Tag Archives: Incarceration

Gratitude for Being Invited into a New Community


Photo from LA convening of incarcerated women and women working in public health.
Charlene Sinclair, Center for Community Change, speaking at A Women’s Gathering on Criminalization and Community Health Inequities.

In mid-September, I attended A Women’s Gathering on Criminalization and Community Health Inequities. The gathering was different in many ways, but one aspect of it really stood out: We were being invited into a community that most of us knew very little about, a community of women who had been incarcerated at some time in their lives.

As Andrea James, founder of Families for Justice as Healing and The National Council of Incarcerated and Formerly Incarcerated Women and Girls (The Council) said, “I am a former lawyer, a community activist, the wife of a man who was incarcerated, an active resident of Roxbury, MA, and a mother. I have a lot of professional and personal experience. But I didn’t become a expert until I was incarcerated.”

Only now am I beginning to understand this reality. For the past two years, I’ve been researching the health and equity impacts of the criminal justice system and working with advocates to create a new system, one that puts health and wellbeing, instead of punishment, at the forefront. Some of the people I collaborated with had been incarcerated, and I felt as if I had some understanding of how the criminal justice system destroys people and families.

But, really, it wasn’t until September 15, 2016—when 30-plus women who had been incarcerated met with about 15 women who worked in the field of public health—that I became more profoundly and intimately connected to those experiences and impacts. The women I met drove home the urgency of needing to work together to create a system of justice that values every life, treats people with dignity, demonstrates compassion, promotes a restorative and rehabilitative approach, creates space for accountability, and improves both health and safety.

And particularly for women and girls.

The reality hit me that, as women, we all have some degree of familiarity with the conditions that led to the women being incarcerated. While I had not had the experience of being incarcerated, I had experience with many of the pre-cursors—and that was a connection I had not made until hearing their stories.

Consider this: No woman is immune to the threat of community violence, oppression, being judged by her looks, being harassed on the street. And so many of us women (1 out of every 3) have been physically, psychologically, or sexually abused. And out of women who become incarcerated, that number is even higher—a recent Vera Institute report showed that 85% of women in jail have been physically or sexually abused.

What I heard from the women who shared their experiences is that these exposures (as we say in public health) —combined with acute and ongoing bias, mistrust, and maltreatment among many government agencies and institutions—led to them making choices that were ultimately criminalized. Behaviors that a more humane society would respond to with an offer of support, healing, and recovery—were instead met with surveillance, arrest, and incarceration in the United States.

But while I felt a connection to those exposures, it became deeply clear that we experienced a different, and unequal, set of outcomes based on things like racism and where you live. My childhood and home life weren’t perfect and I had some of the same teenage behaviors that I heard about in the room. But growing up white, in a suburb, middle class—these worked in my favor. People—rooted in institutions and systems—gave me leeway to make mistakes and gave me second chances. That is what privilege looks like, and that is where much of my experience diverged from the women in the room. Being confronted with that in an honest and face-to-face dialogue was so important to our ability to establish trust and try and build an authentic partnership.

Another thing happened that also stretched my understanding of what it takes to build trust with communities who have experienced significant trauma. The public health women in the room, many of whom work in government, were held responsible and asked to own the fact that we worked in and with institutions that repeatedly harmed, alienated, and failed the formerly incarcerated women throughout their lives. The level of distrust that existed in the room—understandably—was, well, rough. But my level of respect and admiration for every single woman in that room went through the roof after hearing their honesty and their doubts. I had such respect for women who are formerly incarcerated for getting themselves to that room, sharing their stories, calling out institutions for failing them, but also having hope that we can work together. And I had such respect for women in public health who listened with compassion and anger at the stories of women, who were not offended by the call to be accountable for the sins of government, and who eagerly asked “What can we do? To help repair the harm.”

It was a full day. It was a day like no other I have ever had in my 20+ years of public health work. The Women’s Gathering on Criminalization and Community Health Inequities was a beginning and we are now figuring out what we can do together. Lots of ideas emerged: new research and advocacy campaigns, new collaborations and capacity-building efforts, invitations into our institutions to humanize each other. It is on all of us now to continue to build this fledgling trust.

To be explicit about my gratitude: thank you to all the women who attended from The Council, women who are formerly incarcerated but may not be part of The Council, and all the women from the public health institutions. Your open hearts and minds is what made the day such a meaningful experience.

And a special thanks to our Women’s Advisory Team who helped plan the gathering: Jeanne Ayers (Minnesota Department of Health), Solange Gould (California Department of Public Health), Donna Hylton (The Council), Paula Tran Inzeo (University of Wisconsin Extension and THRIVE Wisconsin), Andrea James (Families for Justice as Healing & The Council), Marilyn and Pamela Winn (Women on the Rise & Georgia Racial Justice Action Center)—and especially to Charlene Sinclair, Caitlin Dunklee, and Cindy Eigler from the Center for Community Change for organizing the gathering and including HIP as co-conveners. Thank you all!


