Access to Health Care and Criminal Justice Reform – Part 2

“America’s health care system is neither healthy, caring, nor a system.” – Walter Cronkite

A Universal Wraparound Program Available to all Minors Would Break the Cycle of Poor Health, Poverty, and Incarceration.

Too many people fall victim to cycles of poor health, poverty, and incarceration. In this post, I will demonstrate the ways in which the provision of universal wraparound health care services for minors is the best way to break this cycle.

Wraparound services are comprehensive, integrated, community-centered health care services, and meet all four components of sufficient health care access –– coverage, services, timeliness, and workforce. Thus, they address all of the factors contributing to poor health. The National Wraparound Initiative (NWI) service model, combined with the National Wraparound Implementation Center’s (NWIC) implementation strategy, is the ideal model from which a comprehensive, universal health care system for all children should be built.

I am proposing universal wraparound health care services for all individuals in the U.S. from birth until they reach 18 years of age. This will entail providing a health care team to every minor in the U.S. This team will address, at minimum, the wellness needs of every child in the U.S., including physical, emotional, intellectual, social, occupational, and spiritual needs, where appropriate and desired. Wellness needs, however, will act as the floor, not the ceiling, as my program will be modeled on the NWI’s program.

This program will not be means-tested but will require a significant new tax. This tax should be levied progressively against higher-income individuals and families. Within the program itself, efficacy will be measured by the NWI and NWIC’s evaluation protocols. The external success of this program, however, will be measured by the reduction in use of emergency health care services, decrease in preventable disease and associated comorbidities, lower rates of intergenerational poverty, and reduction in future levels of incarceration.

Developing a modified model of wraparound services that is available to all minors would be effective because early intervention is a proven generator of long-term socioeconomic benefits. These benefits will accrue to individuals and society. Individuals will experience better health, economic, and carceral outcomes. Society will benefit through long-term savings on various public programs and institutions. While a universal wraparound program would require enormous front-end investments, the benefits on the back-end could be transformative for individuals and save taxpayers trillions of dollars.

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Access to Health Care and Entry into the Criminal Justice System

“Of all the forms of inequality, injustice in health care is the most shocking and inhuman[e].” –– Martin Luther King, Jr. (1966)

Access to Health Care for all Ages Remains Elusive, Especially for Those in Poverty, and These Conditions Increase the Likelihood of Entry into the Criminal Justice System.

There is a strong, biconditional link between minors’ inadequate health care access and poverty and between poverty and entry into the criminal justice system. That is, poverty worsens health and poor health engenders poverty. Poverty leads to criminal justice involvement and criminal justice involvement leads to poverty.

This post focuses on the link between minors’ inadequate health care access and entry into the criminal justice system. Poverty is the link between inadequate health care access and entry into the criminal justice system. If we can break the link between poverty and poor health — particularly in minors — we can reduce our prison populations.

Insufficient health care access and the cycle of poverty are bidirectionally linked.

Put simply, poverty negatively impacts health and poor health perpetuates poverty. Poverty is an essential element to consider in this relationship because data that directly examines minor populations’ access to health care and future entry into the criminal justice system is scarce. Recently, while some studies have analyzed the relationship between health care access and incarceration, those studies focused on adult populations. While these studies will be illustrative when analyzing minors, currently, it is vital to use poverty as a link.

I will use the Supplemental Poverty Measure (SPM) as the metric for poverty. Unlike the U.S. Census Bureau formulation, the SPM accounts for, inter alia, the receipt of tax credits and government assistance. The SPM has measurement consistency, which is generally a measure of data reliability. In other words, measurement consistency gauges how well the data collection methods are performing at measuring what researchers are intending to measure. Additionally, the SPM is based on “inflows” and “outflows.” Outflows reflect income spent only for basic needs. Inflows include cash income from any source and noncash benefits that contribute towards a family’s spending. Inflows do not include necessary expenses and taxes owed. Ultimately, “[a] family is designated as poor if its annual money inflow, net of necessary expenses, falls below its threshold level of money outflow.”

The majority of individuals and families who experience poverty do not stay in poverty for the remainder of their lives. More often, individuals and families will cycle in and out of poverty. While most adults who experience poverty do so cyclically, the data for adults and children are different. Indeed, children who grow up in poverty are significantly more likely, relative to adults, to stay in poverty their entire lives.

Poverty cripples both physical and mental health. Individuals and families who live in impoverished communities are at greater risk for chronic disease, have a higher mortality rate, and experience lower life expectancy. Even looking only at adult populations, the effects of poverty are punishing and unjust. The effects of poverty, however, take a uniquely cruel and depressing toll on children.

The effects of poverty on children begin in the womb. Women in disadvantaged communities experience higher maternal mortality rates and give birth to children with lower birth weights. Should mom and baby survive childbirth, however, living in poverty increases food insecurity and decreases nutrition access. Continuing as they age, children who live in low-income homes experience higher rates of asthma, developmental and learning disabilities, exposure to tobacco and lead, obesity, poor growth, and learning and behavioral problems. Additionally, children who grow up in impoverished homes are more likely to engage in tobacco use and substance misuse. The disadvantages that accrue with poverty eventually become too burdensome to shoulder, which leads to increased mental health problems and greater rates of suicide.

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Access to Health Care Services and Entry into the Criminal Justice System

My name is Dustin Weber and I am a third-year law student at Santa Clara University School of Law. I completed my undergraduate degree in Political Science, with a Pre-Law emphasis, at California State University, East Bay. Prior to coming to law school, I had a career in the coffee industry.

I have a personal stake in the issue of health care access and delivery. I am a Type-1 diabetic (T1D). Management of this disease is interminable, exhausting, and painful. Improper management of the disease leads to a litany of comorbidities, including potentially dangerous physical and mental complications. This disease is cruel and unforgiving. The United States (U.S.) health care system has made management of the disease significantly more difficult. Before passage of the Affordable Care Act (“Obamacare”), going directly to law school was a greater challenge for someone with a chronic disease about to age off his parents’ health insurance plan. So, given the importance of health care to an individual’s wellbeing, I will be focusing my writing on health care access and its relationship to entry into the criminal justice system.

Specifically, I will demonstrate how expanding the use of wraparound services to all minors, based on the Wraparound Initiative model, would stem the flow of already disadvantaged populations into the criminal justice system. Generally, wraparound services are those not focused only on treating specific health issues, but services that are more comprehensive and aimed at providing individuals with holistic treatment. I will be unpacking this issue in three parts. In the first part, I will establish the link between insufficient health care access as a child and the increased likelihood of entering the criminal justice system. In the second part, I will discuss how our current system has failed and why the Wraparound Initiative model is ideally suited for slowing entry of individuals into the criminal justice system. In the third part, I will propose how to modify and expand the Wraparound Initiative model so that it can be implemented in communities across the country.