published studies document suggest that the reduction is most likely to be relatively small (Travis et al., 2014). Moreover, the report identifies that lengthy, more stringent sentencing practices have at best modest deterrent effects, largely because recidivism rates decline markedly with age and criminal behavior in general is reported less among older populations (Travis et al., 2014). Most compelling within this report lies the meaningful ways in which mass incarceration has disproportionately affected communities of color, particularly poor Black and Hispanic communities where men within those communities are more likely to experience incarceration. The highly racialized and codified prison policies, sentencing policies, and social policies concerning incarceration as the most formidable form of social control for criminally deviant behavior has created a generation at the population level that is disenfranchised in a myriad of ways. The explicit attention provided in this report to the instituional barriers rooted within racist realities such as sentencing policies, as one example, warrants responses that directly redress such structural barriers.
Incarceration, Population Health Research, and Training The current ability to comprehensively understand the influence of incarceration on health is limited. Previous, and current, public health surveillance of incarcerated populations has been inadequate. Limitations in gathering prisoner information and/or information concerning
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incarceration interactions within nationally representative datasets have been identified as a potential barrier (Ahalt, Binswanger, Steinman, Tulsky, & Williams, 2012). Most publicly available national health data sets include only populations that are deinstitutionalized. Moreover, limitations also exist with respect to longitudinal data to derive causality between incarceration experiences and deleterious health (Ahalt et al., 2012; Purtle, 2012; Wang & Wildeman, 2011). This continued surveillance oversight has contributed to deflated representation of the extent of racial health disparities in America in general (Schnittker & John, 2007). Moreover, this data insufficiency threatens the training of the public workforce, especially those pursuing research-oriented job opportunities. The missingness of incarcerated populations results in the lack of acuity to this population’s need in training researchers to obtain cultural sensitivity necessary to efficiently serve this population. Also, throughout graduate tenure the inability for students to readily access data sets with incarcerated populations often results in practitioners not being well equipped postgraduation with an understanding of how incarceration comprises the health of those incarcerated and the communities from which they are incarcerated and/or returning to. The public health community has responded to growing demand for a stronger public health workforce experienced in evaluation and programming, evident by greater integration of evaluation content within curricula (Adams & Dickinson, 2010; Fierro & Christie, 2011). In recent years, largely in response to lack of cultural consciousness among the public health workforce concerning issues of diversity, we have seen the uptake in programming/training for those from diverse backgrounds (Adams & Dickinson, 2010; Christie & Vo, 2011; Cohen, Gabriel, & Terrell, 2002; Williams et al., 2014). However, such integration of content on mass imprisonment is quite limited, particularly content that is historically situated with a critical lens on the institutionalization processes that have been vital in shaping mass imprisonment. The Kronenfeld study (Kronenfeld, 1981) on evaluation curricula noted that the University of South Carolina’s School of Public Health actively engaged in planning evaluations on prison health in 1981. However, recently while giving a lecture on incarceration Dr. Treadwell was precariously asked by Kasim Ortiz (while a student at the University of South Carolina in the Arnold School of Public Health): “Why was it that he could not recollect many courses which had integrated content on mass imprisonment in the public health courses he’d taken?” This is not to generalize to all public health schools, nor be representative of all courses offered within the esteemed Arnold School of Public Health, yet elucidates a potential diminishing value in studying this population in general within public health curricula
content. How do we expect our public health workforce and researchers to be fully equipped to handle prisoner populations (pre-/postincarceration) if we are not guaranteeing they are provided appropriate training?