Group photo
Group photo at A Women’s Gathering on Criminalization and Community Health Inequities

Expanding Access to Preschool Could Improve Health and Equity in Cincinnati, August, 2016

One of my favorite things about doing HIAs and other projects at Human Impact Partners is the unexpected “Aha!” moments that occur, when we find something in the research that surprises us.

Today, Human Impact Partners and our partners from The AMOS Project are excited to release a report that examines the health and equity impacts of expanded access to preschool for children in Cincinnati. Our study concludes that expanding access to preschool would benefit the health and equity for children, families, and other residents of Cincinnati. That’s actually not an “Aha!” for me. I expected that improved education would have benefits to health and equity. But I didn’t exactly expect all of the connections we found.

To me, it makes sense that if children get a better chance at high-quality education earlier on in life, they will do better in school later on. What I didn’t expect was how far those ripple effects would reach. It makes sense that high-quality preschool education could improve reading and math scores in third grade. But interestingly, those impacts don’t always continue over time. By the fourth grade, children who had access to high-quality preschool don’t always show significantly different reading or math scores from those who didn’t. But, they are less likely to be held back to repeat a grade in school, and they are less likely to require special education services. Essentially, they are able to keep up. And this ability to keep up allows them to remain connected and engaged in the school system, which means that they stay in school. They graduate. And if they graduate, they have better job options with higher wages. Which means they are not as likely to become involved in the criminal justice system.

Higher wages and less crime because of preschool. Those are some far-reaching ripple effects!

Figure 1

And guess what else? I really didn’t expect this one, but it makes sense to me. Family relationships are better. Being a parent of a young child can be stressful. When parents don’t have resources to deal with that stress, a small proportion of the time it can unfortunately manifest in child abuse and neglect. But research suggests that high-quality preschool has some pretty impressive protective factors for this. High-quality preschools not only give parents a break from the stress of parenting, they give children an opportunity to learn social and emotional skills when interacting with other children, and they give parents structured and guided ways to interact with their children. In our study we predicted that nearly three out of ten children in Cincinnati who would have experienced abuse or neglect would not experience it if they were sent to preschool. And improved family relationships last over time as well. Forty-year-old adults who attended preschool as children are still more likely to say their family relationships are better than those who did not. Again – those are some far-reaching ripple effects!

Of course, increased education, improved wages, less crime, less stress, and better social relationships can all lead to improved health. And that’s a wonderful, amazing thing. But it turns out that preschool could also be a key factor in breaking the cycle of generational inequities. Due to multiple forms of structural discrimination, growing up in poverty, in a single-parent household, or with a parent who is incarcerated are all more common experiences for children of color. These experiences increase the odds of negative physical and mental health outcomes and lead to a vicious cycle that continues through multiple generations, further contributing to ongoing inequities. When preschools and the school systems that they feed into have a trauma-informed approach to discipline, focusing on the root causes of the problem behaviors, rather than zero-tolerance suspensions and expulsions, preschools could help break that cycle.

Figure 2

This is especially important for communities like Cincinnati, where many of these risk factors are nearly double the national rate.

Figure 3

Thus, based on our findings, our study recommends the following actions:
1. Expand access to high-quality preschool programs to all children
2. Prioritize to reach those most in need, such as children living in poverty
3. Assure high-quality preschools and teachers through adherence to preschool program and training features that research has proven to be successful
4. Utilize a trauma-informed approach to discipline that incorporates an understanding of the source of the behavior problem, in preschool and beyond, rather than zero tolerance policies such as suspensions and expulsions
5. Assure that high-quality preschools are geographically distributed throughout the city

This Health Impact Assessment was produced in partnership with our Advisory Committee members from Cincinnati Children’s Hospital, StrivePartnership, Interact for Health, Mercy Health, and United Way’s Success by 6.

The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records

For individuals with a criminal history, finding affordable and stable housing becomes extremely difficult in a place like the Bay Area, with high cost and limited supply. People with a criminal history can legally be excluded from housing. In a survey from the 2015 Ella Baker Center for Human Rights and Forward Together report, “Who Pays? The True Cost of Incarceration on Families,” 79% of people who had been incarcerated were either ineligible or denied public housing as a result of criminal history. More than half of those released from jail or prison have unstable or nonexistent housing.

Safe and affordable housing is a fundamental basis for success in all areas of life, and without stable housing, an individual’s health, employment and education opportunities, family reunification and social networks are compromised. In Alameda County, California, nearly 20,000 people are at risk of residential instability because of having a recent criminal history.

Having housing improves health directly and indirectly, decreases recidivism, improves the chance of becoming employed and having more income, and helps with family reunification. These factors, known in public health as the social determinants of health, create opportunities to succeed and are known to be important for health and wellbeing. For example:

  • Moving often affects recidivism. The odds of recidivism increase by at least 70% for every time someone who is formerly incarcerated changes their residence.
  • Six randomized control trials analyzed supported employment in public housing against other approaches to help residents find jobs, and found 58% of public housing program participants obtained employment compared to 21% in the control group.
  • More than 70% of those leaving prison indicated that family is an important factor in keeping them out of prison, and up to 82% of people leaving prison or jail expect to live with or get help from their families.
  • Having stable housing upon leaving jail or prison decreases a person’s chance of having their probation revoked.

