Public Health Epidemics Without Diseases

Photo by "BankingBum" - Wikimedia Commons

Photo by "BankingBum" - Wikimedia Commons

The leading cause of death for American black men between the ages of 15 and 34 isn’t cancer, AIDS, heart disease, or even accidents. It’s homicide, which accounted for more than half of the deaths of black 15 to 24-year-olds and more than a third of those aged 25 to 34. In Chicago, African-American males aged 15-24 are 10 times more likely to be killed in a homicide than white males, and in 2004, more African-Americans died from homicide than diabetes, HIV, or stroke. Genetic predisposition, access to health care, diet and exercise – all pale in comparison to bullets and knives.

Those numbers clearly argue that any discussion of health disparities between white and black populations in the United States can’t be limited to disease, said Harold Pollack in his MacLean Center for Clinical Medical Ethics seminar in late January. Urban, minority populations bear the brunt of the consequences of crime, he demonstrated, including not only homicides but also non-fatal injuries, incarcerations, economic damage, and stress. So while a project like the University of Chicago Crime Lab, for which Pollack serves as co-director, is rooted in the social sciences, the success or failure of its mission will surely have an impact upon medicine and community health.

“If you actually count up the number of dead bodies and in particular the number of life-years lost, homicide is a significant public health threat and it requires a systematic, determined response,” Pollack said.

The most shocking graph Pollack showed during his talk had nothing to do with cancer rates or disease mortality, but instead with incarceration. While the proportion of Americans behind bars remained stable from 1920 to 1970 at roughly 1 in 1,000, from there the numbers took an upward spike to make the climate change “hockey stick” graph jealous, increasing fivefold to today’s rate. As the numbers of jailed Americans skyrocketed, the prison population also became significantly less white, Pollack said, with the white incarcerated population dropping from 60 percent to 30 percent of the whole.

The “incarceration epidemic” causes significant public health ripples, both direct (through violence, HIV transmission, and drug addiction) and indirect. Disparities of incarceration have strained relations between minority communities and police, Pollack argued, making crime prevention in dangerous neighborhoods more difficult. Hiring biases against applicants with criminal records make it hard for convicted felons to find jobs (not to mention health insurance) after their release, steering them back toward illegal activity. For those jailed as juveniles, the lost time in school only intensifies the struggle to find legit work.

In response, one approach to reducing crime (and by extension, improving health) would be to reform the American justice system toward more sensible incarceration, Pollack suggested. An upcoming study by Pollack with Eric Sevigny and Peter Reuter finds that reversing these trends is no easy task; despite an oft-repeated claim, non-violent drug offenders comprise only a small chunk of America’s jailed population. Pollack offered a slew of other ideas, including supply-side drug enforcement, improved parole programs, leniency towards older offenders, hiring more police, and improving school attendance. A program called B.A.M. Sports Edition, designed to reduce violence among high school students, is currently being tested by the University of Chicago Crime Lab at some of Chicago’s most dangerous schools, Pollack said.

But so far, policymakers have been slow to make fighting urban violence a priority, even as they take steps to address public health through legislation such as the Patient Protection and Affordable Care Act, Pollack said.

“People are sad that this is going on, but there’s no sense of urgency,” Pollack said. “There’s very little evidence that the political system is responding to the urgency that low income people are feeling about this issue. I think if you say ‘why aren’t we being more effective as a society?’, I think the economic and political marginality of the victims and the offenders is fundamental.”

[Each academic year, the MacLean Center for Clinical Medical Ethics organizes a series of lunchtime seminars by physicians, biologists, economists, social scientists and other experts covering the biggest questions in health care and ethics. This year’s theme is “Health Disparities: Local, National, Global,” and the series was put together with the Urban Health Initiative, the Global Health Initiative, and Finding Answers. ScienceLife will carry regular coverage of this unique series, and video of the lectures will be posted when available.]

About Rob Mitchum (526 Articles)

Rob Mitchum is communications manager at the Computation Institute, a joint initiative between The University of Chicago and Argonne National Laboratory.

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