Public Health Critical Race Praxis and Imprisonment The first comprehensive work designed to bring strategic focus to the issues of prisoner health recently occurred in October 2005, in which Treadwell served as a Guest Editor for a themed issue in the American Journal of Public Health (Treadwell & Formicola, 2005). The intent was to break the silence and foster and promote research on the public health implications of incarceration. Since that AJPH issue, there has been a growing emphasis on the need for research among this underserved population. Even with the continuing limitations in data availability and greater need for conscious curricula, research exploring the impact of incarceration on health outcomes has increased recently (Turney & Wildeman, 2013; Wildeman, Lee, & Comfort, 2013; Wildeman & Muller, 2012; Wildeman, Schnittker, & Turney, 2012). Most recently, public health literature has experienced rejuvenation in exploring the impact incarceration has on family disruption (Graham & Harris, 2013; Lee, Porter, & Comfort, 2014; Turney, 2013), mental health concerns among prisoners and those connected to incarcerated persons (Lawson & Lawson, 2013; Lee, Fang, & Luo, 2013; Murray, Farrington, & Sekol, 2012; Turney, Lee, & Comfort, 2013; Turney, Wildeman, & Schnittker, 2012), and the effects of incarceration on children of those incarcerated among a myriad of other issues (D’Andrade & Valdez, 2012; Kjellstrand & Eddy, 2011; Wakefield & Wildeman, 2011, 2014). A common theme within this body of research centers on the historical reality that men, particularly men of color, are often disproportionately affected by incarceration, jeopardizing their health. Thus, a critical response from public health warrants a lens for improving our understanding of this population that openly acknowledges structural determinants that shape these racial disparities. Critical race theory as a form of knowledge production and community activism is well-suited to improve our ability to confront racial disparities in mass incarceration that resonates with health. Public Health Critical Race praxis draws inspiration from critical race theory (CRT), whereas CRT encourages the development of solutions that bridge gaps in health, housing, employment, and other factors that condition living (Ford & Airhihenbuwa, 2010). This new theoretical construct offers the field of public health a new paradigm for investigating the root causes of incarceration as
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Treadwell et al. well as tools to empower mobilization to redress mass incarceration. CRT centers on knowledge production as its main tool of operation, in which the theoretical framework is an iterative methodology for investigators to ensure proper attention is given to issues of equity/racialization (Ford & Airhihenbuwa, 2010). Four basic features of CRT are (a) race consciousness, (b) contemporary orientation, (c) centering in the margins, and (d) praxis. Race consciousness is concerned with redressing beliefs, and methodological approaches that may utilize nonracial factors (e.g., income) to fundamentally explain ostensibly racial phenomena (Ford & Airhihenbuwa, 2010). Also, this feature advocates for racialization of research questions in understanding how race affects the problem at hand (Ford & Airhihenbuwa, 2010). The second feature, contemporary orientation, suggests examining the sociohistorical context of not only the individuals being studied but also the conditions that contributed to the experiences of those being studied (Ford & Airhihenbuwa, 2010). Comparable to warnings from researchers examining social determinants of health (Dumont, Allen, Brockmann, Alexander, & Rich, 2013; Xanthos, Treadwell, & Holden, 2010), CRT proposes examining structural aspects of racism that have evolved across time and contexts that have undoubtedly contributed to mass incarceration acceleration. Such emphasis should include increased acuity to how racialized stigmatization, which corresponds to misinformed perceptions concerning deviant criminality and needed public safety, has facilitated mass incarceration. Crime rates have continuously decreased since the 1970s (Uggen & McElrath, 2014), yet mass imprisonment has exploded, fortifying a new era of what Michelle Alexander has termed The New Jim Crow (Alexander, 2010). America in a post–Civil Rights era has experienced characterization where ordinariness is common, speaking to the difficulty to identify racism in a post–de jure segregated society (Ford & Airhihenbuwa, 2010). Ordinariness may cause individuals to become desensitized to racist realities. Centering on the margins revolves around the constant advocacy of making the perspectives of socially marginalized groups the central axis around which discourse on a topic develops (Ford & Airhihenbuwa, 2010). Lastly, praxis substantiates a foundation for an iterative methodology focused on self-reflection during research processes and research based on lived experiences of a marginalized group. This process should include going beyond examinations of race, but rather the intersectionality of the study population, particularly with using qualitative methodological approaches (Ford & Airhihenbuwa, 2010). CRT suggests that public health research should not view “race” as a risk factor, but rather as a marker of risk for racism-related exposures (Ford & Airhihenbuwa, 2010). For example, we should not rely on an
oversimplification of the school to prison pipeline, as it could potentially perpetuate thinking that racial minority young men of color being particularly prone to criminality without appropriating the likelihood of them experiencing racism and racist institutions that deem their bodies disposable and subject to an enduring life on the prison expressway. At the core of CRT is an emphasis on knowledge production that facilitates activism for targeting policies to remedy social inequities, such as mass incarceration (Alfred & Chlup, 2009; Brewer & Heitzeg, 2008; Lopez, 2010). It might be a beginning in the changing of tides as U.S. Attorney General Eric Holder has implemented practices to decrease disparities in drug sentencing and many states are beginning to legalize marijuana, which many racial minority young men encounter judicial systems as a result of minor drug offenses disproportionately in comparison with their White peers. CRT as a framing lens is better suited for producing stronger public health research uncovering the deleterious effects of incarceration on health as well. Moreover, CRT’s emphasis on activism is much needed to further a public health response to mass incarceration.