It’s clear from the research; the lack of stable and affordable housing forces families to frequently move and live in unhealthy and crowded environments, increases stress and depression, and can lead to homelessness. Homelessness brings higher rates of infectious diseases; substance use and mental health disorders; exposure to violence; overexposure to cold and rain; and suicide. Studies show that 25% to 50% of people who are homeless have histories of involvement with the criminal justice system.

Public housing admissions screening policies play an important role in creating the conditions for successful reentry of people who were incarcerated. HIP recently released a report called, “The Long Road Home: Decreasing Barriers to Public Housing for People with Criminal Records” done in partnership with Ella Baker Center for Human Rights (EBC). I worked closely with EBC staff starting in September 2015 to complete this Health Impact Assessment (HIA), as part of my Health & Equity Fellowship with HIP. We studied the Oakland Housing Authority (OHA) as a case study to understand the impacts of screening policies on health.

To fully understand OHA’s admission and screening policies, HIP met with two staff from their office. We learned that OHA denials due to a criminal history in the first round of screening have decreased significantly from 12% to 0.8% between 2010 and 2012. Of those who were screened out by OHA due to a criminal history, 75% request an informal hearing, and 64% of those have the decision reversed, allowing them to continue on in the application process. This is a powerful statement for the presentation of mitigating circumstances; at OHA, when people are allowed to tell their story and present supporting documentation, it often results in a reversal. We know that historical policies have created racial inequities in housing and health outcomes. However, data on race and ethnicity is not being recorded or reported, making it impossible in OHA’s case to analyze inequities in screening practices.

While more people with criminal histories are able to move forward in the screening process when OHA allows them to present mitigating evidence, there are additional changes OHA and other public housing authorities can make to improve housing stability for individuals with criminal history:

  • Allow mitigating circumstances to be presented in the initial application for public housing
  • Ensure proper implementation of policies that allow individuals with criminal history to join their family in public housing, and eliminate any practices of evicting existing residents from public housing for allowing a family member returning from prison or jail or denying admission if there is no valid reason for doing so
  • Collect, track, and publicly report the race and ethnicity of applicants and those screened out due to their criminal history to examine the potential impact of screening policies on people of color with a criminal history

Read more of the findings & recommendations in the full report.

Together we are Stronger: Intersectionality of Immigration and Incarceration

Last week the Haas Institute for a Fair and Inclusive Society launched We Too Belong: A Resource Guide of Inclusive Practices in Immigration and Incarceration Law and Policy at a half-day event that brought together the contributors to share their stories, their work, and engage in meaningful dialogue.

Immigration is often thought of as a Latinx issue, and incarceration thought of as a Black/African-American issue. However, the event centered on the intersectionality of these issues and highlighted that the immigration and criminal (in)justice systems are highly racialized. For those of us who have been impacted and involved in one movement or another, this is nothing too new — we’ve experienced the entanglement.

Experiencing the entanglement of immigration and incarceration is one thing, but this event generated the necessary uncomfortable conversations about how the systems have us working in silos, pointing fingers at one another, and fighting for resources. These approaches perpetuate oppression, fuel violence, hate, and pin us against each other. Working together makes us stronger, and is a key part of the process for liberation. I believe that these conversations need to be had among groups and organizations working on social justice and public health issues.

Particularly, I want to share a few nuggets of wisdom that panelists at the event announced and that I think anyone working for a more just and equitable society could reflect on:

  • Build transformational relationships instead of just transactional ones. We need to show up as much as possible for our partners; our work is not over after we’ve completed a project.
  • Elevate lived experiences, highlight non-traditional and inspiring stories, and create unified narratives. This is quite a task to accomplish especially while also recognizing that communities are not homogenous, even within the immigrant community, for example.
  • Expand the level of human concern in the policy work we do. This means making sure we use inclusive language and check ourselves.
  • Work towards what we want, not just towards what we don’t want or what we’re fighting against. Let’s use our energies effectively!

The overarching message I took was that while we work to dismantle oppressive systems, we must remember that at the core of it all are individual humans. Yes, poverty and racism are hurting and killing us, but we should equally acknowledge that we are also strong, resilient, and powerful.

The communities most impacted by policies are the ones with the solutions, we are not saving anyone—this was very clear based on the faces, stories, and histories panelists shared. Our task in public health (or whatever sector we work in) is to elevate that strength. By elevating community strength, we elevate our collective strength.

After each presenter shared their work and their story, the event attendees repeated these beautiful phrases, that reminded us how intertwined our work together is. I invite us all to contemplate these words as we continue our work together: Thank you. Thank you for your story. Thank you for your work. My freedom is bound to yours.

