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Mass Incarceration is Making Us Sick

by Sandro Galea, MD, MPH, DrPH
June 5, 2018

Sandro Galea is a professor and Dean of Boston University School of Public Health. His book, Healthier: Fifty thoughts on the foundations of population health, was published in June 2017. Follow him on Twitter: @sandrogalea.

Ours is a culture of incarceration. There are currently about 2.2 million people locked up in the US. Our incarceration rate is higher than any other country in the world; despite being only about five percent of the world’s population, Americans comprise 21 percent of the world’s prisoners.

One in every 37 American adults is under some manner of correctional supervision.

Our astronomical rates of imprisonment, and the extent to which they disproportionately affect populations of color, have rightly made mass incarceration not just a legal issue, but a moral one. Less talked-about, however, is its status as a threat to health, not only the health of those incarcerated, but all our health.

Mass incarceration undermines health on multiple levels, harming individuals, families, and communities. This harm is felt most keenly by the incarcerated themselves. Prisons represent a dangerous convergence of threats to physical and mental health. The cramped environment of prisons, and the unprotected sex and injection drug use that occurs within them, can increase the risk of exposure to diseases like TB, viral hepatitis, and HIV. At the same time, reviews of the evidence suggest that rates of mental illness are higher in prisons, with many people who might once have been institutionalized diverted into a system that is not designed to cope with their mental health needs.

Heightening disease risk is not the only way incarceration undermines quality of life for those it affects. Upon release, many former prisoners are denied access to basic civic resources like housingsocial welfare benefits, and even, in some states, the right to vote. By excluding these people from the resources necessary for smooth reentry into society, we make them vulnerable to the poor health that comes from a lifetime of marginalization and economic hardship.

As much as incarceration harms the health of those who live behind bars, it also undermines the health of the families they leave behind.

About 2.7 million American children have an incarcerated parent. The problem touches so many kids that, in recent years, Sesame Street introduced a character with an incarcerated parent, to teach children strategies for coping with this difficult reality.

What are the effects of incarceration on families? According to Pew Research Center data, more than two-thirds of incarcerated men were employed before serving their sentence, and about half had lived with their kids before going to prison. Over half of imprisoned parents were the main earners supporting their children. When these breadwinners are removed from the household, the wage-earning burden falls on the remaining parent, with all the challenges that come with this responsibility, including having less time to spend with the child. It is worth noting that these problems do not always disappear when the incarcerated parent returns. Incarceration reduces earning power, keeping the financial pressure on families indefinitely.

Finally, incarceration can make entire communities sicker. In 2015, I worked on a study that found that people who live in neighborhoods with a high rate of incarceration are likelier to meet the criteria for a major depressive disorder than those who live in a neighborhood with a lower rate. Evidence also suggests that incarceration may increase rates of violence and infectious disease within communities.    

For all the distinct health hazards associated with incarceration, its capacity for causing harm is even greater than the sum of its parts. The "prison-industrial complex” has turned incarceration into a kind of contagion, spreading physical hazard, mental distress, and social breakdown within communities and within prisons themselves.

The “cure” would be, of course, to dismantle the socioeconomic incentives that have allowed this system to flourish.

In the short-term, however, we need to rethink the legal structures that perpetuate it; in particular, the mandatory minimum sentences that have sent so many nonviolent drug offenders to prison and fueled incarceration rates to such an extraordinary degree. This is especially critical as the Trump administration mulls increasingly punitive approaches to solving the opioid crisis, including strict enforcement of drug laws, and even the execution of drug dealers.

At core, we are faced with a simple choice. We can choose to view our criminal justice system as merely a means of punishment or as a first step on the road to rehabilitation. If we choose to discard the incarcerated, keeping them out of sight and, as much as possible, out of mind, their health, and ours, will continue to suffer. If, on the other hand, we choose to empathize with the incarcerated, and work toward making them once again fully productive members of society, we can create a system that is indeed truly corrective, and a society that is far healthier.