A Plague of Prisons: The Epidemiology of Mass
Incarceration in America

A Plague of Prisons: The Epidemiology of Mass

Author: Ernest Drucker
Publisher: New York: The New Press, 2011. 240p.
Reviewer: Shenique Thomas | March 2012

Ernest Drucker, an internationally recognized public health researcher, scholar, professor emeritus and physician, offers a novel approach to explain the explosion of incarceration in the United States. Through an epidemiologic lens, Drucker successfully applies the public health modes of analysis – outbreaks, contagion, prevalence and incidence, potential years of life lost, and disability adjusted life years – to contend that mass incarceration is a “man-made disaster of epidemic scale." Using the metaphor of the Broad Street pump which fueled the spread of cholera (London, Summer 1854), Drucker suggests that the "outbreak of mass incarceration," is a result of deliberate public policies and political decisions. Specifically, he identifies the "pump" of the outbreak as New York’s 1973 enactment of the Rockefeller drug laws that were based on strictly calculated mandatory sentencing guidelines. These laws, accompanied with exorbitant sentences, would become a "model for the adoption of a range of state laws and national policies." Drucker likens imprisonment to a chronic, contagious condition, with potentially long-term effects. Unsurprisingly, this virus discriminates. Low-level, non-violent offenders residing in poor Black and Hispanic communities are most susceptible to contract the virus of imprisonment.

To illustrate how epidemiology provides critical information on the dimensions of an epidemic, Drucker recounts the outbreak, and subsequent increased prevalence, incidence, and responses to the transmission of AIDs (acquired immune deficiency syndrome) in the Bronx, NY. By employing epidemiology to explain the increased prevalence and incidence of AIDs in some of the poorest Bronx neighborhoods, public health researchers were able to conclude that AIDs was a "synergy of plagues" – drugs, AIDS, prisons, TB perpetuated by politics, racism, homophobia, and nonsensical criminal justice policies which "created ideal conditions for AIDs to thrive."

From 1880 to 1975, the U.S. experienced a flat rate of imprisonment averaging 100-150 individuals imprisoned for every 100,000 members of the population. Today, approximately 750 individuals are imprisoned for every 100,000 members of the population. A total of 7.3 million individuals are under the control of the criminal justice system:  2.3 million prisoners behind bars, 800,000 parolees, and 4.2 million on parole. The U.S. reached its tipping point and experienced a decline in prison population growth in 2010, after 35 years of relentless growth. Drucker engages the reader throughout the book by using descriptive and analytic epidemiology coupled with revealing empirical evidence, to explain the way in which the U.S. achieved this historically unprecedented rate of incarceration. He further compels the audience by comparing the potential years of life lost (YLL), to drug incarceration in New York state (1973-2008) to deaths in 9/11 World Trade Center (WTC) attack. Potential YLL represents the number of years that would have been lived by a victim had s/he not died in the epidemic or disaster. In the WTC attacks, in which more than 2,800 people died, an estimated 104,303 YLL. Due to the thirty-five year course of the Rockefeller drug laws, 368,000 YLL have been lost in the imprisonment of drug offenders – equivalent to the deaths of 10,606 individuals. Drucker further  conceptualizes incapacitation as a disability and examines the impact of imprisonment and its aftermath by measuring the disability-adjusted life years (DALY) – “the sum of years of productive life lost due to disability.” In 2004, at any time, approximately 13 percent of the U.S. population were considered disabled; of the 700,000 prisoners released in 2009, 30 percent were "sufficiently ‘disabled’ to fail at reentry and were reincarcerated in the first year after release." In advancing his argument that incarceration is a debilitating disease that further destabilizes families and communities simply by exposure, Drucker evaluates intergenerational transmission and consequences associated with “toxic” exposure to mass incarceration and the “revolving prison door.” The “Plague of Prisons” closes with a public health model for prevention.

Drucker effectively documents the growth of the U.S. imprisonment rate, with great reliance on statistical figures for New York. Throughout the “Plague of Prisons,” he emphasizes the consequences indicative of short-sighted criminal justice policies and the difficulties associated with reversing the unintended costs of such legislation. His work significantly contributes to the ongoing effort to frame mass incarceration as a public health issue. Despite his meticulous application of epidemiology, Drucker circumvents the glaring and formative question of why the political and policy regimes responsible for the "war on drugs" legislation spawned a war on urban, minority communities.

Shenique Thomas is Research Assistant Professor, Rutgers University School of Criminal Justice.


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