Prison Overcrowding Crisis Unhealthy for All Californians

New America Media, Commentary, Donna Willmott, Posted: Dec 04, 2008

Editor's note: California prisons have become the largest mental health system for the poor, the largest battered women's shelter, and the largest system of public housing, observes NAM contributing writer, Donna Willmott, M.P.H. Willmott is the Family Advocacy Coordinator at Legal Services for Prisoners with Children and teaches in the Health Education and Community Health Studies Department of City College of San Francisco.

As a public health professional who has spent over 10 years advocating for prisoners' rights, I am dismayed to see the health of prisoners once again become a political football.

More than two years ago, the federal courts acknowledged what every prisoner in California already knew – that there has been an "unconscionable degree of suffering and death" in our prisons. With all due respect to those who are working under the federal receivership to reform prison medical care, most of the systemic issues that underlie substandard care have, in our clients' experience, remained essentially unchanged. While the Receivership has succeeded in hiring a new cadre of qualified medical providers, the fact remains that progress has been painfully slow for the 178,000 prisoners trapped in this system, and many will continue to suffer needlessly in the meantime.

Overcrowding is at the root of this paralysis. The Receivership proposes to build 10,000 new medical and mental health beds, at a construction cost to taxpayers of over $7 billion dollars. Even if this project had the support of the legislature and received the required money, the crisis would not be solved. It's not possible to build and maintain these facilities, then recruit and retain sufficient numbers of well-trained staff for this constantly expanding enterprise without bankrupting the state. Without shrinking the prison system, it will be impossible to provide the required constitutional level of medical care to prisoners.

Decades of failed public policy frame this crisis. Years of a tough-on-crime approach have spelled disaster for the health and well-being of poor people and people of color who are incarcerated at dramatically disproportionate rates. We have tried to use prisons as an answer to social problems, with devastating results. Our prisons have become the largest mental health system for the poor, the largest battered women's shelter, and the largest system of public housing. The social cost of decimating our already frayed safety net in order to expand prisons is beyond calculation. We sacrifice precious community resources to maintain a prison system that creates instability, ill health and disease, while failing to keep us safe.

Perhaps taking a page from history will help us envision a new solution to this crisis. Over 150 years ago, Rudolf Virchow, the founder of "social medicine," was sent by the German government to report on the causes of a devastating 1848 typhus epidemic. Instead of recommending the simple solution of more doctors and more hospitals to avoid catastrophic loss of life in the future, Virchow called for full employment, universal education, and agricultural cooperatives as the path to preventing future epidemics. He analyzed the root causes of the epidemic, and called for a fundamental reconstruction of society to create conditions in which people could be healthy.

If Virchow were with us today, it's likely that he would be horrified by the idea of building 10,000 beds for prisoners who are extremely frail or mentally ill, people whose incarceration couldn't possibly serve public safety. He would no doubt want us to put our resources into sentencing reform, releasing low-risk prisoners, redirecting our state budget towards universal healthcare, quality public education, training and employment opportunities, and expanding drug treatment. In short, we should be ensuring the conditions in which people can be healthy as the basis for safe communities.

If Californians continue to pour billions into massive incarceration, it will mean more pink slips to school teachers, more children turned away from their doctors, more seniors denied in-home aid, more families forced into poverty and homelessness. What will it take to bring health care to California prisoners? It'll take a new way of looking at crime and punishment, a fundamental shift in our priorities and a commitment to social equity as the foundation for public safety. Bricks and mortar can't solve this one.

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