The Health Consequences of Incarceration

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The Health Consequences of Incarceration

• Michael Massoglia
• Penn State University

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2 Basic Questions

• Does incarceration affect later physical health?
• Does incarceration explain some of the racial
  disparity in health between whites and nonwhites?

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Mechanisms and Processes

• The correlates of health and crime are similar.
• Macro structures Inequality, poverty,
  residential conditions.
• Shaw and Mckay (1934)
• Life course markers Marriage, educational
  attainment, income
• Individual factors Substance use, risk taking
  behavior

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Spurious Associations

• Lifestyle theories
• Suggests an association may be evident, but a
  function of lifestyle choices (i.e. drug use) and
  therefore spurious
• Personality theories
• Suggests an association may be evident, but a
  function of underlying individual characteristic
  (i.e. risk taking behavior) and therefore spurious

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Linking Health to Incarceration Status

• Social Bonds and the Life Course
• Fractured bonds
• Living Conditions
• Exposure to disease and stress
• Social Hierarchy
• Societal participation and control over life

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Racial Differences In Health

• One of the most persistent findings in the
  literature indicates racial inequalities in
  health
• Whites have better health than minorities across
  almost all indicators of health
• Williams and Collins (1995) conclude that black
  health functioning has worsened over the last 25
  years
• Blacks can expect to live fewer years while at
  the same time living more of their life with
  chronic disease (Hayward 1999)
• Large scale systems of inequality are often used
  to explain these persistent health differences

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Incarceration in the United States

• Significant increase in rates of incarceration
  over the last 25-30 years
• Incarceration a phase in the life course for
  some individuals, particularly poor minorities
  (Pettit and Western 2004)
• Risk of imprisonment Changes from 1979-1999
• Whites (1.4------2.9) Less than HS
  (4.1----11.2)
• Blacks (10.5----20.5) Less than HS (17.1---58.9)

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Incarceration in the United States

• Correctional policies and the emergence of a new
  felon class in society. Estimates indicate
  this new class comprises
• 7.5 percent of the adult population
• 22.3 percent of the black adult population
• 33.4 percent of the black adult male population
• (Uggen et al 2006)

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Prisons and Inequality

• System of inequality?
• Prisons and stratification in the labor market
  and earnings (Western and Beckett 1999 Western
  2002 Pager 2003)
• In the labor market, Pager concluded the mark
  of a criminal record is more detrimental to
  blacks
• Disruption of the marriage market more severe for
  blacks (Staples 1987 Wilson)
• Irwin (1985) underclass of society

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Prisons and Exposure

• National Commission on Correctional Health Care
  report (2002)
• Total HIV/AIDS 151,000-197,000 (20-26)
• Hepatitis B 155,000 (12-16)
• Hepatitis C 1.3-1.4 million (38)
• Tuberculosis outbreaks linked to correctional
  institutions

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Data

• National Longitudinal Survey of Youth (NLSY79)
• A comprehensive health module in the NLSY, given
  to respondents at the age of 40 (N5556)
• Dependent Variable Measure of physical health
  functioning at age 40.
• A composite indicator capturing a range of health
  functioning taken from a widely used health
  questionnaire (SF-12)

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NLSY

• Equally divided between men and women, ages
  40-44, 66 married.
• 20 at or below 125 of poverty level.
• Approximately 75 white, average 13.7 years of
  schooling, 81 in the labor force.
• About 23 report binge drinking (5 drinks at one
  time, 2-3 times a month) or cigarette use.
  Slightly less than half the sample reports weekly
  exercise.
• Slightly more than 5 of the sample was
  incarcerated, disproportionately minority.
  Average time of incarceration about 34 months.

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Basic Associations in Health
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Health Values-Racial Differences
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Two types of analysis

• Regression analysis with covariate adjustment
• Controls for prior health, life course markers,
  and lifestyle indicators
• Propensity models
• Account for differences across persons or groups
  in the likelihood of experiencing a treatment
• Rationale Non-random likelihood of experiencing
  incarceration may bias the results generated from
  OLS

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Propensity Score Models

• Account for differences across persons or groups
  in the likelihood of experiencing a treatment.
• Rationale Non-random likelihood of experiencing
  incarceration may bias the results generated from
  OLS.
• Average effects and standard estimator (Rosenbaum
  and Rubin 1983 Winship and Morgan 1998).
• The way individuals are assigned, or assign
  themselves, to the treatment determines how
  effectively the standard estimator estimates the
  true effect.
• Key assumption Assignment into treatment is
  uncorrelated with outcome.
• Tables.pdf

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Discussion

• Incarceration is a powerful predictor of health
• Suggest incarceration impacts health multiple
  ways
• Disease and stress exposure
• Fractured social bonds
• Social hierarchy and social status
• Contributes to racial inequalities in physical
  health

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Implications for Policy

• Prison as part of the health care system.
• Much attention toward health care while in
  prison. Yet little attention toward the long
  term health implications.
• Consequences of releasing 600,000 people a year
  from prisons.
• Prison programs that promote maintaining social
  bonds.
• Social policies that promote societal
  reintegration
• Education and workplace skills programs.
• Restoring the rights of inmates.

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Directions for Future Work

• Short term vs long terms effects of incarceration
• Gender differences
• Regional or institutional variation
• Variation in mental health