Report-back from National Public Health and Criminal Justice Convening

On November 9, Human Impact Partners and the Vera Institute of Justice co-convened over 40 criminal justice advocates and public health practitioners from around the country at a groundbreaking, first of its kind convening. The event grew out of the idea that health and justice system leaders’ work in the pursuit of health equity, public safety, and social justice could be magnified by a powerful partnership across the fields of public health and criminal justice to advance these collective goals.

ConveningGroupPictureAn advisory committee – with leaders from JustLeadershipUSA, The Sentencing Project, Ford Foundation, WISDOM, and Drug Policy Alliance – helped HIP and Vera envision what the gathering could accomplish, and ultimately proposed a bold and audacious goal: to develop an alternative vision for a justice system that works to improve population health and wellbeing at every step and to develop an agenda for collaborative work to achieve that vision.

The convening was envisioned as a space to build relationships between people working at the intersection of public health and criminal justice and had an ambitious agenda. We began with participants recounting the modern history of mass incarceration and its disproportionate effects on communities of color. Participants spent time describing how they using a public health approach to issues such as drug policy and drug use, sentencing, over-incarceration, victims’ services, and reentry. Over and over, the group kept coming back to the significance of the current political moment and recognized that the progress we’re witnessing today was due to the committed efforts of community organizers – many of whom were formerly incarcerated and some of whom were in the room – who kept a constant spotlight on the injustices of the criminal justice system over many decades.

The group then turned to a discussion of their vision for an alternative justice system, and principles that should ground that vision. It was a robust dialogue, with participants highlighting the need to make a broad statement about our societal obligation for health and safety and that both the criminal justice and public health systems need to be transformed to focus on creating the social, economic, and political conditions necessary for all to thrive. This includes making the criminal justice system the choice of last resort for addressing social problems, and instead, upholding and supporting communities to overcome those challenges. The group agreed on the need to explicitly name race and racism as a root cause of poor health and over incarceration, and that the vision should be framed as a call to action. At the end, the group came to agreement on points of unity for the vision and clarity about who the vision was for. It was quite an accomplishment!!

Finally, the last part of the day focused on identifying a set of joint goals to move the vision forward. It was another rich conversation with many ideas of how the group could collaborate. The group was able to come to consensus on a set of research, communications, policy, and community building goals to advance together. Working groups are kicking off their efforts in the New Year, and we anticipate convening again in 2016.

We continue to be inspired by the energy and commitment of convening participants. A deep thanks to them for working hard and giving each other the benefit of the doubt as they explored what it means to be in relationship with one another. A special thanks to Mari Ryono – our fearless facilitator – as well as Ford Foundation for hosting the event and Open Philanthropy for funding it.

This work is part of HIP’s Health Instead of Punishment Program, which grew out of our recently adopted Strategic Plan. Contact us if you’re interested in learning more!

Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust, not Trauma in Ohio

Today, Human Impact Partners released a report that examines a critical perspective undervalued in current conversations about policing: the health perspective. Shocking cases of mistreatment, injury, and death grab headlines and go viral on social media; this report fills in the less often discussed mental, emotional, and behavioral impacts of policing for communities of color and police officers.

Developed in partnership with the Ohio Justice & Policy Center and Ohio Organizing Collaborative, and with the assistance of a 14-member Advisory Committee, Stress on the Streets (SOS): Race, Policing, Health, and Increasing Trust, not Trauma describes how policing practices affect the health of black communities and police. The report draws upon research evidence in health and criminology from across the US, as well as new information from a survey of 470 residents in select neighborhoods of Cincinnati and Akron, eight focus groups that included police and community, and conversations with key informants.

The report shows that for many black people, the perceived color of their skin means more uneasy interactions with police than white people, and stress and anxiety that in turn result in poorer physical and mental health. Among black respondents, nearly 59 percent said they have stress specifically because of police encounters compared to about 40 percent of white respondents. The report also shows that for police, heightened stress and anxiety put officers at greater risk of cardiovascular disease, substance abuse, depression, and suicide.

Survey findings include:

  • About one in seven black respondents reported being stopped by police one or two times a day, and almost one in five reported being stopped one or two times a week. Only three percent of white respondents reported being stopped once or twice daily, and just another two percent said they were stopped once or twice weekly.
  • Among white respondents, almost 70 percent said they trust the police in their community either “somewhat” or “a lot” compared to about 40 percent of black respondents.
  • Nearly two-thirds of black respondents said they had feared police would injure or kill them, or had those fears for someone else in an incident they witnessed. The response from white respondents was almost the exact opposite – nearly two-thirds said they’d never had those fears.

The good news is the report finds that changes in policing models and practices can build trust between police and black communities, improving public health and public safety.

The report looked at four widely accepted models of policing, finding that the problem-solving approach in combination with community policing is most effective in reducing crime, building trust, and addressing inequities. The standard model is least effective for these outcomes. The report also finds that based on available information, Akron’s approach is similar to the standard model with some indication of community policing, while Cincinnati’s approach combines the community-oriented and problem-solving models.

