Incarceration, Reentry and Disparities in Health: What are

the connections?

Nicholas FreudenbergHunter College, May 5, 2006

Presented at the Prisoner Reentry Institute’s

Occasional Series on Reentry Research

Overview Do incarceration and reentry policies in US

contribute to disparities in health between socioeconomic and racial/ethnic groups?

What are the pathways by which incarceration and reentry influence health?

What changes in incarceration and reentry policies can improve population health and reduce disparities in health?

Racial/ethnic disparities in health

Disparities in Criminal Justice Involvement

Blacks more likely than whites to be: Arrested Incarcerated Released under continuing

supervision Given longer sentences Reincarcerated

Lifetime Likelihood of Serving a State or Federal Prison Sentence for Males Born in 1974 and 2001, by Race and Ethnicity

2,2%

13,4%

4,0%

5,9%

32,2%

17,2%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

35,0%

Non-Hispanic White Non-Hispanic Black Hispanic

Life

time

Like

lihoo

d of

Goi

ng to

Pri

son

1974

2001

So what’s the connection between disparities in health and incarceration?

Model 1 Model 2

Poverty, inequality and

racism

Poorhealth

Incarceration

Poverty, inequality and racism

Incarceration

Poor health

So what’s the connection between disparities in health and incarceration?

Model 3

Poverty, inequality and racism

Poorhealth

Incarceration

What are the pathways by which incarceration contributes to disparities?

1. Exposure to unhealthy jail/prison environment

2. Incarceration as stigma3. Revolving door contributes to

community disorganization4. Missed opportunities for intervention5. Diversion of resources from other

social problems

1. Exposure to unhealthy jail/prison environments

Crowding contributes to transmission of infectious diseases

Jails as schools for crime Jails as site of risky behavior Jails as generators of violence Jails as amplifiers of coercive masculinity Jails as source of social stress

Risk Behavior on Entry and During Incarceration, USA

IDU MSM

On Entry 25% - 40% 0% - 7%

During Incarceration

12% 33%

Correctional Facilities Concentrate People with Infectious Diseases

Condition Releasees with condition in 1997 as % of total in US with condition

HIV infection 22.2-31.3%

Hepatitis C 29.4-43.2%

Tuberculosis 39.6%

Source: Hammett et al, 2002.

Incarceration as stigma

Increased isolation post-release Reduced opportunities for employment Reduced opportunities for education Alienation from family and friends Loss of benefits such as Medicaid, public

assistance, public housing

Revolving door between prison and community contributes to community disorganization

Cycle disrupts family life and parenting Contributes to housing, employment and

educational instability, key anchors for communities

Impact most severe on high incarceration communities

“Churning” reduces social cohesion, thus diminishing community capacity to respond to threats to health

Missed opportunities for intervention... a public health disaster

Failure to screen, treat and refer for infectious diseases, psychiatric problems, substance use and chronic conditions respresents lost opportunity for improving health of most vulnerable populations.

Diversion of resources from other problems

New York City and State spend $250 million per year to incarcerate Harlem residents. Could this money be spent to achieve better outcomes?

In NYC, it costs $92,500 to jail one person for one year.

Many states are facing fiscal crises as a result of increasing expenditures for corrections and Medicaid.

What strategies can reduce adverse health impact of incarceration and reentry?

Strategy 1: Reduce number of people going to jail.

Strategy 2: Ensure that every person leaves jail or prison in better health than when he or she entered.

Strategy 3: Reduce stigma of incarceration; end punishment at jail gate.

Strategy 1: Reduce number of people going to jail

Expand and improve alternatives to incarceration.

Divert people with mental illness and substance abuse problems into treatment.

Reduce school dropout rates. Restructure probation and parole to

reduce revocations. Rethink goals of policing.

Strategy 2: Ensure that every person leaves jail or prison in better health than when he or she entered.

Restructure health services in jail to emphasize chronic disease management, health promotion, and resolution of acute problems.

Establish working system for electronic medical records to share information.

Re-establish full range of drug treatment services in jail.

Shift resources into reentry services. Connect people to Medicaid. Fund health centers in high incarceration

communities to serve those returning.

Strategy 3: Reduce stigma of incarceration; end punishment at jail gate.

Bar employment discrimination based on incarceration status absent direct evidence of harm.

Public campaigns to encourage positive support for people returning from incarceration.

Public dialogue on how best to improve public safety, protect community health and use tax payer dollars efficiently