RAND Review News for Summer 2009

California Parolees Have High Need for Health Care but Poor Access to Services

To deal with its fiscal crisis, California, like other states, is releasing prisoners back into communities. But California communities will have a hard time providing parolees with access to health care services because of strained safety nets, according to a RAND study.

“The release of prisoners is coming at a time when the state and other funders are reducing support for the health care infrastructure, which serves both parolees and others,” said Lois Davis, the study’s lead author and a RAND senior policy researcher. “Parolees will be competing with others who have lost insurance coverage, and all of them will be trying to see providers who are being squeezed financially.”

The study examined the geographic distribution of parolees across California and found that certain counties and communities are disproportionately affected by reentry. Four representative counties were studied in depth — Los Angeles, San Diego, Alameda, and Kern — all of which have distinct clusters of parolees.

California inmates have high health care needs and even higher mental health and drug treatment needs relative to the general population, but many parolees reside in areas with the lowest access to facilities to meet such needs. Some of the most prominent gaps in access to health care for parolees appear in southern Los Angeles County (in particular, supervisorial district 2), where the number of parolees is high and access to hospitals and clinics is poor (see the figure).

Parolees Are Often Concentrated Where Health Care Resources Are Not: The Example of Central Los Angeles

Parolees Are Often Concentrated Where Health Care Resources Are Not: The Example of Central Los Angeles

SOURCE: Understanding the Public Health Implications of Prisoner Reentry in California: Phase I Report, 2009.

NOTES: MISP = Medically Indigent Services Program (service providers). In 2007, Martin Luther King Jr./Charles R. Drew Medical Center changed from a fully functioning hospital to a multiservice ambulatory care center providing only urgent care and outpatient services. District 4 includes the area south and east, including Long Beach.

The study also found that access varies by race and ethnicity. In Los Angeles County, more African-American parolees live in areas with lower accessibility to hospitals than do Latino or white parolees.

For policymakers, it could make sense to tailor strategies for services to those communities disproportionately affected by reentry. Mapping parolee concentrations and showing their accessibility to services also highlights the importance of community clinics in filling gaps in the health care safety nets.

“The approach of mapping and of measuring accessibility can help policymakers and practitioners understand the public health implications of reentry and best allocate resources and funding for this population,” said Davis. square

For more information:

Understanding the Public Health Implications of Prisoner Reentry in California: Phase I Report, RAND/TR-687-TCE, 2009.

Economic Costs of Major Oil Supply Disruptions Pose Key Security Risks

The United States imports nearly 60 percent of the oil it consumes, raising concerns that such dependence threatens national security through the economy, through risks of political coercion, and because of the costs of defending foreign oil fields and shipping lanes. According to a RAND study, the political risks of relying on imported oil (as shown in the table) are overblown. The two most serious risks related to oil dependency are economic: a large disruption in global oil supplies and the higher consumer costs associated with such a disruption.

The Biggest National Security Risks of Relying on Imported Oil Are Economic Ones

Category Potential Link Between Oil Dependence and U.S. National Security Assessed Risk
Economic Large disruption in global supplies of oil Major
Increased payments by U.S. consumers because of reduced oil supplies Major
Political Use of energy exports to coerce or influence other countries in ways detrimental to U.S. interests Minimal
Competition for oil supplies among consuming nations Minimal
Increased incomes for “rogue” oil exporters Moderate
Oil-export revenues supporting small terrorist groups Minimal
Oil-export revenues supporting Hamas and/or Hezbollah Moderate
Military Costs to U.S. military budgets of protecting oil from Persian Gulf Moderate

SOURCE: Imported Oil and U.S. National Security, 2009.

“There is an integrated world oil market, and embargoes do not work. But a large extended drop in the global supply of oil would trigger a sharp rise in oil prices and harm the U.S. economy, no matter how much or how little oil the United States imports,” said Keith Crane, the study’s lead author and a RAND senior economist.

