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Aggressive Policing tends to work at the forefront of the belligerent US Penal System. Scholars have suggested that the role of the police system has had a considerably destructive impact on the health of the incarcerated and their families. It has led to an expansive distaste of their presence and contributes to a cycle of Systemic Racism.

"Aggressive Policing - a set of strategies to proactively control disorder and strictly punish all levels of deviant behavior" (Esposite, Larimore, and Lee 2021)

As compared to the world, United States civilians are forced to face an undeniably greater risk of death by law enforcement. The effects of this can be seen at an individual level. People who have negative experiences with law enforcement experience a greater proportion of substance abuse, mental health complications, and "suppression of the immune system." In a long-term view, these things can be devastating for chronic health outcomes (shortening of telomeres).

After initial involvement with the law, the negative relationship is sustained. The maintained relationship through aggressive persistency increases the prevalence of depression, suicidal ideation, bodily inflammation, and cardiovascular disease in targeted groups.

These persistent physiological consequences can then be carried over into community health. The constant surveillance can lead to broad distrust of the police. This can lead to psychological distress, decreased health resource utilization, worse chronic health outcomes, and increased level of vigilantism.

“Aggressive Policing, Health, And Health Equity, " Health Affairs Health Policy Brief, April 30, 2021.
DOI: 10.1377/hpb20210412.997570

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It has been shown that prisoners have disproportionately lower levels of health and are products of their specific environments. Many of these concerns can be a cause for selection into incarceration. They also tend to highlight many of the ethnic and racial health disparities present in the United States and how they contribute to poor living conditions and eventually poor neighborhoods and increased incarceration rates.

Some important findings:

Many male adolescent inmates had experienced asthma prior to incarceration (Freudenberg et al 2005). Other morbidities like asthma are made worse based on the conditions of living in a penal facility. However, this study does not elucidate any relationship between physical illness and its relationship with a cause for incarceration. It only suggests that physical illnesses may be worsened by the justice system.

Many individuals experienced several psychiatric complications prior to incarceration (Schnittker et al 2012). Criminality is often associated with mental health concerns that are left unmet. It leads to selection into incarceration. Mental health as it is makes things difficult for inmates, however, incarceration only stands to worsen its effects on individuals.

Due to limited information, overarching conclusions are more difficult to draw, however, the suggestion that poor health tends to precede incarceration would not be of a complete surprise to researchers.

Nicholas Freudenberg, Jessie Daniels, Martha Crum, Tiffany Perkins, and Beth E. Richie, 2005:
Coming Home From Jail: The Social and Health Consequences of Community Reentry for Women, Male Adolescents, and Their Families and Communities American Journal of Public Health 95, 1725_1736, https://doi.org/10.2105/AJPH.2004.056325

Schnittker J, Massoglia M, Uggen C. Out and Down: Incarceration and Psychiatric Disorders. Journal of Health and Social Behavior. 2012;53(4):448-464. doi:10.1177/0022146512453928

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To develop the relationship between incarceration and health, studies reveal directly how imprisonment negatively affects the health outcomes. A within-person longitudinal study conducted by Schnittker and John (2007) empirically developed the inverse relationship between incarceration and positive health outcomes.

1. Individuals with a History of incarceration present with more chronic health problems after their period of incarceration than before
2.The authors accounted for the chronic health issues before which allowed them to empirically isolate the cause (incarceration)
3. The length of incarceration is less important than the actual fact of incarceration itself.

Massolgia(2008) found that those who are incarcerated, relative to those who have not, disproportionately experience worse health outcomes as it relates to infectious disease and stress-related conditions. This suggests that prisons are an unsanitary location for infectious disease. As scholars have argued for decades, prisons are not a good place for an infectious disease to spread. Due to overcrowding and other issues, many have found that diseases like tuberculosis and hepatitis are more common in prisons. COVID-19 has also been seen to spread easily within prisons, which negatively affects prisoners' morbidity (Maner et al 2021).

