CorrectCare

EpiCrim 101
Why Epidemiological Criminology Matters to Health Professionals

by Mark M. Lanier, PhD, and Thozama M. Lutya, MS

A new field called epidemiological criminology is being developed by both public health and criminal justice scholars. What utility does this new academic development have for health care practitioners? For people actually working in the field? This article will define EpiCrim and illustrate how it is useful for health care administrators, staff and clients by providing specific examples: (1) assistance with securing grants, (2) forming and facilitating interdisciplinary teams, (3) replacing and/or explaining redundant terminology, (4) exposing harmful criminal justice policy, (5) highlighting the correlates between disciplines and (6) identifying crime victims.

Both policy and practice evolve with changing administrative and legal mandates; this is especially true for health care policies involving “unwilling subjects” such as inmates. Policy is shaped in response to different historical realities, whether cultural, political or economic in nature. This list includes various short- and long-term public health and criminal justice demands that guide actual workplace practice. Consider, for example, how HIV/AIDS has changed the day-to-day practices of everyone in both health care and correctional jobs. Health issues that impact society, such as HIV/AIDS, have a magnified effect in correctional environments. Consequently, health issues are forcing modification of correctional policy and practice.

The concept of epidemiological criminology is presented as a bridging framework for better understanding the role of public health in criminal justice and vice versa. For generations, the theories and methods advocated by epidemiology have served a legitimate role in the study of disease processes and tracking. Criminal justice could very well apply the same theories and methods to track things such as the spread of specific types of crime (e.g., crystal meth in the Appalachian region, home invasions in Orlando).

This has been done before; in the 19th and early 20th centuries, the fusing of public health theory and methods to crime control was a common practice. Benjamin Rush, a 19th century physician, was instrumental in developing a theoretical model on crime. His conceptualization of crime as a “moral disease” informed crime control policy and the design of the American penitentiary system. And the first women’s prisons in England were heavily influenced by psychiatric notions of the criminality of women. The ideologies of doctors and psychologists in this era were extremely important in creating therapeutic regimes and shaping contemporary thinking on women in prison. After this early linkage of health and corrections, the two disciplines diverged. EpiCrim seeks to reaffirm these connections.

Defining Terms
Criminology refers to the systematic study of the nature, extent, cause and control of law-breaking behavior, while criminal justice refers to the crime control practices, philosophies and policies used by police, courts and corrections. Criminology is more concerned with theory (policy) while criminal justice is more concerned with practice.

Public health is devoted to the prevention and eradication of diseases that may infect communities. Epidemiology is, above all else, a methodology. It is the study of variables and factors that affect health. Epidemiology has traditionally served as the foundation for public health interventions. Epidemiology could be considered policy while public health is practice.

In our view, epidemiology/public health and criminology/criminal justice issues are closely related and often inseparable. EpiCrim is the merging of these disciplines. EpiCrim involves the study of anything that affects the health of a society, be it crime, flu epidemics, global warming, human trafficking or HIV/AIDS. Consider the following examples that illustrate how health care professionals may benefit from EpiCrim.

Hepatitis C, tuberculosis, aging prison populations and substance abuse are just a few of the health issues that are straining and subsequently altering correctional policy and practice worldwide. By necessity, public health is becoming highly important as a funding source, for technical expertise, for medical staffing and for policy making within correctional institutions. Numerous research reports and funding trends have documented this health-mandated change. The Federal Bureau of Investigation has even used public health analogies.

Furthermore, most destructive crime-related behaviors have strong ties to mental and physical health problems. For example, driving under the influence of intoxicating substances is a destructive behavior that affects the mental and physical capabilities of the driver. Interventions aimed at reducing this dangerous trend should consider mental and physical factors contributing to the use of intoxicating substances. Then a combination of criminological and public health factors may shed light on the reasons behind the reasons for drunk driving.

How EpiCrim Benefits Health Professionals

Example 1: Securing Grants
Because it is difficult to separate the criminal justice and public health behavioral correlates, the interdisciplinary nature of many funded research projects should come as no surprise. In fact, the National Institutes of Health’s “Roadmap Initiative” encompasses not only the biomedical sciences, but also their relationship to the epidemiological, behavioral and social sciences. What percentage of your funding is grant-related or agency-dependent? Having a new, solid and exciting theoretical basis for grant proposals greatly strengthens their odds of being funded.

