About two years ago, a patient was gunned down by an assailant in the emergency room at the Joseph N France General Hospital an hour after I had seen and examined a patient in that very same room. Yesterday, there was a police chase and the firing of some shots on the street several yards from my home of abode. And three days ago, two security guards were gunned down and one succumbed to her wounds outside of a shopping mall in the heart of town. What these three incidents in particular, and violent crime in general, have taught me, is that no one of us is safe, as stray bullets could have affected me or my family or my friends if ever we were in the wrong place or at the wrong time, at work, at home or even at the shopping mall.
What I endeavour to do in this article is to share with you some insights I have gained from trying to come to terms with the social determinants of health and to show you that we are not just dealing with a criminal justice system, but in truth and in fact we are dealing with a public health and mental health issue that calls for immediate, short-, medium- and long-term strategies, that use the practices of prevention and rehabilitation in its full armament of action. We have to now accept that law and police enforcement, prosecutions in courts and incarcerations in prison do not deal with the upstream determinants and root of these antisocial behaviours, and that a holistic approach by all sectors, be they governmental, business and civil society, have to be implemented if we are going to make a dent in the tsunami of criminal activity that is hijacking our nation and has the potential to derail the social and economic growth and development of our people in the Federation.
We must first look at the mental capital of our people and to determine the factors that affect its development over the life course and to determine the enabling and disabling influences. I will use the system map below to guide our discussion.
A synthetic view of the mental capital trajectory and factors that may act upon it. Adapted from Mental capital and wellbeing: making the most of ourselves in the 21st century
As is shown above, although biology plays some role, there are several other important factors that are important:
- the quality of our relationships with other people, especially our parents, teachers, friends and peers, mentors and role models, coworkers and neighbours,
- our cultural mindsets,
- our environmental exposures, be it
- the home/family environment,
- the school environment,
- the media/information environments, and
- the work environment,
- and most important of all the lifestyle choices at our disposal given the limitations imposed on us via internal socioeconomic factors and to which I will add external geopolitical factors.
Let us zoom in some more to look at childhood development.
As is shown above, the social valuation of parenting is very important. Parenting skills, positive parenting styles and parental modelling along with the quality of maternal bonding and maternal care are vital in this most formative period of our children’s life. It is primarily here where the knowledge, attitudes and aspiration towards parenting, education and health behaviours sets the foundation that propels our children on the right path to wholesome growth and development. We have also learnt from the Adverse Childhood Experiences study that early home experiences, early stress exposure and childhood trauma and neglect negatively affect the physical, mental and social wellbeing and development of our children and which have long-lasting effects on them as adults.
Also important are the social valuation of teachers and education and we now know that early school experiences influence our children’s disposition to learn; hence the importance of the quality of our education system and ensuring that all of our children are given the best head start in life and are encouraged to think critically and to develop the curiosity, drive and a mindset to make lifelong learning and continuous personal education in all aspect of life very rewarding.
And this brings us now to the socioeconomic gradients within which our parents and children are born, grow, learn, work and play, which can either positively or negatively affect the mental development of our children. These include immigration status, education, employment, income, occupational and social status, transport, housing and other living conditions. These in turn may enhance or inhibit the capacity of our parents to give our children the time and energy they need and deserve so as to invest in their positive physical, mental and social growth and development. Hence more attention and investment needs to be placed on the early home experiences of our children.
Let us move on to the adolescent phase of our development.
It is in this most critical maturation period of brain development that our environmental exposures are crucial, and where the crucible of criminal activities are nurtured and festered. Peer influence may move in to fill the void of lack of parental discernment and early and continual investment, and in families at risk, the presence of mentors and role models can and do act as counteracting forces and safety nets for our children.
It is also here that the media and entertainment factors play a significant role, as well as the permissivity and risk-taking cultural and social attitudes towards drugs and alcohols. Since the onset of substance use coincides with a critical maturation period of parts of the brain that are affected by alcohol and drugs of abuse, every attempt must be made to prevent exposure of our adolescent to their use. Although I support the decriminalization of marijuana, I do not support its use during this most fragile developmental period. It goes without saying the same goes for alcohol, tobacco and other drugs which have done more harm than marijuana itself. It must be noted that these mind altering drugs affect learning, attention, executive functioning (please see below) and their episodic and working memory; hence their ability to store and retrieve vital information that is being taught at home, in their schools and in their communities.
