Fact Sheet: Policies to Address Criminal Justice as a Driver of Poor Health

Introduction 

The criminal justice system’s influence on health includes not only direct physical harm, but also chronic stress, mental health crises, infectious disease transmission, and the erosion of community social capital. A Milbank Quarterly Perspective by Rashawn Ray of the University of Maryland and Keon Gilbert of The Brookings Institution explores the detrimental impact of the criminal justice system on health, particularly for people of color and low-income people, as well as policy gains and persistent failures, and proposes actionable solutions for policymakers. 

Context 

While focused on the health harms of the criminal justice system, the authors point to several positive trends, including: 

• A significant decline in overall US violent crime rates over the last several decades, lessening exposure to trauma and injury. 
• A 25% drop in the incarcerated population between 2009 and 2022, with notable reductions for drug-related offenses. 
• State adoption of alternatives to incarceration for non-violent offenses, such as diverting individuals to drug treatment programs or mental health services.  
• Growing adoption of crisis intervention training for law enforcement officers and co-responder programs with mental health experts. 

Nevertheless, police killings have increased significantly over the past two decades, particularly for members of marginalized communities. In the article, the authors identify six social problems that continue to establish criminal justice as a determinant of health, including: 

• Disproportionate Police Violence and Its Health Consequences. While Black people constitute roughly 13% of the US population, they make up 31% of all people killed by police and about 40% of those killed while being unarmed and not attacking. Additionally, policing practices are a public health hazard for all residents in areas with frequent police killings.  
• The Health Burden on Law Enforcement. A high percentage of police officers experience depression, anxiety, and chronic stress (roughly 80%), recurring memories, family problems, anger, and sleep issues. Sixteen percent report thoughts of suicide, and 15% report substance use disorders. 
• Systemic Obstacles to Accountability: Qualified Immunity and Police Union Contracts. Entrenched law enforcement resistance to accountability, which is embedded in legal doctrines and union contracts, contributes to public health harms. This immunity now extends to United States Immigration and Customs Enforcement (ICE) agents and border patrol.  
• Health Crises in Carceral Settings: The COVID-19 Pandemic and Beyond. Overcrowding, poor sanitation, and limited access to quality health care create an environment where viruses can spread rapidly and lethally. The federal prison rate for COVID infections was nearly double that of the general population.  

Policy Solutions 

Addressing the role of the criminal justice system as driver of poor health requires a multi-faceted approach involving policy shifts, reallocations of resources, and changes in practice, the authors say. These include: 

• Reimaging Public Safety. Research shows that police spending can consume 40% of municipal budgets. A portion of these funds can be redirected from law enforcement to community-based health, housing, education, and violence prevention programs that address the root causes of crime and poor health.  
• Implementing Equitable Policing Policies and Practices. Measures to reduce police use of force include 1) mandating data collection and transparency for all instances of use of force and death involving law enforcement, and 2) the removal of qualified immunity to hold officers directly responsible for misconduct. 
• Prioritizing Officer Well-being and Professional Development. Some key solutions include: mandatory mental health counseling for officers to destigmatize mental health treatment, mandatory housing subsidies for officers to live where they work, mandatory bias training, and enhanced training for de-escalation, crisis intervention, and cultural competency.