How Mass Incarceration is a Plague Infecting Our Nation — Literally

It's becoming steadily contagious, and its hurting the U.S.


Copyright © 2011 by Ernest Drucker. This excerpt appeared in A Plague of Prisons: The Epidemiology of Mass Incarceration in America published by The New Press Reprinted here with permission. 

We already know that an epidemic is different in important ways from the sum of its individual cases. An epidemic disease produces large-scale effects that go beyond its clinical expression in single cases and can lead to significant social consequences. We have seen how the explosive growth and large scale of mass incarceration in America over the last thirty-five years are among the things that define it as an epidemic. Another crucial and defining characteristic of an epidemic is its ability to sustain itself by creating new cases— becoming contagious (communicable from person to person) and spreading to new populations and locations. As in other epidemics, the collective effects of mass incarceration transcend those of individual punishment, lending it different and more harmful (even lethal) consequences— including increased risk of contagion. 

For any communicable disease to sustain itself and grow, it must create new cases at a rate that exceeds the number of cases that are either cured or die from the disease. An epidemic’s “rate of reproduction” is commonly represented as R. If an epidemic is growing, we say that R equals more than 1 (R > 1); if R is less than 1 (R < 1), the epidemic is shrinking. The epidemiologist’s job is to identify the factors and conditions that determine the reproductive rate of any epidemic, first by isolating the specific mechanisms responsible for creating new cases (the biological causes of the illness and the means of transmission) and then by figuring out how to intervene to bring R below 1. 

In the system of descriptive epidemiology we used to look at the Titanic data and AIDS, we considered three variables: time, person, and place. These three dimensions give us a systematic way to count, characterize, and map the individual cases that have occurred. They allow us to understand the patterns of prevalence and incidence of an epidemic. But in public health we want to go beyond description; we want to understand causes, including the biology of the agent’s action, how the agent is transmitted, and vital social and environmental mechanisms that can help us to contain or stop epidemic growth. These are the pieces of information we need to influence the epidemic’s reproduction. This methodology is called analytic epidemiology, where we use another trio of factors— the “epidemiological triad”— for considering new epidemics and their mechanisms of reproduction. 

The epidemiological triad is composed of the three essential components of any epidemic: agent, host, and environment. The agent is the specific biological cause of the disease— HIV, the cholera vibrio, the carcinogens in tobacco smoke. The host (e.g., a human) is infected by exposure to the agent. Epidemiologists are especially interested in the different characteristics of hosts (individuals and populations) that put them most at risk for being exposed to the agent and acquiring it. For example, the elderly have an escalated risk of catching the flu because of their weakened immune systems and lungs. Finally, the environment (e.g., air, water, food, or blood) is what carries the agent or makes its transmission possible. Epidemiologists are most interested in the aspects of the environment that either allow the disease to spread from person to person, causing the epidemic to grow, or limit it by being inhospitable to the agent’s survival or spread. 

Mass incarceration reproduces itself in at least three distinct ways, all resulting in more individuals spending more time in the criminal justice system. First, the criminalization of drugs and the use of large-scale arrests for low-level drug offenders mean that millions of individuals a year— most of them young men of color— are “infected” by exposure to the criminal justice system, most often by arrest at a young age. Many of those infected by these early encounters with the criminal justice system go on to serve more time in prison for other, more serious crimes later in life. 

Second, massive imprisonment of young men and women, most of whom are parents, has now created several generations of “children of the incarcerated.” These young people, who grow up without access to at least one parent for a significant portion of their childhood, are affected both psychologically and socially, including being placed at extremely high risk themselves of becoming prisoners later in life. 