This can be done by stewarding the cognitive, emotional and intentional skills and capacities of our youth so that they can be functionally literate and numerate (i.e read, write and count sufficiently). Their ability to organise, manage and control their behaviour (i.e their executive functioning) is also very important as this capacity would determine whether they are better ‘self-controlled’ and are resistant to peer resistance, or whether they are prone to ‘impulsivity’ that may lead to negative health outcomes of teenage pregnancy and smoking and the use of other drugs of abuse. Also, their level of self-esteem and emotional and social cognition (i.e how in tune are they to themselves, their emotions and social cues) will determine whether they become positively socially engaged with positive attitudes of competence, confidence, good character and caring heart, or whether negatively socially adjusted and prone to antisocial behaviour: thus predisposing them to a vocation of gainful, meaningful productive employment or a life of crime, disability or early death, respectively.
At this point, having highlighted the socioeconomic determinants of our mental capital development and how its nurturing and stewarding in our youth can lead our children towards or away from a life of anti-social behaviour and crime, I would like to bring up the issue of the economics of criminality and why there are policy decisions which we are taking which we may inadvertently be influencing the mindset and culture of our youth that may predispose them to criminality. My thoughts are influenced by the paper, The Socioeconomic Determinants of Crime. A Review of the Literature by Paolo Buonann (2003):
Starting from Becker’s seminal paper we review the first contributions to the economics of crime, stressing how with the first model of criminal choice, due to Becker, the way of conceiving criminal behaviours has drastically changed. In fact, criminal choice ceases to be viewed as determined by mental illness or bad attitudes, but it is considered on the basis of a maximization problem in which agents have to compare costs and benefits of legal and illegal activities taking in account the probability of being arrested and punished and the expected returns from crime. Criminal decision is an economic choice by rational agents. In the second part of the survey, in which we focus our attention on empirical works, we present the main recent contributions to the economics of crime; in particular we outline the determinants of criminal behaviours and explore the relationships existing between crime and socioeconomic variables emerging from the literature. In fact, the economics of crime interacts with different and heterogeneous fields (i.e. sociology, criminology, psychiatry and geography). It is closely related to poverty, social exclusion, wage and income inequality, cultural and family background, level of education and other economic and social factors that may affect individual’s propensity to commit crimes such as cultural characteristics, age and sex.
If we look at the latest spate of shootings where money is involved, be it at a bakery, delivery van or depositing of money at a bank, we at once realise these are speculative, get-rich-fast, high net-worth targets, and this begs the question of why? It would come as no surprise that our CBI program has legalised a scheme that also deals with speculative, get-rich-fast, high net-worth individual and I submit that the mindset of our policy makers have trickled-down to our youth on the street. Both involve “rational choices” by economic agents on “the basis of a maximization problem in which agents have to compare costs and benefits of legal and illegal activities taking in account the probability of being arrested and punished and the expected returns.” Although this is no justification for criminality, if we are really serious about preventing criminality we need to also focus on those at the top who are at risk in addition to those at the bottom.
Another case in point is the seizure of marijuana plants that have put a major dent in the source of income of a few (despite it being illegal) without compensating them in terms of providing land, skills training and the resources to use their agriculture skills to make a decent living and contribute in a meaningful way to the growth and development of their communities. What if some of them were indebted to their suppliers, and their lives were in danger because of non-payment of debt, did we not foresee that what had transpired over the past week was inevitable? The point I am trying to make is that if we are going to clamp down on illegal economic activities, we need to provide options so that our youth can engage in legal economic activity in a way that is not only meaningful and rewarding but also self-supporting of themselves and their family.
