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Markkula Center for Applied Ethics

The Impact of Mass Incarceration on Health Outcomes

Inmates lined up at an Alabama prison

Inmates lined up at an Alabama prison

Nicole McInerney

Brynn Anderson/AP Photo

Nicole McInerney is a senior majoring in biology, minoring in economics and a 2020-21 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.

While only one in 17 white men will be incarcerated during his lifetime, one in three Black men face the same reality. This racial disparity is even more startling if you consider that America’s incarceration rate is the highest in the world and is home to 20% of the world’s prison population. In 2018, Black people made up only 12% of the American population, yet 33% of U.S. prisoners. African Americans are being disproportionately affected by a criminal justice system that allows private prisons and bail bond companies to prioritize profits over the lives of actual people.

It would be false, and even dangerous, to believe that the root of these disparities can be explained by anything other than racism. Having so many Black Americans in prison exacerbates the racial disparity in health outcomes between minorities and white Americans, and also devastates the health and wellness of Black communities. Mass incarceration is a public health crisis and should be given the attention and resources necessary to confront the problem.

The racist origins of mass incarceration in the United States can be cited back to the 1700s with the creation of the slave patrols to catch and punish runaway slaves. In 1865, despite the end of the Civil War and the enactment of the 13th amendment, strict policing of Black people continued through enforcement of Black Codes, which were laws that limited former slaves from accessing basic rights and freedoms. These policies were soon replaced by Jim Crow laws which lasted until the end of the 1960s. In 1971, Richard Nixon established the War on Drugs, a racially motivated initiative, which quadrupled the incarceration rate by 1996 and disproportionately imprisoned Black people. To this day, Black communities still face aggressive over-policing through stop-and-frisk policies, invasive police surveillance technologies, and many other forms.    

Incarceration is linked to adverse health effects that extend far beyond prison cells. Compared to the general population, individuals who have been incarcerated face higher rates of mental illness, substance use disorder, communicable disease, and chronic disease. Many inmates are likely to leave prison with medical problems that they did not have before their incarceration, including HIV, diabetes, hypertension, and asthma. These long-term health consequences can be attributed to living in unhealthy prison facilities with poor ventilation, solitary confinement, low-quality healthcare, and scarce medical resources.

After their release, individuals re-enter society and experience limited access to jobs, education, affordable housing, and familial support. Additionally, individuals with criminal records face stigmatization and discrimination that can lead to social exclusion. Good health requires a support system and opportunities for gainful employment, which our society does not provide for former inmates. They are thrown back into society with a criminal record to face the same structural racism that may have led to their incarceration in the first place, and expected to survive with little to no outside help. We can see the ultimate effect on those who have been incarcerated through lower life expectancies, with each year in prison taking off approximately two years of life.

In addition to harming the health of prisoners, incarceration also impacts their families, as well as entire communities. Studies show that children with incarcerated parents are more likely to develop learning disabilities, behavioral issues, and anxiety. They are also burdened by limited social and economic opportunities, which ultimately reduces their ability to lead healthy lives. With each person lost to the prison system, communities are harmed by the loss of work, a smaller tax base, and a weaker voting bloc. Economic development is curtailed and, at a broader level, the political power of minority communities is diminished. This contributes to the continuance of inequitable practices and undemocratic policies that do not serve people of color.

Our society values fairness, yet our criminal justice system has continued to disproportionately compromise the health of Black people for the last 300 years. We should recognize that our country’s policing not only punishes the people who are accused of breaking the law, but entire families and communities. We cannot live in a just society if we do not ensure health equity for every individual, whether they have criminal records or not. Neglect for the health of prisoners is particularly evident during the COVID-19 pandemic. Even though prisons are largely overcrowded and inmates are unable to take measures to socially distance or adequately protect themselves from being infected, many people in power oppose the allocation of the vaccine to this vulnerable population. Ultimately, this stance reflects our societal perception of prisoners: that they are all criminals who deserve to be behind bars, when the truth is that too many were targeted because they are Black, poor, or both. Just because individuals are in prison does not mean they do not deserve basic human rights that ensure good health.

The empirical evidence in health outcomes for incarcerated people demonstrates that mass incarceration is threatening health equity. How can healthcare providers effectively improve the health of patients who are cycling in and out of the prison system? How can doctors and nurses truly serve and protect the welfare of Black patients knowing that there are overarching forces that harm them? It is easy to overlook the connections between the origins of policing, mass incarceration, and current racial disparities in health outcomes; each of these subjects is complex on its  own. In order to confront these issues, we must call mass incarceration what research and data say it is: a public health crisis.

Mar 8, 2021

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