The report assessed four specific practices getting a lot of attention these days – civilian review boards, body-worn cameras, department-wide performance measures, and training, supervision, and evaluation of officers. If fully implemented as described in the report, these practices can increase public trust, and some can reduce the use of force. If not properly implemented, these practices can actually lead to harms.

To improve public health and public safety – in Akron, Cincinnati, other cities in Ohio, and nationwide – the report makes five priority recommendations (the full report details specific actions for implementing recommendations and who can do them):

  • Publicly recognize the historical contexts that have shaped current relationships between the public and police.
  • Implement community-oriented and problem-oriented policing according to promising practices, with primary aims of improving public safety and building trust.
  • Fully implement the four specific practices described in this report.
  • Issue an annual State of Police report and identify, regularly collect, and publicly report department-level measures that include and go beyond crime statistics, and report statistics by race or ethnicity.
  • Match police department resources – including staff skill sets – to the responsibilities necessary to serve all communities and create MOUs with community-based organizations to fill gaps beyond the skill sets of police.

Visit www.TrustNotTrauma.org for a full electronic version of the report, executive summary, and appendices. Be sure to follow #TrustNotTrauma to find out more about any additional activities related to these findings.

Advisory Committee members include the following (in alphabetical order; organizational names are included for identification purposes): Amy Bush Stevens of Health Policy Institute of Ohio, DaMareo Cooper of Ohio Organizing Collaborative, Erik Crew of Ohio Justice & Policy Center, Patrisse Cullors of Ella Baker Center for Human Rights, John Eck of University of Cincinnati, Victor Garcia of Cincinnati Children’s Hospital Medical Center and CoreChange, Raymond (Ray) E. Greene, Jr. of Altruistic Organization and My Brother’s Keeper, James Hayes of Ohio Student Association, Maris Herold of Cincinnati Police Department, Stephen JohnsonGrove of Ohio Justice & Policy Center, Camille A. Jones of Cincinnati Health Department, Iris Roley of Cincinnati Black United Front, Amaha Sellassie of Ohio Student Association and Sinclair Community College, and Susan Shah of Vera Institute of Justice.

Does Organizing Have a Place in Public Health?

Many social movements in the United States have used community organizers to mobilize and strengthen collective power to liberate communities from systems of oppression. Today, the concept of “organizing” is becoming mainstream as we watch Black communities unite to address police brutality and reform the criminal justice system.

Some people relegate “organizing” as an advocacy strategy to push a single-issue, minimizing the historical impact. I consider organizing a strategic process that brings together community to influence institutions, policies, and government through relationship building and education.

The purpose of public health is to protect the health of individuals and communities from harmful conditions in the workplace and the environment where they learn and live. With public health’s unique focus on improving the health of populations, the field has set workplace safety standards, enacted policies to ban smoking indoors, and created nutrition programs in schools. These are all institutional, policy, and government changes; the same kind of changes influenced through community organizing. By organizing and framing issues as a public health matter, our profession has been able to elevate the health of communities.

Historically, communities have relied on their own power to organize against injustices they were experiencing and/or witnessing. The long history of organizing is rooted in changing structural systems to grant civil liberties to those who have been marginalized. Ella Baker, a community organizer during the Civil Rights Movement, was a leader in collective leadership development. Rejecting the need for a charismatic leader and formal hierarchy, Baker preached, “In order for us as poor and oppressed people to become part of a society that is meaningful, the system under which we now exist has to be radically changed…It means facing a system that does not lend its self to your needs and devising means by which you change that system.”

My own experience with organizing started while I was a public health student in Seattle, Washington. I worked closely with Ending the Prison Industrial Complex (EPIC), a coalition organizing to prevent the building of a new youth jail. Organizing around mass incarceration helped me to understand the intersectionality between systems of oppression and health outcomes.

Over the past two years, I’ve been on the ground working with EPIC to bring public health analysis to the No New Youth Jail campaign. EPIC uses ten anti-racist principles from The People’s Institute for Survival and Beyond to transform communities by providing political education to understand their power and hold elected officials accountable. During my time with EPIC, I along with other public health students expressed our strong opposition and challenged city council members to consider their support of the jail as being in direct contradiction with the goals of protecting our youth. We highlighted the health consequences of incarceration; beyond individual health, we talked about community and economic effects like the high costs associated with incarcerating youth, the justice system’s perpetuation of racism and discrimination against Black and brown youth, and incarceration’s inability to solve the underlying problems of communities.

Because of our strong organizing, we garnered support from one city council member, Kshama Sawant who voted “no” to investing over $200 million dollars in building a detention center. The persistent pressure from organizing groups and community did not end even in the face of adversity. Modeling alternatives and changing the narrative of incarceration, a resolution to end youth incarceration was written with the support of EPIC and Youth Undoing Institutional Racism. On September 17, 2015, the City Council’s Public Safety committee voted to end youth incarceration in Seattle and now the measure will go to the city council for approval.

