post by Bill Gardner
The US imprisons more of its citizens on a per-capita basis than any other country in the world. The Bureau of Justice Statistics reported that in 2008 there were about 1.6 million US prisoners.
Consider incarceration as a health risk exposure, in the epidemiological sense. What are the consequences?
Dora Dumont and her colleagues review the evidence about how this affects the health of the imprisoned, and the rest of us. It was not a surprise to discover that inmates have substantially worse health than age and gender-matched persons who are not incarcerated. They are five times more likely to be HIV+ and nine times more likely to be infected with hepatitis C than the rest of us. They have far higher rates of mental disorders. Many inmates suffer injuries or death from physical or sexual assaults.
What was a surprise is that, despite this,
At first sight, incarceration appears to provide a protective health influence to many of the underserved who enter the criminal justice system, particularly those from violent or homeless backgrounds. However substandard, the system provides shelter and meals; it also enforces supervision and highly-structured routines, a stabilizing force for some. Moreover, several recent studies of inmate mortality rates appear to indicate that the black-white mortality gap shrinks within correctional facilities because black male inmates’ mortality rate is lower than that of the general black male population but white male inmates’ mortality rate is either the same or slightly higher than that of the general white male population (emphasis added).
Think this through. The implication is that the population being incarerated lives under such dangerous circumstances in their communities that they suffer little or no additional risk while they are behind bars. And it's not okay if a preventable health problem is acquired in prison even if the person was equally likely to suffer outside of prison.
More importantly, as the authors note, the apparent 'benefit' of being incarcerated disappears when you include the health effects of imprisonment that manifest themselves following release. The effects of HIV, hepatitis C, other infections, or the chronic stress of confinement will affect former prisoners for their entire lives. I was stunned, however, to learn about the health risks suffered by prisoners in the days immediately following their release:
Each year, more than 600,000 inmates leave prison and more than 7 million leave jail... The weeks following release from a correctional facility present extraordinary risks to releasees and others. Former prisoners are 12 times more likely than the general public to die of any cause in the 2 weeks following release and 129 times more likely to die of a drug overdose. Some of this postrelease mortality is due to “compassionate release” of the dying, but much of it reflects the instability of circumstances in the days following release and the concomitant return to high-risk behaviors.
Again, think this through: It is not just that we are failing to rehabilitate persons in prison, we are setting them up for immediate and catastrophic life failure.
There's lots to do to improve the health care of prisoners (my wife and I have made a small contribution here to the literature on health care for youths in juvenile justice). The most important thing we can do, however, is to find methods to control felons that avoid prolonged incarceration. Read Mark Kleiman's superb When Brute Force Fails: How to Have Less Crime and Less Punishment, for an argument about why and how to do this.
And, Canadians, think very carefully about whether you want to follow US policies of mass incarceration.