Inequality, Crime, and Health among African American Males

Marino A. Bruce, Darnell F. Hawkins, Marino A. Bruce, Darnell F. Hawkins

• Publisher: Emerald Publishing Limited
• Year: 2018
• Print ISBN: 9781786350527
• eBook ISBN: 9781787148895
• Topic: Social Sciences
• Subtopic: African American Studies
• Index: Social Sciences

Imprisonment, homicide, non-lethal assault and other crime, chronic and infectious disease, substance abuse, suicide, and accidents all contribute to the much wider gap in the community-level sex ratios found among African Americans compared to those observed found among other ethnic and racial groups in the United States. This wide array of causes and correlates of African American male mortality, disability, and confinement suggests an area in need of interdisciplinary inquiry that examines the intersection between public health and public safety.  

Health analysts and social scientists across many disciplines have studied the disproportionately high levels of disease, disability, premature death, and exposure to the criminal justice system in African Americans communities extensively. To date, there has been little overlap between the diverse literatures even though the very same factors leading to crime and punishment among African American males often contribute to their poor physical and mental health profiles. This book addresses this omission by including chapters exploring the multifaceted dimensions of the varied disadvantages faced by African American males. 

Authors draw from an array of theoretical and methodological frameworks to illustrate how poor outcomes and sharp disparities among individuals and communities can be linked to the interplay of multiple factors operating at multiple levels. This volume is a useful resource for serious scholars and makers of public policy who seek to understand the causal interplay among economic and racial inequality, gender, crime, punishment, and health outcomes among all African Americans.

A SOCIAL ECOLOGICAL FRAMEWORK OF INMATE HEALTH: IMPLICATIONS FOR BLACK–WHITE HEALTH DISPARITIES

Kathryn M. Nowotny

ABSTRACT

This review integrates and builds linkages among existing theoretical and empirical literature from across disciplines to further broaden our understanding of the relationship between inequality, imprisonment, and health for black men. The review examines the health impact of prisons through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology interact with prisons to potentially contribute to deleterious health effects and the exacerbation of race/ethnic health disparities.

This review finds that there are documented health disparities between inmates and non-inmates, but the casual mechanisms explaining this relationship are not well-understood. Prisons may interact with other societal systems – such as the family (microsystem), education, and healthcare systems (meso/exosystems), and systems of racial oppression (macrosystem) – to influence individual and population health.

The review also finds that research needs to move the discussion of the race effects in health and crime/justice disparities beyond the mere documentation of such differences toward a better understanding of their causes and effects at the level of individuals, communities, and other social ecologies.

Keywords: Social ecological theory; prison; prisoners; population health; race/ethnic health disparities; inequality

A large body of research has documented black–white disparities in health and mortality in the United States (Adler & Rehkopf, 2008; Frisbie, Song, Powers, & Street, 2004; Geruso, 2012; Pampel, Krueger, & Denney, 2010; Williams & Jackson, 2005; Williams & Mohammed, 2009). Racial differences in socioeconomic status (e.g., income, education) largely account for these gaps with individual and institutional discrimination, residential segregation, and bias in healthcare settings also explaining some of the variation in black–white disparities (Braveman et al., 2011; Williams, 1999; Williams & Jackson, 2005). Incarceration is an often ignored and poorly understood factor in health disparities research (Binswanger et al., 2011; Moore & Elkavich, 2008) despite the fact that black men are incarcerated at 6 times the rate of white men, 2.5 times the rate of Latino men, and 25 times the rate of black women (Danielle & Cowhig, 2018). Put another way, incarcerated persons comprise less than 1% of the US population (PEW Center, 2008) but 11.4% of all black men aged 20–34 (the age group most at risk for incarceration), and 37.2% of black men aged 20–34 with less than a high school education (Pettit, 2012). During the past several decades, the overall size of the prison population in the United States has increased substantially, growing more than sevenfold (The Sentencing Project, 2016), so that the United States now has the highest rate of imprisonment compared to all other countries (Walmsley, 2016). This has led some scholars to speculate that the US system of mass incarceration may be contributing not only to health disparities within the United States, but also to global disparities among high-income countries (Nowotny, Rogers, & Boardman, 2017; Wildeman & Wang, 2017).