The fight to end youth incarceration is far from over. Patrick McCarthy, CEO of Annie E. Casey Foundation in June 2015, urged states to close down youth prisons. “We need to admit that what we’re doing doesn’t work, and is making the problem worse while costing billions of dollars and ruining thousands of lives,” said McCarthy.

On the ground organizing is pushing elected officials to consider the unfair treatment of Black and brown people from early childhood to adulthood in school, employment, housing, criminal justice system, and other sectors. Public health has a unique opportunity to use anti-racist community organizing principles to frame issues to radically transform the living conditions and opportunities for communities.

Lead Poisoning and Crime: Why the Pipeline to Prison is Running Dry

In my previous post (Does less lead mean less crime?), I wrote about research showing how the rise and decline in environmental lead levels could account for the bulk of crime trends in the US since the 1940s. (In fact, lead exposure is correlated to crime as far back as the 1870s.)

At the end of my post, I asked about the seemingly growing gap between lead exposure levels and crime rates since the early 2000s. Rick Nevin, a Senior Economist with ICF International and one of the researchers at the forefront of investigating the lead/crime connection, reached out to HIP to address that question and write a guest blog providing more information about his research, how lead exposure is driving the aging of the U.S. prison population, and the implications that may have for the criminal justice system.

At HIP, we are passionate about understanding the complex ways that social, political and economic factors interact with the environment to impact health outcomes, and the relationship between lead exposure and crime is a perfect example of this dynamic. We thank Rick for contributing his time to help us learn more about this phenomenon and sharing his professional and personal perspective on the topic.

Darío Maciel

Rick Nevin is a Senior Economist with ICF International. More information about his research can be found at www.ricknevin.com.

I want to thank HIP for this opportunity to present more evidence linking lead exposure and crime trends. The ongoing strength of this relationship has important implications for debates over the death penalty, criminal justice racial disparities, and mass incarceration.

I knew very little about the effects of lead poisoning, or crime data, when I began work in 1994 on an Economic Analysis of lead paint hazard regulations. My initial bias was to doubt that the costs of that regulation were justified by benefits. I was mistaken: costs were far lower than benefits associated with how lead exposure affects IQ, education, and lifetime earnings. My client also mentioned that we didn’t even count crime prevention benefits, suggested by recent research. I was aware of studies showing a strong relationship between lead exposure and leaded gasoline use in the past, and I wondered if there might be a relationship between crime trends and earlier gas lead trends. What I found was a stunning visual fit with a 23-year lag, consistent with early childhood lead exposure affecting the peak age of violent offending.

In 2000, Environmental Research published my first peer-reviewed study on lead exposure and USA violent crime trends. The same journal published my 2007 study on lead exposure and international crime trends, and my 2009 study on lead exposure and education trends. My 2009 study reported related shifts in incarceration rates by age and race, and showed that the lead research literature demonstrates all of the accepted indicators of causation: lead exposure is not just correlated with subsequent trends in intellectual disability, education achievement, and crime rates – lead poisoning caused those societal trends.

I have acknowledged that the strength and consistency of societal impacts from preschool lead exposure sounds like a bad science fiction plot. As an economist, starting out with a healthy skepticism about the costs of lead poisoning prevention, I am also an unlikely advocate for this improbable plotline, but the evidence is overwhelming.

Historic Trends: Dangerous Dust, Delinquency, and Crime
The most pervasive cause of lead poisoning is lead in dust, contaminated by lead in paint and air lead fallout. Lead in dust is ingested via normal hand-to-mouth activity as children learn to crawl. The bloodstream carries lead to the brain where it causes neurodevelopmental damage. Behavioral impacts are most evident after affected children reach adolescence, during another period of rapid brain growth.

Variations in biological vulnerability and lead exposure severity result in different outcomes for individual children, but higher risks of delinquent behavior among youths with preschool lead exposure have been documented by Denno, Needleman, Dietrich, and Wright. My study in 2000 found that homicide rates from 1900-1998 were also largely explained by the use of lead in paint and gasoline from 1879-1977.

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The use of lead paint fell over the 1920s and 1930s but we didn’t ban lead paint until 1978. From the 1940s through the 1980s, average blood lead tracked trends in air lead fallout from leaded gasoline, as lead paint exposure changed slowly with changes in the housing stock. Many children in the 1960s had additive exposure to city air lead and lead paint in old homes, sending “large numbers of comatose and convulsing children” to inner city hospitals. Lead in dust from lead paint in older homes is the main cause of USA preschool lead exposure today.

My 2000 study also found that 90% of violent crime rate variation from the early-1960s to 1998 was explained by earlier lead exposure trends. The time-lag relationship between lead exposure and violent crime has now been confirmed in state and city crime studies. My 2007 study found that lead exposure also explained most of the violent and property crime rate variation across decades in the USA, Britain, Canada, France, Australia, Finland, Italy, West Germany, and New Zealand. The best-fit lag was 18 years for property crime and 23 years for violent crime, consistent with peak ages of offending. In seminal reporting on this issue, Kevin Drum calls this “an astonishing body of evidence. We now have studies at the international level, the national level, the state level, the city level, and even the individual level.”

