1. Incarceration, Reentry and Disparities in Health: What are the connections? Nicholas Freudenberg Hunter College, May 5, 2006 Presented at the Prisoner Reentry Institute’s Occasional Series on Reentry Research

2. Overview  Do incarceration and reentry policies in US contribute to disparities in health between socioeconomic and racial/ethnic groups?  What are the pathways by which incarceration and reentry influence health?  What changes in incarceration and reentry policies can improve population health and reduce disparities in health?

3. Racial/ethnic disparities in health

6. Disparities in Criminal Justice Involvement Blacks more likely than whites to be:  Arrested  Incarcerated  Released under continuing supervision  Given longer sentences  Reincarcerated

9. So what’s the connection between disparities in health and incarceration? Model 1Model 2 Poverty, inequality and racism Poor health Incarceration Poverty, inequality and racism Incarceration Poor health

10. So what’s the connection between disparities in health and incarceration? Model 3 Poverty, inequality and racism Poor health Incarceration

11. What are the pathways by which incarceration contributes to disparities? 1.Exposure to unhealthy jail/prison environment 2.Incarceration as stigma 3.Revolving door contributes to community disorganization 4.Missed opportunities for intervention 5.Diversion of resources from other social problems

12. 1.Exposure to unhealthy jail/prison environments  Crowding contributes to transmission of infectious diseases  Jails as schools for crime  Jails as site of risky behavior  Jails as generators of violence  Jails as amplifiers of coercive masculinity  Jails as source of social stress

13. Risk Behavior on Entry and During Incarceration, USA IDUMSM On Entry25% - 40% 0% - 7% During Incarceration 12%33%

14. Correctional Facilities Concentrate People with Infectious Diseases Condition Releasees with condition in 1997 as % of total in US with condition HIV infection22.2-31.3% Hepatitis C29.4-43.2% Tuberculosis39.6% Source: Hammett et al, 2002.

15. Incarceration as stigma  Increased isolation post-release  Reduced opportunities for employment  Reduced opportunities for education  Alienation from family and friends  Loss of benefits such as Medicaid, public assistance, public housing

16. Revolving door between prison and community contributes to community disorganization  Cycle disrupts family life and parenting  Contributes to housing, employment and educational instability, key anchors for communities  Impact most severe on high incarceration communities  “Churning” reduces social cohesion, thus diminishing community capacity to respond to threats to health

17. Missed opportunities for intervention... a public health disaster  Failure to screen, treat and refer for infectious diseases, psychiatric problems, substance use and chronic conditions respresents lost opportunity for improving health of most vulnerable populations.

18. Diversion of resources from other problems  New York City and State spend $250 million per year to incarcerate Harlem residents. Could this money be spent to achieve better outcomes?  In NYC, it costs $92,500 to jail one person for one year.  Many states are facing fiscal crises as a result of increasing expenditures for corrections and Medicaid.

19. What strategies can reduce adverse health impact of incarceration and reentry? Strategy 1: Reduce number of people going to jail. Strategy 2: Ensure that every person leaves jail or prison in better health than when he or she entered. Strategy 3: Reduce stigma of incarceration; end punishment at jail gate.

20. Strategy 1: Reduce number of people going to jail  Expand and improve alternatives to incarceration.  Divert people with mental illness and substance abuse problems into treatment.  Reduce school dropout rates.  Restructure probation and parole to reduce revocations.  Rethink goals of policing.

21. Strategy 2: Ensure that every person leaves jail or prison in better health than when he or she entered.  Restructure health services in jail to emphasize chronic disease management, health promotion, and resolution of acute problems.  Establish working system for electronic medical records to share information.  Re-establish full range of drug treatment services in jail.  Shift resources into reentry services.  Connect people to Medicaid.  Fund health centers in high incarceration communities to serve those returning.

22. Strategy 3: Reduce stigma of incarceration; end punishment at jail gate.  Bar employment discrimination based on incarceration status absent direct evidence of harm.  Public campaigns to encourage positive support for people returning from incarceration.  Public dialogue on how best to improve public safety, protect community health and use tax payer dollars efficiently