The incarceration rate in the United States (698 per 100,000 people) is higher than any other large country in the world, and nearly five times higher than the median worldwide. There are about 2 million incarcerated adults, or nearly 1 in 100 Americans. Meanwhile another nearly 5 million people are on probation or parole, for a total of 7 million adults—about 1 in 35 US residents—under correctional supervision.
The chorus of voices showing us how deeply flawed, broken perhaps, our justice system is has grown too loud to ignore. The criminal justice system perpetuates racial inequities in the country that continue centuries of disenfranchisement of minorities. African Americans make up 13 percent of Americans but 40 percent of the incarcerated population. Structural racism, from arrests through sentencing, characterizes the criminal justice system. A for-profit bail bond system means that low-level charges can trap lower income families in a cycle of incarceration that can bankrupt them, destroy families, and deepen class and attendant health divides.
Why does this matter to the public’s health? First of all, jail and prison are profoundly unhealthy environments. Disability-adjusted life years lost linked to incarceration is over double that attributed to other conditions commonly experienced in the general population. Although prisoners are the only US citizens with a constitutional right to health care, they often face delays in access to care, restrictive medication formularies, a lack of acute care options, and understaffing of specialty care medical providers, particularly in the areas of mental health and addiction treatment.
But well beyond this, the health effects of our justice system extend into all reaches of the population. Mother’s incarceration, for example, is associated with a 30 percent increase in infant mortality rate, with a stronger effect among Blacks than Whites. Residents of neighborhoods with high incarceration rates have a two- to threefold increase in rates of depression and anxiety. This likely reflects a combination of the social strain of incarceration among families and a confluence of adverse social circumstances that contributed to incarceration in the first place, compounding the challenges faced by residents of these communities. There is little question that we are consistently underestimating how deeply incarceration influences health.
While a justice system is undoubtedly necessary for social order and safety, a broken justice system compromises the health of the public and deepens the unfairness that characterizes racial health inequities in the country.
Warmly,
Michael Stein & Sandro Galea