Minji Jung

B H 456
December 18, 2015
Ad Hoc Project
This project aims to examine what impact mass incarceration has on the health of communities. As
more recent literature has been studying incarceration and its consequences on health, it is becoming
clearer that health impacts are not isolated to a person in prison alone, but rather, incarceration has
profound effects on the health of inmates even after release and on their families and larger communities.
This literary matrix serves to gather a slice of the related literature in order to help frame how health
impacts of mass incarceration cascades through spheres of influencestarting from the individual, to
family, and then community level. Highlighting these common themes within the literature can help shed
light on the ensuing implications for public health action and research.
Before delving into this matrix, some background information can provide a framework for
understanding mass incarceration in todays context. Beginning in the 1970s, the prison population rapidly
increased and changed compositionally, and by 2005, the number of prisoners in the US had nearly tripled
from 20 years ago (Cho, 2009). An even more disconcerting pattern appeared in who was doing time; the
proportion of blacks in prison skyrocketed from 21% in 1926 to 44% in 1986, even while the proportion of
blacks in the US increased only marginally by 4% (Dumont, Allen, Brockmann, Alexander, & Rich, 2013).
Furthermore, findings reveal that incarceration is not distributed evenly but highly concentrated in urban
areas with poor people and people of color (Freudenberg, 2001). This unprecedented prison boom and
dramatic changes in the prison composition cannot be explained by individual faults or ethical missteps
alone. From the 1970s, the federal government embraced a new attitude towards the justice system,
boasting a new tough-on-crime discourse (Dumont et al., 2013). Local police forces were induced to
pursue more drug crimes, fueled by cash grants that rewarded more drug arrests and greater freedom to
exercise power, courtesy of the federal government (Dumont et al., 2013). This War on Drugs, combined
with harsher sentences, shutting down of mental health institutions, and a criminal justice approach that
emphasizes punishment rather than remediation have all contributed to a sociopolitical context which
produces webs of inequality and disadvantage especially for people of color and low socio-economic
status. Modern incarceration operates under highly racialized policies in order to achieve a model of social
control reminiscent of the intimidation and injustice of the Jim Crow era (Alexander, 2010). The efforts of
mass incarceration, to criminalize behaviors proclaimed deviant in society, produce a population-level
disenfranchisement that generate robust consequences in health not only for the incarcerated individual,
but the surrounding communities as well (Treadwell, Ortiz, & McCoy, 2014).

Author,
year &
title

Dumont,
Dora M.,
Allen, Scott
A.,
Brockmann,
Bradley W.,
Alexander,
Nicole E.,
Rich, Josiah
D.

Key Point or
Purpose
Hyperincarcer
ation can be
used to better
describe
modern
incarceration
because of its
concentration
in low-income
areas.

2013
Incarcerati
on,
Community
Health, and
Racial
Disparities

Rich, Josiah
D.,
Cortina,
Sandra C.,
Uvin, Zoe
X.,
Dumont,

The Affordable
Care Act gives
an opportunity
to help
incarcerated
population,
their partners,
and families for
better health
outcomes.

Determinant
s of
Incarceratio
n
Lack of
community
healthcare is a
determinant of
incarceration.
Mental health/
illness, now
the largest
institutions
that house the
mentally ill are
prisons.
People
dependent or
addiction to
substances,
war on drugs.

Inmate health
impact
Prison may be
beneficial for
inmates, specifically
black mens, health.
Evidence of more
equitable and less
racial disparities of
mortality in the
prison population vs.
general population.
Infectious diseases,
especially HIV and
Hep C are at much
elevated prevalence
in prison than in
general public. Right
after release (2
weeks) much higher
chance of dying.
Healthcare delivery
systems vary, little
is known about the
quality and extent of
care.
Mental illness and
addiction observed
at higher rates for
incarcerated women
than incarcerated
men.

Family &
Children health
impact

Women with
incarcerated male
partners have
much higher risk of
HIV and STI
infection. Families
may be at risk of
poverty and
homelessness.

