Population Care

Criminal justice reform can improve public health

Mass incarceration poses a threat to public health, fueling chronic disease and mental illness that physicians must address, according to a recent panel discussion.

A physician’s duty

Physicians have a duty to work for health justice for inmates, especially minors, said Nzinga Harrison, MD, a founder of Physicians for Criminal Justice Reform, an activist organization made up of academics, government officials, psychiatrists, neurologists and others.

Dr. Harrison and other panelists explained their efforts on behalf of health justice at a discussion held by the AMA Minority Affairs Section during the 2016 AMA Annual Meeting in Chicago.

Primary goals for justice reform

Dr. Harrison said Physicians for Criminal Justice Reform invites physicians, medical students and the lay public to join in working for its primary objectives:

  • Decriminalizing mental health and addictive disorders. Across the nation, people with severe mental illness are three times more likely to be in jail or prison than a mental health facility. Twenty percent of prison inmates have serious mental illness, and up to 60 percent have serious addictive problems, Dr. Harrison said.
  • Diverting at-risk youths from adult jails and prisons. Youths in adult jails are 36 times more likely to take their own lives than youths housed in juvenile facilities, Dr. Harrison said, and minors are far more likely to be victims of sexual assault in jails.
  • Providing adequate physical and mental health care for inmates. Inmates are far more likely to enter prison without a history of primary care and to suffer from addictive disorders. Prison inmates suffer a higher incidence of chronic and infectious diseases such as AIDS and hepatitis C than the general population, Dr. Harrison said.

The United States incarcerates far more of its residents than any other industrialized nation, Dr. Harrison said, so improving care for that population improves the health of the community as a whole. Diversion from the criminal justice system not only saves lives but saves money in the long run, she said.

Three foundations of health

Spiritual, physical and mental health care are intimately linked, both in prisons and the community at large, the Rev. Carmin Frederick told attendees at the session.

“We are all connected,” said Rev. Frederick, a panelist. She is associate pastor to teens and families at Trinity United Church of Christ. The Chicago church works for social justice, an end to mass incarceration, access to health care and a living wage.

Poverty itself undermines well-being and plays a role as an early and powerful social determinant of health, according to panelist Carl Bell, MD, a psychiatry professor at the University of Illinois College of Medicine in Chicago.

“Being poor is a problem,” Dr. Bell said. “Because if you’re poor, you’re going to be living in a community where the only business that is thriving is the liquor store.” His work at the Jackson Park Hospital’s Family Medical Clinic highlights the long-term impact of fetal alcohol syndrome on youths.

“They’re slow in school. They’ve got bad tempers. They have poor social skills,” he said.

Tools for achieving justice reform

Physicians for Criminal Justice Reform named strategies to advocate for changes in health care and the criminal justice system:

  • The organization increases awareness of the ties between health and the justice system by educating the public with consulting services, webinars and keynote speakers.
  • It maintains a social media presence, circulates petitions and fosters a relationship with the media to expand awareness of its issues.
  • It partners with allied organizations to leverage distribution of its message.

Dr. Harrison issued an appeal to action for physicians to recognize the relationship between the justice system and health.

“We can make a change,” she said. “I hope I have compelled you to joins us and raise your voice so we can minimalize the impact of the criminal justice system on our patients.”