And third, mass incarceration, concentrated as it is in specific urban communities, alters the ecology of those neighborhoods irreparably, fostering contagion by undermining the social and family support structures that are especially important for the poorest populations. Residents of neighborhoods targeted in the war on drugs are arrested at levels that destabilize and damage the social fabric that typically keeps individuals functioning as law-abiding citizens in their own communities. This effect in turn perpetuates drug markets, crime, and mass incarceration. Applying the tools of analytic epidemiology to mass incarceration can help us understand each element of this epidemic. Arrests and incarceration under drug laws are the most important agent of transmission that creates new cases of incarceration; the highest-risk host populations are minority drug users (who are the most vulnerable to high rates of drug arrest and imprisonment); and the enabling environment is the political and policy regimes responsible for the set of laws that criminalize drug use— the rules and sentencing practices of the war on drugs. Framing it in this way, it is clear that the criminalization of drug use and the deployment of the full force of the greatly enlarged criminal justice system to enforce our drug policies is the “pump” that has caused and sustains the epidemic of mass incarceration. This is most apparent in poor urban corners of America, driving the reproductive rate (R) of this new epidemic above 1, to the point where mass incarceration now bears all the features of a self-perpetuating epidemic. 

The next step is to identify mass incarceration’s mechanisms of reproduction— the specific features that account for a reproduction rate greater than 1. To accomplish this we must first measure the extent of any individual’s and population’s exposure to the criminal justice system. We will therefore consider various ways in which unusually high levels of exposure to arrest and imprisonment may serve to create new cases at a rate that makes the epidemic of incarceration self-sustaining. 

The concept of exposure is used in public health to identify and measure the risk of an agent infecting a host; more exposure implies more risk of infection. When it is applied to bacteria, viruses, or environmental hazards (such as asbestos, cigarette smoke, or mercury), we readily appreciate the sequence of cause and effect— a person is exposed to HIV by sex or contaminated needles; inhaling tobacco smoke causes cancer. The dangerous effects of any exposure and its potential to do harm (to individuals and populations) are a function of the level of the exposure. How likely are you to contract the flu through one exposure to the virus on a crowded bus, or to become infected with HIV from a single sexual encounter? For exposures to toxins or other dangerous substances— drugs, cigarette smoke, chemical fumes— we are concerned with the level of exposure, or dosage. For most toxins, we are accustomed to using the amount of exposure as a measure of risk or hazard— dose relationships are used for gauging the effects of illicit drugs and prescribed medications, as well as dangerous exposures such as radiation and tobacco smoke. 

The medieval physician (and alchemist) Paracelsus put it simply: “The dose makes the poison.” He understood that the difference between a medication and a poison could be simply a matter of the amount to which a person is exposed. Things that are helpful or tolerable in small doses can kill in large enough doses. This is true of most drugs, some foods, and even water.

 Levels of dosage or exposure are also useful ways to think about incarceration. We speak of a “dose of punishment” as though it were medicine. But is it a helpful or harmful dose? This idea of exposure allows us to consider the effects of incarceration measured as a function of its duration, frequency, and severity as experienced by any individual. We may measure the doses of punishment across the life span of individuals, for example as the number of arrests or periods of time spent in prison. 

But we may also measure the extent of exposure to this agent for an entire population. As with the level of any other risky exposure for a population, involvement in the criminal justice system (arrest, imprisonment, parole) is an exposure of humans to a potentially harmful agent. When the dose becomes too strong for an individual or any population, as it has become with incarceration in many communities, the effect is similar to a toxic exposure. Figure 7.1 shows this exposure generally for the entire U.S. population born after 1910—successive birth cohorts exposed to increasingly high rates of incarceration—the epidemic as a thirty-year tsunami of punishment washing across the American people. 

We all have been exposed to a dose of punishment— meted out by parents, teachers, bosses— most times without being “poisoned.” But is there a point where the level or dose of punishment is too severe for an individual, for a community, or for an entire society? Is there a “just right” amount of punishment? Clearly, high doses of punishment (especially cruel punishment such as torture or harsh conditions of imprisonment) can be both physically and mentally damaging for individuals. Some forms of punishment can cause physical and psychological damage that perseveres afterward and can scar for life. The possibility of long-lasting harm is inherent in the idea of posttraumatic response— a notion we now routinely invoke for understanding the damages experienced by many war veterans or by chronically abused children. Does punishment, when it is administered to an entire population (for example, via a massive level of incarceration in a community) equal a collectively damaging or toxic exposure, leaving a trail of posttraumatic effects?