Community health
(& social capital)
impact

Public Health
Implications

Th

Imprisoning (most
often men) disrupts
stable relationships
and male:female
ratio, creates social
structure that
promotes STIs.
Perpetuates health
disparities because
most inmates are
black/latino, and
after prison
homelessness,
barriers to
education,
employment, and
HC. Incarceration,
instead of
preventing crime,
may actually make it
more likely after a
certain threshold.

Even though
correctional
facilities provide
prime opportunity
to address
disadvantaged
groups (black,
underserved
population), using
prisons as a health
solution is
problematic.
Overall,
incarceration
worsens disparities.

Dis
in
pri
he

Partners of
prisoners are a
vulnerable
population.
Exposure to
incarceration can
have health risks.

Par
pri

Dora M.
2013
Women,
Incarceratio
n, and
Health.

Kruger,
Daniel J., De
Loney, E
Hill.
2009
The
association
of
incarceratio
n with
community
health and
racial
health
disparities.

Freudenber
g, Nicolas.
2001
Jails,
prisons, and
the health
of urban
populations:
a review of
the impact
of the

Communitybased public
health survey
to address how
incarceration
may have
health
consequences
for those
connected to
incarcerated
individual.

Incarcerated
persons are
burdened with
disproportionat
e morbidity,
including
poorer
outcomes in
infectious
diseases,
mental health,
and safety.
Incarceration
has robust
effects on

Policies that
mandate
minimum
sentences, the
deinstitutionali
zation of
mental illness,
and the higher
concentrations
of poverty and
people of color
in urban areas
all contribute
to mass
incarceration.

Short term: Though

prisons provide
educational, mental
health, and
substance abuse
services, few
inmates actually
receive services.
Though about 75%
inmates need drug
treatment, less than
20% receive it, and
is often not very
intensive programs.
Higher chance of

Those who knew

someone
incarcerated
reported worse
mental and
physical health,
and more stress
and depressive
symptoms. Those
who were closer
and more
proximate to the
person in prison,
such as family
members, had
even worse
outcomes.

Blacks are more

likely to know
someone in prison
and be closer to that
person than whites.

Research in the
future should focus
on the relationship
between
community health
and incarceration,
and identify risk
and protective
factors between
these two.

Co
he
soc
pro
inc
n

Short term:
Incarceration may
lead to family
disruption,
separation/breaku
p, and children in
foster care. The
family is also at
higher risk of
becoming
homeless or
economically
unstable.
Long term:
Children with

Rehabilitation to
prepare inmates for
release addresses
individual needs and
health, but also the
success of
community
reintegration.
Incarceration may
reduce overall
unemployment by
reducing the
applicant pool, but
produces severe
inequalities of

Alternatives to
incarceration such
as drug or
community courts
differ from the
traditional justice
system by working
more closely with
service and
treatment centers,
and bringing more
awareness of
restorative justice
on a public safety
level rather than

Pri
he
com
he
pu
he
act

correctional
system on
community
health.

Wildeman,
Christopher

Lee, Hedwig

Comfort,
Megan.
2013

family and
community
health as well,
and public
health must
address
incarcerations
impact on
disadvantaged,
urban
communities
especially.

Lack of
education
programs, job
skills
programs, and
community
reentry
services
contribute to
recidivism and
inmates
returning to
the prison
system.

infectious disease
transmission in
prisons. Assaults and
violence in juvenile
correctional facilities
are increasing.
Suicide is much
higher in prisons,
leading cause of
death in prisons.
Long term: Less
knowledge on
prevalence of
chronic disease
among inmates.

incarcerated
parents are at
higher risk of
entering prison
themselves. Also,
the absence of a
parent, largely a
father figure, may
hinder childs
ability to be a
successful parent
later on.

