Justice, Health, and Democracy

The Justice, Health, and Democracy Project
Driving Transitions from Criminal Justice to Public Health Models for Solving Social Problems

In 1971 Richard Nixon declared a War on Drugs and cemented the use of a criminal justice paradigm for drug control. The human and financial costs of the War on Drugs have been tremendous, yet drug use is at roughly the same levels now as it was in the late 1970s. The War on Drugs has been a primary driver of mass incarceration, and Black and Latino people are ten times more likely to be arrested and incarcerated for drugs despite comparable rates of use, distribution, and possession among Whites. It’s not remotely clear that the criminal justice approach to controlling drug use is in fact the most cost-effective strategy, let alone a just and ethical strategy. The Justice, Health, and Democracy Project (JHD) will build and implement a nationwide platform to support programs that redirect low-level drug offenders away from prisons and into social services.

JHD is a team of academics across Harvard who are leaders in their fields of law, health, criminal justice, and public policy who have been independently researching subsets of our problem and an evaluation team from the Crime and Justice Institute of Community Resources for Justice in Boston, MA. A project planning year has been generously supported by the Ford Foundation.

Permanently shifting drug control strategies from a criminal justice to a public health paradigm will require defining: (1) the treatment practices that work; (2) the statutory frameworks that will enable the transition to a public health paradigm; (3) the spectrum of feasible governance structures at municipal and state levels; (4) the training necessary for police, justice, and prosecutors to exercise discretion at key points in interactions with drug offenders; and (5) the expertise (legal, medical, policy, public health, and governance) that is necessary to sustain a new public-health based paradigm over time.

We can achieve all five of these goals by examining the living examples of criminal justice diversion in our partner jurisdictions, distinguishing best practices, and then replicating and driving them to scale. Working together, we will review the state-level laws that must be overhauled to clear the way for dissemination and scaling of this change; we will propose strategies for reversing the force of stigma; we will develop evaluation protocols to permit identification of successful programs; and we will integrate legal, medical, public health, sociological, policy, fiscal, and governance knowledge in support of program success.

Expanding this model to a national scale will involve an intensive project of education and dissemination, as well as a public opinion campaign about the core concepts structuring the change.

The central components that drive this project are:

  1. Research Team: A Harvard-based research network uniting researchers in law, public policy, public health, and medicine that will build an interface between criminal justice and public health conceptualizations and approaches to drug control and treatment. This network will identify the legal and health frameworks at a state-level that would require revision in order to support such a transition, clarify where such transitions can be effected at the level of discretionary authority, and clarify where the use of such discretionary authority also needs support through legislative change.
  2. Diversion Professionals: A network of professionals conducting experiments in “diversion,” a strategy to direct those entangled in the drug economy from the criminal justice system to social services, whether pre-arrest, or post-arrest but pre-prosecution. Building a formal network of experimenting practitioners, and supporting their work financially, will make it possible to test and establish proof of concept for the idea that the transition from the criminal justice system to social services might be both a more just and more cost-effective strategy for approaching narcotics control. The research network will work with the professional network to evaluate experiments, develop an evidentiary foundation for best practices, and identify and execute research initiatives that would facilitate and strengthen this sort of experimentation. 
  3. Gang Reintegration and Prisoner Reentry Professionals: A second, similarly constructed network of professionals will focus on the relationships among drug sale and use, gang member re-integration and post-imprisonment re-entry. We believe that this is a crucial but overlooked component of drug policy reform in the US. The research network will also work with this professional network to conduct and evaluate reentry innovations, develop best practices, and identify and execute research areas that will facilitate and strengthen this sort of work.

Our country currently spends $80 billion a year on incarceration, and African Americans are incarcerated at six times the rate of Whites. Although Blacks and Latinos are only one-quarter of the US population, they were 58% of the total incarcerated population in 2008. The disproportionate incarceration rate can be directly traced to the aggressive criminalization of drug use during the War on Drugs and related violence. At the same time, we are in a national crisis of opioid drug use. There has been a 300% increase in opioid prescriptions for pain treatment since 1999, and opioid use has led directly to our crisis of heroin abuse. Alarmingly, HIV and Hepatitis C infection rates have increased substantially in the past two years, and Hepatitis C is now considered an epidemic in populations of people who inject drugs and in incarcerated populations.

Questions of both justice and efficacy are at stake in how we steer this transition. Researchers have suggested this kind of shift to a public health paradigm in the past; the difference now is that there are significant initiatives at the grassroots law enforcement and prosecution level, as well as growing political interest in facilitating such change. Criminal justice diversions for low-level drug offenders are a promising new paradigm for drug control that will reform the criminal justice system and address the national crisis of opioid abuse. Pre-arrest and pre-booking diversion programs empower police officers, attorneys, and judges to help redirect drug offenders to recovery services offered by their non-profit service provider partners.Diversion programs stem the flow of drug offenders from cycling in and out of jail, which reduces recidivism, increases public safety, and drastically cuts costs to the community.

Ultimately, a dramatic shift in our national drug policy will have an immediate benefit to our most vulnerable populations: men and women of color in urban communities, homeless populations, veterans, and those with diagnosed and undiagnosed serious mental illnesses who self-medicate with drugs. By stemming the tide of the exploding prison populations and redirecting the funds from incarceration to mental health and addiction services, we will ensure that millions of people gain access to necessary resources for immediate and long-term care. The burden of responsibility for addiction care will be removed from police, attorneys, judges, and hospital Emergency Rooms that are currently the first access point to care for many people, and redirected toward those best equipped to assist these vulnerable populations. The impact of this type of change and on this scale will affect not only current but also future generations through the promotion of stability within families and communities that have been hardest hit by the current failing system.

The Justice, Health, and Democracy Project was selected as one of the Top 200 entries of the MacArthur Foundation's 100&Change Competition in 2017

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