The study evaluates commonly suggested links between oil imports and U.S. national security and assesses the economic, political, and military costs and benefits of potential policies to address the suggested national security risks.

The political risks of relying on imported oil are overblown.

Moderate risks posed by a heavy dependence on imported oil include higher incomes for “rogue” oil exporters, such as Iran and Venezuela; costs to the U.S. military of protecting Persian Gulf oil supplies; and higher oil revenues being diverted to the Hamas and Hezbollah terrorist groups. In contrast, there are minimal risks to U.S. security from the use of oil exports by energy-exporting countries to manipulate other countries in ways inimical to U.S. interests, from competition for oil supplies among consuming nations, and from diversion of oil revenues to finance small terrorist groups.

The United States would benefit from policies that diminish the sensitivity of the U.S. economy to a sudden decline in the supply of oil, whether the oil is imported or not. By reducing demand or increasing competitive alternative energy supplies, the United States would place downward pressure on world oil prices and ease risks to U.S. national security.

Four policies would reduce the risks to U.S. national security of importing oil, according to the study. The United States should (1) support well-functioning oil markets and refrain from imposing price controls or rationing during times of severe supply disruptions; (2) initiate a high-level review of prohibitions on exploring and developing new oil fields in restricted areas so that policymakers have up-to-date and unbiased information on the economic benefits and environmental risks of relaxing those restrictions; (3) ensure that licensing and permitting procedures and environmental standards for developing and producing oil and oil substitutes are clear, transparent, efficient, and balanced in addressing costs and benefits; and (4) impose an oil excise tax to increase incentives to economize on fuel and thus soften growth in oil demand. square

For more information:

Imported Oil and U.S. National Security, RAND/MG-838-USCC, ISBN 978-0-8330-4700-7, 2009.

United States Should Build Strategic Partnership with Mexico to Improve Its Security

According to a RAND study, the deteriorating security situation in Mexico and the change in U.S. administration call for the United States to rethink its policy options with respect to Mexico.

U.S. aid to Mexico has typically focused on a narrow set of areas, such as improved technology, training, and equipment to prevent drug trafficking. But “the United States must engage Mexico in a way that not only combats narcotics trafficking but also helps to build and strengthen the nation’s security institutions,” said Agnes Gereben Schaefer, the study’s lead author and a RAND political scientist.

Almost all those interviewed for the study agreed that the primary security threat to the United States from Mexico is organized crime.

Almost all those interviewed for the study agreed that the primary security threat to the United States from Mexico is organized crime, because it has infiltrated all levels of Mexico’s government and police forces and is involved in many illegal activities that are on the rise, notably drug trafficking, human trafficking, and arms trafficking.

Other security concerns within Mexico include illegal migration, terrorism, and rebel insurgencies. The study found no evidence that the concern about terrorists crossing the border into the United States has been realized, although such a possibility must be guarded against, particularly if Mexican institutions continue to weaken.

The study identified the four U.S. priority areas shown in the table and assessed them against three U.S. policy options: a strategic partnership with Mexico that emphasizes reform and longer-term institution building; the status quo approach, which focuses on ad hoc, issue-specific cooperation but does not emphasize reform or longer-term institution building; and a retrenchment that focuses on U.S. domestic efforts to combat security threats emanating from Mexico and on disengaging from partnerships with Mexico.

The table shows that, from a U.S. perspective, a strategic partnership would likely have a high impact on all priority areas, whereas retrenchment would likely have a low impact. The current strategy — status quo — promises to have an impact much closer to that of retrenchment than to that of strategic partnership.

Given U.S. Priorities with Mexico, Pursuing a Strategic Partnership Is the Best Policy Choice

U.S. Policy Priority for Mexico Likely Impact of Three Policy Options
Strategic Partnership Status Quo Retrenchment
Develop a cohesive security strategy and reform the security structure to meet that strategy High Low Low
Bridge the gap between federal and local security forces High Low Low
Support Mexico’s efforts to address domestic concerns High Low Low
Focus aid less on technology and equipment and more on increasing transparency in government institutions High Medium Low

SOURCE: Security in Mexico: Implications for U.S. Policy Options, 2009.