Women with a
partner in
prison or
released from
prison are an
invisible group
that havent
been
considered
much in
research. This
study examines
the broader
health status of

Those who
were put into
foster care or
were
homeless as a
child or youth
had higher
rates of being
incarcerated
later on.

Nearly half of all

recently released
prisoners in this
study did not have
health insurance.
Females with
partners recently
released from prison
who also had a
history of
incarceration or jail
time face an added
burden of not only
the poorer health

Having a sexual
partner that is in
prison or recently
released increases
a womans risk for
contracting
infectious diseases
including HIV. More
broadly, however,
women with
partners in prison
exhibited as least
as poor health in
nearly every

employment in
disadvantaged
neighborhoods. But
the release of many
inmates in a certain
area may lead to
neighborhood
instability and
increased social
isolation, which are
factors that both
contribute to
increased crime in a
community.
Furthermore, many
states
disenfranchise
inmates, preventing
political voice and
participation. At a
certain proportion of
community
members behind
bars, prison culture
can spillover and
become normative
culture, which may
reduce the effect of
prison as a deterrent
for crime.

just punishment.
Also role of
probation and
parole to facilitate
successful inmate
reentry into
community. State
and federal
governments divert
funds from
education and other
public services to
the correctional
system, and overall
spend more on
correctional
services than public
health. Community
reentry for released
inmates should be
emphasized to
highlight healthier
access and choices
and reduce
recidivism.

Public health should

recognize and
target female
partners of
prisoners recently
released prisoners
as a vulnerable
population subject
to considerable
weathering on
their overall mental
and physical health.
This study
recognized the

Par
pri
an
rec
rel
pri

A New
Vulnerable
Population?
The Health
of Female
Partners of
Men
Recently
Released
from Prison

Schnittker,
Jason

John,
Andrea
2014
Enduring
stigma: the
long-term
effects of
incarceratio

female
partners of
recently
incarcerated
males.

associated with
prison, but also the
stress and social
effects of a partner
in prison. Female
partners health
outcomes are
stratified by the
extent of contact
and involvement
with the correctional
facilities.

outcome
measured. The
upshot of these
findings is that
female partners
are not solely
vulnerable in
terms of infectious
disease or sexual
health, but also in
the broader
context of mental
and physical
health.

If the link
between
incarceration
and health is
qualified by
stigma, then
the
mechanisms of
such a
relationship
occurs at
multiple levels
in an
interactive and
cumulative

Short term:
Incarceration may
have a positive
impact on health of
inmates by providing
screenings and
treatment.
Long term: Official
sanctions, such as
denying felons the
right to vote, some
bans on welfare for
those with a drug
conviction, and
housing policies that

Incarceration may
affect social
integration in
context of families.
Many marriages
may not last
because of the
effects of losing
cohabitation and
little
communication.
Incarceration can
also elicit feelings
of shame and
anger in family

The extent or
amount of contact
with prison is less
important than
having any contact
at all. On a
community level,
the large number of
short-sentences can
exert a widespread,
population-level
impact. Also, in
some neighborhoods
where incarceration
is a more common

Affordable Care Act

as a opportune way
to direct more
attention, funding,
and research to
help mediate and
prevent adverse
health
consequences to
this group. Health
care practices, in
addition, should
screen for intimate
contact with a
partner in prison
likened to how
domestic-abuse,
and homelessness
status are routinely
screened. A
continuum of highquality care,
especially during
the transition of
prison to the
community, is vital
to prisoners and
their partners
future health.
Public health should
recognize the
central role that
stigma plays in
affecting former
inmates health and
also family and
community health.

Sti
str
pro

n on
health.

Treadwell,
Henrie M
Ortiz, Kasim
S
McCoy,
James R
2014
Miles to
go: the
prison
expressway
, health
research,
and health
activism.

way.
Incarceration
has powerful
health
implications
especially
when it imparts
stigma, but this
effect is only
seen after
release.

