The Incarceration Epidemic

About one-fourth of all incarcerated people on Earth is in the U.S. That constitutes a public health problem.
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The U.S. incarceration rate has more than quadrupled since 1980. It's now the highest in the world, just ahead of Russia and Rwanda. It is estimated that approximately 2.3 million Americans are now behind bars. This is about one-fourth of all the incarcerated people on Earth, though the U.S. represents only one-twentieth of the world's population. When the figures for those under probation and parole are added, about 1 in 18 U.S. men is under some form of monitoring or control. The figure for blacks is 1 in 11.

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From a medical point of view, the number 2.3 million is huge. It is double the number of Americans infected with HIV, the virus that causes AIDS. People in prison are much more likely to carry and contract a variety of communicable diseases, including tuberculosis, syphilis, and hepatitis B and C. Recent articles in The Atlantic have detailed horrible prison conditions and egregious abuses of mentally ill prisoners. From a medical perspective, putting someone in prison is putting them in harm's way.

Why have U.S. incarceration rates skyrocketed? The answer is not rising crime rates. In fact, crime rates have actually dropped by more than a quarter over the past 40 years. Some look at these statistics and find confirmation of their view that expanding prison populations reduces crime rates. In fact, however, these same decreases have occurred even in places where incarceration rates have remained unchanged.

The state of California spends approximately $9,000 per year for each public school student it educates but over $50,000 per year for each inmate it keeps incarcerated.

New sentencing guidelines have been a key factor. They have reduced judges' discretion in determining who goes to jail and increased the amount of time convicts sentenced to jail spend there. A notable example is the so-called "three-strikes" law, which mandates sentences ranging from 25 years to life for many repeat offenders. Though championed as protecting the public, such sentences have resulted in long confinements for many non-violent offenders, who constitute half of all inmates.

Perhaps the single greatest contributor has been the so-called "war on drugs," which has precipitated a 12-fold increase in the number of incarcerated drug offenders. About 1.5 million Americans are arrested each year for drug offenses, one-third of whom end up in prison. Many are repeat offenders caught with small quantities of relatively innocuous drugs, such as marijuana, a type of criminal activity often referred to as "victimless."

Some sentencing laws seem little less than perverse. For example, in the 1980s, crack cocaine received a great deal of public attention. In response, the U.S. Congress passed legislation imposing a 100 to 1 sentencing ratio for possession of crack cocaine, as compared to its powdered form. That is, someone carrying 5 grams of crack cocaine would get the same sentence as someone carrying 500 grams of powdered cocaine. From a medical point of view, this makes little sense.

The costs of incarceration are high. For example, the state of California spends approximately $9,000 per year for each public school student it educates but over $50,000 per year for each inmate it keeps incarcerated. The proportion of the state budget devoted to imprisonment has been increasing at a rate much faster than that for education. Moreover, despite California's huge prison expenditures, its prisons recently held 140,000 prisoners in facilities designed for only 80,000.

Does prison do any good? This is a surprisingly difficult question to answer. Incarceration certainly works to prevent criminals from committing repeat offenses by removing them from contact with the public. It also provides retribution, satisfying some members of the public that the incarcerated are paying for their crimes. Anyone who visits a prison would be hard pressed to say that it does not represent a powerful form of punishment.

Yet it is difficult to make the case that so-called correctional institutions do much in the way of correcting, reforming, or rehabilitating inmates. The recidivism rate at 3 years post-release is about two-thirds, of which over half end up back in prison. The most important factor in preventing recidivism is not the amount of time people serve in prison, but the age at which they are set free. The older inmates are at the time of their release, the less likely they are to return.

Incarceration converts two-parent families to one-parent families and one-parent families to no-parent families.

Even the U.S. Congress admits that prison is ineffective at correcting and rehabilitating those convicted of crimes, and it has directed federal judges to avoid sending people to prison with this objective in mind. If we are the product of our environment, then prison, which puts people convicted of crimes in close daily contact with other criminals, might well cause more problems than it solves. Far from correcting and rehabilitating, prison itself may serve as a school for crime.

Perhaps some people do need to be incarcerated. However, it is difficult to argue that the numbers of such people has increased rapidly over the past 40 years, at the same time that the crime rate has fallen. In fact, there are good reasons to suppose that in many cases incarceration does more harm than good, and that those suffering this damage include not only criminals themselves but their families, their communities, and society as a whole.

The toll on families is clear. Incarceration converts two-parent families to one-parent families and one-parent families to no-parent families. Husbands are taken away from wives, and in many cases (over 100,000 inmates are juveniles) children are taken away from their parents. Incarceration itself causes suffering for families, who must do without their loved ones for long periods of time. The penumbra of its stigma can prove especially burdensome for children.

Incarceration also takes a big toll on communities. Its costs, both direct and indirect, are high, and it draws resources away from other equally or more worthy needs, such as education and healthcare. Some communities, particularly in inner cities, are devastated by incarceration. For example, blacks are incarcerated at nearly 6 times the rate of whites, and if current trends continue, nearly 1 in 3 black males born today can expect to be incarcerated at some point in life.

America likes to think of itself as the land of the free. In the mid-1800s, Alexis de Tocqueville, perhaps the greatest student of America, came here to study the U.S. prison system. Instead, he left enlightened and elevated by the American conception of freedom, and in response, he wrote Democracy in America. Were Tocqueville to visit again today, he might well complete his prison report, shaking his head that the land of the free has become the home of the jailed.

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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