Sam Podnar

28 December 2023

The U.S. criminal justice system takes a punitive approach to confronting crime that has not proven effective. While the U.S. has the highest incarcerated population in the world, both overall and per capita, these increases in incarceration rate have not been accompanied by decreases in crime (1). This problem requires reframing crime in terms of its determinants, from which we can derive a different approach to crime reduction. Crime does not happen in a vacuum. While it is certainly a direct result of individual choices, external factors shape what options and opportunities people have or lack. 

Crime should be viewed as a public health problem, with violence, incarceration, poverty, and a lack of social services begetting poor health and crime in a vicious cycle. Incarcerated individuals, for example, have higher rates of high blood pressure, asthma, cancer, arthritis, and infectious diseases than the general population (2). But we can also draw useful parallels between public health and a more aspirational approach to crime reduction, engineering solutions around a key component of the field: crime prevention. Tackling poverty and mental illness, especially during childhood, can decrease crime much more successfully and cost-effectively than detaining people without guidance.

The World Health Organization (WHO) Commission on Social Determinants of Health asks a vital question: “Why do we keep treating people for illnesses only to send them back to the conditions that created illness in the first place?” (3) The same can be said about crime: Why do we lock people up only to send them back to an environment that puts them at a higher risk of being both victims and perpetrators of crime?

This environment is marked by material deprivation and routine violence. Poverty and income inequality are highly correlated with both violent and non-violent crime rates (4). Weak social services, a lack of education and employment opportunities, and high indebtedness are sources of poverty that incentivize people to commit property crimes. Childhood poverty is positively correlated with poor health and a propensity to commit violent crimes later in life; one 2010 study also found that childhood neglect and poverty predicted PTSD and adult arrest (5).

Poor mental health and poverty go hand in hand, with routine exposure to violence, a negative perception of one’s neighborhood, and unstable employment and income linked to PTSD and depression (6). And because a high percentage of the mentally ill are arrested, and incarceration reduces future employment opportunities, mental illness begets further poverty. Traumatic stress as a child can hinder an individual’s development and identity formation, leading them to resort to criminality and violence; weak youth mental health systems also bring children with mental disorders into the juvenile justice system (7). 

Taking a public health approach, then, involves identifying and reducing the risk factors of poverty and violence, especially among children—breaking the cycle of trauma and deprivation to enable individuals to heal and move forward.

The policy recommendations implied by this approach are broad. Diversion programs, for example, offer an alternative to incarceration, requiring an individual charged with a crime to undergo substance abuse treatment, pay restitution, or perform community service (8). A meta-analysis of youth diversion programs found that in 60 of 73 programs examined, the recidivism rate for diverted youth was lower than that for youth processed by the traditional justice system (9). By offering an alternative to a life constantly pointing back to incarceration and punishment, and opening up avenues for people to achieve better health and a steady income, diversion programs break the cycle of harm. 

Various cities have pursued major changes to their crime reduction strategies when traditional approaches have not solved crime waves. In 1996, Boston implemented Operation Ceasefire, a strategy tackling gang violence that involved direct communication with gangs and offers of economic support and social services to members if they refrained from gun violence. In the four years the program ran, Boston experienced a 63 percent decrease in the monthly number of youth homicides. The city saw an increase in crime when the program was discontinued in the early 2000s and another reduction when it was restarted in 2007 (10). 

One Safe Houston, a violence reduction initiative involving the deployment of mental health professionals, rather than police officers, to respond to certain crises; domestic violence abuse response teams; and assistance for formerly incarcerated individuals reentering society has seen a decrease in incidents of homicide, robbery, rape, and aggravated assault during its tenure (11). Newark has achieved a massive reduction in homicides and rates of overall crime over the last few decades through programs resolving community mistrust of police officers, investment in trauma recovery and workforce development, and a team of trusted community leaders spearheading conflict mediation and public safety roundtables. In 2020, rates of overall crime were 70 percent lower than in 2000, and by 2019, homicides had reached their lowest point since 1961 (12). 

These citywide transformations are promising examples of how wholesale shifts in the approach to criminal justice can yield the results that traditional methods promise but ultimately fail to deliver. Decades of research have also revealed which specific strategies are most effective. 

One 2001 study comparing a litany of crime reduction programs found that mental health interventions for juvenile offenders yielded the largest and most consistent economic returns, with a form of intensive home-based family therapy for juvenile offenders producing $131,918 in benefits per participant, with a cost-to-benefit ratio of twenty-eight dollars for each dollar of taxpayer cost (13). A Stanford researcher estimates that investing in Medicaid for low-income men with mental health issues returns double in crime-related benefits alone (14). Every dollar invested in drug treatment returns twelve dollars in the form of reduced crime and health care expenses (15).

