Defund for Health: The Effects of Prisons on Health
*Editor’s Note — ‘Defund for Health: The Effects of Prisons on Health’ is Part II of a three-part series. Read Part I here.
As 2021’s Black History Month came to a close, the news that Mumia Abu-Jamal had contracted COVID-19 spread across the internet. Mumia is a political activist, journalist, member of the Black Panther Party, and many consider him to be a political prisoner. He is currently serving a life sentence in prison. This is not the first life-threatening illness Mumia has tested positive for since his incarceration; in 2012 he also tested positive for Hepatitis C and was denied proper medical care. Being imprisoned has had lasting, material effects on his health, and Mumia’s story is far from unique in that matter.
The demands to defund the police that rose from the streets in the summer of 2020 are only one aspect of dismantling the racist carceral system in the United States. For many people, especially Black and Brown people, their interactions with police do not end after citation or arrest. Police are merely an intermediary to the prison-industrial complex, which has grown exponentially since the 1970s. So-called “three strikes” laws and the implementation of cash bail have resulted in the population of incarcerated people ballooning.
Defunding the police would ultimately impact the number of people who find themselves behind bars. Not only are the exile and ex-communication of imprisonment not true justice, the impact that prisons have on people’s health further deteriorates communities.
However, before getting into all the ways that prisons are bad for health, the demographics of the prison population and its growth over the past few decades cannot be ignored. Across the United States, Black people are incarcerated more than five times the rate of white people. It is especially difficult to ignore the gravity of this fact when remembering that while the 13th amendment abolished slavery in the U.S., it made a specific exception for the punishment of a crime.
The Cost of Prisons
The demands for defunding are part of a call to reallocate funds to budget lines that actually support communities, such as health departments, transportation and infrastructure, social services, and recreation. The demand is especially loud when police and prisons make up outsized proportions of municipal budgets. The Bureau of Justice Statistics estimates that the United States spends more than $80 billion to keep 2.3 million people behind bars, but the true cost is closer to $182 billion according to the Prison Policy Initiative.
Since the early 1980s, prison budgets have steadily increased, only being slowed by the Great Recession. When compared to funding for public health, experts say that current funding levels are inadequate and that a $20 billion increase — a fraction of what is spent on imprisoning people — would bring spending up to adequate levels.
The Negative Health Effects of Prisons
COVID-19 is Running Rampant in Jails and Prisons
After a year of wearing masks, washing hands, and social distancing, it’s difficult to grasp just how difficult, or even impossible, these pandemic precautions are in jails and prisons. The realities of life behind bars have meant that jails and prisons have been entirely unable to get a handle on the novel coronavirus.
Soap is a rationed commodity for incarcerated people, and personal supplies quickly run out before the next ration due to increased hand-washing. At low-security facilities, sleeping arrangements are often dormitory-style, and even at high-security facilities cells are shared, making isolation and quarantine next to impossible. During the course of the pandemic, many facilities have gone into lockdown, which further restricts the movements of people who are incarcerated and often limits their time outdoors.
There have been at least 385,000 cases in prisons and nearly 2,500 deaths due to COVID-19. The unchecked and unmitigated spread of coronavirus in prisons and jails, and the deaths associated with it, merely highlight the inadequate healthcare that is provided to those on the inside.
Impact of Incarceration on Physical Health
With such a large population of people who have been or are incarcerated, there has been quite a bit of research done into the impacts that incarceration has on individuals. One of the most significant is that merely the experience of being locked up, regardless of the length of time, is associated with negative changes in physical health status and lower self-reported health. Additionally, people who have been incarcerated disproportionately experience infectious diseases and stress-related illnesses.
The physical conditions of prisons are detrimental and hazardous to incarcerated people’s health. From low nutritional quality meals and insect and rodent infestations to poor sanitation and ventilation, the designed environment of prisons does little to promote the health of the people who live there. Incarcerated people and formerly incarcerated people have an elevated risk of chronic conditions such as infectious disease, cardiovascular disease, hypertension, and cancer when compared to the general population.
Generally speaking, simply the experience of being incarcerated has a greater impact on a person’s health than even the length of time spent imprisoned. This may be because prisons are hotbeds for infectious diseases (the rate of tuberculosis at Rikers Island has been found to be higher than in many developing countries), or it may be the stress of significant life changes that happen upon being incarcerated. In either case, the length of time spent behind bars doesn’t change the exposure to things that negatively impact health.
One chronic illness that is especially exacerbated by incarceration is a substance-use disorder or addiction. A drastic reduction or even complete cut-off of substances will send people into withdrawal, which has dangerous and deadly effects on people. Even if people with substance-use disorders don’t die from withdrawal while behind bars, prisons and jails rarely have treatment programs to treat the disease and this lack of programming may contribute to relapse and reincarceration. Like all chronic conditions, the underlying biology of addiction must be appropriately managed for the long-term, which is not happening in prisons and jails.
While incarcerated people have a constitutional right to healthcare (to deny it would constitute “cruel and unusual punishment”), the quality of that care is not always monitored and assessed. In 2010, the Supreme Court found that the overcrowding of California’s prisons negatively impacted the healthcare available so much that it was considered a violation of the Eighth Amendment. Whether it’s private prisons or state-run facilities, the budget implications of healthcare are constantly scrutinized, and whittled down as a part of cost-saving measures, leading to understaffing and deadly health outcomes.
