AVOIDING THE RUNAROUND: THE LINK BETWEEN CULTURAL HEALTH CAPITAL AND HEALTH MANAGEMENT AMONG OLDER PRISONERS*

• DOI: http://doi.org/10.1111/1745-9125.12188
• Published date: 01 November 2018
• Author: MEGHAN A. NOVISKY
• Date: 01 November 2018

AVOIDING THE RUNAROUND: THE LINK BETWEEN

CULTURAL HEALTH CAPITAL AND HEALTH

MANAGEMENT AMONG OLDER PRISONERS∗

MEGHAN A. NOVISKY

Department of Criminology, Anthropology, and Sociology, Cleveland State

University

KEYWORDS: incarceration, prisoners, prisons, aging, chronic illness

The link between incarceration and health is of emerging empirical interest to crim-

inological scholars. Yet, we still know little about the needs of the rising population of

older prisoners and the health issues they face. By drawing on qualitative data gathered

from 193 interviews with older men incarcerated across three U.S. prisons, I examine

the specific health promotion strategies available to, and used by, these men through a

cultural health capital framework. Findings show that older prisoners make deliberate

choices to protect their health from the constraints and deprivations inherent in their

carceral lives. In the hopes of better managing chronic and acute disease, the strate-

gies prisoners reference include acquiring medical information, making food and diet

modifications, and health advocacy. Notably, the mobilization of cultural health cap-

ital is situated within a context of privilege, leaving important implications for both

incarcerated individuals and correctional administrators.

The United States currently houses more than 1.5 million men and women in state

and federal prisons (Carson and Anderson, 2016). Reflective of an era of mass incarcer-

ation, the prison population has multiplied five times over since 1978 (National Prisoner

Statistics Bulletin [NPSB], 1980), a trend that gained momentum despite decades of de-

clining crime rates (see Truman and Morgan, 2016). Taxpayers spend on average $33,274

per prisoner annually to keep correctional budgets afloat (Mai and Subramanian, 2017),

overcrowding rates are extensive (see Carson, 2015), and only one other country in the

world has a higher prison population rate (Walmsley, 2016).

The expansion of the prison population has caught the attention of social scientists

partially because of a growing need to understand the collateral consequences of

mass incarceration. Beyond the disparate impact of incarceration on people of color

(Alexander, 2010), scholars have identified incarceration as a powerful stratifying force

on both micro- and macro-levels (see Wakefield and Uggen, 2010, for a review). As a

result of the stigma of incarceration (Decker et al., 2015; Pager, 2003, 2007), and because

work and educational opportunities are disrupted, lifetime employment prospects and

∗Partial funding of this research was provided by a Kent State University GSS Research Award. The

author would like to thank Criminology Co-Editor Jody Miller and the three anonymous reviewers

for their comments, all of which made this article considerably stronger.

Direct correspondence to Meghan A. Novisky, Department of Criminology, Anthropology, and

Sociology, Cleveland State University, 2121 Euclid Ave, TR 1721, Cleveland, OH 44115 (e-mail:

m.novisky@csuohio.edu).

C2018 American Society of Criminology doi: 10.1111/1745-9125.12188

CRIMINOLOGY Volume 56 Number 4 643–678 2018 643

644 NOVISKY

wages are diminished (Jung, 2015; Western, 2002). Incarceration also elevates risks for

divorce and relationship dissolution (Lopoo and Western, 2005; Massoglia, Remster,

and King, 2011; Siennick, Stewart, and Staff, 2014; Turney, 2015), diminishes childhood

well-being (Geller et al., 2012; Hagan and Foster, 2012; Murray, Loeber, and Pardini,

2012; Turney, 2014, 2017; Wildeman, 2010), and weakens communities (Clear, 2007;

Morenoff and Harding, 2014; Warner, 2015).

Research findings also link incarceration to many deleterious outcomes involving

health and well-being (see Massoglia and Pridemore, 2015, for a review). Imprisonment

worsens indicators of population health (Schnittker et al., 2015; Wildeman, 2016) and

heightens risks for both infectious (Massoglia, 2008) and foodborne illnesses (Marlow

et al., 2017). Furthermore, incarceration is tied to chronic disease (Binswanger, Krueger,

and Steiner, 2009; Schnittker and John, 2007), obesity (Houle, 2014), diminished mental

health (Porter and Novisky, 2017; Schnittker, 2014; Schnittker, Massoglia, and Uggen,

2012), trauma exposure (Anderson, Geier, and Cahill, 2016), and hastened mortality

(Binswanger et al., 2007; Patterson, 2013; Pridemore, 2014; Spaulding et al., 2011).

These links between incarceration and health are now being compounded by an aging

prisoner population. In their report on the aging state prisoner population, Carson and

Sabol (2016) reported state prisoners 55 years of age and older increased 400 percent

between 1993 and 2013 alone. My goal for this study is to provide an understanding of

how older prisoners understand and respond to chronic and acute health needs during

incarceration. I use data from in-depth interviews with 193 older incarcerated men and

assess their accounts of strategies they use in attempts to protect their health from the

depriving environments they are forced to live within. My examination contributes to the

literature by offering important insights into not only how the health issues plaguing many

older prisoners are experienced but also by contextualizing some of the realities of prison

health care that prisoners must learn to navigate for survival.

