Congress Has a Chance to Consider How Incarceration is Harmful — Will They?

By Evie Lopoo, Project Manager for the Square One Project, Tyler Harvey, Program Administrator at SEICHE Center for Health and Justice, and Emily Wang, Professor at Yale School of Medicine

Decades of research show that a person’s surroundings — including access to quality food, good schools, a steady income, and affordable housing — affect health. Professionals call these factors social determinants of health.

After years of advocacy, a newly convened Congressional Social Determinants of Health (SDOH) Caucus will work to meaningfully integrate social determinants of health, including “food, housing, transportation, and other important drivers of health,” into federal investments in health and healthcare.

This is good news but the Caucus leaves out one of the biggest drivers of health: mass incarceration and the harm it imposes on men, women and children as well as neighborhoods.

The United States incarcerates more people than any other nation in the world; if the United States prison population were a city, it would be fifth-largest, ranking slightly below Houston. Nearly one in two Americans have experienced the incarceration of an immediate family member or relative.

And, as you might expect, the cumulative effects of mass incarceration are felt most profoundly by people who are poor or identify as Black or Latinx. One in three Black men will be imprisoned during their lifetime (white men have a one in 17 lifetime likelihood) and Black people are 50% more likely to have a family member incarcerated than white people.

A personal history of incarceration has serious health consequences, including the shortening of a person’s lifespan.

• A 2015 study found that each year of imprisonment corresponds to a two-year life expectancy reduction.
• Incarcerated individuals are more likely to experience a range of health conditions, including high blood pressure, hepatitis C, and opioid use disorder, compared to those never incarcerated.
• Following incarceration, individuals are at high risk of mortality, particularly from drug overdose and heart disease.
• Working in carceral systems also presents a high risk to health. According to the National Institute of Justice, the mean life span of a correctional officer is 59 years.

Incarceration affects not just people who live and work in prisons but entire families and communities. Having a parent imprisoned is linked to numerous health conditions and poor life outcomes that persist through adulthood. Simply having a family member ever incarcerated lowers life expectancy by two years. High neighborhood incarceration rates even affect life expectancy and mental and physical health of those not systems-impacted, as well as community-wide labor markets and political and economic infrastructures.

The Congressional SDOH Caucus needs to acknowledge incarceration as a core driver of health and integrate targeting the harms of incarceration into federal investments in health and healthcare.

To start, incarceration could be a social need targeted for action through the Center of Medicare & Medicaid Innovation’s Accountable Health Communities. People who work and live in jails and prisons can be considered a “disparity population” by the National Institute of Health to encourage more funding of formerly incarcerated researchers and more thoughtful research targeting mass incarceration.

As part of these efforts, Congress must urge and incentivize greater collaboration between community healthcare systems and our nation’s 5,000 plus jails and prisons. The COVID-19 pandemic has revealed again that prisons and jails are hotspots of infectious disease outbreaks and that the silos between these two systems weaken our nation’s ability to manage pandemics.

Creating a federal infrastructure that oversees the health of incarcerated people within the Centers for Disease Control and enabling state Medicaid programs to use funds to care for incarcerated people are critical, especially during this pandemic. As part of any government effort, prioritization of directly-impacted voices is required. Alleviating the harms of incarceration will require solutions and community strategies that have been informed by those with lived experience.

It’s been fifty years since the era of mass incarceration began. By ignoring incarceration, one of the largest social and economic forces dictating health the new Caucus would fail to provide effective care for the millions of Americans whose lives have been impacted by mass incarceration.

Congress must act now by acknowledging incarceration as a social determinant of health and adding incarceration to the new Caucus’s agenda would be an important first step.