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

Published date01 June 2021
Date01 June 2021
Subject MatterArticles
Criminal Justice Policy Review
2021, Vol. 32(4) 403 –426
© The Author(s) 2020
Article reuse guidelines:
DOI: 10.1177/0887403420916907
Examining the Relationship
Between Incarceration and
Population Health: The Roles
of Region and Urbanicity
Robert R. Weidner1 and Jennifer Schultz1
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.
mass incarceration, population health, urbanicity, region
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
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

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT