The duty of public health professionals is to prevent disease morbidity and premature mortality in all populations by maximizing social, environmental, and structural conditions required for healthy living and abating harmful conditions. The social determinants of health perspective acknowledges the need to shift the focus of public health beyond the medical treatment of cases to the role of education, housing, transportation, business, community planning, and agriculture in determining outcomes. Increasingly, population health researchers and policymakers see incarceration as a major social determinant of health, opening the way for a more assertive role in public health in addressing reforms especially in the mainstream of juvenile justice. With more than 80 billion dollars per year spent on state and federal prisons that house 2.24 million Americans, the U.S. leads all other nations on criminal justice investments. And with states spending on prisons growing six times the rate invested in higher education, an average of 7% of states general funds in 2007 went to corrections agencies making them the fifth-largest state budget category behind health, education and transportation. Accompanying the rise in incarceration in the U.S. over the past several decades has been the disproportionate incarceration of minorities, especially young black men, and those with low levels of education, who comprise nearly a third of the incarcerated population.
This societal crisis has prompted public health officials to devise intervention strategies and program models to reduce delinquency and to promote proactive social development. With a costs to the states of billions of dollars a year to arrest, prosecute, incarcerate, and treat juvenile offenders, investing in successful delinquency-prevention programs reaps rewards in the form of reduced spending on incarceration. It turns out that the most successful programs are those that prevent youth from engaging in delinquent behaviors in the first place. They include home-visiting programs that target pregnant teens, home visits and hands-on work with parents to curtail drug use, delinquency, anti-social behavior, and early school drop-out; and community-based programs with a capacity to divert first-time offenders from further encounters with the justice system. With more than a decade of evidence attesting to their efficacy, only about 5% of at-risk youths who should be eligible ever participate.
Public health officials will be increasingly called upon to contribute their expertise in devising a rational policy for the nation, its poor neighborhoods, and children who are at risk for increased morbidity and mortality.