Public Health Activism and Incarceration Health activism has been a cornerstone of public health as both an academic discipline and practice; exhibited in the work of John Snow (Cwikel, 2006), W. E. B. DuBois (White, 2011), and the Black Panther Party (BPP) (Nelson, 2011), to name a few. Alondra Nelson’s text Body & Soul: The Black Panther Party and Their Fight Against Medical Discrimination does an outstanding job of uncovering the health activism of the BPP that provided a foundation for what we now know to be community health clinics and its subsequent infrastructure in providing care to low-income populations (Nelson, 2011). Moreover, Nelson highlights the BPP support of universal health care and their support for eradicating mass incarceration of Black persons (Nelson, 2011). Continuing with the tradition of collective mobilization against the structural forces that cement the connection between social vulnerability and incarceration, the Formerly Incarcerated & Convicted Peoples Movement (FICPM) acknowledge both the institutional and structural facts of mass incarceration that directly affects both those incarcerated and the communities to which they reside (FICPM, 2012). Most interesting is the organizations plea for “Proper Medical Treatment.” Within their platform they highlight: Our government should seek to save money by stopping mass incarceration rather than failing to maintain legal and
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moral standards for those it has chosen to take over full custody. . . . The standards of medical treatment for prisoners should not fall below levels of care available in the community, including laws on medical confidentiality, and prisoners should not be charged to access medical care. (FICPM, 2012)
This excerpt from the FICPM national platform highlights a concentrated community grassroots form of activism targeted at the inhumane mass incarceration for which they advocate for restorative justice in many arenas. Understanding the significant impact that mass incarceration has on individual- and population-level health, we must coalesce stronger coalition building to confront mass imprisonment collectively for a more meaningful impact on ending this practice as a form of social control. Another great example of the uniting of research efforts and activism surrounding mass incarceration can be found within the Morehouse School of Medicine’s Community Voices. Two projects ground the work around improving the quality of life of recently released incarcerated populations: (a) Mental Health and Substance Abuse Prevention for Male Adolescent Detainees and (b) New Beginnings: Mental Health, Substance Abuse Treatment and Reentry Support for Men and Women. Each program is structured to facilitate research, but heavily also centers on the collective action of community members, policy stakeholders, and community serving organizations to not only be mindful of the “on the ground” needs of formerly incarcerated populations but its collective action has resulted in a community-based participatory approach to the research that meaningfully contributes to public health activism. Community Voices aims to not only improve the lives of formerly incarcerated populations via facilitating successful reentry into communities which is garnered through a myriad of community organizations to ensure educational opportunities, employment opportunities, civic engagement, and continuity in health care, but it also seeks to ensure that community-based participatory research efforts pay keen attentiveness to the policy changes necessary for decreasing the mass incarceration culture that determines the lives of thousands of men of color.
Conclusion A fundamental and ethical question is implicated within our commentary, “Are we as a public health community willing to challenge ourselves to respond effectively to the lives of an invisible visible population that ultimately could change the trajectory of population-level health?” We have described a prison expressway that undoubtedly needs acuity from every aspect of public health, from teaching, research, policymaking, and activism. Also, we
have outlined potential areas for greater attention that can lead to a decrease of stigmatization and policy focused solutions to improve the lives of those imprisoned and others affected by mass incarceration. In doing so, it is our hope that we have shed light that mass incarceration warrants collective action because in some form or fashion we are all affected by the explosion of mass incarceration. The public health community has a vital role to decrease mass imprisonment as well as better prepare to handle those that have been collaterally affected by its lasting impact. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Kellogg Foundation, Battle Creek Foundation, Grant Number 20147691.
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JMHXXX10.1177/1557988314542419American Journal of Men’s HealthTreadwell et al.
