“For Health Equity, We Must End Mass Incarceration”

The title of this post is the title of this recent “Viewpoint” piece published in the Journal of the American Medical Association and authored by Emily A. Wang and Shira Shavit. Here is an excerpt:

As primary care physicians, we have seen the harms of mass incarceration extend across 3 generations of a family (grandparents, parents, and children) and how the harms may be transmitted biologically.  There is increasing evidence that psychosocial stress from the conditions of confinement; the challenges obtaining housing, food, and employment for individuals with criminal records; and the increased caregiving duties, costs of visitation, and stigma for family members are drivers of worse health outcomes.  Individuals with histories of incarceration and their family members have altered physiological stress responses, including increased levels of C-reactive protein, cortisol, and epigenetic age acceleration that are associated with developing and accelerating chronic health conditions, even after adjusting for neighborhood environment.8 Mass incarceration is now encoded into the DNA of the US.  And yet, when health policy analysts decry structural racism, mass incarceration is rarely if ever mentioned.

Undoing the health harms of mass incarceration should not only be the concern of frontline clinicians, but that of the whole medical community (including health systems and payers).  Recognizing this in 2006, we created the Transitions Clinic Network model that transforms primary care systems to better care for patients who have been incarcerated and for their families by employing community health workers with the lived experience of incarceration.  Today, the Transitions Clinic Network is the largest example of the medical community’s capacity to address mass incarceration, with a consortium of 44 primary care programs in 14 states and Puerto Rico that provide health and social service support for individuals returning from incarceration.