Incarceration rates and hospital beds per capita: A cross-national study of 36 countries, 1971-2015

Structural racism and health: Assessing the mediating role of community mental distress and health care access in the association between mass incarceration and adverse birth outcomes

Research has linked spatial concentrations of incarceration with racial disparities in adverse birth outcomes. However, little is known about the specific mechanisms of this association. This represents an important knowledge gap in terms of intervention. We theorize two pathways that may account for the association between county-level prison rates and adverse birth outcomes: (1) community-level mental distress and (2) reduced health care access. Examining these mechanisms, we conducted a cross-sectional study of county-level prison rates, community-level mental distress, health insurance, availability of primary care physicians (PCP) and mental health providers (MHP), and adverse birth outcomes (preterm birth, low birth weight, infant mortality). Our data set included 475 counties and represented 2,677,840 live U.S. births in 2016. Main analyses involved between 170 and 326 counties. All data came from publicly available sources, including the U.S. Census and the Centers for Disease Control and Prevention. Descriptive and regression results confirmed the link between prison rates and adverse birth outcomes and highlighted Black-White inequities in this association. Further, bootstrap mediation analyses indicated that the impact of spatially concentrated prison rates on preterm birth was mediated by PCP, MHP, community-level mental distress, and health insurance in both crude and adjusted models. Community-level mental distress and health insurance (but not PCP or MHP) similarly mediated low birthweight in both models. Mediators were less stable in the effect on infant mortality with only MHP mediating consistently across models. We conclude that mass incarceration, health care access, and community mental distress represent actionable and urgent targets for structural-, community-, and individual-level interventions targeting population inequities in birth outcomes.

Multiple Disadvantage and Social Networks: Toward an Integrated Theory of Health Care Use During Reentry From Criminal Justice Settings

Research consistently finds the disproportionate negative health impact of the criminal justice system on racial and ethnic minorities. Yet less is known about the underlying mechanisms of health care utilization during community reintegration. We contribute to the literature theoretically by integrating two perspectives: network theory of social capital and multiple disadvantage hypothesis and providing a more nuanced explanation of health service use during reentry. We identify incarceration history as a unique disadvantaged status that precludes people from accessing social networks and social capital. We further elaborate on the phenomenon of racialized reentry and illustrate how multiple disadvantaged statuses are linked to social networks and health care.

COVID-19 and European carcerality: Do national prison policies converge when faced with a pandemic?

The article analyses an original dataset on policies adopted in 47 European countries between December 2019 and June 2020 to prevent coronavirus from spreading to prisons, applying event-history analysis. We answer two questions: 1) Do European countries adopt similar policies when tackling the COVID-19 pandemic in prisons? 2) What factors are associated with prison policy convergence or divergence? We analyze two policies we identified as common responses across prisons around the world: limitations on visitation rights for prisoners, and early releases of prisoners. We found that all states in our sample implemented bans on visits, showing policy convergence. Fewer countries (16) opted for early releases. Compared to the banning of visitation, early releases took longer to enact. We found that countries with prison overcrowding problems were quicker to release or pardon prisoners. When prisons were not overcrowded, countries with higher proportions of local nationals in their prisons were much faster to limit visits relative to prisons in which the foreign population was high. This research broadens our comparative understanding of European carcerality by moving the comparative line further East, taking into account multi-level governance of penality, and analyzing variables that emphasize the ‘society’ element of the ‘punishment and society’ nexus.

The relationship between community public health, behavioral health service accessibility, and mass incarceration

Background

The relationship between healthcare service accessibility in the community and incarceration is an important, yet not widely understood, phenomenon. Community behavioral health and the criminal legal systems are treated separately, which creates a competing demand to confront mass incarceration and expand available services. As a result, the relationship between behavioral health services, demographics and community factors, and incarceration rate has not been well addressed. Understanding potential drivers of incarceration, including access to community-based services, is necessary to reduce entry into the legal system and decrease recidivism. This study identifies county-level demographic, socioeconomic, healthcare services availability/accessibility, and criminal legal characteristics that predict per capita jail population across the U.S. More than 10 million individuals pass through U.S. jails each year, increasing the urgency of addressing this challenge.

Methods

The selection of variables for our model proceeded in stages. The study commenced by identifying potential descriptors and then using machine learning techniques to select non-collinear variables to predict county jail population per capita. Beta regression was then applied to nationally available data from all 3,141 U.S. counties to identify factors predicting county jail population size. Data sources include the Vera Institute’s incarceration database, Robert Wood Johnson Foundation’s County Health Rankings and Roadmaps, Uniform Crime Report, and the U.S. Census.

Results

Fewer per capita psychiatrists (z-score = -2.16; p = .031), lower percent of drug treatment paid by Medicaid (-3.66; p < .001), higher per capita healthcare costs (5.71; p < .001), higher number of physically unhealthy days in a month (8.6; p < .001), lower high school graduation rate (-4.05; p < .001), smaller county size (-2.66, p = .008; -2.71, p = .007; medium and large versus small counties, respectively), and more police officers per capita (8.74; p < .001) were associated with higher per capita jail population. Controlling for other factors, violent crime rate did not predict incarceration rate.

Conclusions

Counties with smaller populations, larger percentages of individuals that did not graduate high school, that have more health-related issues, and provide fewer community treatment services are more likely to have higher jail population per capita. Increasing access to services, including mental health providers, and improving the affordability of drug treatment and healthcare may help reduce incarceration rates.

Early days of the pandemic-The association of economic and socio-political country characteristics with the development of the COVID-19 death toll

This article examines cross-national differences in growth of deaths by COVID-19 over time in the first phase of the pandemic, during the time period of 31st December 2019 to 2nd April 2020. We seek to understand and explain country level reaction in the initial period of the pandemic. We explore socio-economic and socio-political country characteristics as determinants of deaths per day and we examine whether country characteristics act as moderating factors for different growth patterns of deaths per day over time. The country characteristics include variables about economy, globalization, health care and demography. We examine data published by the European Center of Disease Prevention and Control (ECDC) in combination with World Bank data and a webscraping approach. Using a conditional growth model specified as a multilevel regression model with deaths by COVID-19 per day as the outcome variable, we show that economic variables are not significantly associated with decrease or increase of deaths by COVID-19. In contrast, variables about national health care mitigate the impact of the pandemic. Demography shows expected effects with an increase of growth of deaths in countries with a higher percentage of people older than 65 years. Globalization predicts the death toll as well: Social interaction between people is deadly on a short-term scale (in the form of tourism). Our results mirror frequent demands for global investment in national health systems.

Incarceration as a Fundamental Social Cause of Health Inequalities: Jails, Prisons and Vulnerability to COVID-19

Although research has established the disproportionate health burdens among incarcerated persons, the literature has yet to identify a theoretical framework for outlining the harms of incarceration associated with pandemics. We advance the literature theoretically by arguing two points. First, we assert that incarceration is a potent structural driver of health inequalities that must be considered as a fundamental social cause of disease. To underscore this point, we review how incarceration meets each of the four fundamental social cause criteria originally proposed by Link and Phelan. Second, given that incarceration is a fundamental social cause of disease, both currently and formerly incarcerated populations are likely to face heightened vulnerabilities to pandemics, including COVID-19, further exacerbating health disparities among incarceration-exposed groups.