Houle (2014) investigated the relationship between incarceration and obesity. They found that the aggressive US penal system may "condition" the mechanisms of obesity in the US Population disproportionately due to Systemic Racism

Houle B. (2014). The Effect of Incarceration on Adult Male BMI Trajectories, United States, 1981-2006. Journal of racial and ethnic health disparities, 1(1), 21–28. https://doi.org/10.1007/s40615-013-0003-1

Maner M, LeMasters K, Lao J, Cowell M, Nowotny K, Cloud D, et al. (2021) COVID-19 in corrections: Quarantine of incarcerated people. PLoS ONE 16(10): e0257842. https://doi.org/10.1371/journal.pone.0257842

Massoglia M. Incarceration as Exposure: The Prison, Infectious Disease, and Other Stress-Related Illnesses. Journal of Health and Social Behavior. 2008;49(1):56-71. doi:10.1177/002214650804900105

Schnittker J, John A. Enduring Stigma: The Long-Term Effects of Incarceration on Health. Journal of Health and Social Behavior. 2007;48(2):115-130. doi:10.1177/002214650704800202

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89% of deaths in prison are due to internal health issues. The other 11% of external deaths are due to suicide, homicide, drug abuse, and accidental injury (descending order). The majority of internal health issues are due to cardiovascular complications, cancer, liver disease, and AIDS.

In a study of Texas' male inmates, the incarcerated had a 2 to 3 times greater proportion of death due to infection as compared to the general population of Texas. This is due to the poor structure of prisons and how they operate. The transmission of infectious disease has been an issue in many prisons across the country due to poorly developed distancing and health protocols. (Harzke et al 2011).

The statistical findings for increased mortality among men in prison only applies to white men however. Some scholars believe that black men experience a "protective effect" from incarceration due to the systemic issues found in the external society. Despite how the data appears to present, the data can be explained to support an opposing view. Compassionate release for prisoners that are near death reduce the data input for incarcerated deaths. When adjusting for these changes, this "protective" effect disappears. Thus the idea that incarceration protects black men from external issues is just an artifact of end of life prison policy.

Harzke AJ, Baillargeon JG, Kelley MF, Pruitt SL, Pulvino JS, Paar DP. Leading medical causes of mortality among male prisoners in Texas, 1992--2003. J Correct Health Care. 2011 Jul;17(3):241-53. doi: 10.1177/1078345811401362. Epub 2011 May 15. PMID: 21576121.

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Health as it relates to post-incarceration has been shown to be worse than health before and during incarceration.

The rates for mental health issues, Substance use disorders, suicide attempts, overdose, suicide, disabilities, homelessness, and death are all higher in justice-involved populations than the general population.

The rates for HIV/AIDS, hepatititis C, and sexually transmitted diseases are all higher in returning cohorts and these effects can spillover into communities that have higher incarceration rates.

Declines in health immediately following release could be driven by the return to dangerous neighborhoods which prisons formerly protected them from.

Tolerance for drugs and stressful readmission into society can increase the mortality risks for drugs and stress-related illnesses.

Former inmates may face stigmatization from employers and insurance companies as it pertains to income and health care support. These effects produce negative health outcomes in released inmates.

Mortality for released inmates is 12.7 times greater than comparable individuals. (Binswanger et al 2007). These deaths are typically attributed to accidents, homicide, HIV, and drug abuse. Additionally, post-incarceration is associated with elevated rates of cardiovascular disease (Wang et al 2009).

Massoglia (2008) show that prior incarceration increases the risk of infectious and stress-related diseases. He also explores the the long-term health outcomes for the incarcerated at a meta scale. There he determines that post-incarceration health relates to the racial disparities seen in the country and the incarceration system exacerbates the disparities through inequitable health outcomes.

Binswanger. “Release from Prison — a High Risk of Death for Former Inmates.” New England Journal of Medicine, vol. 356, no. 5, 2007, pp. 536–536., https://doi.org/10.1056/nejmx070008.

Massoglia, M. (2008), Incarceration, Health, and Racial Disparities in Health. Law & Society Review, 42: 275-306. https://doi.org/10.1111/j.1540-5893.2008.00342.x

Wang EA, Pletcher M, Lin F, et al. Incarceration, Incident Hypertension, and Access to Health Care: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Arch Intern Med. 2009;169(7):687–693. doi:10.1001/archinternmed.2009.26

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Mental health plays a significant role in selection for incarceration. In other words, those with mental health issues are more likely to find themselves incarcerated than the general population. However, incarceration itself has been shown to exacerbate mental health symptoms and presentation.