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Ongoing Trends: Shifts in Arrests and Incarceration by Age

The crime decline in recent years has been slower than the earlier decline in blood lead because steep arrest rate declines for youths have been partially offset by rising arrest rates for older adults. From 1991-2013, arrest rates for children under 10 fell by 83% for violent crime and 94% for property crime, and juvenile (under 18) arrest rates fell by 63% for violent crime and 71% for property crime, as arrest rates for adults ages 50 and older increased. In absolute terms, the violent crime arrest rate for juveniles was twice the rate for ages 35-49 in 1991, but the juvenile rate was lower in 2013. The property crime arrest rate for children under 10 was about the same as the rate for ages 35-49 in 1991, but the 2013 rate for children under 10 was just 7% of the 2013 rate for ages 35-49. This shift in arrest rates shows ongoing massive declines for youths born across decades of declining lead exposure, smaller arrest rate declines for adults born in the early years of the lead exposure decline, and increasing arrest rates for older adults born when lead exposure was increasing.

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The shift in arrest rates has caused a corresponding shift in prison incarceration. From 2001 to 2013, incarceration rates fell by 59% for males ages 18-19 and 30% for males in their 20s, but increased 33% for men ages 40-44 and surged 86% for men ages 45-54. Proponents of “tough-on-crime” sentencing credit prison incapacitation for much of the USA crime decline – “when a criminal is locked up, he’s not ransacking your house” – but the largest arrest rate declines have occurred among younger age groups with large contemporaneous incarceration rate declines.

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From 2000 to 2013, there was also a 69% decline in the number of juveniles in adult prisons, and a 46% decline in juveniles placed on probation. Juveniles in local jails also fell 40% from 2000-2014, and the number of youths in residential placement fell 50% from 1999-2013 (juvenile offenders account for 90% of youths in residential placement). The largest percentage declines were recorded by the youngest juveniles, including an 82% decline in the number of children under age 13 in residential placement. Mendel reports that lead exposure can explain juvenile justice trends that cannot be explained by reform efforts or other crime theories.

Ongoing declines in juvenile arrests reflect blood lead declines over the 1990s (the birth years of juveniles in 2007-2013). The percent of children ages 1-5 with blood lead above 5 mcg/dl fell from 31.4% in 1988-1991 to 2.6% in 2007-2010, due to new homes without lead paint, demolition and renovation of old housing, and implementation of the Residential Lead Hazard Reduction Act of 1992 (including regulations that were the subject of my 1990s analysis).

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Future Trends: A Road Less Traveled
Two decades after I first saw the correlation between gasoline lead and crime, the research on this issue is still ignored in many news stories related to lead poisoning. Jim Haner, who wrote extensively about lead poisoning for the Baltimore Sun, was the only reporter who wrote about my study in 2000, just a few years after Freddie Gray was poisoned by lead paint in Baltimore, steering his life toward academic and crime problems shared by many lead poisoning victims. In 2006, John Pekkanen wrote a brilliant story about this issue for Washingtonian magazine, but we are still waiting for an answer to the question posed by his story title: “Why Is Lead Still Poisoning Our Children?”

The “pipeline” to prison has alliterative appeal, but it is a misnomer. There is a road to prison, with signs that some offenders fail to heed. A 1991 prisoner survey found that 80% of inmates had served prior sentences to probation or incarceration, including 40% with prior sentences as juveniles. Another analysis found that prisoners released in 1994 after serving sentences for nonviolent offenses had criminal records that included, on average, 9.3 prior arrests and 4.1 prior convictions. We can disagree about many criminal justice issues, but one thing we know for certain is that very few prisoners made it to age 20 before their first felony arrest. The steep declines in juvenile arrest rates and the age 18-19 incarceration rate ensure that the road to prison will be a road less traveled for many years to come.

The Supreme Court has ruled that the death penalty and life without parole are excessive sanctions for crimes committed by juveniles, citing evidence that “adolescent brains are not yet fully mature in regions and systems related to higher-order executive functions such as impulse control, planning ahead, and risk avoidance”. We now know that preschool lead exposure impairs those specific types of brain development linked to impulse control, planning, and risk avoidance; other research links those specific types of brain impairment to homicide offending; murder trends by city size have tracked lead exposure trends from 1900-2013; and murder arrest rates by race and racial disparities in death penalty sentences have tracked racial disparities in lead poisoning.

From the 1950s through the 1970s, African-Americans were disproportionately exposed to city air lead and lead paint hazards in substandard urban housing. The percent of black preschool children with blood lead over 30 mcg/dl fell from 12% in the late-1970s to less than 1% in the late-1980s, and the black juvenile murder arrest rate then fell by 83% from 1993 to 2003. Black children are still disproportionately exposed to lead contaminated dust in older homes, but the racial disparity in elevated blood lead has narrowed from the late-1980s through 2010.

