The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:
- Economic Stability
- Health and Health Care
- Neighborhood and Built Environment
- Social and Community Context
Incarceration is a key issue in the Social and Community Context domain.
The Bureau of Justice Statistics defines the incarcerated population as the “number of inmates under the jurisdiction of state or federal prisons or held in local jails.”1 State and federal prisons house inmates sentenced to more than 1 year of incarceration.2 Local jails hold inmates sentenced to less than 1 year; people who violate parole or probation; and those awaiting trial, sentencing, or transfer to prison.2 Between 1980 and 2014, the United States incarceration rate increased by 220%, which can be linked to state and federal policy changes that enacted harsher sentencing rules.3 In 2014, there were approximately 2.2 million people incarcerated in state or federal prisons and local jails,1, 3 and an additional 4.7 million individuals under community supervision (i.e., on probation or parole).1 Incarceration is a mechanism to punish criminal offenses,4 but it can affect the health and well–being of those currently incarcerated, those with a history of incarceration, and their families and communities.2, 5
Higher rates of incarceration are often seen among racial/ethnic minorities6–8 and people with lower levels of education.7 For example black and Hispanic people are disproportionality arrested and convicted of offenses.8 One study found that, among men ages 18—64, 1 in 87 white men were incarcerated, versus 1 in 36 Hispanic men and 1 in 12 black men.7 The data for incarcerated women shows similar racial/ethnic disparities. Another study found the lifetime risk of being incarcerated is 5 per 1,000 for white women, 15 per 1,000 for Latinas, and 36 per 1,000 for black women.6 Research has shown that some of the racial disparities in the U.S. incarceration rate may be influenced by state and federal policies such as “three strikes” and mandatory minimum sentences.8 In regards to education, data indicate that people without high school diplomas or GEDs have a greater likelihood of being incarcerated than their more educated peers.7 These data also showed that, for white men ages 20—34, the rate of incarceration was only 1 in 57; however, the rate was 1 in 8 for white men in the same age group who did not have a high school diploma or GED.7 Disparities in incarceration are also evident at the community level, as some communities are disproportionately burdened by high rates.9–11 High rates of recidivism (being arrested or incarcerated again) are also seen in these communities,10, 11 which tend to be predominately non–white and have higher rates of crime, poverty, and unemployment.2, 9 11 Overall, incarceration and recidivism can negatively impact the well–being of communities and individuals.5
When compared to the general population, men and women with a history of incarceration are in worse mental and physical health. Data from the Bureau of Justice Statistics found that, in 2005, more than half of all prison and jail inmates had mental health problems.12 Studies have shown that when compared to the general population, jail and prison inmates of both genders are more likely to have high blood pressure, asthma, cancer, arthritis,13 and infectious diseases, such as tuberculosis, hepatitis C, and HIV.2, 14–16
Women with a history of incarceration face a greater burden of disease than men with a history of incarceration.17–19 Several studies have shown that women with a history of incarceration, compared with men with a history of incarceration, are at greater risk for several diseases, such as HIV/AIDS, HPV, and other sexually transmitted diseases because they are more likely to have experienced childhood trauma, physical and sexual abuse.6, 17, 18 20 In addition, female offenders with a history of drug abuse were more likely than their male counterparts to suffer from conditions such as tuberculosis, hepatitis, and high blood pressure. 17, 20
The number of older adults (ages 50 and above) in U.S. prisons is growing.21–25 Many correctional facilities, however, are not equipped to address the special health needs of these individuals21, 26 While incarcerated, some older inmates do not receive adequate treatment for their ailments,21, 26 particularly mental health conditions. 21, 27 A study found that only 18% of older inmates were prescribed medication to treat their mental health conditions.27 Reintegrating into society also poses special challenges for older prisoners. Those who have spent significant time in prison may find adjusting to changes that have occurred in society and their specific communities to be stressful, particularly if family support is lacking.26, 28 Furthermore, older adults with a history of incarceration are more likely to suffer from abuse and neglect due to lack of family support when compared to their younger counterparts.26
In many instances, an incarcerated individual's family is negatively affected by their incarceration. Children are especially vulnerable to the effects of parental incarceration.29 According to data from 2011–2012, more than 5 million U.S. children (approximately 7% of all U.S. children) have experienced the incarceration of a parent who they resided with at some time.30 Children of incarcerated parents may be more likely to live in poverty and be homeless.30, 31 In addition, they may be more likely to witness domestic violence or substance abuse by a parent and reside with a person who is mentally ill or suicidal.30 Evidence shows that children of incarcerated parents often have higher rates of learning disabilities, developmental delays, speech/language problems, attention disorders, and aggressive behaviors.29, 32 Additionally, children of incarcerated parents have been found to be up to 5 times more likely to enter the criminal justice system than children of non–incarcerated parents.2, 33