This then brings me to the most troubling determinant of them all, and this is the geopolitical determinants. It must be obvious that we do not manufacture guns and bullets in the Federation and there is a reason why the youths have access to guns as there are some assets that they are protecting. Also it has been known for some time that the islands were viewed by the US State Department in the past as strategic outposts, again, for economic activities and as a matter of fact of national interest. In the following article, ‘Killing the Host’: the financial system is destroying the global economy, Paul Craig Roberts paraphrases what Michael Hudson wrote in his book of the same name “Killing the Host”:
“Hudson’s next task was to estimate the amount of money from crime going into Switzerland’s secret banking system. In this investigation, his last for Chase, Hudson discovered that under US State Department direction Chase and other large banks had established banks in the Caribbean for the purpose of attracting money into dollar holdings from drug dealers in order to support the dollar (by raising the demand for dollars by criminals) in order to balance or offset Washington’s foreign military outflows of dollars.
If dollars flowed out of the US, but demand did not rise to absorb the larger supply of dollars, the dollar’s exchange rate would fall, thus threatening the basis of US power. By providing offshore banks in which criminals could deposit illicit dollars, the US government supported the dollar’s exchange value.
Hudson discovered that the US balance of payments deficit, a source of pressure on the value of the US dollar, was entirely military in character. The US Treasury and State Department supported the Caribbean safe haven for illegal profits in order to offset the negative impact on the US balance of payments of US military operations abroad. In other words, if criminality can be used in support of the US dollar, the US government is all for criminality.”
(Please also see, Laundering Havens for War Budgets, and An Insider Spills the Beans on Offshore Banking Centers for how the offshore bank centers were initially set up for tax avoidance purposes for big oil and other extractive industries and also to money launder drug proceeds from foreign entities)
Initially I found this too farfetched to believe until I came across this article: The CIA, the Cold War, and Cocaine: The Connections of Christopher “Dudus” Coke which showed the connection between the USA, CIA, politics, gangs, guns and drugs in the Caribbean which leads directly and correlates with the origin and escalation of violent crimes in our Federation. Here is a revealing excerpt:
“The connections between the CIA and the Shower Posse have long been known. Former CIA agent Philip Agee, for example, revealed that “the CIA was using the JLP [Jamaica Labour Party] as its instrument in the campaign against the Michael Manley government, I’d say most of the violence was coming from the JLP, and behind them was the CIA in terms of getting weapons in and getting money in.”
In 1989, former Shower Posse member Charles “Little Nut” Miller was charged with drug trafficking but agreed to testify against other gang leaders in order to receive immunity. In his testimony – in which he implicated himself in nine murders – Miller revealed his connection to the JLP as a “political enforcer,” as well as to the CIA, going as far to state that “the United States made me what I am”(Newsweek, July 13th, 1998). After testifying, Miller returned to his native St. Kitts where he blossomed into one of the regions most notorious drug barons, though he has been in prison in the United States since 2000 on drug charges.”
(Please also see: Jamaica’s Shower Posse: How The CIA Created “The Most Notorious Criminal Organization, Informant a Thorn in Justice Dept.’s Side, and Miami Jury Convicts Caribbean Drug Lord on Narcotics Charges.
If you haven’t seen the documentary on the Shower posse, you can see it here:
The Bing Bang of murders in the Federation can be seen from 29:56 – 34.03 above and is reproduced below:
But that is not all, as based on Ava DuVernay’s “extraordinary and galvanizing documentary” 13TH (please see below), you will begin to see how the economics of criminality has produced a thriving corporate prison-industrial complex and why a constant supply of drugs and manufactured criminalities allow big business to profit legally off of crime. I gather that if there is no demand to create criminalogenic environments for profiteering sake in the USA, the demand for trans-shipment points in the Caribbean would decrease and hence the importation of drugs and guns and its attendant supply of criminality in the Federation would decrease significantly.
This has led us to the root cause of all causes of criminality in the region and around the world and as you can see that this is bigger than any individual, family, community, government or region to handle if the status quo remains, and it all boils down to the globalisation of a very dysfunctional economic system that depredates our physical, mental and social health and enables criminality for the local economic and foreign vested interests.
If we want to make our world a healthier and safer place we need to go upstream and identify the global determinants of health and criminality, make an accurate diagnosis of the systemic causes that enables and fosters structural violence in terms of the socioeconomic determinants and the transnational organised-criminal-industrial complexes and show how they are connected to transnational corporations that put money maximization, profit and rent seeking above physical, mental and social health and well-being.