Editorial
Miles to Go: The Prison Expressway, Health Research, and Health Activism
American Journal of Men’s Health 2014, Vol. 8(6) 449–456 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988314542419 jmh.sagepub.com
Henrie M. Treadwell, PhD1, Kasim S. Ortiz, MS2, and James R. McCoy3
Introduction On February 27, 2014, President Barack Obama delivered a speech commencing a new White House Initiative titled, “My Brother’s Keeper.” President Obama remarked, “We need to encourage fathers to stick around, and remove the barriers to marriage, and talk openly about things like responsibility and faith and community” (The White House, 2014). Earlier in his speech the President proclaimed, If you’re African American, there’s about a one in two chance you grow up without a father in your house—one in two. If you’re Latino, you have about a one in four chance. We know that boys who grow up without a father are more likely to be poor, more likely to underperform in school. (The White House, 2014)
The contention of these two statements explains largely an ill-directed narrative of individual responsibility, poor policy development in addressing social inequities that shape the health of men of color comprehensively and an unwillingness to recognize the institutionalized realities that prevent men of color from “sticking around.” Such political rhetoric is at minimum thwarting to social progress concerning men’s health and the influence of mass incarceration wherein this rhetoric of “sticking around” is not fully understood through a lens that highlights the systemic epidemic of mass incarceration that challenges full opportunity for many to “stick around.” One major area of concern for the President is the impact mass incarceration has had on the life trajectory of men, particularly men of color. In this commentary, we detail how mass incarceration has compromised the health of all Americans, outline what we describe as a prison expressway, and raise concern for greater public health response to address the needs of those that are incarcerated and/or formerly incarcerated.
100 per 100,000 people were incarcerated in the mid1970s to roughly 500 per 100,000 people by the mid2000s (Wakefield & Uggen, 2010). According to the Justice Department’s Bureau of Justice Statistics 2012 advance count, there was a prison population of 1,571,031 persons at yearend (Carson & Sabol, 2012). With these figures being in decline for the second consecutive year, understanding the factors that facilitate in successful reentry requires an upstream approach that considers those contextual factors that create populations most vulnerable to incarceration. Rates of incarceration and interaction with the criminal justice systems are largely predicated on various racial biases embedded with the criminal justice system (Wright, 1987). The overall impact of mass incarceration is detrimental to the quality of life for not only formerly incarcerated persons but equally jeopardizes quality of life for all Americans. For example, growing tax spending for privatization of incarcerated populations is benefiting some communities while depleting resources from others (Fulcher, 2012). It has been demonstrated that states with growing private prisons are also compromising employment opportunities for communities that host private prisons (Genter, Hooks, & Mosher, 2013). Relative to health effects resulting from mass incarceration, those consistently engaged with the criminal justice system have demonstrated higher rates of sexually transmitted infections and mental health complications when compared with the general population. Such health affects in-turn jeopardizes the health of family members of incarcerated persons and community members in which those might be returning to (Travis, Western, & Redburn, 2014). Concerted efforts have centered on redressing the “school to prison” pipeline (Ladson-Billings, 2009), yet this framing insufficiently describes the connection between incarceration and population-level health. Rather, mass incarceration 1
Morehouse School of Medicine, Atlanta, GA, USA Vanderbilt University, Nashville, TN, USA 3 American University, Washington, DC, USA 2
A Prison Expressway? The portion of the U.S. population imprisoned has skyrocketed since the 1970s, disproportionately affecting men and particularly men of color, wherein approximately
Corresponding Author: Kasim S. Ortiz, Department of Sociology, Vanderbilt University, PMB 351811, Nashville, TN 37235-1811, USA. Email: [email protected]
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Figure 1. Exiting the prison expressway. Addressing mass incarceration in African American and Latino boys and men.
