More than 10,000 children and teens in Philadelphia have been affected by a public health crisis that too few people – even those dedicated to helping the most vulnerable to thrive – fully understand. This condition affects at least two or three children in every city classroom, and can set up children for worsening asthma, autoimmune diseases, and even cancer as they get older, as well as double the rates of substance abuse, promiscuity, and suicidal behavior.
Of the 22 children I cared for at our clinic on a single day last week, five were exposed to this serious health risk. A 6-month-old not rolling over yet. Two 7-year-olds – one was suddenly not doing well in school, and the other was exhibiting all the signs of ADHD. A remarkably sullen 11-year-old. A teen who was emotionally disengaged from everything she once found exciting.
The public health crisis all these children share: having a parent in prison.
A study of more than 13,000 adolescents and young adults with a history of paternal incarceration, published in this month's Pediatrics journal, powerfully demonstrates the effects of having an incarcerated mother or father. These youths are far less likely to have routine health care, instead waiting until a small issue needs emergency room attention – which means worse health for the individual, and higher costs for everyone. Parental incarceration also meant a 50 percent higher chance of prescription drug abuse and 2.5 times higher likelihood of using illegal injection drugs such as heroin and fentanyl, which caused most of Philadelphia's 1,200 drug overdose deaths last year.
Another recent study connected parental incarceration with visible changes in the DNA of 9-year-old children. Telomeres, like the plastic aglets on the tips of shoelaces, keep a person's DNA healthy, and better able to ward off cancer, autoimmune diseases, and even early death. In these 9-year-olds, however, the telomeres were significantly shorter than normal. Unlike a worn shoelace that can be replaced, DNA cannot.
In our homes, day-care facilities and schools, the toxic effects of parental incarceration on developing brains can be a major driver of delays in development and learning. A 2014 study of more than 95,000 children whose parents had spent time in prison found double the usual rate of developmental delays and speech problems in infants and preschoolers. In school-aged kids, learning disabilities were also doubled, and ADHD diagnoses were tripled. There was also a 50 percent higher school absentee rate. All these factors add to the "school to prison pipeline" and the cycle of incarceration that put children of incarcerated parents at a six times higher risk of prison time themselves.
Although the United States has only 5 percent of the world's population, we house 25 percent of the world's prisoners. There are 2.5 million adults in state and federal prison; one million are parents of minors. On average, 2.7 million kids in the U.S. have a parent in prison at any given time, according to the Pew Charitable Trusts. With census figures showing that there are 75 million children in the U.S., that comes out to 1 in 28 – the equivalent of one child in each classroom. But the burden falls disproportionately on communities such as Philadelphia, where 1 in 8 kids who live in poverty have a parent in prison.
It costs more than $43,000 a year on average to keep someone in prison in Pennsylvania, three times the price of a public education and 13 times that of having a child in an accredited pre-K program. The total prison tally to the state: $3.2 billion dollars a year. The medical, educational and societal costs are much higher, but the cost to an individual child is immeasurable.
In effect, whenever a parent goes to prison, it's a double sentence; the adult is behind bars, and the child falls behind at school and life.
Author Neil Bernstein articulates the effects of parental incarnation fittingly. "The dissolution of families, the harm to children — and the resultant perpetuation of the cycle of crime and incarceration from one generation to the next — may be the most profound and damaging effect of our current penal structure."
Of course, people who break the law must pay a penalty. But some judicial reform and public health approaches have shown promise in serving both the need for law enforcement and also child development.
Reduce sentence lengths with more effective rehabilitation in prison.
Consider alternatives to prison for nonviolent offenders, addicts, and mentally ill, with community-based sentencing alternatives.
Rate prisons, just like medical interventions, on effective decreases in recidivism.
Increase funding for early-childhood education and public schooling.
Train teachers and others who work with children to identify those with an incarcerated household member by asking nonjudgmental questions, such as "who else is involved in your life?" and when a parent is not available, finding out if he or she is "away."
As I drive home along Erie Avenue, I pass underfunded schools, a large line for a food bank, a young man with the characteristic blank expression of a heroin user. As I approach the intersection of Broad and Erie, I glance up at the ever-present sign attached to the Black and Nobel Bookstore: "We Ship to Prisons," spelled out in two-foot-tall letters. My mind goes to an unintended double meaning as I think of our current situation as a ship that is capsizing too many of our children.
Daniel R. Taylor, D.O., is an associate professor at Drexel University College of Medicine and director of community pediatrics and child advocacy at St. Christopher's Hospital for Children.