The study cautions that U.S. government officials should consider how the Mexican government may react to each of the policy options, given Mexico’s historical sensitivity to U.S. involvement in Mexican internal affairs. At the same time, it seems clear that Mexican President Felipe Calderón wants more than a status quo relationship with the United States and is interested in longer-term reform and institution building.

“The new U.S. administration should take advantage of this historic window of opportunity and further engage the Calderón government in a deeper and broader relationship that strives toward a long-term strategic partnership,” Schaefer said. square

For more information:

Security in Mexico: Implications for U.S. Policy Options, RAND/MG-876-RC, ISBN 978-0-8330-4719-9, 2009.

Illicit Drugs Are As Much a Problem Globally in 2007 As They Were in 1998

At the United Nations (UN) General Assembly Special Session in 1998, member states committed to achieving measurable results in reducing the illicit supply and demand for drugs by 2008. But there is little evidence that the global drug problem was reduced during this period, according to a joint study by RAND Europe, the RAND Drug Policy Research Center, and the Trimbos Institute.

“For some nations, the problem declined; but for others, it worsened; and for some of those, it worsened sharply and substantially,” said Peter Reuter, the study’s lead author and a RAND consultant. “The problem generally lessened in richer countries and worsened in a few large developing or transitional countries,” namely Russia, Ukraine, Iran, and Mexico.

Drug Policies Have Had, at Best, a Marginally Positive Influence

Drug Policy Influence
Production control Produced some local successes but has been unable to affect availability of drugs globally
Trafficking control Closed down some paths that drugs can take from production points to final markets but cannot affect all routes
Enforcement in local markets Failed in most nations to prevent continued drug availability
Treatment Reduced harms both of dependent users and of society but has not reduced the prevalence of drug use
Prevention Broadly used but is handicapped by a lack of programs of proven efficacy
Harm reduction Helped an increasing number of countries but is focused on a narrow element of the drug problem

SOURCE: Assessing Changes in Global Drug Problems, 1998–2007, Main Report, 2009.

The usage pattern of specific drugs also varied. For cannabis (marijuana, hashish), the total number of users might have fallen despite a substantial rise in those seeking treatment for cannabis addiction, suggesting that the number of heavy users and harms might have risen. The increased demand for such treatment held for every Western country for which data were available. For cocaine, a roughly stable consumption pattern was found in the United States and Western Europe, particularly Spain and Britain. In aggregate, the data indicate that the global drug problem became somewhat more severe.

The study also found that the total revenues from illicit drug sales were smaller than had been estimated by the UN Office on Drugs and Crime (UNODC). The study provides a range of estimates, with a “best estimate” for the total global cannabis retail market of €70 billion in 2005, which is about half of the UNODC estimate for 2002–2003.

Between 1998 and 2007, there was a convergence of national drug policies, with demand reduction being increasingly emphasized and harm reduction (such as providing clean needles) finding wider acceptance. Some countries for which tough enforcement had been central came to accept measures, such as methadone treatment, as an alternative way to reduce heroin-related problems. Policies toward sellers and traffickers, meanwhile, toughened over the time frame.

The study argues that the policies employed had no more than a marginally positive influence (as shown in the table). However, as the study points out, the enforcement of drug prohibitions did cause some substantial harms, such as providing a lucrative role for Colombian rebels in the drug trade, generating a wave of killings in Mexico, causing environmental damage, and depriving children of their parents for extended periods. Some of these effects were borne by nations other than the ones carrying out the enforcement.

On balance, national policies had both positive and negative consequences. “The challenge ahead will be to constructively build on lessons of such policies so policymakers can increase the positive benefits of policy interventions and avert the negative consequences,” Reuter noted. square

For more information:

Assessing Changes in Global Drug Problems, 1998–2007, Main Report, RAND/TR-704-EC, 2009.