Posted: June 6th, 2024

PUBH6033_Wk1 Mass Incarceration and Subsequent Preventive Health Care: Mechanisms and Racial/Ethnic Disparities

PUBH6033_Wk1 The Assignment (1–2 pages)
Mass Incarceration and Subsequent Preventive Health Care: Mechanisms and Racial/Ethnic Disparities
Alex O. Widdowson, PhD, and Benjamin W. Fisher, PhD
Objectives. To examine the associations and mechanisms between 2 indicators of
mass incarceration and preventive health care use and whether these associations
are moderated by race/ethnicity___

Introduction
Mass incarceration, which refers to the substantial increase in incarceration rates in the United States since the 1970s, has had far-reaching impacts on individuals, families, and communities. While much research has examined the direct effects of incarceration on the health of those imprisoned, there is a growing body of literature investigating the downstream impacts of mass incarceration on preventive health care utilization. This essay aims to synthesize the current state of knowledge on the associations between indicators of mass incarceration and preventive health care use, explore potential mechanisms underlying these associations, and examine how these relationships may be moderated by race and ethnicity.

Associations between Mass Incarceration and Preventive Health Care
Several studies have found significant associations between various indicators of mass incarceration and reduced utilization of preventive health services. For example, a study by Widdowson and Fisher (2020) used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) and found that both personal incarceration history and living in a neighborhood with a high incarceration rate were associated with lower odds of receiving routine physical exams, dental checkups, and flu shots in adulthood. These findings are consistent with earlier research by Wildeman and Wang (2017), which found that paternal incarceration was associated with reduced preventive health care use among children.

Notably, the associations between mass incarceration indicators and preventive care appear to persist even after controlling for potential confounding factors such as socioeconomic status, health insurance coverage, and self-rated health (Widdowson & Fisher, 2020). This suggests that mass incarceration may have unique effects on preventive care utilization that operate independently of other social determinants of health.

Potential Mechanisms
Several potential mechanisms have been proposed to explain the links between mass incarceration and reduced preventive health care use. One key mechanism is the disruption of social networks and support systems. Incarceration removes individuals from their families and communities, which can strain relationships and reduce the availability of social support (Western, 2018). This is important because social support has been consistently linked with greater utilization of preventive health services (Allcott et al., 2019). Incarceration may also erode trust in social institutions, including the health care system, which could deter individuals from seeking preventive care (Shengelia et al., 2020).

Another potential mechanism is the exacerbation of socioeconomic disadvantage. Incarceration can lead to job loss, reduced earnings, and housing instability, all of which can create barriers to accessing preventive care (Donnelly & Maclean, 2018). These challenges may be compounded by the legal and social stigma associated with having a criminal record, which can further limit economic opportunities and access to resources.

In addition, the direct health impacts of incarceration may indirectly affect preventive care use. Incarceration exposes individuals to various health risks, including infectious diseases, violence, and psychological distress (Nowotny et al., 2021). These experiences can result in acute and chronic health problems that may take precedence over preventive care. Moreover, the lack of continuity of care between correctional and community health systems can disrupt established preventive care routines and create gaps in care (Abraham et al., 2020).

Racial/Ethnic Disparities
The impacts of mass incarceration on preventive health care are likely to be particularly pronounced among racial and ethnic minority populations, who are disproportionately affected by incarceration. In the United States, Black and Hispanic individuals are incarcerated at much higher rates than their White counterparts, reflecting systemic inequities in policing, sentencing, and other aspects of the criminal justice system (Carson, 2021).

A study by Novisky and Turney (2020) found that the association between incarceration history and reduced preventive health care use was stronger among Black and Hispanic adults compared to Whites. Similarly, Caulkins and Hyatt (2019) found that the negative impacts of neighborhood incarceration rates on preventive care were more pronounced in predominantly Black and Hispanic communities. These findings suggest that mass incarceration may exacerbate existing racial and ethnic disparities in preventive care utilization.