The U.S. releases over 7 million people from jail and more than 600,000 people from prison each year.2 However, recidivism is common.10, 11, 34 Within 3 years of their release, 2 out of 3 people are rearrested and more than 50% are incarcerated again.34, 35 Many people face obstacles reintegrating into society following their release, such as problems with family, employment, housing, and health, as well as difficulty adjusting to their new circumstances.26 Formerly incarcerated individuals often have difficulty securing employment and housing because of their criminal history.2, 36 Additionally, those with certain convictions may lose state and federal benefits, including access to education assistance, public housing benefits, food stamps, and their drivers' licenses.37 Felon disenfranchisement laws can restrict individuals with felony convictions from participating in the political process through voting.38, 39 Furthermore, formerly incarcerated individuals are at an increased risk for experiencing health issues.2 For example, within the 2 weeks following their release, former prisoners are 129 times more likely than the general public to die of a drug overdose.2, 8 40–42 Former prisoners are also at a higher risk for committing suicide soon after their release.8, 43
Strategies, such as “front–end” programs (e.g., drug treatment courts), providing comprehensive health care services during incarceration, and linking people to health care services post release may help to improve the health and well–being of those who are incarcerated and those with a history of incarceration.8 For example, developing drug treatment courts could potentially reduce both drug use and incarceration rates, by providing alternatives to incarceration for first–time offenders. Furthermore, research into programs that address social, psychological and medical needs of incarcerated individuals or those with a history of incarceration could be beneficial.8 For example, in Hawaii, Project HOPE (Hawaii Opportunity Probation with Enforcement) has shown effectiveness in treating problems of drug abuse without relying on incarceration.8
Additional research is needed to better understand how to improve services for people and communities impacted by incarceration. This additional evidence will facilitate public health efforts to address incarceration as a social determinant of health.
Disclaimer:This summary of the literature on incarceration as a social determinant of health is a narrowly defined review that may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges or as additional research is conducted.
i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.
ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.
1 Kaeble D, Glaze L, Tsoutis A, Minton T. Correctional populations in the United States, 2014. Washington, DC: Bureau of Justice Statistics; 2015. Available from: https://www.bjs.gov/content/pub/pdf/cpus14.pdf
2 Dumont DM, Brockmann B, Dickman S, Alexander N, Rich JD. Public health and the epidemic of incarceration. Annual Review of Public Health. 2012;33:325.
3 Council of Economic Advisers. Economic perspectives on incarceration and the criminal justice system. Washington, DC: Executive Office of the President of the United States; 2016. Available from: https://obamawhitehouse.archives.gov/sites/whitehouse.gov/files/documents/CEA%2BCriminal%2BJustice%2BReport.pdf
4 Kessler D, Levitt SD. Using sentence enhancements to distinguish between deterrence and incapacitation. NBER Working Paper no. 6484. Journal of Law and Economics. 1999;42(1):343–63.
5 Clear TR. The effects of high imprisonment rates on communities. Crime and Justice. 2008;37(1):97–132.
6 Freudenberg N. Adverse effects of US jail and prison policies on the health and well-being of women of color. American Journal of Public Health. 2002;92(12):1895–99.
7 The Pew Charitable Trusts. Collateral costs: Incarceration’s effect on economic mobility. Washington, DC: The Pew Charitable Trusts; 2010.
8 Travis J, Western B, Redburn FS. The growth of incarceration in the United States: Exploring causes and consequences. Washington, DC: The National Academies Press; 2014.
9 Sampson RJ, Loeffler C. Punishment’s place: The local concentration of mass incarceration. Daedalus. 2010;139(3):20–31.
10 Kubrin CE, Stewart E. Predicting who reoffends: The neglected role of neighborhood context in recidivism studies. Criminology. 2006;44(1):165–97.
11 Mears DP, Wang X, Hay C, Bales WD. Social ecology and recidivism: Implications for prisoner reentry. Criminology. 2008;46(2):301–40.
12 James DJ, Glaze LE. Mental health problems of prison and jail inmates. Bureau of Justice Statistics Special Report. Washington, DC: Bureau of Justice Statistics; 2006. Available from: https://www.bjs.gov/content/pub/pdf/mhppji.pdf
13 Binswanger IA, Krueger PM, Steiner JF. Prevalence of chronic medical conditions among jail and prison inmates in the United States compared with the general population. Journal of Epidemiology and Community Health. 2009;63(11);912–19.
14 Restum ZG. Public health implications of substandard correctional health care. American Journal of Public Health. 2005;95(10):1689–91.