should be viewed as an expressway, a prison expressway. Such an illustrative portrayal situates exits from the expressway that includes opportunities. Far too often such opportunities are limited from full access and deter formerly incarcerated populations back onto the expressway. A school to prison pipeline does indeed exist that foments the life trajectories of many men of color, which has decreased in that young boys in earlier grades are being labeled for entering such pipeline (Ladson-Billings, 2009). The prison expressway perpetuates marginalization of men of color wherein heightened vulnerability for increasing likelihood of early police contact leads to social/community stigmatization (Travis et al., 2014) (see Figure 1). Incarceration consequences can linger far beyond periods of jailing such that incarceration can jeopardize future employment opportunities, civic engagement, health statuses, educational opportunities, greater potential for reentry into prisons, and as the President identified negatively disrupt families and communities (Wakefield & Uggen, 2010). Confronting the impact of mass incarceration requires attention to a myriad of issues such as postincarceration educational opportunities, civic engagement, health statuses (pre-/postincarceration), family disruption, and community disruption (e.g., federal spending for community development that is depleted from urbanized areas where many men of color reside but yet are not counted within Censuses because of incarceration; Drake, 2011; Wagner, 2011). To achieve this we
have to figure out better ways to help the incarcerated population obtain means for navigating the prison expressway to secure more meaningful lives or prevent such mass imprisonment from the onset. Affirming the consequential life chances described previously and ascribing to a prison expressway realization warrants public health researchers’, practitioners’, and health policymakers’ attentiveness to these areas to fully understand the health effects of mass incarceration at a population level. More important, a public health response must mobilize around these areas to decrease the growing epidemic of mass incarceration efficiently. How might the public health community respond to make progress toward ending the prison expressway? We detail three areas of emphasis for which we believe are possible target areas: (a) increase research and training to improve consciousness of mass incarceration, (b) integration of a public health critical race praxis to confront mass incarceration that produces an antiracist paradigm, and (c) greater health activism. Before outlining these foci, we first turn attention to detailing the President’s Initiative and then highlight a recent National of Academies of Science report on mass incarceration.
My Brother’s Keeper In May 2014, the My Brother’s Keepers Task Force Recommendations to the President was released. The
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Treadwell et al. primary focus is on increasing mentorship opportunities for young men of color in targeted areas to improve their livelihoods. This report outlined recommendations for the Initiative, ranging from cross-cutting recommendations to very specified targeted recommendations for milestones of focus areas to track progress. Cross-cutting recommendations and areas of opportunity identified include (a) Establishing National Indicators, which included closing gaps in data collection of invisible populations; (b) Incentives for Implementation of Evidence Based Effective Strategies; (c) Support Comprehensive, Cradle to College, and Career Strategies Rooted in Local Communities; (d) Recognize the Importance of Parents and Other Caring Adults. Other focus areas included school readiness and adequate access to high-quality early education, implementation of universal early health and developmental screening, improving high school graduation and college readiness, increased attentiveness to assisting men of color with completion of postsecondary education and/or training, and workforce and employment opportunities to name a few. Specific attention was provided to issues relative to men of color, the criminal justice system, and incarceration. These recommendations included (a) reducing violence in high-risk communities by integrating public health approaches, (b) encourage law enforcement and neighborhoods to work hand-in-hand, (c) reform the juvenile and criminal justice systems to keep youth on track, and (d) eliminate unnecessary barriers to reentry and encourage fair chance hiring options. Within these recommendations lies optimal opportunity to improve the life of men of color while simultaneously their subsequent communities and families, especially incarcerated populations. However, these recommendations have yet to be materialized into policy prescriptions for guaranteeing their success. The primary mechanism for achieving these goals is utilizing governmental and non-governmental entities (via primarily philanthropic groups) for developing critical indicators of life outcomes for men of color for mentoring efforts. One approach is to utilize the Federal Intergency Forum on Child and Family Statistics (Children’s Forum). Such efforts are useful as data gaps impeding a knowledge base to produce evidence based approaches for addressing life outcomes of men of color currently are lacking. However, it should be careful in the development of efforts to not perpetuate highly racialized perceptions of men of color being necessary for familial developments as the sole primary foci for improving the well being of communities of color. Moreover, it should be highly integrated within the My Brother’s Keeper Initiative a key focus on developing interagency policy initiatives that directly confront racism that shapes the livelihood of young men of color. This could be manifested in greater research funding for
studying men of color explicitly. While we recognize that the efforts proposed from the My Brother’s Keepers Initiative are plausible and a positive step in a good direction, we must also recognize that mentoring is only one means for improving the livelihoods of men of color. Equal vigorous efforts should be placed on changing policies that jeopardize the lives of men of color and other multifaceted approaches that do unite governmental and non-governmental responses.
