Our study contributes to evidence that the burden of imprisonment is not evenly distributed across gender and race in the United States population. Males spend a greater proportion of their life in prison or jail than females. Considering either gender, African Americans spend much more of their life in prison or jail than Hispanics or Caucasians. The burden, if not the disparity, would be even larger if we considered people confined under the jurisdiction of local authorities and people that were on parole or probation, since the latter group is currently twice the size of those imprisoned [11
]. Furthermore, the percentage of time spent in prison is conservative in our study because the estimate of life expectancy is from birth, even though most people who are imprisoned are between 18 and 44 years of age.
Although data are limited, there is a growing concern that imprisonment can have serious negative health consequences [12
]. Prison populations exhibit an elevated prevalence of communicable disease [14
]. High levels of violence, including sexual violence, have been reported among imprisoned populations [15
]. Consensual sex without condoms as well as drug injection and tattooing without sterile equipment are reported to occur at dangerous levels and to result in transmission of diseases, such as HIV [12
]. Additionally, imprisonment may have life altering health consequences mediated by factors such as a decline in socio-economic status [22
Our findings, and the growing literature on the negative health consequences of imprisonment, suggest that the extensive reliance on incarceration to control behavior in the United States has social costs that have not been fully recognized [22
]. These social costs are not evenly distributed and may be contributing to population health disparities [23
]. These health consequences may be reduced to some degree by making prisons more salubrious – by introducing better health, addiction treatment and mental health care, distributing condoms and needles, preventing violence and coordinating services as inmates move back into the community [12
]. The most direct way to reduce these consequences would be to reduce the number of people who go to prison. One way to accomplish this would be by reducing the number of behaviors subject to imprisonment. Because laws criminalizing drug possession are the major driver of the imprisonment of the non-violent offenders in the United States, changes in these laws could be expected to have a significant impact. Other steps would include investing more in drug treatment, mental health care and other services that can forestall offending, reduce recidivism or serve as alternatives to imprisonment.
The use of mid-year sample data from the Bureau of Justice Statistics to measure the number of persons imprisoned may represent a limitation in our analyses. These data are based on sample estimates and do not reflect a complete census of prisoners. We must also recognize that these data exclude persons confined in locally administered facilities who are under the jurisdiction of local authorities and those who are on parole or probation [4
]. Additionally, the Sullivan method does not reflect transitions in and out of prison. However, regardless of prison term or transitions in and out of prison, the potential health consequences identified above are still of concern.
More research on the health effects of imprisonment and new interventions to reduce them should be an urgent priority within both corrections and public health. Even in the absence of additional data, our study suggests that health consequences should be given greater weight in discussions of law enforcement strategies generally and drug policy in particular.