With approximately 2.2 million U.S. adults and youth behind bars, the United States incarcerates many more persons—both in absolute numbers and as a percentage of the population—than any other nation in the world.
Mass incarceration disproportionately impacts lower-income communities, communities of color, and persons with disabilities, creating a barrier to achieving health equity. People who are incarcerated face greater chances for chronic health conditions, both while confined and long after their release. Incarceration exposes people to a wide range of conditions, such as poor sanitation and ventilation and solitary confinement, that are detrimental to long-term physical and mental health. After release, previously incarcerated individuals often face higher mortality rates and experience limited opportunities for gainful employment, stable housing, education, and other conditions needed for good health.
Mass incarceration’s reach extends far beyond the jail cell, impacting not only those behind bars, but their families, their communities, and the entire nation. Almost 10 million children have experienced having one or both parents incarcerated at some point in their lives—impacting their health and future opportunities. Within communities, mass incarceration disrupts social and family networks and economic development while across the country it consumes large portions of government budgets with negligible impact on crime rates.
Produced in partnership with the University of California, San Francisco, this report examines the links between mass incarceration and health equity. Through pairing data with examples of successful approaches, this report shows how mass incarceration negatively impacts everyone’s health and well-being and also suggests solutions for reducing both incarceration and crime rates and increasing opportunities for all.
Mass incarceration’s effects on health last far beyond the period of imprisonment. It impacts social, educational, and economic opportunities; increases the prevalence of chronic health conditions; and decreases life expectancy, with a 2015 study suggesting that each year spent in prison corresponds with a two-year reduction in life expectancy.
Parents’ incarceration influences their children’s educational, economic and social opportunities, which in turn shape their children’s health throughout life. Parental incarceration increases children’s risk of substance abuse and involvement in crime as they mature and contributes to future health problems, such as HIV/AIDS, high cholesterol, and post-traumatic stress disorder, limiting children’s opportunities for a healthy life.
Mass incarceration disproportionately impacts people of color, people with disabilities, and people of lower economic status. People of color represent 39 percent of the national population, but make up 60 percent of incarcerated persons, and people with disabilities are 4 times as likely as non-disabled people to end up in jail. Incarcerated people have a pre-incarceration median income 41 percent lower than that of non-incarcerated people. Many people are incarcerated because they cannot afford bail or court-imposed fees or fines.
Inequitable policies and practices drive these dramatic disparities in incarceration. While crime rates remained stable or declined from the 1970s to the early 2000s, many new prisons and jails were built and anti-crime policies became increasingly severe. These policies—such as mandatory minimum sentencing laws and three-strikes provisions—have contributed to high rates of incarceration and significant public health problems among vulnerable communities.
Mass incarceration harms communities and the entire nation. High rates of incarceration disrupt social and family networks, reduce potential economic development, and generate distrust toward law enforcement. For the nation as a whole, it consumes large portions of government budgets with local, state, and federal governments spending almost $180 billion each year on corrections, policing, and criminal court systems.
Investing in evidence-based strategies will help build a more just system while deterring crime and treating people fairly. Since 2007, 33 states have passed laws intended to reduce incarceration and crime rates simultaneously, such as reducing excessively long sentences. Nationally, more than 30 states have reduced both incarceration and crime. The First Step Act—enacted December 21, 2018—impacts the more than 180,000 Americans in federal prisons, but does not address the primary drivers of mass incarceration and more action is required to reach all those behind bars.
The full report and executive summary include a listing of evidence-based approaches that can help end mass incarceration, such as eliminating mandatory minimum sentences; investing in alternatives to incarceration and inmate rehabilitation and community integration programs; and ensuring access to high-quality healthcare, drug treatment, and education. The full report discusses in more detail how these and other strategies can help create a more just system that deters crime, protects public safety, rehabilitates offenders, and treats people fairly.
What is Health Equity?
Consensus around the definition of health equity can help bridge divides and foster productive dialogue among diverse stakeholder groups.
What Can the Health Care Sector Do to Advance Health Equity?
Health equity must be a priority for health care providers and systems because inequities in health and health care are pervasive.
Achieving Health Equity
As health disparities in the U.S. continue to grow, RWJF's health equity toolkit provides resources, data, and examples of communities working to achieve better health for all.
Wealth Matters for Health Equity
Substantial evidence links greater wealth with better health. Building wealth and income in communities that have long lacked opportunity is essential for improving health equity.