Using a public health approach to rethink and reduce mass incarceration in the U.S.

Written by Barbara Baumgartner, PhD, director of Undergraduate Studies, Women, Gender and Sexuality Studies and associate director of Washington University Prison Education Project

The United States incarcerates more of it citizens per capita than any other country in the world. Since most prisons are located away from urban centers, the magnitude of the problem is largely invisible, and our leading incarceration rate is a fact that surprises and shocks many Americans.

The United States didn’t always hold this dubious distinction. After holding steady for much of the twentieth century, the prison population has risen dramatically over the last four decades. While many factors contributed to the rise, one leading contributor has been the decision to use a criminal rather than medical approach to addiction. The War on Drugs was declared by Richard Nixon in 1971, but it was under the Reagan Administration that the United States began an incarceration binge. Congress and many states passed mandatory minimum laws that imposed obligatory, non-negotiable sentences for certain crimes, mostly drug offenses, which took sentencing discretion away from judges. These mandatory minimums often stipulated long prison sentences, even for non-violent, first-time offenders, and greatly contributed to the meteoric rise in the prison population. In 1980, the incarceration rate in the United States was 139/100,000; by 2015, it was 698/100,000. The significantly lower incarceration rates of our peer countries, such as Canada (114/100,000), France (101/100,000), and Germany (76/100,000) illustrate how extreme and unusual our propensity is for locking up our citizens.1

The tremendous swelling of our prisons has had a profound impact in our country, not only ravaging individual lives but causing colossal collateral damage to relationships, families, and communities. But the most significant consequences of mass incarceration has been on people of color, who make up approximately 30% of the population, but 60% of the prison residents. 1 in every 15 African-American men and 1 in every 36 Hispanic men, but 1 only 1 in every 106 white men are behind bars.2 Some urban neighborhoods of color have been decimated by these practices; for example, Wayne Country Michigan, where Detroit is the county seat, makes up 18% of the population, but 35% of Michigan’s state and federal prisoners. Certain neighborhoods are particularly hard hit, such as the East Side of Detroit, which has 1 in 22 residents under correctional control (“One in 31,” Pew Report, 8).

While men are much more likely to be behind bars than women, the war on drugs has also targeted women. Even though women currently comprise approximately 7% of the prison population, the result of the change in policies has been that women are being sent to prison at higher rates than men. Between 1980 and 2010, the number of women in prison increased at almost 1.5 times the rate of men: in this thirty year period, the number of incarcerated women rose by 646%; the rate of men’s incarceration rose 419%.3 (Once again, communities of color are hit harder: the imprisonment rate for black females (113 per 100,000) was twice the rate of white females (51 per 100,000).4 In addition to the disparate impact that incarceration has on women of color, women from lower socioeconomic groups are also disproportionately affected. Women in prison have lower levels of educational attainment, experience higher levels of physical and mental illness, and are more likely to have suffered from physical or sexual abuse.

While it is devastating for families when either parent goes to prison, it is particularly difficult for children when their mothers are locked up. Women are more likely than men to have minor children who lived with them prior to their being sent to prison, and while biological mothers most often care for children when fathers go to prison, the reverse is not true: when women go to prison, it’s usually grandparents or other relatives who take in the children.5

If sending people to prison actually helped them and their communities, there might be a justification for incarcerating so many Americans. But there is little evidence that rates of incarceration are connected to lowering crime rates,6 and there is substantial evidence showing the ways that prison negatively impacts individual’s lives, families, and communities. With state recidivism rates at 76.6% after five years, time in prison clearly isn’t helping people.7

With the war on drugs as a primary catalyst for the increase in incarceration rates, it only makes sense to revisit our country’s decision to criminalize addiction and the multiple factors that contribute and are connected to it. A public health approach is an effective way to think about our current system of mass incarceration and what we might do differently.

From a public health perspective, prevention is an excellent starting point. It is important to first prevent initial involvement in the criminal justice system. This can be accomplished through programs that reduce poverty and economic disadvantage, develop and strengthen early childhood education, expand public benefits that support low-income communities and communities of color, and increase access to health care, especially mental health services and addiction treatment. Once someone is involved in the criminal justice system, alternatives to incarceration need to be expanded and utilized. Drug or mental health courts that mandate behavioral health interventions and other appropriate treatment have proven to be effective options. Probation and parole need to be based on evidence-based practices that have proven to reduce recidivism. Reducing barriers to employment after incarceration is also essential.

The impact of incarceration extends far beyond the person who is imprisoned. Families and communities are also affected. A public health approach that looks at both the causes of incarceration and the factors that lead to the high recidivism rates can lead to strategies to address the roots of the problem, develop viable, effective alternatives, and reduce our reliance on incarceration.


  2. 11351/the-top-10-most-startling-facts-about-people-of-color-and-criminal-justice-in-the-united-states/
  3. Incarcerated_Women_Factsheet_ Sep24sp.pdf
  5. Incarcerated_Women_Factsheet_ Sep24sp.pdf
  7. welcome.aspx