Department of Research and Academic Engagement, Drug Policy Alliance, New York, NY, USA.
Drug Policy Alliance, New York, NY, USA.
Ann Med. 2022 Dec;54(1):2024-2038. doi: 10.1080/07853890.2022.2100926.
There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts. KEY MESSAGESA that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.
公共卫生和医学领域越来越认识到，健康的社会决定因素（SDOH）在推动不同群体之间的健康不平等和差距方面发挥着关键作用，因此，如果不考虑决定个人健康管理能力的宏观因素，仅仅关注个人层面的医疗干预措施，其效果将是有限的。虽然已经探讨了大规模监禁对健康的影响，但人们对美国的“禁毒战争”如何加剧许多对健康和福利产生负面影响的因素关注较少，这不成比例地影响了已经面临包括歧视、投资不足和种族主义在内的结构性挑战的低收入社区和有色人种。美国的禁毒战争使数百万人被定罪、监禁和留下终身犯罪记录，破坏或完全剥夺了他们获得足够资源和支持以过上健康生活的机会。本文探讨了“禁毒战争逻辑”如何嵌入关键的 SDOH 和系统，如就业、教育、住房、公共福利、家庭监管（通常称为儿童福利系统）、毒品治疗系统和医疗保健系统。美国的禁毒战争并没有支持个人、家庭和社区的健康和福利，而是通过药物测试、强制报告、零容忍政策和强制治疗等做法，在这些系统中加剧了伤害。我们认为，由于禁毒战争已经嵌入这些系统，医疗从业者可以通过减少刑事定罪对医疗服务提供的影响，并参与政策改革努力，在促进个人和社区健康方面发挥重要作用。
一种优先考虑和证明毒品禁止、刑事定罪和惩罚合理的理念，在美国日常生活的众多方面助长了毒品监测和控制机制的扩张，对包括住房、教育、收入和就业在内的关键社会决定因素产生了负面影响。
美国禁毒战争的前线执行者不再仅仅是警察，现在还包括医生、护士、教师、邻居、社会工作者、雇主、房东和其他人。
医生和医疗保健提供者可以通过减少刑事定罪对医疗服务提供的影响并参与政策改革，在促进个人和社区健康方面发挥重要作用。
