Thread by @GalvinAlmanza

Good morning. It's Thursday and I want to talk to you about how our punishment system is not just ineffective, but destroying the health of entire communities (and making your healthcare cost more). You in? Cool, let's go.

Incarceration, like socio-economic status, is considered a “Fundamental Social Cause of Health Inequalities” because it is related to multiple disease outcomes, related to multiple risk factors of disease, affects access to resources.

Incarceration destroys health in two ways: directly and indirectly. An example of directly would be that incarceration causes chronic health problems *no longer how long or short a person is locked up* ncbi.nlm.nih.gov/pmc/articles/P…

Being imprisoned leads to higher risk of hypertension, asthma, stress-related disease, mental health issues, and general health functioning. link.springer.com/content/pdf/10…

State prisons, which hold over 85% of incarcerated people, are becoming more deadly: In 2018, the rate of mortality was higher than it had been since the BJS started collecting data in 2001. prisonpolicy.org/blog/2021/06/0…

Second cite for the above (re BJS) bjs.ojp.gov/content/pub/pd…

Suicide, homicide, and death by drug or alcohol intoxication are rising among people impacted by incarceration.

Between 2016-2018, suicide rose by 22% (now higher than ever).

Drug and alcohol-related death rose by 139%.

Over a 25 year period, people who have been incarcerated were more likely to die from homicides, accidents, substance use, HIV, liver disease, and liver cancer. ncbi.nlm.nih.gov/pmc/articles/P…

Each additional year in prison produced a nearly 16% increase in the odds of death and a 2-year decline in life expectancy.
ncbi.nlm.nih.gov/pmc/articles/P…

So for a 30 year old, 5 years in prison would increase the odds of death by approximately 80% & result in a loss in life expectancy of approximately 10 years. ncbi.nlm.nih.gov/pmc/articles/P…

Being locked up adds 10 to 15 years to a person's physiological age and shaves two years off their life expectancy for every year locked up.

prisonpolicy.org/blog/2021/06/0…

All of this means higher rates of hospitalization for people who have been locked up, meaning higher healthcare costs for whole systems and communities. ​​aafp.org/about/policies…

And the same factors that make certain ppl more likely to interact with the criminal legal system are also related to poorer health outcomes (racism, criminalization, hyper-surveillance by police, poor resources, poverty, neighborhood, etc.) link.springer.com/content/pdf/10…

These factors are racialized, often hitting Black women the hardest. (I very much agree with @glennEmartin btw that talking about race in incarceration can be...pretty fucked up with White audiences. But this thread is for educating, not fundraising).

journals.sagepub.com/doi/abs/10.117…

Women feel their own heightened impact here. In comparison with other low-income women, those who interact with the criminal legal system have higher rates of chronic substance use challenges, PTSD, and mental health issues.
ajph.aphapublications.org/doi/full/10.21…

Having a family member incarcerated increases the likelihood of women to experience heart attack, stroke, obesity, or poorer health. ncbi.nlm.nih.gov/pmc/articles/P…

A Louisiana study found that there was a higher risk of preterm birth for Black women who live in parishes with higher incarceration rates - maybe because of economic and social impacts stemming from mass incarceration. …pregnancychildbirth.biomedcentral.com/articles/10.11…

And that's just the DIRECT IMPACTS, and likely only a portion of them. So let's talk about ripples: specifically how these consequences spiral out and impact kids and families. ncbi.nlm.nih.gov/pmc/articles/P…

You're probably not surprised to learn that having a parent incarcerated is incredibly bad for children's health. sciencedirect.com/science/articl…

The cumulative effect of adverse childhood experiences like this? It's bad. Poor mental health/behaviors (alcoholism, depression, suicide), poor physical health in adulthood (heart disease, cancer, chronic lung disease, skeletal fractures, liver disease). journals.lww.com/forensicnursin…

The list of impacts goes on and on. Family processes and stability are irrevocably disrupted. ncbi.nlm.nih.gov/pmc/articles/P…

The ability to form healthy relationships. ncbi.nlm.nih.gov/pmc/articles/P….

Someday, relationships with partners could be impacted. We're talking generational harm, extending over decades, simply because we cannot choose better ways to deal with accountability in this society. ncbi.nlm.nih.gov/pmc/articles/P…

It goes on:
Changes in economic well-being
Educational performance
Toxic stress
The trauma of witnessing arrest
Separation from a caregiver
Stigmatization of the incarcerated person’s family
Residential instability
Increased drug and alcohol use among children

AND THAT'S "JUST" THE KIDS. Can we talk about the community? After all, if you follow @_Eric_Reinhart you know how profoundly incarceration damages not just individual/familial health, but whole neighborhoods and social networks.

Neighborhoods with high levels of incarceration have damaged social capital, interfere with family and social connections, and increase overall rates of mental health issues.

Community incarceration rates positively predict infant mortality, child mortality (for Black children only), preterm births, and low-weight births. europepmc.org/article/med/33…

People with multiple arrests have serious health needs (higher rates of serious mental illness, psychological distress, substance use disorders, and HIV infection). BUT they are less likely to have health insurance: prisonpolicy.org/reports/repeat…

Individuals who were arrested and booked more than once were over 3 times more likely to have no health insurance (27%) compared to those with no arrests in the past year (8%), and slightly more likely to lack insurance than people arrested just once (23%).

Access to Medicaid coverage reduces recidivism rates among people convicted of violent and public order crimes. papers.ssrn.com/sol3/papers.cf…

And then, of course, there's the degree to which public officials allowed jails to become literal covid-spreading machines. From @_Eric_Reinhart pnas.org/content/118/21…

And also usatoday.com/story/opinion/…

All of which is to say, by letting our public officials pour money into prisons and jails, we're driving up healthcare costs, increasing crime, decreasing economic mobility and wellbeing, and basically punching ourselves in the face. Again and again and again.

What would happen if we poured that money into healthcare? If we made the huge % of people who are only in the criminal system because of a mental health or substance use issue able to access treatment and *not engage in harm*?

It's not just that we're destroying public health, it's also that there is no safety payoff. All of this stuff creates more crime. We're making ourselves poorer and less safe...all because we like punishments to feel mean.

Also this thread would not have happened without the incredible skillz of @cjboyers so go follow her too.