The physical health of people who are behind bars is ultimately diminished overall by that experience, and there is not much support to change that. There has been little improvement to health care provided to incarcerated people over the years, in part due to “persistent apathy” by authorities and the public for their well-being. Even as the constitutional and human rights of incarcerated people were recognized by the courts, the popularity of “law & order” approach wore away public support for imprisoned people seeking protection of those through the courts.
Impact of Prisons on Mental Health
Jails and prisons have an outsized relation to mental health. At least half of all those behind bars have some mental health concerns, and 10 to 25 percent experience some kind of serious mental health disorder. In the 1960s, the movement to close down mental health institutions across the country, paired with the lack of community-based mental health support, led to many of the people who were in those institutions cycling into jails and prisons. It’s estimated that the deinstitutionalization movement can account for 7 percent of the prison population growth, or up to 72,000 people, who were incarcerated between 1980 and 2000. These are people who would otherwise be receiving treatment at a mental health facility or hospital.
However, it is not just the fact that people enter prisons with pre-existing mental health issues. The prison environment has negative impacts on people’s mental health by fostering a sense of hypervigilance, interpersonal distrust, and suspicion; using emotional over-control, alienation, and psychological distancing; and inducing post-traumatic stress reactions.
These statistics above are in reference to general prison populations, however, there is a subset of those who are incarcerated that experience solitary confinement, which itself creates serious psychological risks. People who are held in solitary confinement are often confined to a single room for 23 hours a day. For much of the 20th century, solitary confinement was relegated to a few days or weeks as punishment. However, now thousands of incarcerated people spend years in this situation.
The impacts of solitary confinement on individuals are wide-ranging. Doctors and researchers have mentioned seeing people enter such segregation without any symptoms of mental illness only to develop them over the course of their confinement. Many people who experience solitary confinement report feelings of panic and rage, anxiety, and depression. These symptoms do not subside after isolation either; post-confinement people show maladjustment disorders and difficulty adjusting to social contact.
It is not uncommon for the symptoms of depression among those who are incarcerated to escalate to self-harm and attempts at suicide. In fact, suicide is the leading cause of death in jails and second in prison, behind illnesses.
Yet in spite of these well-known statistics, the number of incarcerated people receiving mental health treatments has been slashed. As with physical healthcare, mental healthcare is seen as a part of prison budgets to cut costs, leaving people with no way to seek help.
Impact of Incarceration on Community Health
Imprisonment doesn’t just affect the individuals who are incarcerated; it also impacts family and community health. When people are incarcerated, it cuts them off from their social support network, and it cuts their friends and family off from using them as a part of their support system. This support comes both as emotional support, but also financial support, and the benefits, such as health insurance for dependents, that come from employment.
Having a family member behind bars increased women’s likelihood of heart attack, stroke or to have fair to poor health. This can be linked to the increased expenses that come from having a family member incarcerated, a decrease in household income, and the increase in stress and social isolation. Because the majority of Black men who did not finish high school are likely to experience incarceration before their 30s, Black and Brown women disproportionately experience family incarceration and the accompanying poor health impacts.
Children’s health is impacted because family incarceration has impacts on their education, their caretaker’s ability to work (which is tied to health insurance in the US) and housing. Additionally, children with an incarcerated family member are more likely to have behavioral issues as well as increased drug and alcohol use. However, the impact of incarceration on children’s health may be overlooked, possibly because incarceration impacts communities of color more than white communities, which has further implications for community health.
Even beyond the family, incarceration has a negative association with population-level health. Communities with higher rates of incarceration have higher rates of infant mortality and higher infection rates of immunodeficiency syndromes. These communities are also paradoxically less safe.
The impact of incarceration has long-lasting, intergenerational impacts on people’s health. And because Black and Brown people have been disproportionately targeted and locked up, incarceration is a major contributor to the racial disparities within the US.
Not only are the health impacts of incarceration on physical, mental, and community health devastating and disproportionately affecting Black and Brown communities, they are a part of a vicious cycle with outwardly spiraling effects. Decarceration in response to the COVID-19 pandemic was a significant public health move as the coronavirus pandemic increased in intensity across the country, with more than 170,000 people being released. The impacts of this move should be considered for the broader health challenges that prisons pose.
Another approach to reducing the number of people in prison is to defund the police. Police are a major part of the pipeline to imprisonment and numbers of arrests and convictions are typically used to justify their large budgets. If we look at the overall health impact of those arrests and imprisonments, the public health cost is tremendous and alarming.
Reducing the number of people in prison would be a step in addressing the systemic racism that the United States is built upon, and it would positively change the health of individuals and communities. If we are going to truly address systemic racism in the United States, and the health problems that it is causing, then we need to be serious about dismantling the systems where that racism is most entrenched.
Christine Bedenis was a 2018–2019 Global Health Corps fellow and worked at the Communications and Resource Mobilization Fellow at Art & Global Health Center Africa in Malawi. They currently work at GlobeMed as the Communications and Development Manager.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
