Abstract
Ernest Drucker, a renowned public health scholar and leader in international harm reduction, takes an innovative approach to a current social problem in his recent book, A Plague of Prisons. Drucker convincingly argues that epidemiology offers a useful approach for understanding and dismantling mass incarceration in the United States.
In the first three chapters, Drucker shows epidemiology is useful in understanding and containing epidemics such as cholera and AIDS. He discusses the birth of modern epidemiology and demonstrates how epidemiology was useful in identifying the source of cholera outbreaks in London. Before there was a cure for cholera, physician John Snow (a founder of descriptive epidemiology) identified the source of the outbreak, preventing numerous deaths. In the chapter on AIDS, focusing on the Bronx, Drucker explains how descriptive epidemiology was useful in identifying how AIDS was transmitted (shared needles). Moreover, Drucker describes how politics and policies such as criminalizing drugs and related paraphernalia have exacerbated the spread of AIDS. A public health approach could have prevented many new cases from emerging.
Drucker then turns to his primary point; mass incarceration can be approached through the lens of epidemiology. Drucker shows how the plague of incarceration has all the characteristics of an epidemic: rapid growth rate, large magnitude, persistence, and self-sustaining qualities. Focusing primarily on New York City (NYC), Drucker explains the source of this epidemic: the Rockefeller Drug Laws. Throughout this book, Drucker focuses almost solely on drug laws and policies in analyzing the epidemiology of incarceration.
Descriptive epidemiology uses the details of time, place, and person to develop a better understanding of an epidemic. Drucker empirically discusses all of these details in relation to the plague of incarceration in New York. Expectedly, the implementation of the Rockefeller Laws and their penalties led to the outbreak of mass incarceration over time. More intriguingly though, Drucker shows how in terms of place, NYC—or more specifically just 14 neighborhoods in NYC—have become feeder communities, fueling the prisons at far greater rates than other areas of the state. In terms of who, Drucker quantitatively corroborates much research on the war on drugs and shows this plague primarily impacts young Black men. Drucker describes the prevalence of mass incarceration in both NYC and the United States through his focus on arrests, sentencing, probation, and parole.
Drucker offers two methods of assessing the relative impact of mass incarceration compared to other epidemics. His first method of comparison is through a measure termed years of life lost (YLL) and his second is through disability-adjusted life years (DALYs). In terms of YLL, Drucker argues that the number of years an individual spends behind bars can be directly compared to other epidemics by examining the number of years of life that individuals have lost. Drucker compares the Rockefeller Laws to the World Trade Center Attack and drug incarceration in NYC to AIDS among Black men in this manner. In both comparisons, Drucker finds greater YLL due to the war on drugs than to the other scourges. This seems slightly problematic to compare incarcerated years to years not alive, implying that one is essentially dead while incarcerated.
However, Drucker’s other method of comparing mass incarceration to other epidemics through chronic incapacitation measured as DALYs is more convincing. DALYs due to incarceration are over twice as high as DALYs in the U.S. population. Drucker describes the ways in which time spent in prison (health, drug addiction and treatment, mental health, homicide and suicide, and solitary confinement) creates disabilities for those exposed to the system. He explains how postincarceration, individuals subject to prison continue to be disabled.
Drucker explicates how incarceration reproduces itself and is self-sustaining. Using quantitative data, case studies, and relevant anecdotes, Drucker details many ways in which incarceration has become a self-sustaining epidemic. The criminalization of drugs and the use of large-scale arrests for low-level drug offenses “infect” individuals and leads to a greater probability of future incarceration. Incarceration has an intergenerational impact; children of imprisoned individuals are psychologically and socially disadvantaged and at a greater risk of becoming imprisoned themselves. Because of the concentration of incarceration in specific communities, the ecology of certain neighborhoods has been altered. The dismantling and destabilizing of these localities leads to higher crime rates (the very thing incarceration is allegedly intended to fight), so members of these communities continue to feed prisons.
Finally, Drucker argues that by utilizing epidemiology and a public health perspective, three methods of prevention used in conjunction with one another can reduce the harm caused by incarceration and minimize the number of individuals who become involved in the system. The first, primary prevention, involves reducing the scale of the current criminal justice system through drug-sentencing policy reform—reducing the number of individuals who become incarcerated and the length of time they serve. Secondary prevention involves reducing the harms of incarceration and reentry for those who are currently imprisoned by improving services and conditions. The third, tertiary prevention, involves minimizing the disabling consequences of prison for the formerly incarcerated through a restorative justice approach where both individuals and societies acknowledge the harm they caused.
Drucker’s approach explains many aspects of the current plague of prisons and proposes the usefulness of a public health perspective to tackle the problem. A Plague of Prisons reveals how the war on drugs fueled the prison system. However, it does not address how other laws and tough-on-crime policies have contributed to our prison epidemic. In his afterword, Drucker addresses these issues by discussing some of the other criminal justice trends and policies that have emerged: the increasing incarceration of women, banishment and the criminalization of poverty, sex offenses and registries, the privatization of corrections, and immigration detention to name a few. Drucker’s work would have been strengthened by an inclusion of these issues within the body of his text, but nevertheless he offers valuable insights into a modern epidemic and the necessary approaches we must take if we want to reduce the further harm it will otherwise ineluctably cause.