The carceral environment has been shown to be damaging to mental health in multiple ways. This can be seen through social isolation, overcrowding, solitary confinement, and routine exposure to violence.

Scholars argue that incarceration can lead to a phenomenon known as Post-Incarceration Syndrome which is similar to PTSD in that individuals continue to suffer additional adverse mental effects after being in prison.

"The prison environment is almost diabolically conceived to force the offender to experience the pangs of what many psychiatrists would describe as mental illness.” - Dr. Seymour Halleck

Incarceration is associated with social separation and often results in separation from family members and children. This can have deteriorating effects on mental health, such as depression, guild, and distress.

Incarceration is often related to boredom, lack of autonomy, lack of stimulation, education, and programming. This eventually leads to extreme boredom and a lost sense of self and purpose. These effects can result in suicide and depression for many inmates. These effects also have residual impacts post release. (Nurse, Woodcock, and Ormsby 2003).

Solitary Confinement can lead to the development of psychiatric disorders. The stress caused by this confinement often causes permanent changes in the brain that resemble the changes after a significant time experiencing physical pain. (Andersen et al 2000).

A few studies have found that released individuals experience a cluster of mental health symptoms, and borderline personality disorder traits that hinder their ability to socially integrate and develop long-lasting social relationships. They also experience a greater prevalence of Post-Traumatic Events. (Alicia Piper & David Berle 2019)

Piper, Alicia, and David Berle. “The Association between Trauma Experienced during Incarceration and PTSD Outcomes: A Systematic Review and Meta-Analysis.” The Journal of Forensic Psychiatry & Psychology, vol. 30, no. 5, 2019, pp. 854–875., https://doi.org/10.1080/14789949.2019.1639788.

Andersen, Henrik Steen, et al. “A Longitudinal Study of Prisoners on Remand. Repeated Measures of Psychopathology in the Initial Phase of Solitary versus Nonsolitary Confinement.” International Journal of Law and Psychiatry, vol. 26, no. 2, 2003, pp. 165–177., https://doi.org/10.1016/s0160-2527(03)00015-3.

Nurse J, Woodcock P, Ormsby J. Influence of environmental factors on mental health within prisons: focus group study. BMJ. 2003 Aug 30;327(7413):480. doi: 10.1136/bmj.327.7413.480. PMID: 12946970; PMCID: PMC188426.

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One of the largest impacts on recidivism rates is related to mental health.

Recidivism is defined as the tendency for a released inmate to reoffend

Individuals released from Prison often return to their local communities. Many of these communities are economically and socially unstable areas. (Clear, Rose, Waring, & Scully, 2003)

Approximately 50 percent of those who are released from prison meet the DSM-IV criteria for for drug dependance or abuse. Many also require considerable mental health support. (Prins & Draper, 2009).

"Mentally ill offenders released from prison who fail to establish connections with formal support services are likely to decompensate, which in turn could result in further criminal behavior" (Council of State Governments, 2002; Walsh & Holt, 1999).

Individuals with mental health needs and no parole requirements experienced the highest rates of recidivism. Those with mental health needs and parole requirements had higher rates of recidivism than parolees without Mental health needs.

Parole as been shown to have a significantly beneficial impact on reducing recidivism rates among former inmates. However, it is clear that mental health concerns need to be supported in these systems. With the focus on meeting mental health needs, recidivism rates be stunted and improve the overall health of the released.

Michael Ostermann & Jason Matejkowski (2014) Exploring the Intersection of Mental Health and Release Status with Recidivism, Justice Quarterly, 31:4, 746-766, DOI: 10.1080/07418825.2012.677465

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The effect of incarceration on children can be detrimental to long-term attainment and social mobility. Due to the lacking structures available to support family member incarceration as well as the overaggressive United States judicial system, children of the incarcerated face numerous obstacles in regards to economic status, mental health, and physical health.

Paternal Incarceration has been shown to negatively impact attainment processes needed for health development in children. This includes a higher educational barrier, difficult job market, and reduced residential safety. The mechanisms for these outcomes can be found in the continuous engagement with aggressive policing, the weathering on the maternal parent, and the social environment that the child is placed into. Since paternal incarceration affects people of color more than white individuals, Wakefield and Wildeman (2013) concluded that paternal incarceration greatly contributes to racial disparities in childhood health and well-being.

