In Pennsylvania, there are about 73,00 people behind bars, including 29,000 in local jails who are mostly awaiting trial because they can’t afford bail.
Of those people, Black Americans are incarcerated at unequal population rates compared to white people, especially for low-level, non-violent offenses, such as drug possession. They also receive the harshest sentences, including death sentences.
Social determinants of Health (SDoH) are the non-medical forces that shape a person’s well-being from birth to death. They play a role in this inequity, especially bias and discrimination in policing practice, drug law enforcement, sentencing, pretrial detention, and cash bail.
The ripple effect
University of Pittsburgh’s Dr. Emily Dauria, Assistant Professor, Behavioral and Community Health Sciences, studies incarceration as a significant driver of public health. “Incarceration affects the health and well-being of the person who’s incarcerated,” she explains. “We know from research that people who are or have been incarcerated are disproportionately in poor health before, during, and after their incarceration.
“Incarceration may also affect the health of the person’s family, neighborhood and community. “It alters important emotional and social bonds,” she continues.
Dr. Dauria’s research asks important questions about incarceration’s impact on the health of Black and Brown people and the places they live. For example, How are women and communities affected when Black and Brown men, are removed and incarcerated disproportionately? How does incarceration impact the health of people who are detained and living with HIV/AIDS? What is the best way to ensure they receive care and medication while they’re confined — and connect them to care when they return to the community?
What Dr. Dauria and others’ research shows is that when we put someone behind bars, it causes disruptions in every aspect of their life. Not only can it worsen their health, but also impact their employment, housing, education, and healthcare, including Medicaid coverage. It also damages relationships within families, social sets, religious groups, and even alters neighborhood dynamics.
These changes can affect physical and mental health for generations, which weighs heavily on communities already struggling with systemic racism and disparities beyond their control.
“Incarceration has a deep ripple effect on health outcomes,” says Dr. Dauria. “Not only on the individual who enters the carceral system, but also on the people in their life, especially the 10 million children who have had one or both parents incarcerated.”
Within Allegheny County, 35,000 children and youth have experienced parental incarceration. Since 2003, nonprofit organization Amachi Pittsburgh has supported these families. The organization uses trauma-informed, strengths-based approaches to engage the whole family system. Services include a mentoring program for children, an ambassador program for high school students that reduces stigma and amplifies voices for civic engagement, and a family strengthening program. “Amachi” is a Nigerian-Igbo word that means, “who knows but what God has brought us through this child.”
Black and Brown people who enter the carceral system already face daunting and disparate health issues caused by poverty, substance use, sex work, untreated mental health factors, LGBTQIA+ discrimination, limited or no health insurance, and lack of access to quality healthcare providers. Incarceration often makes those conditions worse.
Dr. Dauria explains. “Individuals with opioid use disorder, for example, who might not get treatment during detention, may be released and begin using again at pre-jail levels which can trigger an overdose. If that person is using alone or there’s no easy access to Naloxone, the result could be death.”
She continues, “The treatment for people who use opioids in prisons and jail, too, is challenging. If treatment stops when a person begins serving a sentence — or there’s a pause in treatment — there’s a greater chance of harmful consequences of withdrawal and a return to use and potential overdose in the community.”
The U.S. Constitution requires that all people who being detained receive adequate medical care. However, there can be huge disparities and gaps in the quality. This is caused by facility turnover, a shortage of service providers, and overcrowding, which may create health conditions, such as COVID, hepatitis, and TB.
One example that’s especially disturbing is pre- and post-natal care for incarcerated birthing people who, depending on the state they live in, may be shackled during delivery and subject to the inspection process after they’ve given birth — and who often receive little or no lactation support.
Mental health care is also lacking. The distress caused by being locked up can make other mental health conditions worse as can solitary confinement 23 hours a day.
“For some, the healthcare they receive while they’re incarcerated may be their first,” says Dr. Dauria. “But it can vary from system to system — adequate in one place and substandard in another. Plus, it’s hard to address comprehensive healthcare needs in a system designed to punish.”
The care is also temporary. “Unfortunately, when the person is released, the care that started inside may not continue outside,” she adds.
What’s being done to improve health outcomes?
In Pittsburgh and nationwide, there are programs to help divert people from incarceration, especially for low-level offenses.
There are also programs to boost healthcare outcomes for incarcerated people and reduce recidivism, which occurs when a formerly incarcerated person returns to the system. Recidivism can happen as the result of parole violation technicalities.
Preventing initial incarceration
Dr. Steven M. Albert, Professor of Behavioral and Community Health Sciences at Pitt , is especially hopeful about a recent report titled “How Long is Long Enough?” The report focuses on the U.S. tendency to put too many people in prison for too long.
In the report, there are 14 recommendations, including reducing racial and ethnic disparities in sentencing and lowering recidivism by providing health services, training, and other opportunities in prison.
Dr. Albert explains, “If we can shorten people’s sentences, for example, we can use the money we save to offer more and earlier drug prevention and treatment programs. This improves health outcomes for substance users and helps them move away from the carceral system altogether.”
These “diversion” programs uncover the root causes that lead to someone becoming incarcerated, including unmet physical and mental health needs, homelessness, lack of education and jobs, and more.
Co-lead by Dr. Albert and Richard Garland, Reimagine ReEntry provides opportunities, reduces barriers, and supports returning citizens, their loved ones, and communities.
“Health outcomes for recently released people are overwhelmingly negative and include greater instances of homelessness, substance abuse, and murder,” Dr. Albert notes. “We know from research that staying out of the carceral system for about three years greatly improves a person’s chances of staying out long term. But people need help to do that.”
With that in mind, Reimagine ReEntry works with a formerly incarcerated person for three years after they leave the system. The coaching staff helps the individual build and re-build support networks, find and receive education, training and a good-paying job, take advantage of mental health resources, and reunite with family members.
Turning differences inside-out
David Harris, Professor of Law at Pitt, studies, writes, and teaches about police behavior, law enforcement and race, and search and seizure law.
Among the courses Professor Harris teaches is the Inside-Out Prison Exchange Program, where traditional Pitt students learn and study alongside people who are incarcerated in the State Correctional Institute (SCI)—Greene.
Pitt and SCI-Greene are two of 150 campuses and correctional facilities that participate in Inside-Out nationwide. The program was founded in 1997. Pitt has been a participating member since 2017.
Inside SCI-Greene, Pitt students and incarcerated people, who may be studying to earn their GED, learn together about law and criminal justice issues.
“It’s good for my law students to meet, talk to, and get to know people who are incarcerated in the place they’re confined,” Professor Harris explains. “It helps to break down stereotypes and creates a learning community between two groups of people whose paths differ greatly.”
The breakdown often results in a realization for Pitt students that differences stem from the circumstances of a person’s birth — where they were born, their gender, and the color of their skin.
“For incarcerated students, the value of Inside-Out is dignity and worth,” says Professor Harris. “In the classroom setting, they’re treated as human beings, partners, and peers. Their experience and thinking are valued. It’s a model program for boosting human connection and understanding human capabilities.”
Professor Harris reminds us, “Every person has value regardless of their circumstances. What we see in the carceral system is a reflection of the disparities taking place in our Black and Brown communities nationwide.”