Mass Imprisonment and Public Health

When public health authorities talk about an epidemic, they are referring to a disease that can spread rapidly throughout a population, like the flu or tuberculosis.

But researchers are increasingly finding the term useful in understanding another destructive, and distinctly American, phenomenon — mass incarceration. This four-decade binge poses one of the greatest public health challenges of modern times, concludes a new report released last week by the Vera Institute of Justice.

For many obvious reasons, people in prison are among the unhealthiest members of society. Most come from impoverished communities where chronic and infectious diseases, drug abuse and other physical and mental stressors are present at much higher rates than in the general population. Health care in those communities also tends to be poor or nonexistent.

The experience of being locked up — which often involves dangerous overcrowding and inconsistent or inadequate health care — exacerbates these problems, or creates new ones. Worse, the criminal justice system has to absorb more of the mentally ill and the addicted. The collapse of institutional psychiatric care and the surge of punitive drug laws have sent millions of people to prison, where they rarely if ever get the care they need. Severe mental illness is two to four times as common in prison as on the outside, while more than two-thirds of inmates have a substance abuse problem, compared with about 9 percent of the general public.

Common prison-management tactics can also turn even relatively healthy inmates against themselves. Studies have found that people held in solitary confinement are up to seven times more likely than other inmates to harm themselves or attempt suicide.

The report also highlights the “contagious” health effects of incarceration on the already unstable communities most of the 700,000 inmates released each year will return to. When swaths of young, mostly minority men are put behind bars, families are ripped apart, children grow up fatherless, and poverty and homelessness increase. Today 2.7 million children have a parent in prison, which increases their own risk of incarceration down the road.

If this epidemic is going to be stopped, the report finds, public health and criminal justice systems must communicate effectively with one another. That requires comprehensive electronic health records that can be shared among agencies, increasing the likelihood that those who leave prison with health problems will not fall through the cracks.

Better health outcomes also depend on giving newly released inmates a real chance to find jobs and housing. The report calls for the end of laws that keep punishing people after they have been released from prison, like denying public housing and food stamps to those with drug felony convictions.

Finally, the Affordable Care Act — which provides more coverage for mental illness and substance abuse, and expanded Medicaid for childless adults — is a big step in the right direction.

Like any epidemic, mass incarceration must be tackled at many different levels. It is an opportune time for such an approach, as states around the country are thinking more broadly, pulling back on harsh sentencing laws and focusing more on alternatives to incarceration. But the moment may not last long. Public health professionals should seize a unique opportunity to help guide criminal justice reform while they have the chance.

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