===Background===
<p>Policing, corrections, and other carceral institutions are under scrutiny for driving health harms, while receiving disproportionate resources at the expense of prevention and other services. Amidst renewed interest in structural determinants of health, roles of race and class in shaping government investment priorities are poorly understood.
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<h3><span class="mw-headline" id="Methods">Methods</span></h3>
<p>Based on the Social Conflict Model, we assessed relationships between city racial/ economic profiles measured by the Index of Concentration at the Extremes (ICE) and budgetary priorities measured by the novel Carceral Resource Index (CRI), contrasting investments in carceral systems with funding for health and social support across the 50 most populous cities in the United States (U.S.). Bivariate correlations, and unadjusted and adjusted polynomial regression models were used to assess the relationship between budgetary investments and population concentration at extremes in terms of income, racial/ethnic composition, and education, controlling for other demographic characteristics.
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<h3><span class="mw-headline" id="Results">Results</span></h3>
<p>In our sample, median CRI was -0.59 (IQR -0.64, -0.45), with only seven cities exhibiting positive CRI values. This indicates that most large U.S. cities spend more on carceral systems than on health and supportive services, combined. Adjusted polynomial models showed a convex relationship between the CRI and ICE-Education, and ICE-Race(White vs. Black)+Income, with quadratic terms that were positive and significant at p&lt;0.05. After controlling for age, the strongest prioritization of carceral systems was observed in cities where the proportion of low-income Black residents approached or exceeded that of high-income white residents.
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<h3><span class="mw-headline" id="Conclusions">Conclusions</span></h3>
Municipal prioritization of carceral investments over health and social support is pervasive in the U.S and exacerbated by racial and economic disparities. The CRI offers new opportunities to understand the role of government investments as a structural determinant of health and safety. Longitudinal research is warranted to examine the relationship between budget priorities, structural racism, and health outcomes.
Britt Skaathun, Francesca Maviglia, Anh Vo, Allison McBride, Sarah Seymour, Sebastian Mendez, Gregg Gonsalves, Leo Beletsky
CC BY 3.0
<a rel="nofollow" class="external free" href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276818">https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276818</a>