Examples of poor health among the poor are everywhere: congenital disease and infant AIDS are far more common among the poor, as are the chronic diseases of childhood. Lead poisoning, asthma, malnutrition, anemia, and chronic middle ear infections are not only expensive to diagnose and treat, but can also lead to permanent impairment. Poor children are twice as likely as affluent children to suffer lead poisoning,20 for instance, and the long-term, deleterious effects on the brain of lead deposits are well known. Severely poisoned children may suffer seizures, coma, and mental retardation, but even those with milder degrees of lead poisoning are at risk for learning and behavior problems. Language acquisition can be delayed, hyperactivity may result, motor coordination may be affected, aggressive or impulsive behavior is more common, and children may have generalized difficulty learning. In addition to being severe problems in their own right, all these symptoms lead to difficulties in school. These difficulties are compounded when the schools in the poor areas lack the capacity to give the individual attention needed; these children may do poorly or drop out altogether. Lead poisoning means that a child enters the challenge of adulthood in the ghetto even less prepared than peers to cope with it.
Childhood asthma has increased dramatically over the last thirty years.21 Both poverty and inner-city residence are independent risk factors for asthma, and poor African-American children are more than twice as likely to get asthma as other non-poor children and more than four times as likely to be hospitalized. The death rate from asthma is four times higher among African Americans than among whites.22 Asthma is not only a serious, potentially life-threatening illness in itself, but among chronic health conditions it causes the most school absences. It is the second leading cause of hospitalization for children aged five to nine and may account for a third of all emergency room visits. For the uninsured, the several medications often combined to treat asthma are prohibitively expensive. Asthma becomes highly disruptive to the life of the child and his or her family, adding further chaos to their lives.
While measuring “hunger” is necessarily subjective, the United States Department of Agriculture’s annual survey of hunger reports that approximately ten million U.S. households, (accounting for 18 percent of the children) are “food insecure” at some point during the year,23 meaning that they do not have access to enough food to meet their basic needs. Over three million of these households experience hunger at some point during the year. On any given night, 562,000 American children go to bed hungry.24 Compared to other low-income children whose families do not experience food shortages, hungry children suffer from over twice as many individual health problems—unwanted weight loss, fatigue, headaches, irritability, inability to concentrate, and frequent colds.
Iron deficiency anemia is also a common result. In the middle-class rural community where I practiced for seven years, anemia was rare. I was shocked, upon moving to the inner city, to discover that well over a third of my young inner-city patients were anemic. Average hemoglobin levels (measuring anemia) were significantly lower than my rural patients’. All of the symptoms of hunger, especially when exacerbated by anemia, mean that hungry children are less able to cope with the difficulties of their environment. School performance suffers, with the expected consequences on future earning power.
Sometimes these health problems exacerbate poverty in surprising ways. Consider middle-ear infections (otitis media). Normal acute ear infections cause pain and lead to emergency doctor visits, where they can usually be treated easily. Sometimes, however, acute otitis media leads to chronic otitis media that may have few symptoms and be detectable only by medical examination. If, as often happens among the poor, the acute, painful episodes are insufficiently monitored through follow-up visits, the chronic otitis media may go undetected. For financial reasons, for instance, a poor child is less likely to revisit the doctor after her acute ear infection seems to have gotten better, so the chronic form remains undiagnosed. This chronic otitis can cause a temporary loss of hearing, which may persist through early childhood. Undiagnosed hearing loss often leads to poor school performance, and so to permanent educational deficiencies, making it that much harder to escape poverty as an adult.
Every illness, of course, makes it more difficult to cope with one’s environment, so the poor health status of poor children becomes a permanent impairment. The surround of force seems inescapable.
In addition, the poor are much more likely to live and work in conditions that are detrimental to health. A friend of mine, for instance, cannot afford to move out of her damp basement apartment although the mold spores it breeds severely aggravate her daughter’s asthma.
Finally, the stress of simply being poor has been documented to be a real health risk.
The poor get it coming and going.
A SECOND GHETTO: PRISON
Over the last twenty-five years, “law and order” has become a politically potent slogan. The impact of the generally bipartisan demand for “law and order” began to be felt in the early 1980s, when both state legislatures and Congress started to write into law not only lengthier sentences for various crimes, but also “mandatory minimum” sentences. Such laws took from judges the discretion they had previously had in the sentencing process, when they could consider the particular circumstances of the offense committed and of the person who committed it. The result has been a substantial increase in the average length of time served in prison. At both federal and state levels, “three strikes” laws have been passed that mandate sentences of twenty-five years to life for the third felony offense. In states like California, these three strikes can be for relatively minor offenses, including drug possession. More people there have been sentenced under the three-strikes law for simple marijuana possession than for murder, rape, and kidnapping combined, and more for drug possession generally than for all violent offenses.25 A young man was recently sentenced to a minimum of twenty-five years for his third conviction—this time for stealing a bicycle.
