Examining the Relationship Between Incarceration and Population Health: The Roles of Region and Urbanicity

• Author: Jennifer Schultz,Robert R. Weidner
• DOI: 10.1177/0887403420916907
• Published date: 01 June 2021
• Date: 01 June 2021
• Subject Matter: Articles

https://doi.org/10.1177/0887403420916907

Criminal Justice Policy Review

2021, Vol. 32(4) 403 –426

© The Author(s) 2020

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DOI: 10.1177/0887403420916907

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Article

Examining the Relationship

Between Incarceration and

Population Health: The Roles

of Region and Urbanicity

Robert R. Weidner1 and Jennifer Schultz1

Abstract

Among the myriad collateral consequences of the high level of incarceration

in the United States is its detrimental effects on public health. Just as there are

geographic variations in level of incarceration within the United States, so too are

there variations in health outcomes. This study examines the relationship between

incarceration rates and population health for a national sample of counties from

2015, with a focus on how this relationship is influenced by both region (South vs.

non-South) and whether a jurisdiction is rural. To obtain unbiased estimates of the

effect of incarceration rates on two alternate health outcomes, it employs two-stage

least-squares modeling, which accounts for the endogeneity of incarceration rates

when determining their effect on population health. Results indicate that level of

incarceration has a detrimental effect on both mortality (i.e., premature death) and

morbidity (i.e., self-reported health), and that these effects are more pronounced

in rural and Southern counties. Implications of these findings for both policy and

research are considered.

Keywords

mass incarceration, population health, urbanicity, region

Introduction

The United States has the highest incarceration rate in the world (Sentencing Project,

2018). For the better part of the 20th century—from the 1920s to the early 1970s—the

U.S. incarceration rate was steady, averaging 110 per 100,000 population (Sampson &

1University of Minnesota Duluth, USA

Corresponding Author:

Robert R. Weidner, Anthropology, Sociology & Criminology, University of Minnesota Duluth, Cina Hall

228, 1123 University Drive, Duluth, MN 55812, USA.

Email: rweidner@d.umn.edu

916907CJPXXX10.1177/0887403420916907Criminal Justice Policy ReviewWeidner and Schultz

research-article2020

404 Criminal Justice Policy Review 32(4)

Loeffler, 2010). However, in the mid-1970s, the number of people incarcerated in

prison or jail began to rise dramatically. By 1980, the nation’s incarceration rate had

increased to 220 per 100,000. By 2016, the rate was 670 per 100,000—an increase of

about 330% (Bureau of Justice Statistics, 2018). This unprecedented long and large

increase in the number of people behind bars is now commonly referred to as mass

incarceration. It has been driven, not by higher crime rates, but by increased use of

prison and jail and increased lengths of stay, especially in regard to the enforcement of

drug laws (Clear, 2008).

The collateral consequences of mass incarceration are myriad. There has been

extensive research on the negative effects of incarceration on one’s subsequent pros-

pects in life (Massoglia, 2008; Pager, 2007; Schnittker & John, 2007). Because the

most disadvantaged members of society are much more likely to be incarcerated, the

nation’s penal system has emerged as a mechanism of stratification and inequality

(Massoglia & Pridemore, 2015). Yet, it is potentially problematic to think of incarcera-

tion in the United States in the aggregate, given the magnitude and complexity of state

penal systems that combine to make up the whole (Campbell, 2018). It is important to

consider the roles of urbanicity (i.e., rural vs. other) and region (South) in assessing

level of incarceration. In regard to the former, much of the research on crime and pun-

ishment has had an emphasis on urban centers, leaving rural communities understud-

ied (Eason et al., 2017). Fifteen years ago, individuals in rural and urban areas were

equally likely to go to prison. More recently, however, individuals in small counties

are about 50% more likely to go to prison than individuals in more populous counties

(Keller & Pearce, 2016). In regard to the latter, the strong relationship between the

Southern region of the country and level of incarceration is widely documented

(Chiricos & Crawford, 1995).

The magnitude of incarceration in the United States ensures that its effects will be

far and wide, as evidenced by the fact that nearly half of all people living in the United

States have an immediate family member who has experienced incarceration

(McCarthy, 2018). The individual-level effects of incarceration ripple outward, from

those incarcerated to their family members, including spouses/romantic partners, chil-

dren, siblings, and parents. Reduced life opportunities of ever-incarcerated men “spill

over” to negatively affect their loved ones and family members, including children; as

a consequence, the effects of mass incarceration are almost certainly intergenerational

(Murray & Farrington, 2008; Turney, 2014b; Tyler & Brockman, 2017; Wildeman,

2012a). High levels of incarceration also can have negative effects on communities.

Research has demonstrated that the spatial concentration of incarceration has negative

effects on phenomena ranging from community-level social dynamics (e.g., rate of

female-headed households) to public safety (Clear, 2007).

Among the collateral consequences of incarceration is its negative effect on health

(Fazel & Baillargeon, 2011; Massoglia & Pridemore, 2015; Wildeman & Wang, 2017).

Prior research has consistently found that incarceration exacerbates societal health

disparities (Iguchi et al., 2005; Massoglia, 2008; Wildeman, 2012). A growing body of

research has examined the relationship between level of incarceration and aggregate

population health outcomes. Studies have examined this issue comparing nations