Mass
incarceration is
a detriment to
those who are
incarcerated,
but also a risk
to the health of
all in the US.
The prison
expressway
better captures
the need to
address social
inequalities
and also the
life trajectory
of African
Americans and
Latinos as
compared to
other schoolto-prison
pipelines.

may discriminate
former prisoners, all
have enormous longterm effects on
health. Stigma
attached to
incarceration places
a long-term burden
of stress and
lowered status on
inmates, even far
after their release.
Lack of true
opportunity
and full access
excludes
some,
especially
males of color,
and pushes
them into the
prison
expressway.
This pathway
is marked with
disadvantage
and
accumulates
harms to
health.
Education,
criminal
justice reform,
media,
economic
security,
health, and
community
and family all
play a key role
in producing
(and

members, and
distrust in friend
relationships.
Children of
prisoners not only
experience trauma
from the absence
of a parent, but
also stress from
trying to escape
from the stigma
now attached to
their parent.

experience, prison
may have a more
positive connotation,
undermining the
deterrent value of
the prison system.
Utilizing prisons too
heavily instead of
more informal
methods of social
control that can help
prevent crime and
violence in a
community.
Mass incarceration
has consequences
for health beyond
just health status,
including education,
employment
opportunities, civic
and political
engagement, family
disruption, and
community
disruption. Mass
incarceration
impacts each of
these spheres of life,
particularly in
already marginalized
communities.
Neighborhoods with
increased police
contact can lead to
greater
stigmatization of
those communities.

Public health
research and
literature must
address the often
invisible groups and
communities
affected by mass
incarceration.
Furthermore, racial
equality and health
equity should be
emphasized in
order to address
the fundamental
causes of
disparities in
incarceration. Public
health should also
actively pursue
health activism,
which is
operationalized as
grassroots efforts
for restorative
justice or collective
action of the
community,
organizations, and
policy stakeholders,
under the guiding

Pri
exp
,h
act
an
com
ba
res

Golembeski,
Cynthia

Fullilove,
Robert
2005
Criminal
(in)justice in
the city and
its
associated
health
consequenc
es

Murray,

The prison
system and
community
reentry process
for former
prisoners
needs to be
reformed in
major ways.
Approaches to
reform should
center on the
community and
the role
neighborhoods
play in
producing,
preventing,
and absorbing
incarceration.
With a focus
increasing
collective
efficacy of
neighborhoods,
improving
health of
individuals and
communities is
more of a
reality.

Children of
prisoners can

remediating)
the harms due
to mass
incarceration.
Dramatic
increase in
prison
population is
primarily due
to harsher
sentences,
approaching
crime with a
more punitive
focus, and the
privatization
of prison
services and
industry.

efforts of
community-based
research.
Short term: Often
times, high rates of
infectious disease in
prisons are caused
by overcrowding and
lack of quality
medical care and
proper ventilation.
Though females are
in prison at
considerably lower
rates, they are at a
significantly higher
risk of poor health
and disease
morbidity.
Long term: Harsh
environment of
prison affects
inmates emotionally
and exacerbates
existing mental
health issues.
Criminal sanctions
restrict the rights of
citizenship. Some
lawful permanent
residents convicted
of a felony can even
be deported. In
addition, federal
benefits like welfare,
student loans, public
housing, and food
stamps are all
compromised for
those incarcerated.

Inmates are often

transported to
remote locations,
which displace
typically urban
populations into
largely white,
suburban areas. This
shifts the national
census and
consequently diverts
the resources and
voice from urban
communities most
affected by mass
incarceration to
more affluent,
nonurban
communities. Losing
residents to prisons
deprives those
communities of
potential funding
and political
representation,
placing another
layer of burden on
those communities.