In closing, I would like to impress on everyone that the social determinants of health and the social determinants of crime are one and the same thing: that which increases health will decrease criminality, and that which increases criminality will decrease health and longevity. So crime is a public health issue and should be viewed and dealt with as such with all stakeholders, from legal, health, education, agriculture, civil society, political parties, and yes, finance and foreign affairs involved, sitting at the same table to find solutions to these socioeconomic and geopolitical problems. We don’t have to reinvent the wheel and can use the same tools and principles of public health and finding solutions to chronic conditions as summarized respectively below.
Clinical course of a disease: four prevention stages. Adapted from AFMC Primer on Population Health A virtual textbook on Public Health concepts for clinicians: Chapter 4: Basic Concepts in Prevention, Surveillance, and Health Promotion
Innovative Care for Chronic Conditions Freamework. Adapted from Innovative Care for Chronic Conditions: Building Blocks for Action. GLOBAL REPORT, 2002, WHO
Come to think of it, we are also dealing with the social determinants of justice, which is much deeper and more broader than the criminal justice system of police, prisons, lawyers and courts. In order to do justice to this injustice of victimizing the victims of life-disabling socioeconomic and geopolitical determinants and also adding insult to injury, the public health approach, of prevention and having a positive policy environment with health in all policies, is the only viable and sustainable solution. In the article entitled, Stopping crime upstream: The social determinants of justice, the author writes:
“Clive Weighill: Some politicians talk about getting tough on crime. I’m saying you don’t just want to get tough on crime, you have to get tough on the issues of poverty, poor housing, disadvantage. People are products of their environment, and if we can’t solve those social issues, we’re not going to solve the big picture in the end. I firmly believe that we have to work on poverty…
…RM: We often talk about those issues in the health world as the social determinants of health — income, education, housing — the things that make the biggest difference in whether we’ll be ill or well.
CW: They’re the social determinants of crime as well….
It leads to young men wanting to be involved in gangs because it gives them a place where they can feel that they have a bit of power, where they fit in, where they’ve got some kind of a future, something they don’t feel they have in general life…
…RM: I’m also wondering about the other way around, the health impacts of being involved in the justice system. Once somebody has been incarcerated or charged, what do you see in terms of that affecting the trajectory of their life, whether it’s further involvement in crime or just their health?
CW: A large majority that are in penal institutions are suffering from some type of mental illness, substance abuse issues — that’s part of what’s got them to where they are. My fear is that when people are incarcerated, if they’re on remand they’re not getting any help for their issues because they’re just on remand.
If they are sentenced the programming still isn’t sufficient to help anybody get over substance abuse or mental health issues. They’re certainly not preparing people for that transition from when they are incarcerated to get them back into society. You can lock somebody up, put them away for ten years, but if you don’t give them help and you put them right back into the same environment they came from, you’re going to replicate the problem you had in the first place.
“When you get people some proper housing and take care of them properly, you see how many fewer times they have interactions with the police, how many fewer trips to emergency, how many fewer ambulance rides. All of these things are very expensive.”
It’s hard to get the understanding of short mandates for government to look long-term at how to fix some of these issues, because they’re looking at a four-year term. They have to convince the taxpayers of what they’re doing. We’re dealing with people — people’s feelings, people’s mental health, people’s status — this is not a four-year fix.”…
I would like to end on a quote from the article, Bryan Stevenson: To heal our national trauma, we need to face our genocidal past:
“The opposite of poverty is not wealth. It’s justice.”
And please don’t forget to take time to watch Ava DuVernay’s “extraordinary and galvanizing” documentary 13TH. The trailer is shown below:
Published on Sep 26, 2016
The title of Ava DuVernay’s extraordinary and galvanizing documentary 13TH refers to the 13th Amendment to the Constitution, which reads “Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States.” The progression from that second qualifying clause to the horrors of mass criminalization and the sprawling American prison industry is laid out by DuVernay with bracing lucidity. With a potent mixture of archival footage and testimony from a dazzling array of activists, politicians, historians, and formerly incarcerated women and men, DuVernay creates a work of grand historical synthesis. Now Streaming on Netflix.