15 Maruschak LM, Beavers R. HIV in prisons, 2007–08. Bureau of Justice Statistics Bulletin. Washington, DC: Bureau of Justice Statistics; 2009.
16 Spaulding AC, Seals RM, Page MJ, Brzozowski AK, Rhodes W, Hammett TM. HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: Declining share of epidemic but persistent public health opportunity. PLoS One. 2009;4(11):e7558.
17 Covington SS. Women and the criminal justice system. Women’s Health Issues. 2007;17(4):180–82.
18 Braithwaite RL, Treadwell HM, Arriola KRJ. Health disparities and incarcerated women: A population ignored. American Journal of Public Health. 2008;98 Suppl 1;S173–75.
19 Maruschak LM, Beck AJ. Medical problems of inmates, 1997. Washington, DC: Bureau of Justice Statistics; 2001.
20 Messina N, Grella C. Childhood trauma and women’s health outcomes in a California prison population. American Journal of Public Health. 2006;96(10):1842–48.
21 Loeb SJ, AbuDagga A. Health-related research on older inmates: An integrative review. Research in Nursing & Health. 2006;29(6):556–65.
22 Gal M. The physical and mental health of older offenders. Mental Health. 2003;38(30.8):17–22.
23 Aday RH. Golden years behind bars-special programs and facilities for elderly inmates. Federal Probation Journal. 1994;58:47.
24 Lemieux CM, Dyeson TB, Castiglione B. Revisiting the literature on prisoners who are older: Are we wiser? The Prison Journal. 2002;82:440–58.
25 Merianos DE, Marquart JW, Damphousse K, Hebert JL. From the outside in: Using public health data to make inferences about older inmates. Crime & Delinquency. 1997;43(3):298–313.
26 Stojkovic S. Elderly prisoners: A growing and forgotten group within correctional systems vulnerable to elder abuse. Journal of Elder Abuse & Neglect. 2007;19(3–4):97–117.
27 Fazel S, Hope T, O’Donnell I, Jacoby R. Unmet treatment needs of older prisoners: A primary care survey. Age and Ageing. 2004;33(4):396–98.
28 Travis J, Petersilia J. Reentry reconsidered: A new look at an old question. NCCD News. 2001;47(3):291–313.
29 Turney K. Stress proliferation across generations? Examining the relationship between parental incarceration and childhood health. Journal of Health and Social Behavior. 2014;55(3):302–19.
30 Murphey D, Cooper PM. Parents behind bars: What happens to their children? Washington, DC: Child Trends; 2015.
31 Wildeman C. Parental incarceration, child homelessness, and the invisible consequences of mass imprisonment. The ANNALS of the American Academy of Political and Social Science. 2014;651(1):74–96.
32 Geller A, Cooper CE, Garfinkel I, Schwartz-Soicher O, Mincy RB. Beyond absenteeism: Father incarceration and child development. Demography. 2012;49(1):49–76.
33 Freudenberg N. Jails, prisons, and the health of urban populations: A review of the impact of the correctional system on community health. Journal of Urban Health. 2001;78(2):214–35. doi: 10.1093/jurban/78.2.214
34 Awofeso N. Prisons as social determinants of hepatitis C virus and tuberculosis infections. Public Health Reports. 2010;125 Suppl 4:25–33.
35 Langan PA, Levin DJ. Recidivism of prisoners released in 1994. Federal Sentencing Reporter. 2002;15(1):58–65.
36 Moore LD, Elkavich A. Who’s using and who’s doing time: Incarceration, the war on drugs, and public health. American Journal of Public Health. 2008;98(5):782–86.
37 Chin GJ. Race, the war on drugs, and the collateral consequences of criminal conviction. Journal of Gender, Race & Justice. 2011;6:255–78.
38 McDaniel M, Simms MC, Monson W, Fortuny K. Imprisonment and disenfranchisement of disconnected low-income men. Washington, DC: Urban Institute; 2013.
39 Chung J. Felony disenfranchisement: A primer. Washington, DC: The Sentencing Project; 2013.
40 Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, et al. Release from prison—a high risk of death for former inmates. New England Journal of Medicine. 2007;356(2):157–65.
41 Seaman SR, Brettle RP, Gore SM. Mortality from overdose among injecting drug users recently released from prison: database linkage study. BMJ. 1998;316(7129):426–28.
42 Spaulding AC, Seals RM, McCallum VA, Perez SD, Brzozowski AK, Steenland NK. Prisoner survival inside and outside of the institution: implications for health-care planning. American Journal of Epidemiology. 2011;173(5):479–87.
43 Pratt D, Appleby L, Webb R, Shaw J. Suicide in recently released prisoners: A population-based cohort study. Lancet. 2006;368(9530):119–23.