The Cracks in the Road The recently published National Academies of Science report “The Growth of Incarceration in the United States: Exploring Causes and Consequences” outlines how the United States has turned into the current carceral nation state. The report explicitly outlines the culmination of increased violence prior to the 1970s and political transformation of U.S. race relations created the perfect storm in which racial attitudes were guised under a need for better social control to decrease crime (Travis et al., 2014). The authors of the report identify that increased incarceration might have contributed to decreased crime, the magnitude of this reduction is highly uncertain, and most published studies document suggest that the reduction is most likely to be relatively small (Travis et al., 2014). Moreover, the report identifies that lengthy, more stringent sentencing practices have at best modest deterrent effects, largely because recidivism rates decline markedly with age and criminal behavior in general is reported less among older populations (Travis et al., 2014). Most compelling within this report lies the meaningful ways in which mass incarceration has disproportionately affected communities of color, particularly poor Black and Hispanic communities where men within those communities are more likely to experience incarceration. The highly racialized and codified prison policies, sentencing policies, and social policies concerning incarceration as the most formidable form of social control for criminally deviant behavior has created a generation at the population level that is disenfranchised in a myriad of ways. The explicit attention provided in this report to the instituional barriers rooted within racist realities such as sentencing policies, as one example, warrants responses that directly redress such structural barriers.
Incarceration, Population Health Research, and Training The current ability to comprehensively understand the influence of incarceration on health is limited. Previous, and current, public health surveillance of incarcerated populations has been inadequate. Limitations in gathering prisoner information and/or information concerning
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incarceration interactions within nationally representative datasets have been identified as a potential barrier (Ahalt, Binswanger, Steinman, Tulsky, & Williams, 2012). Most publicly available national health data sets include only populations that are deinstitutionalized. Moreover, limitations also exist with respect to longitudinal data to derive causality between incarceration experiences and deleterious health (Ahalt et al., 2012; Purtle, 2012; Wang & Wildeman, 2011). This continued surveillance oversight has contributed to deflated representation of the extent of racial health disparities in America in general (Schnittker & John, 2007). Moreover, this data insufficiency threatens the training of the public workforce, especially those pursuing research-oriented job opportunities. The missingness of incarcerated populations results in the lack of acuity to this population’s need in training researchers to obtain cultural sensitivity necessary to efficiently serve this population. Also, throughout graduate tenure the inability for students to readily access data sets with incarcerated populations often results in practitioners not being well equipped postgraduation with an understanding of how incarceration comprises the health of those incarcerated and the communities from which they are incarcerated and/or returning to. The public health community has responded to growing demand for a stronger public health workforce experienced in evaluation and programming, evident by greater integration of evaluation content within curricula (Adams & Dickinson, 2010; Fierro & Christie, 2011). In recent years, largely in response to lack of cultural consciousness among the public health workforce concerning issues of diversity, we have seen the uptake in programming/training for those from diverse backgrounds (Adams & Dickinson, 2010; Christie & Vo, 2011; Cohen, Gabriel, & Terrell, 2002; Williams et al., 2014). However, such integration of content on mass imprisonment is quite limited, particularly content that is historically situated with a critical lens on the institutionalization processes that have been vital in shaping mass imprisonment. The Kronenfeld study (Kronenfeld, 1981) on evaluation curricula noted that the University of South Carolina’s School of Public Health actively engaged in planning evaluations on prison health in 1981. However, recently while giving a lecture on incarceration Dr. Treadwell was precariously asked by Kasim Ortiz (while a student at the University of South Carolina in the Arnold School of Public Health): “Why was it that he could not recollect many courses which had integrated content on mass imprisonment in the public health courses he’d taken?” This is not to generalize to all public health schools, nor be representative of all courses offered within the esteemed Arnold School of Public Health, yet elucidates a potential diminishing value in studying this population in general within public health curricula
content. How do we expect our public health workforce and researchers to be fully equipped to handle prisoner populations (pre-/postincarceration) if we are not guaranteeing they are provided appropriate training?