Afterschool programs are also incredibly effective in addressing juvenile crime. A study of California public schools found that a specific afterschool program caused a decrease in vandalism and stealing, violent acts and instances of carrying a concealed weapon, arrests, and disciplinary action for participating students. 20 percent of at-risk youth enrolled in the program were arrested during the six-month intervention period, while the rate was more than double for their counterparts not in the program (16). The availability of constructive ways for youth to spend their time outside of school keeps them out of contact with the criminal justice system, which is crucial when many who enter the system in adolescence never leave.

But the unfortunate reality is that many communities are not in the position to implement these effective interventions and are simply focused on retaining existing services, which are often in danger of being cut. In the mid-2010s, as Chicago reduced social services, vocational training, afterschool and summer programs, and mental health care, which also coincided with funding cuts to the Chicago Public Schools, it experienced a surge of violence in certain communities (17). The Stanford study examining the returns to investment in Medicaid stemmed from the discovery that the likelihood of incarceration for low-income men in South Carolina sharply diverges between the group that loses Medicaid eligibility at 19 and the group that retains it, with the incarceration rate of the former being 15 percent higher than the latter (18). Investing in the wellbeing of people works in curtailing criminal behavior. But the question is more often than not about preventing a further thinning of the social safety net, rather than implementing innovations in strengthening it.

There is certainly a widespread and not completely baseless fear of how the weakening of traditional enforcement mechanisms in favor of alternative ones might be taken advantage of by violent criminals. In 2021, only 15 percent of Americans wanted to see a decrease in police spending (19). But despite loud calls to “defund the police” since 2020, police funding has actually increased in cities and counties across the country, though conservative politicians have falsely cited a correlation between crime waves and a decrease in police spending in Democratic-run cities (20). Multiple analyses have actually found no relationship between annual police spending and crime rates, which points to the impact of what else we are, or aren’t, spending on (21). Police are fundamentally a reactive force. They respond to, record, and attempt to solve crimes, but they currently aren’t solving the underlying issues that drive crime—desperate poverty, for example, or grievances that drive domestic disputes. The public health approach evident in these alternative interventions is a preventive approach that can complement and ultimately aim to transform the traditional approach. 

It is important to remember that traditional and alternative strategies both aim not to eliminate crime but to reduce it. An authoritarian state that invasively surveils and completely controls its citizens would likely succeed in eliminating crime, but that is not preferred to a much more reasonable state that allows some amount of crime while maintaining a much more free and comfortable life for its citizens. The goal is to employ crime reduction strategies that yield the greatest benefits while minimizing harms. Historically, policing has not only proved largely ineffective at reducing crime (so, not addressing senseless crimes that some fear will proliferate under a more compassionate criminal justice system) but also inflicts great harm on marginalized communities. Continuing to pour money into a system that has exacted so much brutality is a bad idea, and relegating that harm to the margins of public policy, with wide disparities in who experiences police brutality and mass incarceration simply as a secondary issue to address, is both irresponsible and unjust.

These alternative interventions focusing on prevention are not only more humane and constructive but also more cost-effective, similar to how preventive health care like immunization is much cheaper than treating disease. This rebuts traditional wisdom arguing that government money is being wasted on social services and health interventions and instead makes a case for proactive policymaking that eliminates the conditions putting people at a higher risk of offending and being victims of crime. Those that criticize social safety net programs as a strangling extension of “big government” fail to recognize that our major cities already have “big government,” just in the form of policing and mass incarceration. Even with Mayor Ed Gainey’s slight reduction in Pittsburgh’s allocations for the Bureau of Police, law enforcement is still the second largest expense in the city’s preliminary 2024 budget, with the nearly $123 million making up 18 percent of the city’s $683 million budget (22). In 2020, the U.S. spent twice as much on law and order (police, prison, and courts) as welfare programs, a disparity that only began to emerge in the 1980s with President Reagan’s legislation cracking down on drug use (23). The current reality of “big government” is thus a state positioned as an apparatus of brutality.

But we can direct government spending towards more humane and restorative ends. A preventive approach to crime reduction that diverts people away from the criminal justice system and makes material improvements in their lives has both moral and practical weight that elevates it over the existing overwhelmingly punitive approach. It is more cost-effective and just plain effective in reducing crime, which should be reason enough to pursue it. But the broader challenge is that these interventions require us to reexamine the role of the state in caring for its citizens, even and especially those who have done something wrong. It is a path of making society better not through an unending cycle of punishment but by making its people well.  

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Works Cited

(1) “Addressing Violent Crime More Effectively.” n.d. Brennan Center. https://www.brennancenter.org/our-work/analysis-opinion/addressing-violent-crime-more-effectively.

(2) “Incarceration – Healthy People 2030.” n.d. Health.gov. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/incarceration#:~:text=Studies%20have%20shown%20that%20when.