In addition, paternal incarceration has been shown to increase aggressive behaviors in children, relate to a higher prevalence of criminality, and induce a greater level of substance abuse among children. These outcomes then result in the distal health complications seen in longitudinally. Maternal incarceration has been shown to have even worse outcomes for their respective children. Since many of these issues are exacerbated by systemic issues and incarceration's relationship to health is disproportionate, these outcomes simply highlight the broad-scale ethnic health disparities present within the United States.

Wakefield, Sara, and Christopher James Wildeman. Children of the Prison Boom Mass Incarceration and the Future of American Inequality. Oxford University Press, 2014.

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It has been estimated that about 3 million women annually have an incarcerated partner. Poor, minority women disproportionately experience family member imprisonment. The effects of having an incarcerated partner can weather the health of women and their children. For women who have children with an incarcerated individual, women must bear the burden of independent parenting. This can lower socioeconomic status, family functioning, reduce social support, and eventually lead to higher levels of chronic stress.

Lee et al. (2014) developed an association between family member incarceration and chronic health complications. They found an increase in obesity, heart attack, stroke, and poor self-reported health in women. These findings elucidate mechanisms for the linkage. The aggressive policing leads to an increase for incarceration of minority men which then leads to family member incarceration. This negatively effects the social and economic capabilities of these families, and places a great amount of stress of the women who remain free. This can weather down their health and lead to these disproportionate health outcomes.

Furthermore, it has been shown that due to the poor health structure within prisons and in the communities that experience perpetuated racism and classism, the transmission of HIV towards women of color has been aggravated when they have a male partner in prison. (Johnson and Raphael 2009)

Hedwig Lee, Christopher Wildeman, Emily A. Wang, Niki Matusko, and James S. Jackson, 2014:

A Heavy Burden: The Cardiovascular Health Consequences of Having a Family Member Incarcerated

American Journal of Public Health 104, 421_427, https://doi.org/10.2105/AJPH.2013.301504

Johnson, Rucker C., and Steven Raphael. “The Effects of Male Incarceration Dynamics on Acquired Immune Deficiency Syndrome Infection Rates among African American Women and Men.” The Journal of Law and Economics, vol. 52, no. 2, 2009, pp. 251–293., https://doi.org/10.1086/597102.

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The Stress Process and Embodiment as it relates to Incarceration 

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The Stress Process and Embodiment as it relates to Incarceration 

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Incarceration can be deemed an acute stressor. The effects of stress due to incarceration can be considerable due to the dramatic changes that are required for adjustment. For longer sentences, the initial acute stress can surmount to chronic stress. This would be an exacerbating mediator of the stress. Additionally, due to the physiological conditioning of the body from daily stressors in prison, the body can succumb to an increased rate of biological aging and decreased immune function. These daily stressors are related to lack of privacy, overcrowding, antagonistic relationships, violence, and threats of victimization (Pearlin 1989). The repeated exposure can increase the allosteric load which will eventually lead to the chronic health complications as mentioned.

Pearlin LI. The sociological study of stress. J Health Soc Behav. 1989;30(3):241–56. [PubMed] [Google Scholar]

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Since incarceration affects a person's ability to receive healthcare, housing, and employment, incarceration plays a direct role in the social determinants of health.

After long periods of incarceration, many prisoners leave without an official ID card. Often, these individuals tend to be estranged from their families, and relocate to areas geographically distant from their place of incarceration. This reduces their economic stability and negative impacts their social and community contexts.

Incarcerated individuals are more likely to be homeless as compared to those in the general population. This directly impacts their access to healthcare resources, and their ability to reintegrate into society. Homelessness can often lead to poor health outcomes.

These individuals also have difficulty obtaining employment which negatively affects their economic stability and educational quality.

Through this, previously incarcerated individuals can often return to environments with lacking social support. These environments also play a role in selection for incarceration. These returns are also often met with higher recidivism rates.