Public Health Critical Race Praxis and Imprisonment The first comprehensive work designed to bring strategic focus to the issues of prisoner health recently occurred in October 2005, in which Treadwell served as a Guest Editor for a themed issue in the American Journal of Public Health (Treadwell & Formicola, 2005). The intent was to break the silence and foster and promote research on the public health implications of incarceration. Since that AJPH issue, there has been a growing emphasis on the need for research among this underserved population. Even with the continuing limitations in data availability and greater need for conscious curricula, research exploring the impact of incarceration on health outcomes has increased recently (Turney & Wildeman, 2013; Wildeman, Lee, & Comfort, 2013; Wildeman & Muller, 2012; Wildeman, Schnittker, & Turney, 2012). Most recently, public health literature has experienced rejuvenation in exploring the impact incarceration has on family disruption (Graham & Harris, 2013; Lee, Porter, & Comfort, 2014; Turney, 2013), mental health concerns among prisoners and those connected to incarcerated persons (Lawson & Lawson, 2013; Lee, Fang, & Luo, 2013; Murray, Farrington, & Sekol, 2012; Turney, Lee, & Comfort, 2013; Turney, Wildeman, & Schnittker, 2012), and the effects of incarceration on children of those incarcerated among a myriad of other issues (D’Andrade & Valdez, 2012; Kjellstrand & Eddy, 2011; Wakefield & Wildeman, 2011, 2014). A common theme within this body of research centers on the historical reality that men, particularly men of color, are often disproportionately affected by incarceration, jeopardizing their health. Thus, a critical response from public health warrants a lens for improving our understanding of this population that openly acknowledges structural determinants that shape these racial disparities. Critical race theory as a form of knowledge production and community activism is well-suited to improve our ability to confront racial disparities in mass incarceration that resonates with health. Public Health Critical Race praxis draws inspiration from critical race theory (CRT), whereas CRT encourages the development of solutions that bridge gaps in health, housing, employment, and other factors that condition living (Ford & Airhihenbuwa, 2010). This new theoretical construct offers the field of public health a new paradigm for investigating the root causes of incarceration as
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Treadwell et al. well as tools to empower mobilization to redress mass incarceration. CRT centers on knowledge production as its main tool of operation, in which the theoretical framework is an iterative methodology for investigators to ensure proper attention is given to issues of equity/racialization (Ford & Airhihenbuwa, 2010). Four basic features of CRT are (a) race consciousness, (b) contemporary orientation, (c) centering in the margins, and (d) praxis. Race consciousness is concerned with redressing beliefs, and methodological approaches that may utilize nonracial factors (e.g., income) to fundamentally explain ostensibly racial phenomena (Ford & Airhihenbuwa, 2010). Also, this feature advocates for racialization of research questions in understanding how race affects the problem at hand (Ford & Airhihenbuwa, 2010). The second feature, contemporary orientation, suggests examining the sociohistorical context of not only the individuals being studied but also the conditions that contributed to the experiences of those being studied (Ford & Airhihenbuwa, 2010). Comparable to warnings from researchers examining social determinants of health (Dumont, Allen, Brockmann, Alexander, & Rich, 2013; Xanthos, Treadwell, & Holden, 2010), CRT proposes examining structural aspects of racism that have evolved across time and contexts that have undoubtedly contributed to mass incarceration acceleration. Such emphasis should include increased acuity to how racialized stigmatization, which corresponds to misinformed perceptions concerning deviant criminality and needed public safety, has facilitated mass incarceration. Crime rates have continuously decreased since the 1970s (Uggen & McElrath, 2014), yet mass imprisonment has exploded, fortifying a new era of what Michelle Alexander has termed The New Jim Crow (Alexander, 2010). America in a post–Civil Rights era has experienced characterization where ordinariness is common, speaking to the difficulty to identify racism in a post–de jure segregated society (Ford & Airhihenbuwa, 2010). Ordinariness may cause individuals to become desensitized to racist realities. Centering on the margins revolves around the constant advocacy of making the perspectives of socially marginalized groups the central axis around which discourse on a topic develops (Ford & Airhihenbuwa, 2010). Lastly, praxis substantiates a foundation for an iterative methodology focused on self-reflection during research processes and research based on lived experiences of a marginalized group. This process should include going beyond examinations of race, but rather the intersectionality of the study population, particularly with using qualitative methodological approaches (Ford & Airhihenbuwa, 2010). CRT suggests that public health research should not view “race” as a risk factor, but rather as a marker of risk for racism-related exposures (Ford & Airhihenbuwa, 2010). For example, we should not rely on an
oversimplification of the school to prison pipeline, as it could potentially perpetuate thinking that racial minority young men of color being particularly prone to criminality without appropriating the likelihood of them experiencing racism and racist institutions that deem their bodies disposable and subject to an enduring life on the prison expressway. At the core of CRT is an emphasis on knowledge production that facilitates activism for targeting policies to remedy social inequities, such as mass incarceration (Alfred & Chlup, 2009; Brewer & Heitzeg, 2008; Lopez, 2010). It might be a beginning in the changing of tides as U.S. Attorney General Eric Holder has implemented practices to decrease disparities in drug sentencing and many states are beginning to legalize marijuana, which many racial minority young men encounter judicial systems as a result of minor drug offenses disproportionately in comparison with their White peers. CRT as a framing lens is better suited for producing stronger public health research uncovering the deleterious effects of incarceration on health as well. Moreover, CRT’s emphasis on activism is much needed to further a public health response to mass incarceration.
