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J Racial Ethn Health Disparities. 2018 Aug;5(4):885-893. doi: 10.1007/s40615-017-0435-0. Epub 2017 Nov 9.

The 21st Century Cures Act Implications for the Reduction of Racial Health Disparities in the US Criminal Justice System: a Public Health Approach.

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Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.
Simmons College Department of Sociology, Women and Gender Studies, Boston, Massachusetts, 02115, USA.
Simmons College Department of Public Health, Boston, MA, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Northeastern University School of Nursing, Boston, MA, USA.


Past drug epidemics have disproportionately criminalized drug addiction among African Americans, leading to disparate health outcomes, increased rates of HIV/AIDS, and mass incarceration. Conversely, the current opioid addiction crisis in the USA focuses primarily on white communities and is being addressed as a public health problem. The 21st Century Cures Act has the potential to reduce racial health disparities in the criminal justice system through the Act's public health approach to addiction and mental health issues. The 21st Century Cures Act is a progressive step in the right direction; however, given the historical context of segregation and the criminalization of drug addiction among African Americans, the goals of health equity are at risk of being compromised. This paper discusses the implications of this landmark legislation and its potential to decrease racial health disparities, highlighting the importance of ensuring that access to treatment and alternatives to incarceration must include communities of color. In this paper, the authors explain the key components of the 21st Century Cures Act that are specific to criminal justice reform, including a key objective, which is treatment over incarceration. We suggest that without proper attention to how, and where, funding mechanisms are distributed, the 21st Century Cures Act has the potential to increase racial health disparities rather than alleviate them.


21st Century Cures Act; HIV/AIDS; Health disparities; Mass incarceration; Mental illness; Substance abuse

[Available on 2019-08-01]

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