PRISONER AGING AND DISEASE

The U.S. prisoner population has not just experienced extensive growth over the

last few decades; demographically, the population is getting older (Porter et al., 2016).

Eleven percent of today’s male prisoner population is at least 55 years of age (Carson and

Anderson, 2016), compared with 3 percent in 2000 (Beck and Harrison, 2001). Although

this is not a new empirical issue, these demographic changes have elevated the urgency

of scholars’ examinations of the needs and vulnerabilities of this growing population.

Termed the “aging crisis in U.S. criminal justice health care” (Williams et al., 2012),

multiple reports have been released as a call to action on this critical issue (American

Civil Liberties Union [ACLU], 2012; Anno et al., 2004; Carson and Sabol, 2016; Center

for Justice at Columbia University, 2015; Chiu, 2010; Human Rights Watch, 2012; Kim

and Peterson, 2014).

One reason it is concerning to have such a rapidly growing older prisoner population

is because it is financially burdensome, as older prisoners cost 2 to 3 times more to im-

prison compared with their younger peers (Anno et al., 2004; Luallen and Kling, 2014;

Pew Charitable Trusts, 2014; Williams et al., 2012). The U.S. Department of Justice (DOJ,

2016) recently reported faring even worse, with federal institutions spending 5 times more

on medical care and 14 times more on medications per inmate in institutions containing

higher percentages of older inmates than those with smaller percentages of older inmates.

AVOIDING THE RUNAROUND 645

Cost differences stem primarily from the greater need for health-related services among

older prisoners given their higher disease burdens.

Older adults are significantly more likely than younger adults are to have chronic health

conditions such as diabetes and heart disease (Centers for Disease Control and Preven-

tion [CDC], 2013). Research findings also reveal that as a population, prisoners experi-

ence accelerated physiological aging, making them vulnerable to chronic health condi-

tions at earlier points in the life course than would be expected if they were living in

the community (see Aday, 2003; Chodos et al., 2014; Loeb, Steffensmeier, and Lawrence,

2008; Williams et al., 2012). The age-related risks for chronic disease, coupled with risks

for accelerated physiological aging, help explain why, when compared with younger pris-

oners, older prisoners are uniquely disadvantaged in regard to morbidity and mortality

risk.

In particular, older state prisoners are significantly more likely to have chronic health

conditions and infectious diseases than are younger state prisoners (Maruschak and

Berzofsky, 2015). Multimorbidity is also normative among older inmates. Unlike their

peers in younger age groups, older prisoners suffer from an average of two to three

chronic health conditions at any given time (Aday, 2003; Chiu, 2010; Harzke et al., 2010;

Loeb and Steffensmeier, 2006; Nowotny et al., 2016). Furthermore, mortality rates are

highest among older prisoners. In 2014, only 18 percent of state prisoners who died in

custody were younger than 45 years of age (Noonan, 2016).

Older prisoners are further disadvantaged in that prisons were never designed to ac-

commodate the needs of an older population. Crawley (2005) used the term “institutional

thoughtlessness” to underscore the difficulties older prisoners face when forced to walk

far distances to medical units, shower on slippery tile without anti-slip mats or grab rails,

and exercise without access to toilets—despite the mobility and morbidity issues that ac-

company older age. Often characterized by long corridors that require much walking,

uncomfortable furniture for sitting and sleeping, and small-capacity medical units, pris-

ons are egregiously inauspicious spaces for the old. Other challenges for older prisoners

include no ability to modify extreme air temperatures and poor ventilation (Trotter and

Baidawi, 2015).

Medical care is often inconsistent for older prisoners as well. Older inmates experience

delays and changes in their medications (Sullivan et al., 2016) and report unmet dietary

needs (O’Hara et al., 2016). Citing staffing shortages, the U.S. DOJ (2016) disclosed that

aging inmates in federal prisons wait an average of 114 days to see needed medical special-

ists in cardiology and pulmonology. Many states are now requiring prisoners to provide

co-payments in order to be seen by medical staff as well (Sawyer, 2017), a practice that

raises serious ethical concerns regarding health-care accessibility.

Although lack of medical care is one of the most commonly cited prisoner grievances

(Calavita and Jenness, 2015), we know little about the health-related behaviors of pris-

oners and how they attempt to maintain their health in an environment that prioritizes

punishment and security above all else. This is particularly the case for older prisoners,

who are especially vulnerable to morbidity and mortality, cost more to incarcerate, and

often lack basic accommodations afforded by other institutions that care for older adults

(Aday, 2003). Given the lack of research on the health management strategies of older

prisoners, qualitative data are well suited to capture their experiences. Next, I introduce

Shim’s (2010) cultural health capital framework as a valuable foundation for unpacking

this pressing problem.