Example 2: Interdisciplinary Collaboration
EpiCrim encourages a paradigm under which disciplinary boundaries are blurred or even eradicated. While other scholars have made linkages between health and criminology, we seek to clarify and expand on what they have observed. HIV/AIDS and other health maladies have been examined by interdisciplinary teams combining public health, medicine and criminology for over 20 years. However, most prior connections have dealt with specific problems. EpiCrim is by nature interdisciplinary and so allows correctional and health care workers a common ground as opposed to the traditional custody vs. health care conflicts. This blending of disciplines should reduce the inherent conflicts.

Example 3: Sharing Terminology|
Health care professionals and criminal justice workers often focus on the same issues and use similar approaches, but they view things through different lenses and use different lexicons. For example, when criminal justice professionals talk about addressing the “root causes” of crime, they mean the same thing as “primary care” to health professionals. Likewise, “tertiary care” is analogous to specialized community policing units. Each discipline can learn from each other and increase its capacity by recognizing the commonality in approaches, methods and techniques.

In illustration, factors that increase epidemics such as HIV/AIDS are entwined with factors contributing to sexual exploitation of women and girls. Violence toward women affects their physical, sexual and reproductive health. Substance abuse is likely to diminish inhibitions, driving users to commit crimes such as rape, intimate partner violence and child abuse. An EpiCrim approach identifies these interconnected factors and encourages development of “primary care” strategies to prevent the root causes.

Example 4: Exposing Harmful Policy
Some criminal justice policies may actually harm public health care efforts. One convincing argument is that current law and law enforcement strategy promulgate, rather than reduce, drug abuse in America. These policies implicitly, and unknowingly, incorporate elements of public health and criminological theory. By making these linkages explicit, an EpiCrim approach may reveal to policy makers that many criminals may benefit more from less criminal justice intervention. This approach would also be useful in reassessing counterintuitive policies such as prohibitions against needle-exchange programs and condoms in prison.

Similarly, the prosecution of human traffickers through criminal justice channels only is not likely to reduce the occurrence of this crime. In South Africa, women and girls are more often trafficked by family members than by organized gangs. Reasons for this include children left behind by parents who have died of HIV/AIDS-related diseases, unemployment of primary caregivers, lack of finances to sustain large families and absolute poverty. Prosecuting traffickers through criminal justice processes may be the least likely means to prevent this crime.

Example 5: Highlighting Correlates
As disciplines such as criminology, psychology, public health and sociology became more specialized, scientists began looking within their own fields and few external methods and approaches were used to help explain behavioral change and deviance. As a result, contemporary practice is that crime causation and health behaviors are discussed only from a particular ideological perspective or academic discipline.

However, the correlates to crime and the correlates to health disparities are identical (e.g., poverty, minority status, lack of education, family history, neighborhood characteristics, geography and other psychosocial indicators). These correlates, as well as their related study designs, prevention strategies and consequences, are often taken for granted by scholars, students and practitioners who presume to understand these relationships. To date, no one has explicitly linked the two disciplines. More specifically, this unifying ideal has not been operationally defined in a way that allows serious contemplation, comparison, analysis and integration from diverse theoretical positions.

Example 6: Identifying Victims
Correctional health care workers are in a unique and favorable position to recognize victims of crimes that the police and prosecutors may overlook. Our research into human trafficking in South Africa and Florida has found several victims who were arrested. Recently, two young women were arrested in Orlando for prostitution. Their attorney discovered that they had come to the United States to be with “boyfriends” they met online and were now living in a van, their passports and children withheld, and being forced to perform sex acts. The traffickers told the victims not to seek law enforcement help since the police will simply arrest or deport them. Correctional health care professionals may be able to identify and assist these types of victims.

Future Needs
Intersections between criminal justice and public health theories, methods and approaches serve as models that can help to explain the dynamic relationships between these two seemingly different fields of study. As the criminal justice system can define criminal behavior, so too can systems of public health define epidemiological disease processes, which can lead to full-blown epidemics. EpiCrim links theories, methods and statistical models of public health to that of their criminal justice counterpart.

Much remains to be accomplished, however. Despite growing awareness and interest, EpiCrim needs greater clarification and explication. More importantly, it needs to start being useful for those outside the ivory towers of academia. In our vision, health care professionals may be among the first to make use of EpiCrim.

— About the author: Mark M. Lanier, PhD, is professor of criminal justice, University of Central Florida, Orlando. Thomaza M. Lutya, MS, is a doctoral student and lecturer in the department of social work and criminology, University of Pretoria in South Africa. Learn more about epidemiological criminology at www.EpiCrim.com.

[This article first appeared in the Fall 2009 issue of CorrectCare.]