The New Jim Crow“In the era of colorblindness, it is no longer socially permissible to use race, explicitly, as a justification for discrimination, exclusion, and social contempt. So we don’t. Rather than rely on race, we use our criminal justice system to label people of color ‘criminal’ and then engage in all the practices we supposedly left behind.” (Alexander, 2)

The New Jim Crow (@thenewjimcrow) by Michelle Alexander lifts the veil of “color-blindness” to expose the comprehensive, deeply routed, and tacitly disguised racialized criminal justice system that functions very similarly to Jim Crow. The authors calls upon the reader to become informed, and to take action. The foreword by Cornel West (@CornelWest) goes so far as to call the book the “secular bible for a new social movement,” and “a grand wake-up call in the midst of a long slumber of indifference to the poor and vulnerable.”

This book is especially relevant to the many clinicians working with disadvantaged and underrepresented minorities, as well as others within the EM social justice and advocacy community.

Why Read the New Jim Crow

Reflection on the current Black Lives Matter movement, and the role that physicians have in it makes reading this book a critical part of understanding the greater societal impact policies have on black lives, particularly black men’s lives in the US. I was familiar with policies like “stop and frisk” and harsh penalties for possession of crack cocaine, but I had never considered how these policies and many others intertwined to create a system in which race is a key predictor for who winds up in prison, not because of differences in crime rates, but because of policy decisions that penalize being black and/or being poor. Similarly, I had never thought about the life-long impacts of being considered a felon, and the governmental rights that are taken away as a result. In The New Jim Crow, Michelle Alexander argues that these rising incarceration rates are no accident. Rather, they are the intended consequence of policy decisions that have been made to create a racial “under-caste” of citizens who can be permanently excluded from voting, jobs, housing, and social services. Though this discrimination is not ostensibly based on race, the labeling of people of color as “criminals” allows for Jim Crow-type discrimination without accusations of racism.

“Today violent crime rates are at historically low levels, yet incarceration rates continue to climb.” (Alexander, 99)

Criminal Justice in the U.S.

Michelle Alexander was a civil rights attorney for the American Civil Liberties Union (ACLU). When she started working there, she suspected the criminal justice system was subject to the same biases as other parts of society, but no more. Through her work with the ACLU, she determined that her prior view was naïve and that the prison system has created a subtle system that intentionally functions in the same way as Jim Crow (Alexander, 3-4). She describes the recent history of criminal justice in the US, and how we have found ourselves in the current situation.

Interestingly, in the 1970s, many experts were predicting the end of prisons because they did not deter crime and were expensive, instead the decades that followed showed a proliferation of prisons and prisoners. Alexander suggests that the subsequent increase in imprisonment were the result of Nixon strategists’ attempts to court working class white voters who were concerned about law and order. This continued through the Reagan administration with the 1982 launch of the “War on Drugs”, described to the public as a response to the effects of crack cocaine in poor, predominantly black neighborhoods. Surprisingly, in 1982, drug use was actually in the decline. However, as the 1980s progressed, the administration was able to leverage the proliferation of crack to secure more funding and more militarization for the War on Drugs.

Alexander confronts two myths about the War on Drugs. First, proponents often argue that these laws are intended to reel in high-level drug traffickers and kingpins. Second, that these laws are meant to eliminate dangerous drugs from the streets. In reality, four out of five drug arrests are for possession rather than sales and most arrests are related to marijuana (Alexander, 59).

Mass Incarceration

Several important factors lead to the disproportionate rates of imprisonment among black and brown people. Policies that penalize behaviors that disproportionately affect communities of color play a role. For example, until 2010, the penalty for possession of crack was 100 times that of possession of a similar weight of cocaine [3]. Conscious or unconscious bias in enforcement and prosecution increase the likelihood that people of color will be targeted as law enforcement agents have freedom to stop, search and arrest as they wish. However, those arrested can only bring claims of racial bias if they can prove that the bias that led to their arrest was intentional. Mandatory sentencing and three strikes laws apply harsh sentences without regard for individual circumstances or even the nature of the crime. Limited or denied access to legal defense often lead to the accused accepting plea bargains to avoid extreme mandatory sentences or the trumped up charges of prosecutors. All of these factors contribute to the large disparities in conviction and imprisonment.

