INCARCERATION AND POPULATION HEALTH IN WEALTHY DEMOCRACIES*

• Author: CHRISTOPHER WILDEMAN
• Published date: 01 May 2016
• Date: 01 May 2016
• DOI: http://doi.org/10.1111/1745-9125.12107

INCARCERATION AND POPULATION HEALTH

IN WEALTHY DEMOCRACIES∗

CHRISTOPHER WILDEMAN

Department of Policy Analysis and Management, Cornell University

KEYWORDS: incarceration, population health, cross-national, collateral consequences

Everywhere you look, incarceration seems to be doing harm. Research has impli-

cated incarceration not only in worse outcomes for individuals, their families, and their

communities but also in growing inequality. Yet incarceration may not always harm

society—even if it does harm those who experience it. To consider this possibility, I

build an argument demonstrating how the macro-level consequences of incarceration

may be distinctively harmful in the United States, focusing on the incarceration–health

relationship as one indicator of a broader phenomenon. I then test my hypothesis by

using an unbalanced panel data set including 21 developed democracies (N =414)

and a series of ordinary least-squares models predicting three measures of population

health as a function of incarceration. Models including only a main effect of incarcera-

tion demonstrate an inverse association between changes in incarceration and changes

in population health. Models including an incarceration by U.S. interaction, however,

indicate that the population health consequences of changes in incarceration are far

worse in the United States than elsewhere. Taken together, the results indicate that the

United States is exceptional for both its rate of incarceration and its effects of incarcer-

ation, although it is unclear what drives this exceptionalism in effects.

Everywhere you look, incarceration seems to be doing harm. For the millions of

Americans who spend time in prison or jail annually (Glaze and Herberman, 2013), their

time behind bars on average leads to a host of negative life-course outcomes including

poor labor market prospects (Pager, 2003; Western, 2002), homelessness (Geller and

Curtis, 2011; Gowan, 2002), and divorce (Lopoo and Western, 2005; Massoglia, Remster,

∗Additional supporting information can be found in the listing for this article in the Wiley Online

Library at http://onlinelibrary.wiley.com/doi/10.1111/crim.2016.54.issue-2/issuetoc.

Support was provided by a postdoctoral fellowship from the Robert Wood Johnson Foundation

Health & Society Scholars Program, a grant from the Robert Wood Johnson Foundation Health &

Society Scholars Program at the University of Michigan, and a grant from the Institute for the So-

cial Sciences at Cornell University. This article benefited immensely from written comments from

Lars Andersen, Jason Beckfield, Sarah Burgard, Maria Fitzpatrick, Jeff Morenoff, Chris Muller,

Andy Papachristos, Jason Schnittker, Olav Sorenson, Bruce Western, and three anonymous

reviewers and Editor Eric Baumer at Criminology,aswellasfromcommentsfromseminar

and conference participants at American University, Columbia University, Cornell University,

the Population Association of America, Stockholm University, the University of Michigan, the

Vera Institute of Justice, and Yale University. Kevin Bradway, Bridget Brew, Candas Pinar, and

Danielle Zucker provided excellent research assistance. Any remaining errors are my fault.

Direct correspondence to Christopher Wildeman, Department of Policy Analysis and Man-

agement, Cornell University, 137 Martha Van Rensselaer Hall, Ithaca, NY 14853 (e-mail:

christopher.wildeman@cornell.edu).

C2016 American Society of Criminology doi: 10.1111/1745-9125.12107

CRIMINOLOGY Volume 54 Number 2 360–382 2016 360

INCARCERATION AND POPULATION HEALTH 361

and King, 2011). The formerly incarcerated also suffer from a range of maladies that are

partly attributable to the time that they spent behind bars. These include not just elevated

mortality rates (Binswanger et al., 2007; Farrell and Marsden, 2008; Pridemore, 2014) but

also both physical and mental health problems (Massoglia, 2008; Schnittker and John,

2007; Schnittker, Massoglia, and Uggen, 2012).1

Looking beyond the effects on inmates, the families of the incarcerated must cope with

the stigma of having a family member incarcerated (Braman, 2004, Comfort, 2007, 2008)

and with the often-dramatic reductions in income (Geller, Garfinkel, and Western,

2011) and increases in both economic hardship (Schwartz-Soicher, Geller, and Garinfkel,

2011) and housing instability (Geller and Franklin, 2014; Wildeman, 2014) that come

along with this incarceration. Because of these effects, the women (Lee et al., 2014;

Wildeman, Schnittker, and Turney, 2012) and children (Geller et al., 2012; Haskins, 2014;

Roettger and Swisher, 2011; Wildeman, 2010) tied to the incarcerated tend to fare worse

than expected in a whole host of important domains. Although empirical tests of the

broader effects of incarceration on community life have been lacking, some research has

linked living in a high-incarceration neighborhood with a host of negative outcomes, in-

cluding far higher than predicted rates of both crime (Clear, 2007, 2008; Clear et al., 2003)

and psychiatric morbidity (Hatzenbuehler et al., 2015).

When these effects are combined with high rates of incarceration—and racial inequality

in incarceration—in the United States, the effects of incarceration may even be observ-

able at the population level (Western and Muller, 2013; Wildeman and Muller, 2012),

provided the effects of incarceration for inmates, families, and communities outweigh its

crime-fighting benefits.2And indeed, studies testing the effects of incarceration in the

United States have shown that incarceration explains much of the racial gap in AIDS

(Johnson and Raphael, 2009) and some of the gaps in earnings (Western, 2006), marriage

(Lopoo and Western, 2005), child well-being (Wakefield and Wildeman, 2011, 2014), and

population health (Wildeman, 2012a, 2012b).

Virtually all existing research on the macro-level consequences of incarceration has to

date focused solely on the United States (but see Stuckler et al., 2008),3however, which

is problematic because there are several reasons to expect changes in the incarceration

rate in the United States and in other developed democracies to yield qualitatively dif-

ferent results. First, and maybe most importantly, because of their low starting rates of

incarceration, the crime-fighting benefits of incarceration in other developed democracies

1. For reviews of these literatures, see Massoglia and Pridemore (2015) and Wakefield and Uggen

(2010).

2. Although the magnitude of the crime-fighting benefits of incarceration has long been contested

(Becsi, 1999; Johnson and Raphael, 2012; Levitt, 1996; Liedka, Piehl, and Useem, 2006; Marvell

and Moody, 1994; Spelman, 2008; Western, 2006), there is emerging consensus that the crime-

fighting benefits of incarceration were substantial at the beginning of the prison boom but have

dropped off since the early 1990s (Travis, Western, and Redburn, 2014).

3. Cross-national research has shown that including inmates in labor force calculations leads the

American employment advantage relative to other developed democracies to erode (Pettit, 2012;

Western, 2006; Western and Beckett, 1999). There is also some individual-level evidence, much of

which uses British (Murray and Farrington, 2005, 2008) or Danish (Andersen and Wildeman, 2014;

Wildeman et al., 2014) data, that parental incarceration has harmful effects on children in other de-

veloped democracies, so although there have been few macro-level studies on the effects of shifts

in incarceration for macro-level outcomes, there has been a strong individual-level research base

in some countries.