These and other new laws have brought about staggering increases in the size of our inmate population. In 1971, there were fewer than 200,000 people in America’s state and federal prisons. By 2001, that number had grown almost to 1.4 million, or close to a seven-fold increase.26 If local jails, youth facilities, military prisons, and other forms of imprisonment are included, on any given day over two million Americans are incarcerated,27 a rate of 736 inmates per 100,000 population. This rate is the highest in the world. Only Russia (with a rate of 675 per 100,000) and other countries of the former Soviet Union even come close to our propensity to incarcerate. Other Western democracies average between 55 and 120 per 100,000, that is, between one-sixth and one-twelfth of the American rate. Japan incarcerates only 36 per 100,000, approximately one-twentieth of our rate.28
Even these figures pale next to the staggering incarceration rates within the African-American community. In the year 2000, roughly one out of every three black males between eighteen and thirty-four years of age was under the active supervision of the criminal justice system: under arrest, awaiting trial, awaiting sentencing, on probation, in jail or prison, in half-way houses or other mandated programs, or on parole.29 In Washington, D.C., half of all young black men are currently in the criminal justice system.30 In nearby Baltimore, it’s even worse. These figures include only those currently in the system. If we also count those who have previously been in the system and have now been released, the numbers are even higher. How did this happen? And what has been the impact of these extraordinary incarceration rates on urban life?
The reasons for such high numbers of African Americans in the criminal justice system are complex. Certainly, proportionately higher percentages of poor blacks commit crimes for which we ordinarily send people to jail, especially drug offenses, but also burglary, robbery, assault, and murder. It is also true, however, that we tend to punish the kinds of crimes committed by the poor more severely than similar ones committed by affluent people. Compare, for example, shopliftin
g and “fudging” on an expense account. Each is a nonviolent crime against business. Since neither source of income is usually reported to the Internal Revenue Service, each is a federal crime. Yet the shoplifter is much more likely to be prosecuted than the executive manipulating his expense account.
Some of the overwhelming increase in incarceration is certainly due to an increase in rates of violent crime between the end of the 1960s, when social conditions in the ghetto began to deteriorate, and 1992, when those rates suddenly started declining, but that’s only part of the story. A large part of the increase in incarceration rates over the last generation has had to do with increased length of sentences for less serious crimes. Comparison with European countries supports both explanations. Violent crime levels are generally higher in the United States than in Europe, but it is also true that both our “propensity to incarcerate” and the length of an average sentence for less serious, nonviolent crimes like drug possession or burglary are greater in the United States than in other Western industrial countries. While exact comparisons are difficult to make because crime and punishment statistics in various countries are kept differently, prison sentences in the United States are on average more than two to three times those in European countries for these lesser crimes. Paradoxically, for violent crimes like murder or armed robbery, our sentences—with the notable exception of capital punishment, of course—are closer to those in Europe.
One of the ways in which the criminal justice system weighs more heavily on the poor—especially people of color—is the process of plea bargaining, through which many run-of-the-mill street-crime prosecutions are resolved. In fact, the mandatory minimum sentence that has taken power away from the judge has for practical purposes transferred that power to the prosecuting attorney, who decides not only what charges will be brought against defendants, but also whether or not to prosecute in federal court, where sentencing standards are more severe than in most state courts. Thus, the prosecuting attorney has the authority to offer a plea bargain for, say, a one- or two-year sentence versus facing trial on a charge that might carry a mandatory minimum of twenty years. It often seems in the best interests of even those who are innocent to plead guilty and take the lesser sentence. The lack of time and resources at the disposal of the public defenders assigned to help the poor means a further tilt toward convicting the poor, only adding to the accused’s incentive to accept a plea bargain.
There can be no doubt, however, that the war on drugs has been the major cause of the increase in incarceration of black inner-city residents. “Declared” in the early 1980s, the emphasis of this war nationwide has been on law enforcement and the incarceration of drug offenders, not on prevention and treatment. It has also concentrated drug law enforcement on inner-city areas and instituted harsher sentencing policies, particularly for crack cocaine. Thanks to this war (which has in truth been largely a war on the poor), between 1985 and 1995 the number of black state prison inmates sentenced for drug offenses rose by more than 700 percent.31 In recent years there has also been a dramatic increase in the number of drug cases heard in federal court, as prosecuting attorneys have exercised their authority to bring more offenders under the scope of the more severe federal mandatory minimum penalties.
