Incarceration as a social determinant of health: A conceptual framework for considering the health of minority communities in the United States

Background: The incarceration rate in the United States is the highest in the world, increasing nearly 400% since 1980. This marked increase and the creation of what critics call the "prison-industrial complex" stems directly from policy measures enacted in the 1970s and 1980s. Like most social phenomena, these mass incarceration rates are socially patterned by both race and class. Methods: This paper proposes a multilevel, life course conceptual framework for considering incarceration as a social determinant of health in minority communities. Results: With one in 21 African American men and one in 279 African American women currently incarcerated and almost one-third of African American men incarcerated at least once in their lifetime, incarceration must be considered when evaluating the health of African American populations, specifically, and racial health disparities, in general. Discussion: Racialized and class-based distortions in the definitions of crime have affected the patterns of disease distribution. Furthermore, given residential segregation in the United States, mass incarceration arguably has compounded social and health disadvantage in already disadvantaged populations. Incarceration policies in the United States should be re-evaluated and attention should be paid to the intersection of "incarceration status" with other minority social statuses as it relates to population health.