Shoot Them Up, Lock Them Up

I've gotten so used to seeing charts of how poorly the U.S. healthcare system compares to other countries -- such as on spending or health outcomes -- that I sometimes forget that those are not the only ways that we are exceptional, and not in a good way.  I want to focus on two issues that, unfortunately, have become politicized almost beyond the point of rational discussion, but which very much are health issues.

Guns and prisons. 

Credit: Jeremy Neufeld, Niskanen Center

The U.S. is gun crazy.  Maybe it isn't so surprising that we own almost half of the world's civilian guns -- we're a rich country and have a disproportionate amount of most things -- but it may come as a surprise that only a small minority of us actually own guns, and the ones who do tend to own multiple guns. 

What shouldn't be a surprise, of course, is what happens with all those guns.  People get killed.  Our homicide rate by guns is almost literally off the chart compared to other countries (in fact, see the chart).
 
It's not that our violent crime rate is higher than those other countries -- it is not -- as it is that, well, there are just a lot of guns out there.  The line charts are pretty clear, whether they are done by state or by country: more guns are correlated with more gun deaths. 

And, of course, too many of those gun deaths come from mass shootings.  The U.S. is not the only country that has mass shootings, of course, but we seem to do a lot more and a lot deadlier than other countries. 

According to the Gun Violence Archive, we've had 261 mass shootings this year alone (as of September 20).  That's almost one a day.  Our shock and dismay at what was once a rare event can't keep up with each new shooting, and we become almost numb to them.  Parkland drives out Sandy Hook, and who is still talking about Las Vegas?

It is too much.

As bad as our gun-related homicide rate is, it is worth pointing out that most gun deaths in the U.S. are suicides,  as Vox pointed out.  There are 50% more gun-related suicides than homicides.  Firearms account for half of all suicides. 

Our supposed rights to life, liberty, and the pursuit of happiness seem to be in conflict with the 2nd amendment "right to bear arms," and the arms have better lobbyists.   

Then there are prisons, America's new growth industry.  Americans like to think of ourselves as benevolent people, living in a democracy that offers hope and opportunity to everyone.  Well, as it turns out, not so much (and I'm not even going to get into our immigration policies). 

The U.S. imprisons over 2 million people.  You might think, well, we're a big country, maybe that is not so much as per capita but our incarceration rates are similar to our gun ownership rates: almost off the charts.  OK, maybe we're not that much higher per capita than, say Russia (and we are higher), but compared to OECD countries, we're pretty far out there.

We have over 40% more people in prison than China does, and they have over four times our population. 

You might think that perhaps we have all those people in prison because of all those guns and those gun deaths, but you'd be wrong.  As cited above, our overall violent crime rates are not particularly high.   What we like to put people in prison for are drugs.  Almost half the people in U.S.prisons are there due to drug offenses. 

We do have a drug problem in the U.S., not just with the current opioid crisis but generally compared to other countries, but the problem is how we deal with it.  Other countries send people with drug problems to drug treatment; we like to send them to jail.  Such is the consequence of our decades long War on Drugs.

As the Sentencing Project details, we've seen explosive growth in sending people to prison over the past 40 years, sending them there for longer terms, and doing so disproportionately for men of color.  Once they do get out of prison, if they get out, they likely are on probation (we have over twice as many people on probation as in prison), and are at risk of being sent back for the slightest infraction.

Of course, once someone has a felony conviction, their options are limited -- many employers won't hire them, they have great difficulty getting in public housing or on SNAP,  and they usually can't vote or serve on juries.   Many were poor before they went to prison and their outlook is worse once they get out.

One estimate of this disenfranchised population puts it at 23 million people.  They are a hidden population.  As Nicholas Eberstadt described::

We don’t know how many children they have, their marital status, who they live with, their housing situations. We don’t know their mortality rates or life expectancy, their disease and disability profile, their mental-health status. We do not know their labor force participation rates, unemployment rates, jobs by sector or wages. Apart from broad generalities, we know roughly nothing about their education patterns, skills or training.

Poor people and people of color have a tough enough time with our healthcare system, but throw in a felony conviction and the barriers to better health grow almost insurmountable.  They might be better off with the prison healthcare, and that is an extremely low bar. 

It's almost political suicide these days for a politician to talk about gun control or about reversing the "War on Drugs," but at some point some of us energized citizens have to say enough is enough.  Allowing so many gun deaths and allowing so many non-violent people to be sent to prison is not the America we believe in.  What we are allowing now is not how we should be protecting the health of any Americans. 

America is an exceptional country, filled with exceptional people.  It is tragic that too many of them are killed by guns or are sent to prison.  These are health crises of the first order.  We should be embarrassed.

Let's stop waving the flag and start addressing the real problems.