Once in the criminal justice system, African Americans are usually treated more harshly than other racial groups. The most notorious example is in sentencing for crack cocaine offenses. Crack cocaine and powder cocaine have the same chemical composition, and powder cocaine can easily be transformed into equal weights of crack. Crack, however, is marketed in smaller, less expensive quantities and has, therefore, more often been used by those in low-income and minority communities, whereas powder cocaine is more likely to be used by the affluent. In federal court and in many state courts, the penalty for selling five grams of crack cocaine is the same five-year mandatory minimum sentence as the sentence for selling five hundred grams of powder cocaine. Despite the fact that two-thirds of crack users are white or Hispanic, 86 percent of all offenders sentenced in federal court for crack offences are African American.32
Both liberal and conservative criminologists agree that any reduction in drug-related crime caused by our vast increases in imprisonment for drug offenses, while difficult to measure with any certainty, is either small or negligible.33 Indeed, some have argued that imprisonment makes ex-offenders more likely to use drugs again, because they come out of prison so poorly prepared to reenter society. While the war on drugs has increased incarceration rates for all groups, the increase for black men has been disproportionate. While African Americans are only 12 percent of the population and 13 percent of the drug users, they are 35 percent of those arrested for drug possession, 55 percent of those convicted of drug possession, and an incredible 74 percent of those actually jailed for drug possession.34
In other words, an African-American drug user is almost twenty times more likely to spend time in prison for his offense than is any other drug user.
Drug treatment both within and outside the criminal justice system would clearly be more cost-effective in controlling drug abuse and crime than the continued expansion of the prison system. The RAND foundation, a not-for-profit, non-partisan research foundation for the study of military, social, and economic issues, estimated, for instance, that every dollar spent on drug treatment would reduce drug use eight times more than spending the same dollar to expand the use of mandatory sentencing for drug offenders. Similarly, expanding the use of treatment has been estimated to reduce drug-related crime up to fifteen times as much as mandatory sentencing.35 Studies of drug treatment for the incarcerated have also shown that those who receive drug treatment are significantly less likely to return to prison for another offense than those who do not. Unfortunately, few prisoners receive drug treatment, just as few poor drug users have access to effective drug treatment programs of any sort.
There is no doubt that we need a strong and efficient criminal justice system. There are dangerous people we must remove—at least temporarily—from society. The question is not whether we are “soft” or “tough” on violent crime, but whether the profound increase in incarceration over the last generation has accomplished what it promised. The question is what works and what does not, what will bring real public safety and what only appears to do so. With the deterioration of the social safety net (over the last twenty years government spending for almost every anti-poverty program except Medicaid has decreased) the prison has become our social policy: our employment initiative, our drug treatment program, our mental health policy, our anti-poverty effort, and our program for children in trouble.
In 1997, the latest year for which Justice Department statistics are available, the cost of incarceration to local, state, and federal government was $130 billion,36 3.6 times the amount spent in 1982, and these figures continue to increase 8 percent per year. Journalist Christian Parenti reports in his book Lockdown America that more than a half-million people work in corrections, making it larger than any Fortune 500 employer except General Motors. Seven billion dollars a year is spent building new prisons. Poor rural areas vie for them and then they immediately become central to the local economy. Five percent of rural population growth between 1980 and 1990 came from prisoners, captured mostly in the cities. Prisons—including the one out of twenty that are private and for-profit—are big business, making it all that much harder, given the ever-greater vested interests in the system, to extricate ourselves from the present morass.
Meanwhile, federal spending on jobs and job training plummets and opportunities for drug treatment disappear. Poverty is correlated with crime, but every extra dollar spent on local, state, and federal penal institutions is a dollar less to spend on the prevention and eradication of poverty. It’s not that we don’t have other options. Because children who have been abused are far more likely to commit violent crimes later in their life than those who have not, programs working with at-risk families to prevent child abuse have been shown to lower the
likelihood of future violent crimes—sometimes dramatically. Timely intervention for young children at risk of impaired cognitive development, behavior problems, and early failure in school can also reduce the likelihood of violent crime, as can programs to intervene in the lives of at-risk adolescents and adolescents who have already had trouble with the law.
There are also enormous hidden costs in our race to incarcerate, costs hidden because they are charged to the ghetto. Keeping half of the young black men in Washington under the supervision of the criminal justice system has devastating consequences. For those actually incarcerated, of course, employment is impossible. One must give up any job one had to go to jail. Most of those on probation or parole are legally allowed to work, but when a criminal record is added to low educational attainment and limited job experience, work proves even harder to come by. Licensing requirements prohibit the formerly incarcerated from some forms of work. Joseph’s House, where I work, cares for homeless men with AIDS. A year ago, the City Council passed a law prohibiting any facility like ours from hiring most people with criminal records—even after they have served their time. For such men who, under the best of circumstances, would have difficulty finding work, the criminal justice system adds but one more impediment to any attempt to climb out of poverty. Soon, they just give up looking. In the jargon of sociologists, they are no longer “attached to the labor force,” and so, in a final irony, they are not even counted among the unemployed, effectively lowering the real unemployment rate. If those incarcerated were counted, the overall unemployment rate for black men would increase by about two-thirds. Many states, in a further gesture of exclusion, prohibit felons from voting, temporarily or permanently. Anyone with a felony conviction for a drug offense is now prohibited from receiving a federal loan for education, making college an even more unrealistic dream.
Urban Injustice: How Ghettos Happen Page 5