To comprehend the broader health effects of mass imprisonment on health disparities (Wildeman, 2011), research has documented patterns of disparities between incarcerated and non-incarcerated persons. Overall, the incarcerated population has significantly higher rates of chronic and infectious diseases (Binswanger, Krueger, & Steiner, 2009; Wilper et al., 2009), mental and behavioral health conditions (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009), and trauma and injury (DeHart, 2008) than the general population. Having ever been imprisoned is also associated with long-term elevated mortality risk (Pridemore, 2014; Spaulding et al., 2011).

This is due, at least in part, to the fact that inmates are largely drawn from vulnerable segments of the US population: the poor and racial and ethnic minorities residing in the most disadvantaged neighborhoods (Clear, 2007; Kirk, 2008). In addition to economic disadvantage (Greenfeld & Snell, 1999; Richie, 2001), persons who are incarcerated come from backgrounds that are characterized by high levels of substance use prior to incarceration including smoking (Belcher, Butler, Richmond, Wodak, & Wilhelm, 2006; Cropsey, Eldridge, & Ladner, 2004), alcohol and drug use (Abram, Teplin, & McClelland, 2003; Daniel, Robins, Reid, & Wilfley, 1988; James & Glaze, 2006; Kerridge, 2008; Proctor, 2012), and high rates of serious mental illness (Fazel & Danesh, 2002; James & Glaze, 2006; Steadman, Osher, Clark Robbins, Case, & Samuels, 2009), factors which are associated with illness and mortality. Therefore, it might be that persons who are incarcerated have worse health only because the causes of incarceration and illness are so closely linked. In other words, it may simply be an issue of selection. If this is the case, then any health “effect” of incarceration would be spurious and there would be no impact on black–white health disparities.

It is also possible that incarceration directly influences health. For example, universal access to healthcare while incarcerated (Delgado & Humm-Delgado, 2008; Greifinger, 2006) may improve individual health, since many people who are incarcerated do not have access to health services in their community (Boutwell & Freedman, 2014; Regenstein & Rosenbaum, 2014). This would mean that, given the overrepresentation of black men in prisons, incarceration would serve as an equalizing force that could contribute to a reduction in population-level black–white health disparities. On the other hand, incarceration spells are characterized by exposure to stress, infectious diseases, and violent victimization (Rhodes, 2005; Slate, 2003; Sung, 2010; Wood & Buttero, 2013), all of which negatively influence health. If incarceration has a direct negative effect on health, the consequence would be a widening of black–white health disparities.

The effect of incarceration on racial/ethnic health disparities has been theorized by others (Asad & Clair, 2018; Binswanger, Redmond, Steiner, & Hicks, 2011), but there have been limited empirical examinations. In a recent review article, five studies were identified that directly assessed this question – all generally supporting the hypothesis that mass incarceration explains some of the racial/ethnic health disparities documented in the United States (Wildeman & Muller, 2012). For example, Wang and Green (2010) used a population-based survey of noninstitutionalized adults in New York City and propensity score matching to examine the association between incarceration and chronic diseases. They found that individuals with a history of incarceration had a higher prevalence of asthma and that the increased rates of incarceration among blacks partially contributed to racial disparities in asthma prevalence. However, knowledge about who is removed from and returned to the community, and how these selective forces are different for black and white communities is critically lacking in health disparities research (Nowotny et al., 2017; Wildeman & Wang, 2017). For example, Nowotny and colleagues (2017) found that there is a differential health selection into prison for whites and blacks, and population health estimates for adult black men in particular are underreporting the true health burden for US adults likely due to the large number of black men “missing” from population health surveillance systems due to incarceration.

