The skanner., January 16, 2013, Page 35, Image 35

H O N O R I N G D R . M A RT I N L U T H E R K I N G , J R .
Tsunami
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ed at more than six times the rate of whites. (2.2 per-
cent for blacks vs. 0.35 percent for whites) The rate of
incarceration for Hispanics was similarly higher at
0.88, approximately two and one half times the rate for
whites. While there are many reasons for the dispropor-
tionate imprisonment of people of color including racist
drug sentencing laws that disproportionately target
crack cocaine, a preferred drug of choice in black com-
munities, vs. powder cocaine, and so-called “frisk and
release” policing policies popular in many cities, most
particularly New York City, significant data suggest the
close correlation between income levels and their close
cousin, level of education achieved, on incarceration
levels.
Why is this important? In 2005, the average cost of
housing a prisoner for a year in the United States was
$23, 876, or $27,192 in 2011 dollars. In 2008, the
Center for Economic and Policy Research estimates
that the U.S. spent $75 billion on incarceration.
Assuming current incarceration rates, as described
above, continue, by 2040, we can anticipate that overall
incarceration rates will rise from 753 to 798 per
100,000 while the number of individuals in prison will
rise from its current level of just over 2,000,000 to near-
ly 4,000,000. At 3.4 percent of state spending, there is
marked concern today at the state level that prison
spending is crowding out spending for education and
other state priorities. Under the scenario outlined
above, by 2040, it will account for nearly 7 percent of
state spending.
Nowhere is the impact of the socio-economic and
health disparities between races and ethnicities more
alarming, from an economic or financial standpoint,
than in the area of health. As Delia Carmen, Executive
Director of the Annie E. Casey-funded Race Matters
Institute, has noted, equity “is not work that needs to be
done; it is the work.” The Joint Center for Political and
Economic Studies has estimated during the four-year
period between 2003 and 2006, racial and ethnic dis-
parities in health status cost the nation $1.24 trillion,
$229 billion in direct health outlays. This translates
roughly into $625 per Hispanic and/or African
American per year for direct health costs alone. (While
Asian Americans also experience disparities in health,
the disparities are lower than is the case with blacks and
Hispanics. Native Americans experience the worst
health of any population in the United States but the
Indian Health Service is funded through the mechanism
of appropriation rather than entitlement, and the popu-
lation is much smaller although growing more rapidly).
Extrapolating to the year 2040, we can anticipate that
the economic impact of the demographic tsunami cur-
rently underway to be approximately $1.5 trillion per
year, fully two-thirds of current total direct annual
expenditure on health care in the United States.
Including indirect costs, the bill rises to roughly $7.9
trillion per year.
Nothing, of course, is static. For example, immigra-
tion from Latin America, in particular Mexico, has
slowed dramatically over the past four years. Hispanic
birth rates have been falling as well. Educational
attainment has been improving. But the reality is that,
despite the election of the first president of color in the
United States, race still matters, and it matters a great
deal.
It has been noted that social determinants of health
are responsible for 70 percent or more of all health care
costs. Those social determinants include income, edu-
cation, healthy child development, personal health
practices, and physical environment. People of color
have always experienced poor social determinants
including worse schools, higher incarceration rates,
poor food and physical environments, etc. The relative
lack of investment into disadvantaged communities has
resulted in significant and severe disparities in socio-
economic status, costs that are borne by taxpayers in the
form of increased outlays for prisons, social welfare,
and health care, amongst others. The major demo-
graphic shifts underway, outlined above, greatly magni-
fy and exacerbate these costs to the point of unsustain-
ability. What was once simply the economic and social
cost of racism becomes, under this demographic tsuna-
mi, the unraveling of the very fabric of the nation.
It is important to note that the return on investment to
address the social determinants of health, also known as
upstream investments, is long-term, twenty years and
See REICHARD on page 20
The Portland and Seattle Skanner Martin Luther King Special Edition January 16, 2013 Page 19