(3) Mercado, Susan, Kirsten Havemann, Mojgan Sami, and Hiroshi Ueda. 2007. “Urban Poverty: An Urgent Public Health Issue.” Journal of Urban Health 84 (S1): 7–15. https://doi.org/10.1007/s11524-007-9191-5.

(4) Fleming, Luke. 2011. “The Relationship between Poverty and Crime: A Cross Section Analysis.” https://digitalcommons.bryant.edu/cgi/viewcontent.cgi?article=1052&context=eeb.

(5)‌ Holzer, Harry, Diane Schanzenbach, Greg Duncan, and Jens Ludwig. 2007. “The Economic Costs of Poverty in the United States: Subsequent Effects of Children Growing up Poor.” https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=909c23d7a11427580380fa3e9543faa1a77216c3.

Valentina Nikulina, Cathay Spatz Widom, and Sally Czaja. 2010. “The Role of Childhood Neglect and Childhood Poverty in Predicting Mental Health, Academic Achievement and Crime in Adulthood.” American Journal of Community Psychology 48, (2011): 309-321. https://doi.org/10.1007/s10464-010-9385-y.

(6) Anakwenze, U., and D. Zuberi. 2013. “Mental Health and Poverty in the Inner City.” Health & Social Work 38 (3): 147–57. https://doi.org/10.1093/hsw/hlt013.

(7) Ibid.

(8) ‌Kubic, Micah W., and Taylor Pendergrass. 2017. “Diversion Programs Are Cheaper and More Effective than Incarceration. Prosecutors Should Embrace Them.” American Civil Liberties Union. December 6, 2017. https://www.aclu.org/news/smart-justice/diversion-programs-are-cheaper-and-more-effective-incarceration-prosecutors.

(9) Wilson, Holly A., and Robert D. Hoge. 2012. “The Effect of Youth Diversion Programs on Recidivism.” Criminal Justice and Behavior 40 (5): 497–518. https://doi.org/10.1177/0093854812451089.

(10) ‌Anthony Braga. 2020. Problem-Oriented Policing. 

(11) ‌“Continuing Efforts to Slow Violent Crime.” n.d. Center for American Progress. https://www.americanprogress.org/article/continuing-efforts-to-slow-violent-crime/.

(12) Ibid.

‌(13) Aos, Steve, Polly Phipps, Robert Barnoski, and Roxanne Lieb. 2001. “The Comparative Costs and Benefits of Programs to Reduce Version 4.0.” https://www.wsipp.wa.gov/ReportFile/756/Wsipp_The-Comparative-Costs-and-Benefits-of-Programs-to-Reduce-Crime-v-4-0_Full-Report.pdf.

(14)‌ Jácome, Elisa. 2021. “How Better Access to Mental Health Care Can Reduce Crime | Stanford Institute for Economic Policy Research (SIEPR).” Siepr.stanford.edu. 2021. https://siepr.stanford.edu/publications/policy-brief/how-better-access-mental-health-care-can-reduce-crime.

(15) ‌Kubic, Micah W., and Taylor Pendergrass.

(16) “After-School Programs Can Prevent Crime.” n.d. https://sedn.senate.ca.gov/sites/sedn.senate.ca.gov/files/2pgr_-_as_2015.pdf.

(17) McCrea, Katherine Tyson, Maryse Richards, Dakari Quimby, Darrick Scott, Lauren Davis, Sotonye Hart, Andre Thomas, and Symora Hopson. 2019. “Understanding Violence and Developing Resilience with African American Youth in High-Poverty, High-Crime Communities.” Children and Youth Services Review 99 (99): 296–307. https://doi.org/10.1016/j.childyouth.2018.12.018.

(18) Jácome, Elisa.

(19) Parker, Kim, and Kiley Hurst. n.d. “Growing Share of Americans Say They Want More Spending on Police in Their Area.” Pew Research Center. https://www.pewresearch.org/short-reads/2021/10/26/growing-share-of-americans-say-they-want-more-spending-on-police-in-their-area/.

(20) “Despite ‘Defunding’ Claims, Police Funding Has Increased in Many US Cities.” ABC News. October 16, 2022. https://abcnews.go.com/US/defunding-claims-police-funding-increased-us-cities/story?id=91511971.‌

(21) Ibid.

(22) Wolfson, Charlie. 2023. “Gainey 2024 Budget Has Fewer Police Slots than Prior Year Plans.” PublicSource. October 2, 2023. https://www.publicsource.org/city-pittsburgh-budget-operating-capital-2024-police-gainey/.

(23) Ingraham, Christopher. 2020. “Analysis | U.S. Spends Twice as Much on Law and Order as It Does on Cash Welfare, Data Show.” Washington Post, June 4, 2020. https://www.washingtonpost.com/business/2020/06/04/us-spends-twice-much-law-order-it-does-social-welfare-data-show/.