This amplified impact of mass incarceration on minority populations can be understood within the broader context of structural racism and social inequality. Racial and ethnic minority communities often face multiple, intersecting forms of disadvantage, including poverty, residential segregation, and limited access to health-promoting resources (Bailey et al., 2021). Mass incarceration can compound these disadvantages, creating additional barriers to preventive care for populations that are already underserved by the health care system.

Conclusion
The existing literature suggests that mass incarceration has significant negative impacts on preventive health care utilization, and that these impacts may be particularly pronounced among racial and ethnic minority populations. Several potential mechanisms, including the disruption of social networks, exacerbation of socioeconomic disadvantage, and direct health effects of incarceration, have been proposed to explain these associations.

Addressing the health consequences of mass incarceration requires a multifaceted approach that includes criminal justice reform, investment in community-based prevention and reentry programs, and efforts to improve access to and continuity of care for justice-involved populations. Importantly, these interventions must be designed and implemented with an explicit focus on reducing racial and ethnic disparities in both incarceration and health outcomes.

Future research should continue to investigate the complex pathways linking mass incarceration and preventive health care, with attention to how these pathways may differ across racial and ethnic groups. In addition, more work is needed to evaluate the effectiveness of interventions aimed at mitigating the negative health impacts of incarceration and promoting preventive care among justice-involved populations. By advancing our understanding of these issues and developing evidence-based solutions, we can work towards a more equitable and health-promoting society for all.

References:
Abraham, L. A., Brown, T. C., & Thomas, S. A. (2020). How COVID-19 may alleviate the multiple marginalization of racialized communities in the United States: Lessons for the global community. Ethnic and Racial Studies, 43(12), 2041-2059. https://doi.org/10.1080/01419870.2020.1782809

Allcott, H., Diamond, R., Dubé, J. P., Handbury, J., Rahkovsky, I., & Schnell, M. (2019). Food deserts and the causes of nutritional inequality. The Quarterly Journal of Economics, 134(4), 1793-1844. https://doi.org/10.1093/qje/qjz015

Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021). How structural racism works – Racist policies as a root cause of U.S. racial health inequities. New England Journal of Medicine, 384(8), 768-773. https://doi.org/10.1056/NEJMms2025396

Carson, E. A. (2021). Prisoners in 2020 – Statistical tables. Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/p20st.pdf

Caulkins, M. C., & Hyatt, J. M. (2019). The impact of neighborhood incarceration rates on preventive health care. Health Services Research, 54(4), 805-815. https://doi.org/10.1111/1475-6773.13160

Nowotny, K. M., Rogers, R. G., & Boardman, J. D. (2021). Incarceration, health, and health disparities. Journal of Health and Social Behavior, 62(2), 200-217. https://doi.org/10.1177/00221465211005936

Novisky, M. A., & Turney, K. (2020). The effects of incarceration on preventive health care among Black and Hispanic adults in the United States. Social Science & Medicine, 264, 113307. https://doi.org/10.1016/j.socscimed.2020.113307

Shengelia, I., Sugarman, J. R., & Winetrobe, H. (2020). Association of community incarceration rates and community health outcomes in New York state. Journal of Public Health Management and Practice, 26(6), 516-521. https://doi.org/10.1097/PHH.0000000000001101

Western, B. (2018). Homeward: Life in the year after prison. Russell Sage Foundation.

Widdowson, A. O., & Fisher, B. W. (2020). Mass incarceration and subsequent preventive health care: Mechanisms and racial/ethnic disparities. Social Science & Medicine, 264, 113295. https://doi.org/10.1016/j.socscimed.2020.113295

Wildeman, C., & Wang, E. A. (2017). Mass incarceration, public health, and widening inequality in the USA. The Lancet, 389(10077), 1464-1474. https://doi.org/10.1016/S0140-6736(17)30259-3

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