Research linking incarceration and health tends to favor direct pathways as an explanatory mechanism such as decreased access to healthcare and other resources following return to the community (e.g., Brayne, 2014; Patterson, 2010). Indirect pathways that have been explored include stress-related processes (e.g., Massoglia, 2008; Schnittker & John, 2007) and the stigma of legal statuses (e.g., Asad & Clair, 2018). Potential spillover effects of incarceration for families and communities is also a growing area of research (Brinkley-Rubenstein, 2013; Schnittker, Uggen, Shannon, & McElrath, 2015), but overall there remains a lack of integrated framing.

Therefore, the purpose of this comprehensive review is to examine the health impact of prisons through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology interact with prisons to potentially contribute to deleterious health effects for black men at the individual-level and the exacerbation of black–white health disparities at the population-level. Social ecological theory proposes that any individual behavior or outcome is influenced by numerous other systems and provides a starting point for the integration of multiple perspectives (Stokols, 1996; Wandersman et al., 1996). The utility of an ecological framework is that it can suggest multiple levels of analysis and strategies for alleviating the health-related harm caused by imprisonment. It is the goal of this paper to stimulate varied analyses and strategies in the social scientific study of health among current and former incarcerated persons by conceptualizing the broader effects of incarceration on health by integrating theoretical concepts and empirical findings from criminology, medical sociology, and public health and medicine.

After a brief introduction to the ecological theory of human development, this paper reviews the research on individual-level health effects of imprisonment including three conceptual approaches: (1) the deprivation of prison life; (2) the prison as an equal access healthcare system; and (3) heath following release from prison. Discussed are the implications of these approaches for black–white health disparities. Next, I examine the interaction of the prison with other nested social ecologies including potential spillover effects for the family, the education system, and the health system. Finally, the relationship among race, incarceration, and health is contextualized within the macrolevel system of racial control.

The enormous scale of imprisonment for black men is undeniable and the negative consequences for individual health are, in general, well documented. However, “community harms [resulting from mass incarceration] affect more than the total number of residents who have been incarcerated […]. There is a social dynamic that aggravates and augments the negative consequences to individual inmates when they come from and return to particular neighborhoods in concentrated numbers” (Roberts, 2004, p. 1281). The new empirical research on incarceration and health should move towards analyzing how racial hierarchies embedded in the system of mass incarceration contribute to health disparities through its interaction with other social ecologies.

ECOLOGICAL THEORY OF HUMAN DEVELOPMENT

Bronfrenbrenner (1979, 1986) conceptualizes the ecological environment as a set of nested structures surrounding the individual representing the micro-, meso-, exo-, and macrosystems. The innermost level is the microsystem, defined as the face-to-face interactions and inter-relations between individuals and others in their immediate setting including family and peers, and the provision of social support through these interactions. The influence of supportive social networks has been shown to be essential to health and behavioral risk reduction (Stokols, 1996). Bronfrenbrenner distinguishes between mesosystems – the linkages between systems and other individuals in the ecological environment – and exosystems – the formal systems with which individuals may or may not have direct contact (such as prisons). In this review, the meso- and exosyst...

Table of contents

• Cover
• Title Page
• Introduction to Volume 20
• A Social Ecological Framework of Inmate Health: Implications for Black–White Health Disparities
• The Relationship Between Health, Cigarette Smoking and Criminal Justice Contact among African Americans
• The Sexual Health of African American and White Men: Does Former Incarceration Status Matter?
• “Maybe It Was Something Wrong With Me”: On the Psychiatric Pathologization of Black Men
• Suicide among Young African American Males☆
• Life Under the Veil: Homicide in Black America Before, During, and After the Drop in US Crime
• Gendered Racism is a Key to Explaining and Addressing Police-Involved Shootings of Unarmed Black Men in America
• The Matter of Lives Underneath Black Male Skin: Using Theory and Media to Explore the Case of “Justifiable Homicides” for Black Males
• Solidarity, Double Consciousness, and Collective Emotion Work: Understanding Negative Black Health Outcomes Resulting from Systemic Police Terror
• Framing Physicality and Public Safety: A study of Michael Brown and Darren Wilson
• Index