Incarceration, Health, and Racial Disparities in Health

Law & Society Review, Jun 2008 by Massoglia, Michael

This article addresses two basic questions. First, it examines whether incarceration has a lasting impact on health functioning. Second, because blacks are more likely than whites to be exposed to the negative effects of the penal system-including fractured social bonds, reduced labor market prospects, and high levels of infectious disease-it considers whether the penal system contributes to racial health disparities. Using the National Longitudinal Survey of Youth and both regression and propensity matching estimators, the article empirically demonstrates a significant relationship between incarceration and later health status. More specifically, incarceration exerts lasting effects on midlife health functioning. In addition, this analysis finds that, due primarily to disproportionate rates of incarceration, the penal system plays a role in perpetuating racial differences in midlife physical health functioning.

The rapid expansion of the correctional system is one of the most significant and dramatic trends in the legal system and contemporary American society. As of 2004, there were approximately six times more inmates and ex-inmates than in the mid-1970s. Presently, there are more than 16 million felons and ex-felons in the United States (Uggen et al. 2006). The growth of penal law in recent decades represents an increase in government social control, which in theory falls disproportionately on the lower classes and has implications for other institutions, such as employment, education, medicine, and public health (Black 1976, 1998).

Little research, however, examines exposure to the penal system as an explanatory factor in health outcomes or racial disparities in health. Prior research in the law and society tradition has investigated how mental health influences criminal sanctions (Hochstedler 1986) and how law and medicine can represent competing institutions (Heimer 1999), yet little work to date explicitly documents the health consequences of an ever-expanding system of penal social control. The present research undertakes that task by empirically examining two questions. First, to what extent does exposure to penal incarceration influence midlife physical health functioning? Second, given the racial disparities in the criminal justice system, does the ever-growing penal system account for some of the persistent racial disparities in health?

While all demographic groups are impacted by the expansion of the penal state, the phenomenon has disproportionately affected various subgroups of the population, in particular black males (Western 2006). In 2002, approximately 12 percent of black males were in correctional facilities (Harrison & Karberg 2003). The lifetime cumulative risk (measured to age 34) of imprisonment for all African American males is more than 20 percent (Pettit & Western 2004). Among African American males without a high school diploma, the lifetime risk of incarceration is 58.9 percent (Pettit & Western 2004). While strikingly high, these estimates carry additional meaning given that they are at least five times higher than the rates of comparable whites. In perhaps the most striking assessment of the scope and reach of the correctional system, Uggen et al. (2006) argue that correctional policies have caused the emergence of a new "felon class" in society. They estimate that this new "class" comprises approximately 7.5 percent of the adult population, 22.3 percent of the black adult population, and 33.4 percent of the black adult male population.

In light of this rapid expansion of the penal system, a number of observers have considered the implications of the growing size and racial composition of the incarceration system. There is an extensive and growing literature on how crime and punishment impact later life chances and outcomes. Research links earlier crime and punishment with later educational outcomes, employment and marital processes, and the labor market (Hagan 1993, 1997; Lopoo & Western 2005; Pager 2003; Sampson & Laub 1990; Pettit & Western 2004; Tanner et al. 1999; Western 2002, 2006; Western et al. 2001). Research consistently finds that contact with the penal system both lowers the likelihood of obtaining gainful employment and depresses wages in the event of employment (Pager 2003; Western 2002), and disrupts marital stability as well (Lopoo & Western 2005).

As a function of differential incarceration rates, minorities disproportionately carry these labor and marriage market deficits. Moreover, Pager concludes that a criminal record is more detrimental to the employment prospects of blacks than whites (2003:961). Other studies reach similar conclusions, finding that the correctional system disproportionately impacts the marriage market in African American communities (Staples 1987; Wilson 1987). Thus both as a function of who is incarcerated, meaning racial differences in rates of incarceration, and as a function of how, meaning racial differences in the consequence of incarceration, the penal system appears to impact minorities more severely.