Saturday, May 05, 2012

A Healthy Society - Chapter 5 Discussion

Chapter 5 of Ryan Meili's A Healthy Society deals with our justice system. And once again while there's little to dispute in Meili's broader point, it's worth noting just how much distance there is between Canada's current governing philosophy, and anything which could possible be expected to produce healthy outcomes.

Here's Meili:
(Our prison system) is analogous to a medical system that is curative rather than preventive. The results are the same: more expense, less effect. The people who need help are met late in the progression of their illness, or their criminal behaviour, too late to make real change. How much easier, and more effective, is it to keep people from smoking than getting them to stop? How much wiser to keep people out of jail than to try to rehabilitate them once they’re in.
If we want to improve health outcomes, we need to address the root causes of illness. Similarly, if we want to decrease crime, we need to address its root causes as well. What is fortunate is that they are the same things. While the justice system hasn’t usually been described as one of the major factors in determining health (the numbers of people in prison are still small enough that it doesn’t have the same statistical impact as the other factors to which all are exposed), it’s clear that incarceration has a substantial impact on health status.

Another way of looking at this is to see it as a companion indicator of social health: the determinants of health are the determinants of involvement in criminal behaviour. Rising or falling crime rates are clear indicators of whether or not we have been successful in producing a safe society, not through intimidation and deterrence, but through an appropriate distribution of opportunity and the common wealth. This is important to consider when designing policy responses to try to make Canada a safer country: are more prisons and tougher sentences the right answer? It depends on what you’re trying to achieve.

There are three potential reasons to punish someone. The first is retribution: looking to exact a repayment for damage done. The second is risk management: seeking to protect others from the actions of someone who does not respect the law. The third is rehabilitation: seeking to correct the behaviour and teach the offender a better way.

In our private lives, in our own homes and families, we discourage revenge as a motivator. Most of us can think back to hear a parent admonishing a fighting child, “I don’t care who started it, you have to stop it.” While it is very tempting to get back at someone who has hurt us, upon sober reflection it is easy to see the ways in which that perpetuates conflict and justifies aggression. Is it not odd, then, that our judicial system, thought to represent the balanced wisdom of the best legal minds, focuses almost entirely on punishment? There is very little in the way of crime prevention, and not nearly enough rehabilitation.
Now, the case for dumb-on-crime policies has been based almost entirely on a combination of the first two of Meili's potential reasons for punishment. And the Harper Cons' vilification of any opposition has mostly focused on their portrayal of any offender without Conrad Black's personal fortune as a sub-human monster undeserving of any consideration - going beyond any possible sense of mere retribution into outright demonization.

But having spent as much time as I have combing through debates in Parliament and political coverage, I'll note that particularly when they're challenged on the barbarism of their worldview, the Cons have also regularly fallen back on a risk management model (albeit one without evidence) as their basis for a lock-'em-up policy. As the argument goes, as long a person is incarcerated, that person can't be committing crimes against the public at large.

From that starting point, it's worth drawing a link between that argument and a theoretical conception of a health-care system operating on the same principles. What if, instead of having reasonable triage and evidence-based disease control, we simply assumed the worst about any possible contagious diseases - preferring to confine people away from anybody besides other potentially-diseased individuals immediately based on even the slightest possibility that having them locked up at the right time might prevent some damage to others? And what if we had a government which vilified the sick, suggesting that anybody who spoke up for the interests of unclean people was on the side of disease against the healthy portion of the population?

Of course, in the health care example the retribution or demonization theory would be patently absurd. But the risk management theory would be almost exactly the same as that presented by the Cons when it comes to crime. And I'm sure we can all recognize how appalling the theory of isolating large numbers of people without any particular expectation of improved results as a matter of risk management would be if detached from the desire for retribution which is rightly questioned by Meili.

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