Parental
incarceration is a

Mass incarceration
has collateral effects

When communities
are neglected and
fail to maintain a
safe, clean
environment
(measured by
number of broken
windows that dont
get repaired), they
are more likely to
have greater rates
of poor health
outcomes and
crime. Public health
must focus on
creating and
sustaining public
cleanliness and
safety to better
community health.
Collective efficacy
offers a model for
community
members to
identity and solve
problems in the
neighborhood, all in
a collaborative way
that includes
released prisoners.
Partnering and
supporting health
clinics, community
organizations, and
service agencies
help reintegrate
former inmates and
boost social capital.
Involving exprisoners in more

Pri
he
com
cen
ap

Par
inc

Joseph

Farrington,
David P.
2008
Effects of
Parental
Imprisonme
nt on
Children

O'Gorman,
Claire M.;
Martin,
Megan
Smith;
Oliffe, John
L.; Leggo,
Carl;

Korchinski,
Mo; Martin,
Ruth
Elwood
2012

be considered
the forgotten
victims of mass
incarceration,
because they
are an
affected, yet
often
overlooked
group.

A health
promotion
project used
participation as
a way to
engage
incarcerated
individuals to
design and test
public health
tools.

strong risk factor

for various adverse
health and
wellbeing
outcomes,
including mental
health problems,
antisocial
behavior, drug
abuse, school
failure, and
unemployment.
These harms may
result from the
trauma of being
separated from a
parent, poverty or
homelessness
caused by parental
imprisonment,
stigma, increased
familial disruption,
and stress over
maintaining a
relationship with
the parent.
Released prisoners
face many barriers
to accessing health
services and
resources. In this
study, people with
incarceration
experience were
engaged from start
to finish in order
develop goals,
scope, and focus on
a health program
that reaches out to
former inmates.
While health of
inmates were not
explicitly discussed,

on the social fabric

of communities.
Stigma not only
applies to individual
prisoners but
communities in
which incarceration
is more
commonplace.

community services
and processes can
help combat the
stigma attached to
their incarceration
history, by
providing the
opportunity for
prisoners to
positively impact
their neighborhood.

n,

Engaging all
stakeholders,
especially the
marginalized voices
of people with
incarceration
histories, fosters a
collaborative
opportunity for endusers to share their
expertise with
public health
workers. In order to
understand health
from the viewpoint
of end-users, in this
case former
prisoners, they

Par
n,
live
exp

Communit
y Voices in
Program
Developme
nt: The
Wisdom of
Individuals
With
Incarceratio
n
Experience

utilizing a process of
participation in this
public health
program shifted the
focus from medicalbased topics to a
more holistic,
biopsychosocial
approach. Valuing
former prisoners
informed the
program to not be
more effective, but
to better reflect the
actual needs and
barriers that former
prisoners face while
also addressing
social determinants
of health.

must be involved as
equal partners in
the entire process,
starting from
research and
planning to
evaluation. In this
study, the public
health investigators
had conceptualized
several diseasecentered topics for
prevention. Those
with lived
experience
contributed
knowledge in topics
that the literature
may be inadequate
or incomplete.

References (from background paragraph)

Alexander, M. (2010). The New Jim Crow. The New Jim Crow, 1, 187222. doi:10.1007/s10611-010-9266-1
Cho, R. M. (2009). Impact of maternal imprisonment on childrens probability of grade retention. Journal of
Urban Economics, 65(1), 1123. doi:10.1016/j.jue.2008.09.004
Dumont, D. M., Allen, S. A., Brockmann, B. W., Alexander, N. E., & Rich, J. D. (2013). Incarceration,
Community Health, and Racial Disparities. Journal of Health Care for the Poor and Underserved, 24(1),
7888. doi:10.1353/hpu.2013.0000
Freudenberg, N. (2001). Jails, prisons, and the health of urban populations: a review of the impact of the
correctional system on community health. Journal of Urban Health: Bulletin of the New York Academy

of Medicine, 78(2), 21435. doi:10.1093/jurban/78.2.214

Treadwell, H. M., Ortiz, K. S., & McCoy, J. R. (2014). Miles to go: the prison expressway, health research, and
health activism. American Journal of Mens Health, 8(6), 44956. doi:10.1177/1557988314542419