Incarceration as a Social Determinant of Health

Adding to Rajiv's discussion of Prop 47...A new report published in the Annals of Internal Medicine draws attention to incarceration and its role as a social determinant of health.

Once released, former prisoners often find themselves locked into a cycle of poverty and poor health. Many states prohibit former inmates from enrolling in important anti-poverty programs. These restrictions often include bans on receiving food stamps and certain types of student financial aid. Additionally, many states ban individuals with prior drug convictions from public housing. Consequently, former prisoners suffer higher rates of uninsurance and homelessness and often lack access to non-emergency healthcare.

Incarceration also affects the health and wellbeing of prisoner’s family members. In addition to the increased stress that arises from a family member’s incarceration, jailed parents can no longer contribute to their family’s income. The negative impact of parental incarceration in children has been well documented. Children of inmates suffer increased rates of anti-social behavior, academic problems, and substance abuse.

Given that the U.S. has the highest rate of incarceration in the world, we need to pay attention to the health disparities created and exacerbated by imprisonment. Allen and his colleagues argue that, “physicians should join ongoing efforts to end policies banning former prisoners from the antipoverty programs designed to promote citizenship, productive participation in society, and along the way, health.” I wholeheartedly agree. 

We also need to recognize that many individuals face incarceration as a result of untreated diseases like mental illness and addiction. For these individuals, incarceration without medical intervention and follow-up will not increase public safety.  

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