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There is a stale statistic that one in three black boys will end up in prison at some time in their life, based on an old analysis that assumed arrest and incarceration rates by age and race would remain unchanged at 1991 levels. Criminologists in the early-1990s used that same assumption to forecast a rising violent crime rate, largely based on projected demographic growth in the black juvenile population. Those forecasts were wildly wrong because the assumption about stable black juvenile offending was wrong. From 1991 to 2012, black juvenile arrest rates fell by 59% for violent crimes, 55% for property crimes, and 61% for weapons offenses. From 2001 to 2013, the incarceration rate for black males fell by 43% for ages 25-29, 50% for ages 20-24, and 62% for ages 18-19.

Lead exposure impacts on crime are as global as the rise and fall of leaded gasoline use. My 2007 study found that 80% to 90% of burglary rate variations in Britain, Canada, and Australia through 2002 were explained by earlier trends in lead exposure. The burglary rates in all three nations fell by more than 50% from 2002-2014, tracking earlier lead exposure trends. The title of a 2013 story in The Economist asked: “Where have all the burglars gone?” Now you know. In the future, the road to prison will be less traveled all over the world.

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A Tale of Two Policies

Last week in Massachusetts saw the release of recommendations from Gov. Charlie Baker’s task force on the epidemics of addiction to and death from opium-derived narcotics prescription drugs. The Massachusetts plan includes welcome public health solutions: 100 new beds for people addicted; increased use of naloxone, a drug that counters the effects of opioids, to help people who have overdosed; longer operating hours for a statewide hotline; public education to reduce the stigma that prevents many from seeking help – 65 recommendations in all. States across the nation are responding in kind, with a similar response from leadership at the federal level. This is great news for people who need rehabilitation and support for their addictions.

But what occurred to me was the response to the mostly white prescription drug addicts who are now using heroin, compared to the government’s response to people who use other drugs – harsh laws that target people of color and criminalize their addictions. Opioids? Let’s help them! Other drugs? Lock ‘em up!

My head-scratching began at the National Health Impact Assessment Meeting, held in Washington in June, in a session examining how well HIAs incorporate equity as well as physical health and well-being. David Liners of WISDOM in Wisconsin, with whom HIP worked on an HIA on Treatment Instead of Prison, talked about how the subsequent dramatic increase in treatment alternative programs, from seven in 2011 to 34 today, has improved prospects for those who go to prison – but because of the opioid epidemic, many of those slots have gone to white addicts. HIP and WISDOM had hoped this solution would help decrease the disparities of over-incarceration of African-Americans in Wisconsin – and it has, but why do these common-sense alternatives to prison continue to benefit whites more?

The War on Drugs that began in the mid-80s is largely to blame for the astronomical increase in imprisonment of people for addiction and other drug-related behaviors. One of the most egregious examples of discriminatory criminalization of addiction is the federal Anti-Drug Abuse Act of 1986, which created a 100-to 1-sentencing disparity for possession or trafficking of crack, largely used by African-Americans, vs. powder cocaine, largely used by whites. Laws that criminalize drug use instead of policies and programs offering support and rehabilitation have been responsible for a dramatic rise in incarceration and in the ranks of people with a criminal record. In the 1980s the number of arrests for drug offenses rose by 126%, compared to a rise of 28% in arrests for all crime. By 2008, The Washington Post reported that 1.5 million Americans are arrested each year for drug offenses, and one in five black men spend time behind bars due to drug laws.

But these laws have not decreased drug use. Drug addiction rates have remained relatively stable despite the incredible amount of money spent criminalizing people with drug problems.

What if we fought the prescription drug epidemic with the same fervor with which the War on Drugs was waged? First we’d lock up the addicts. Then we could go after the pharmaceutical companies that make the drugs that get people addicted, and send them to prison. Then we’d target the distributors – the drugstores. A ridiculous idea, but that was the thinking behind the War on Drugs.

Just compare the public-health term being used for this crisis – “the opioid epidemic” – to the military lingo of “the War on Drugs.” An epidemic is something we are all susceptible to and that we look to our governments to help solve. But battling a war fosters an us-against-them attitude: Drug addicts are not like us. They are morally wrong and they must be suppressed, punished, and eliminated.

That way of thinking must stop. As Massachusetts Attorney General Maura Healey said, “We’re not going to arrest or incarcerate our way out of this. Addiction must be treated like any other chronic illness.” Amen.

Helping Communities Break The Cycle And Regain Their Power

Today’s guest blog post is by Ronald Day, Associate Vice President of the David Rothenberg Center for Public Policy (DRCPP), The Fortune Society. It was originally published by fortunesociety.org

I dropped out of high school in the 9th grade. A substantial number of teenagers in my poor community dropped out, too. Despite our limited knowledge of educational standards, we knew that the schools in our community were low-quality. Read more