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Gregg Caruso’s short and readable book, Public Health and Safety: The Social Determinants of Health and Criminal Behavior, available free online, makes the argument for thinking about crime very differently.  He advocates a “public health quarantine model”, which is a non-retributive approach to crime.  His argument is deeply grounded in a great deal of research as well as his own careful thinking about the issues involved.

Crime as a public health issue

Caruso is a philosopher interested, among other things, in the question of free will, and how we reconcile a belief in free will with our understanding of the multiple ways in which human behaviour is shaped by genetics, upbringing, and circumstances.  When he applies these ideas to thinking about crime, he concludes that we should respond to crime primarily as a public health issue.

Caruso writes that thinking about criminal justice as a public health issue would lead us to emphasize: “changing behaviors related to violence; addressing the traumas that victims face and how those perpetuate crime; reducing adverse childhood experiences; ensuring those leaving prison [have access to services]; and working to reinvest savings from criminal justice reform back into our hardest hit communities.”

The roots of crime

He begins by showing the strong link between criminal behaviour and various background factors that people cannot control, such as poverty, being abused or neglected as a child, or having a parent in jail.  Then there are all the factors that affect people in poverty, such as lower air quality, lower water quality, poorer diet, and a much increased level of lead poisoning. Caruso cites a great deal of research evidence showing how all of these are linked to increased risk of problems, including involvement in crime.  He also notes that these factors are also related; people are much more likely to be homeless or to have a mental illness or to have a substance abuse problem if they grew up in abusive or neglectful settings, and all of those factors are also related to criminal behaviour.  It’s a classic vicious circle, in which each negative factor increases the likelihood of other negatives.

Arresting people does nothing to address these issues.  Moreover, spending time in jail increases rates of poverty, homelessness and other problems which then increase the likelihood of additional criminal behaviour.  Those in the system tend to get little help in addressing problems but are closely supervised so that if they make a mistake they are back in the punishment system.  Repeat crime, then, is also not just a matter of individual will, but of the circumstances in which we make people live both during and after a criminal sentence.  On the other hand, factors like education and decently-paid employment have been shown to reduce recidivism, yet these are often not available to people with criminal records.

Are individuals solely responsible?

The strong evidence for these links raises serious questions about the reliance in the criminal justice system on holding individuals entirely responsible for their actions at all times.  This is simply an ineffective way to combat crime and reduce harm in society.  “It is a mistake to hold that the criteria of individual accountability can be settled apart from considerations of social justice and the social determinants of criminal behavior.”

Instead, Caruso advocates an approach much more like the way we treat disease or other health issues.  We attempt to address the causes while also often treating symptoms.  In some cases we may quarantine people to keep them from spreading illness, but we try to do so in ways that are non-punitive and respect their needs and dignity as human beings.   Similarly, a person who is dangerous can be ‘quarantined’ but there is “no justification for making his life more miserable than would be required to guard against the danger he poses”.  He advocates much improved design for jails, making them as much like non-jail settings as possible, with small size, domestic furniture, natural light, and more personal space.  He also argues against imposing restrictions, such as removing voting rights, after people have completed a criminal sentence.

Elements of well-being

Caruso cites six key elements of human well-being, which we should be trying to support in all areas of social policy: health, the capacity to reason, self-determination, attachment (strong personal relationships), personal security and respect. The criminal justice system clearly does not support these.  Instead, “We cage offenders like animals, dehumanize them from the moment they arrive, segregate and isolate them, and give them minimal autonomy, then we release them and expect they will somehow be model citizens. This is clearly not working.”   Caruso makes a series of recommendations about how the situation could be improved.  These are not new, but are put together here in a brief yet comprehensive and well-justified way.

Caruso also discusses the problem of psychopathy, which affects only about 1% of the population but is much more prevalent among people who commit acts of violence.  This can be a major problem, in that there are few effective treatments, and psychopaths do not learn well from punishment.  However Caruso is strongly opposed to preemptive measures, such as restricting people who have not actually committed a crime on the basis of presumed risk.

Law enforcement cannot be a solution to the problems of crime, but “… a core moral function of the criminal justice system is to identify and remedy social and economic inequalities responsible for crime.”

Prevention should always be the mission of our health and justice institutions.”


Public Health and Safety: The Social Determinants of Health and Criminal Behavior  is published by ResearcherLinks Books in the UK, and can be downloaded here.

Gregg Caruso is a philosopher based at State University of New York, Corning.    @GreggDCaruso on Twitter.