Public Health and Criminal Justice

II. The Need for Collaboration

Criminal justice issues resonate beyond the domains of the police, court, and corrections and threaten the integrity of our society. In fact, disorganized communities experience the cumulative effects of socioeconomic disparities whereby layers of risk factors are nested within larger ecological systems of additional risk factors (M. Lynch & Cicchetti, 1998). Within a nested model, citizens are more or less likely to encounter individual-level risk factors (e.g., poor prenatal care), group-level risk factors (e.g., gang membership), and institutional/social level risk factors (e.g., political and racial oppression). Prolonged exposure to risk factors reduces what sociologist Max Weber (1922/1968) termed life chances, or the opportunities provided to improve one’s quality of life. In addition to the relative deprivation that fuels this phenomenon, there is a loss of cohesiveness in the social relations within these communities (Sampson, 2003). This builds a cyclical pattern in which collective efficacy cannot be realized and the community maintains the “bad part of town” label. Such a despairing portrayal can only reinforce the need for community empowerment through integrating diverse scientific disciplines, agencies, and programs.

Public health has been an appropriate perspective adopted by criminology because crime is “a mirror of the quality of the social environment” (Kawachi, Kennedy, & Wilkinson, 1999, p. 719). Crime and poor health are endemic in low socioeconomic communities and are thought to originate from the same ecological sources. This suggests that criminologists provide an important role in public health by participating in collaborative endeavors and by recognizing crime as a harbinger of community health. To supporters like Moore (1995), the public health and criminal justice systems can maximize outcomes by assuming a complementary rather than substituting role. Here, key stakeholders utilize the specialized training of their respective disciplines but also work with partners outside of the discipline to promote synergy and address gaps in service delivery. Differences between the criminal justice and public health systems are typically found in the following five dimensions: (1) how each views the problem, (2) what particular components of the problem warrant more attention, (3) the analytic framework selected that is based on assumptions rooted in professional experience, (4) the available resources, and (5) divergences of ethical values (Moore, 1995). However these challenges are typically minimized by the collaboration between public health and criminology. An important reconceptualization of crime and delinquency is the role of the criminal justice system as an intervention point that can promote health.

III. Criminal Justice as an Intervention

The United States incarcerates more of its citizens than any other country, and most of these incarcerated citizens will return to mainstream society. In fact, there are currently 500,000 inmates per year who are released from prison alone, a three-fold increase from the 170,000 inmates released in 1980 (Travis & Waul, 2004). Never before has the U.S. criminal justice system been responsible for the personal safety and health care needs of such a large portion of society. To present further challenges, many incarcerated persons are marginal members of society who have had minimal exposure to traditional health care resources. Further subsets of recidivist criminals have typically experienced serious trauma, drug/alcohol abuse, and mental illness over the life course and enter the criminal justice system with deteriorating health conditions. In response, the criminal justice system now functions as an intervention point whereby chronic conditions are evaluated and treated, with the distal goal of promoting compliance with medical directives following release.

This paradigm shift is predicated on the notion that criminal justice institutions are inextricably linked to the broader society. Lessons from the past teach that a dysfunctional correctional system acts as an incubator for communicable disease and violence that permeate neighborhoods. These adverse health outcomes are particularly salient for the children of individuals under correctional supervision, a population that currently numbers in excess of 3.2 million (Travis &Waul, 2004). The policies of mass incarceration have also reduced structural resources (i.e., housing and employment), emotional support, and hope for the future in low socioeconomic and minority communities.

Efficacious policies have been demonstrated through the adoption of the public health perspective. A public health approach includes the epidemiological tenets of surveillance, screening and testing, therapy, medication, and education. Therapy and education are promoted through a range of programs that are ideally linked to meet the needs of the individual. In addition to addressing individual-level behaviors, the field of public health seeks to understand the social determinants of health that occur at the ecological level (Marmot &Wilkinson, 1999). The antecedents of poor community health include economic inequality, fear of crime, education attrition, unsafe schools and housing, demographic vulnerabilities, environmental pollution, and racial/social oppression. These causal factors require the collaboration of several agencies to establish populationlevel interventions.

Another component of the public health perspective is the move from fragmented “silo” databases toward the construction of an integrated data warehouse. Here, data are collected from various agencies and standardized for researchers and policymakers. The integration of data systems enables the identification of at-risk populations. For example, Crandall and colleagues (Crandall, Nathens, & Rivera, 2004) found that 44% of women who were murdered by a spouse had gone to the emergency room within the previous 2 years. This represents a missed opportunity to screen and report intimate partner violence from within the safe confines of a medical setting. These victims fell between the gaps of the criminal justice and public health systems and highlight the need for suggested collaborations. With this in mind, this research paper now introduces readers to several classic public health studies and highlights their significance to the field of criminal justice.

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