Transcript The Health Consequences of Incarceration Michael Massoglia Penn State University 2 Basic Questions  Does incarceration affect later physical health?  Does incarceration explain some of the racial disparity.

The Health
Consequences of
Incarceration
Michael Massoglia
Penn State University
2 Basic Questions

Does incarceration affect later physical health?

Does incarceration explain some of the racial
disparity in health between whites and
nonwhites?
Mechanisms and Processes

The correlates of health and crime are similar.

Macro structures: Inequality, poverty, residential
conditions.

Shaw and Mckay (1934)
Life course markers: Marriage, educational
attainment, income
 Individual factors: Substance use, risk taking
behavior

Spurious Associations

Lifestyle theories:


Suggests an association may be evident, but a
function of lifestyle choices (i.e. drug use) and
therefore spurious
Personality theories:

Suggests an association may be evident, but a
function of underlying individual characteristic (i.e.
risk taking behavior) and therefore spurious
Linking Health to Incarceration
Status

Social Bonds and the Life Course


Living Conditions


Fractured bonds
Exposure to disease and stress
Social Hierarchy

Societal participation and control over life
Racial Differences In Health

One of the most persistent findings in the literature
indicates racial inequalities in health

Whites have better health than minorities across almost all
indicators of health



Williams and Collins (1995) conclude that black health functioning
has worsened over the last 25 years
Blacks can expect to live fewer years while at the same time living
more of their life with chronic disease (Hayward 1999)
Large scale systems of inequality are often used to explain
these persistent health differences
Incarceration in the United States


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Significant increase in rates of incarceration over
the last 25-30 years
Incarceration a “phase in the life course” for
some individuals, particularly poor minorities
(Pettit and Western 2004)
Risk of imprisonment: Changes from 1979-1999
Whites (1.4------2.9) Less than HS (4.1----11.2)
 Blacks (10.5----20.5) Less than HS (17.1---58.9)

Incarceration in the United States

Correctional policies and the emergence of a
new “felon class” in society. Estimates indicate
this new “class” comprises …
7.5 percent of the adult population
 22.3 percent of the black adult population
 33.4 percent of the black adult male population


(Uggen et al 2006)
Prisons and Inequality

System of inequality?
Prisons and stratification in the labor market and
earnings (Western and Beckett 1999; Western 2002;
Pager 2003)
 In the labor market, Pager concluded the “mark” of
a criminal record is more detrimental to blacks
 Disruption of the marriage market more severe for
blacks (Staples 1987; Wilson)
 Irwin (1985) “underclass of society”

Prisons and Exposure

National Commission on Correctional
Health Care report (2002)
 Total
HIV/AIDS: 151,000-197,000 (20-
26%)
 Hepatitis B: 155,000 (12-16%)
 Hepatitis C: 1.3-1.4 million (38%)

Tuberculosis outbreaks linked to
correctional institutions
Data



National Longitudinal Survey of Youth
(NLSY79)
A comprehensive health module in the NLSY,
given to respondents at the age of 40 (N=5556)
Dependent Variable: Measure of physical health
functioning at age 40.

A composite indicator capturing a range of health
functioning taken from a widely used health
questionnaire (SF-12)
NLSY


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Equally divided between men and women, ages 40-44,
66% married.
20% at or below 125% of poverty level.
Approximately 75% white, average 13.7 years of
schooling, 81% in the labor force.
About 23% report binge drinking (5 drinks at one time,
2-3 times a month) or cigarette use. Slightly less than
half the sample reports weekly exercise.
Slightly more than 5% of the sample was incarcerated,
disproportionately minority. Average time of
incarceration about 34 months.
Basic Associations in Health
4
3
2
1
0
-1
-2
-3
-4
Education Employment Marriage
Substance
Use
Prison
Health Values-Racial Differences
55
54
53
52
W hites
51
50
Minorities
49
Minority and
Disadvantage
48
47
46
45
Baseline
College Grad Employment
Prison
Two types of analysis

Regression analysis with covariate adjustment


Controls for prior health, life course markers, and
lifestyle indicators
Propensity models
Account for differences across persons or groups in
the likelihood of experiencing a treatment
 Rationale: Non-random likelihood of experiencing
incarceration may bias the results generated from
OLS

Propensity Score Models


Account for differences across persons or groups in the
likelihood of experiencing a treatment.
Rationale: Non-random likelihood of experiencing
incarceration may bias the results generated from OLS.

Average effects and standard estimator (Rosenbaum and
Rubin 1983: Winship and Morgan 1998).


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The way individuals are assigned, or assign themselves, to the
treatment determines how effectively the standard estimator estimates
the true effect.
Key assumption: Assignment into treatment is uncorrelated with
outcome.
Tables.pdf
Discussion
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
Incarceration is a powerful predictor of health
Suggest incarceration impacts health multiple
ways
Disease and stress exposure
 Fractured social bonds
 Social hierarchy and social status


Contributes to racial inequalities in physical
health
Implications for Policy

Prison as part of the health care system.

Much attention toward health care while in prison.
Yet little attention toward the long term health
implications.

Consequences of releasing 600,000 people a year from
prisons.
Prison programs that promote maintaining social
bonds.
 Social policies that promote societal reintegration

Education and workplace skills programs.
 Restoring the rights of inmates.

Directions for Future Work
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Short term vs long terms effects of
incarceration
Gender differences
Regional or institutional variation
Variation in mental health