  • Human Rights Watch reported in 2000 that, in seven states, African Americans constitute 80-90% of all drug offenders sent to prison. (Alexander, 7)
  • People of all colors sell and use drugs at very similar rates. However, in at least 15 states black men are 20 to 57 times more likely to be in prison on drug charges (Alexander, 7)
  • Today, 500,000 people are in prison or jail for drug-related crimes, as compared to about 40,000 in 1980. In fact, there are more people in prison for drugs today, than there were in prison for all reasons in 1980 (Alexander, 59)
  • 1 in every 14 black men was behind bars in 2006, compared with 1 in 106 white men. (Alexander, 98)
  • In Germany, 93 people are in prison for every 100,000 adults and children. In the United States, the rate is roughly eight times that, or 750 per 100,000. (Alexander, 6)
  • The United States imprisons a larger percentage of its black population than South Africa did at the height of apartheid.  (Alexander, 6)

Application within Emergency Medicine

Alexander’s message has clear implications for the practice of Emergency Medicine. First, both prison time itself and the economic consequences of the label “felon” have tremendous impact on the health of our patients. A study in the American Journal of Public Health found that life expectancy decreases by 2 years for every 1 year spent behind bars [2]. These economic and health outcomes will often effect subsequent generations as well. Second, the emergency department is often the entry point for incarcerated people when they interact with the health care system outside of prison. Third, the disproportionate imprisonment of black and brown Americans is actually skewing medical research. Since the 1960s, ethicists have recommended against research on incarcerated people, as it is difficult to ensure uncoerced consent. However, because there are more black Americans in prison now than were enslaved in 1850, this removes a large part of the population from the pool of research subjects. Wang estimated that “during the past three decades high rates of incarceration of black men may have accounted for up to 65 percent of the loss to follow-up among black men in these studies.” This limits our understanding of the health impact of prison and the health disparities that result [4].

In the age of Obama, in a time post slavery, the Civil Right Movement and Jim Crow, Alexander illuminates a current injustice, the mass incarceration of predominantly black men and women, and the underserved, which results in a social system with implications not very different from the explicit racial prejudice of America’s past, although now perhaps more discrete, and hidden behind a veil of “color blindness.” For many of us, this book is our first glimpse into our own “color-blindness,” and the everyday struggle and fears lived by a community we treat. Having an understanding of this current racial injustice, as well as our own biases, is a necessary step towards better medical care for these underrepresented communities. The New Jim Crow, is most importantly a call to action.

OPPORTUNITIES FOR ACTION

  • Advocate for prison reform within the legislature. Health professionals are uniquely positioned to call attention to the health disparities that result from our current prison system.
  • Act as a faculty advisor for student organizations such as “White Coats for Black Lives”.
  • Organize or participate in your local “EM Day of Service”, which is planned for launching this fall.
  • Partner with local Black Lives Matter groups to challenge discriminatory laws in your area.
  • Monitor health care in your emergency department for evidence of health disparities
  • Partner with black health professional groups to address known health disparities in your area.

Discussion Questions

  1. What role should an interested physician play in activism related to issues that are not considered directly related to health care like prison and judicial reform or the Black Lives Matter movement?
  2. How does the book’s discussion of racial differences in enforcement and penalty impact your perception of patients in police custody or patients who are prisoners?
  3. Why is the US prison system so different from others around the world? Is/should the primary role of prison be punishment of the offender, protection of society or something else?
  4. Given that there are substantial racial differences in providing adequate pain control and many other health outcomes, what work should be done most urgently within medicine to address racial justice?
  5. Did Alexander’s argument that the War on Drugs was an intentional policy decision sway you? Why?
  6. How can we limit the long-term impact of prison on health and health research?

Google Hangout Discussion July 15, 2015

References

  1. Alexander, M. The New Jim Crow. 2012. Perseus Books Group. Kindle Edition.
  2. Patterson EJ. The dose-response of time served in prison on mortality: New York State, 1989-2003. Am J Public Health. 2013;103(3):523-8.[Link]
  3. Shapiro A. “Bill Eases Penalty for Crack Cocaine Possession.” NPR News. Mar 18 2010.
  4. Wang EA, Aminawung JA, Wildeman C, Ross JS, Krumholz HM. High incarceration rates among black men enrolled in clinical studies may compromise ability to identify disparities. Health Aff (Millwood). 2014;33(5):848-55.

Go Further

  1. The New Jim Crow website has more information on the book and ways to take action
  2. Coates, Ta-Nehisi. “An American Kidnapping.” The Atlantic.  (and other articles by Ta-Nehisi Coates)
  3. Building a non-violent revolution against injustice: a conversation with Michelle Alexander”. Acting in Faith website, June 5, 2015.

 * Disclaimer: We have no affiliations financial or otherwise with the authors, references or hyperlinks listed, the books, or Amazon.

Amy Walsh, MD

Amy Walsh, MD

International Emergency Medicine Fellow
Regions Hospital
St Paul, Minnesota