“Prison And Jail Reentry And Health, " Health Affairs Health Policy Brief, October 28, 2021. DOI: 10.1377/hpb20210928.343531

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Inequalities Produced in the United States Penal System 

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Inequalities Produced in the United States Penal System 

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After incarceration, many former inmates have difficulty readjusting to society after being in isolation for years. Incarceration directly diminishes inmates' skills, knowledge, and experience. This reduces their competitiveness in the labor market. Due to the devolution of the rehabilitation system in many prisons, inmates tend to lose foundational skills and fail to gain any new ones. Additionally, employers respond negatively to a presence of a criminal record which contributes to the mentally draining stigma produced by our society as it pertains to incarceration. These issues tend to negatively affect racial and ethnic groups disproportionately than whites in the United States. Thus the US Penal System appears to be widening the disparities present in the country through its incarceration system.

Drawing statistically relevant conclusions is difficult for this particular topic due to the fact that selection bias in research can produce invalid results. Certain prisoners may be placed at a greater propensity for incarceration due to external factors prior to their sentence. Although these facts do suggest inequalities in race and socioeconomic status, the role of incarceration cannot be isolated in many of the studies since it is a representation of the systemic inequalities in society.

Massoglia, M., & Pridemore, W. A. (2015). Incarceration and Health. Annual review of sociology, 41, 291–310. https://doi.org/10.1146/annurev-soc-073014-112326

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What some of the living spaces look like in a Swedish Prison 

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A Look at Swedish and Norwegian Penal Systems 

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A Look at Swedish and Norwegian Penal Systems 

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The Swedish and Nordic Penal systems are among the best in the world. Their model focuses on rehabilitation rather than punishment. According the the Director of the Swedish Prison and Probation Service, their only punishment is the sentence and no further. Their recidivism rate is about 40% which is far lower than the United States many other countries in Europe. The Director believes this is in part due to the way Sweden treats their prisoners.

In Norway a similar model is adopted. They also emphasize rehabilitation and meeting the psychological needs of the inmates. One journalist who explored one of Norway's open prisons said this:

"Common areas included table tennis, pool tables, steel darts and aquariums. Prisoner art ornamented walls painted in mild greens and browns and blues. But the most profound difference is that correctional officers fill both rehabilitative and security roles. Each prisoner has a "contact officer" who monitors and helps advance progress toward return to the world outside — a practice introduced to help officers avoid the damage experienced by performing purely punitive functions."

The practices adopted by Sweden and Norway emphasize the importance of mental health and rehabilitation. This model directly opposes the methods used in the United States. The US has much higher recidivism and overcrowding that tends to create a circling effect in criminality and health. In Norway and Sweden the trends are in opposite directions and it could certainly be due to their alternative judiciary model. An integration of these methods can prove to be beneficial for prisoners and civilians alike in the United States.

https://www.mic.com/articles/109138/sweden-has-done-for-its-prisoners-what-the-u-s-won-t

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In an attempt to neutralize the consequences of incarceration and the US Penal System, there is potential for reform through policy.

Aggressive Policing

Policies with Policing can focus on reevaluating strategies for investigation and contact. Officers can be trained to become less biased and be required to undergo more training and education. Departments can also restructure existing practices and protocols to reduce negative interaction.

According to the ACLU, there are major movements in prison reform across the country. These changes include a reduction in incarceration, better conditions for confinement, a greater emphasis on rehabilitation and treatment, reduction of transfer from child facilities to adult, attention towards the health concern of female inmates, decriminalization of mental illness, the abolishment of private prisons.

Many of these polices hope to spark changes in the spread of infectious disease, the betterment of inmate mental health, and a focus on women's health within prisons. Other policies hope to create a better environment for reentry which would positively affect the social determinants of health as they relate to incarceration.

More about the reform can be found on their website. https://www.aclu.org/other/aclu-policy-priorities-prison-reform

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ACLU Policy Priorities for Prison Reform

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Reduction in Incarceration: Over 2 million men, women and juveniles in the United States live behind bars. The majority of them were not convicted of a violent crime. Unfortunately, the political

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Prison Health does not get the attention it deserves. With the stigmatization of incarceration, many others turn a cold shoulder when released individuals attempt to reintegrate into society. The problems released individuals face cause mental distress and harm. These problems can then exacerbate physical illnesses and eventually lead to chronic illnesses. With the continued stigmatization of mental illnesses, prisoners face some of the harshest isolation and harmful life experiences. A focus on educating others about the affects of incarceration on the individual and society can help to generate more support for prison reform, reduce criminality and recidivism rates, and produce a mutually beneficial program for inmates and society.