Public Health Activism and Incarceration Health activism has been a cornerstone of public health as both an academic discipline and practice; exhibited in the work of John Snow (Cwikel, 2006), W. E. B. DuBois (White, 2011), and the Black Panther Party (BPP) (Nelson, 2011), to name a few. Alondra Nelson’s text Body & Soul: The Black Panther Party and Their Fight Against Medical Discrimination does an outstanding job of uncovering the health activism of the BPP that provided a foundation for what we now know to be community health clinics and its subsequent infrastructure in providing care to low-income populations (Nelson, 2011). Moreover, Nelson highlights the BPP support of universal health care and their support for eradicating mass incarceration of Black persons (Nelson, 2011). Continuing with the tradition of collective mobilization against the structural forces that cement the connection between social vulnerability and incarceration, the Formerly Incarcerated & Convicted Peoples Movement (FICPM) acknowledge both the institutional and structural facts of mass incarceration that directly affects both those incarcerated and the communities to which they reside (FICPM, 2012). Most interesting is the organizations plea for “Proper Medical Treatment.” Within their platform they highlight: Our government should seek to save money by stopping mass incarceration rather than failing to maintain legal and
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moral standards for those it has chosen to take over full custody. . . . The standards of medical treatment for prisoners should not fall below levels of care available in the community, including laws on medical confidentiality, and prisoners should not be charged to access medical care. (FICPM, 2012)
This excerpt from the FICPM national platform highlights a concentrated community grassroots form of activism targeted at the inhumane mass incarceration for which they advocate for restorative justice in many arenas. Understanding the significant impact that mass incarceration has on individual- and population-level health, we must coalesce stronger coalition building to confront mass imprisonment collectively for a more meaningful impact on ending this practice as a form of social control. Another great example of the uniting of research efforts and activism surrounding mass incarceration can be found within the Morehouse School of Medicine’s Community Voices. Two projects ground the work around improving the quality of life of recently released incarcerated populations: (a) Mental Health and Substance Abuse Prevention for Male Adolescent Detainees and (b) New Beginnings: Mental Health, Substance Abuse Treatment and Reentry Support for Men and Women. Each program is structured to facilitate research, but heavily also centers on the collective action of community members, policy stakeholders, and community serving organizations to not only be mindful of the “on the ground” needs of formerly incarcerated populations but its collective action has resulted in a community-based participatory approach to the research that meaningfully contributes to public health activism. Community Voices aims to not only improve the lives of formerly incarcerated populations via facilitating successful reentry into communities which is garnered through a myriad of community organizations to ensure educational opportunities, employment opportunities, civic engagement, and continuity in health care, but it also seeks to ensure that community-based participatory research efforts pay keen attentiveness to the policy changes necessary for decreasing the mass incarceration culture that determines the lives of thousands of men of color.
Conclusion A fundamental and ethical question is implicated within our commentary, “Are we as a public health community willing to challenge ourselves to respond effectively to the lives of an invisible visible population that ultimately could change the trajectory of population-level health?” We have described a prison expressway that undoubtedly needs acuity from every aspect of public health, from teaching, research, policymaking, and activism. Also, we
have outlined potential areas for greater attention that can lead to a decrease of stigmatization and policy focused solutions to improve the lives of those imprisoned and others affected by mass incarceration. In doing so, it is our hope that we have shed light that mass incarceration warrants collective action because in some form or fashion we are all affected by the explosion of mass incarceration. The public health community has a vital role to decrease mass imprisonment as well as better prepare to handle those that have been collaterally affected by its lasting impact. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Kellogg Foundation, Battle Creek Foundation, Grant Number 20147691.
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