By Penal Reform International and the University of Nottingham

Mortality rates are up to 50% higher in prison than in the community, linked to a wide range of causes and contributing factors which raise serious concerns for human rights, public health, and prison management. Yet, information on who is dying in prison and why, including disaggregated data, remains a key problem in understanding and reducing deaths in prisons.

This briefing is a call to action for the international community and national actors to strengthen their approach to deaths in prisons, to take pro-active measures to prevent loss of life and, when deaths do occur, to respond appropriately and conduct robust investigations in line with international human rights standards to identify any systemic concerns and prevent future harm.

Published in partnership with the University of Nottingham, it is based on research conducted as part of the prisonDEATH initiative and survey responses to a call for input from PRI from a variety of stakeholders in 25 countries covering all regions, as well as 19 prison administrations facilitated by EuroPris. Aimed to inspire action, it includes some recommendations to guide human rights-based responses to prevent premature or avoidable deaths in prison.

London: PRI, 2022. 16p.

By Prison Reform International and the University of Nottingham

nvestigating deaths in prisons is an essential part of a state’s human rights responsibilities, including the obligation to guarantee the right to life and the prohibition of torture and other cruel, inhuman or degrading treatment or punishment. Investigations of deaths in prisons provide crucial evidence to find out what went wrong, provide redress to families, improve prison management and ultimately prevent future deaths.

This guide by PRI and the University of Nottingham provides prison authorities, policy makers, law enforcement officials, and families of persons deprived of liberty guidance and analysis on the basic features of human rights-based investigations into deaths in prison. It sets out key international and regional jurisprudence and includes recommendations to assist in designing and implementing an effective investigation system, as well as promising practices to inspire authorities to develop and implement reforms.

London: PRI, 2023. 26p.

By Susan McNeeley, Valerie Clark and Grant Duwe

Individuals released from prison have an elevated risk of premature death, especially during the first few weeks after release. Furthermore, these consequences of incarceration may be exacerbated by racial and ethnic disparities. This study examined three types of post-release mortality – all-cause mortality, natural deaths, and unnatural deaths which include accidents, suicides, and homicides – among individuals released from Minnesota state prisons in order to identify characteristics and experiences that place individuals at risk. In addition, we conducted race-specific models examining these types of mortality among White, Black, and Native American releasees. The results of Cox regression models showed, first, that several personal characteristics were related to risk of death. Black, Asian, and Latino people had lower risk of mortality than White people, while Native American people had higher risk. Those affiliated with security threat groups (STG) had higher risk of death, as did those with more mental and physical health diagnoses and those with higher body mass index (BMI). Second, several aspects of criminal history and incarceration were related to post-release mortality. Sex offenders had lower risk of death, while those incarcerated for driving while intoxicated (DWI) had higher risk. Prison visitation reduced the risk of mortality. Risk of death was higher among those with more prior prison admissions, those incarcerated for supervised release revocations, and those with more discipline convictions – but was lower when individuals were incarcerated for longer periods of time. Third, the circumstances of release were related to risk of death. Individuals released to the Twin Cities Metropolitan area had higher risk of mortality, while those released to community programs had lower risk. Finally, the results also showed that, while many risk or protective factors appeared to be universal, some race-specific risk factors do exist.

St. Paul, Minnesota Department of Corrections, 2023. 43p.

By Susan McNeeley and Doyun Koo

Prior research on violent victimization in prison suggests noncitizens may be less likely to experience violence while incarcerated. In an attempt to better understand this relationship, this study examined whether citizenship status predicts risk among a subsample of foreign-born incarcerated people. In addition, we modeled violent victimization separately for foreign-born and native-born individuals to identify any differences in risk factors between groups. We tested these relationships using a sample of 7,326 individuals incarcerated in Minnesota state prisons. The results of Cox regression models showed foreign-born citizens and foreign-born noncitizens had similar risk for violent prison victimization. We also found that some risk factors for victimization (age, physical health, MnSTARR 2.0 risk level, and idle status) differed across native-born and foreign-born incarcerated people.

St. Paul: Minnesota Department of Corrections, 2023. 27p.

By Nathan W. Link, Kathleen Powell, Jordan M. Hyatt, and Ebony L. Ruhland

Monetary sanctions levied on individuals on probation and parole may dramatically influence their ability to reintegrate into the community and to complete their community supervision. Yet very little work has empirically assessed how agencies respond to these obligations. This is critical, given that individuals under community supervision occupy a liminal space: free in the community yet often at risk of violation, rearrest, additional fines, or re-incarceration. In this article, we introduce an approach to the collection and management of monetary sanctions by an adult probation and parole agency in one Pennsylvania county. This specialized department focuses solely on repayment of fines, fees, and costs for a subset of probationers and parolees who have completed all other supervision requirements. We complement the conceptual overview by presenting administrative data on this caseload (N = 5,811) to describe the population under supervision and assess the factors associated with debt amount, having difficulty with repayment, and being the subject of an enforcement action for non-payment. We conclude with a discussion of the advantages and disadvantages of this model compared with historical and other existing models of debt enforcement during community supervision.

Journal of Contemporary Criminal Justice, Volume 37, Issue 1, February 2021, Pages 128-147

By Annie Harper, Callie Ginapp, Tommaso Bardelli, Alyssa Grimshaw & Marissa Justen & Alaa Mohamedali & Isaiah Thomas & Lisa Puglisi

People involved with the criminal justice system in the United States are disproportionately low-income and indebted. The experience of incarceration intensifies financial hardship, including through worsening debt. Little is known about how people who are incarcerated and their families are impacted by debt and how it affects their reentry experience. We conducted a scoping review to identify what is known about the debt burden on those who have been incarcerated and their families and how this impacts their lives. We searched 14 databases from 1990 to 2019 for all original research addressing financial debt held by those incarcerated in the United States, and screened articles for relevance and extracted data from pertinent studies. These 31 studies selected for inclusion showed that this population is heavily burdened by debt that was accumulated in three general categories: debt directly from criminal justice involvement such as LFOs, pre-existing debt that compounded during incarceration, and debts accrued during reentry for everyday survival. Debt was generally shown to have a negative effect on financial well-being, reentry, family structure, and mental health. Debts from LFOs and child support are very common among the justice-involved population and are largely unpayable. Other forms of debt likely to burden this population remain largely understudied. Extensive reform is necessary to lessen the burden of debt on the criminal justice population in order to improve reentry outcomes and quality of life.

American Journal of Criminal Justice (2021) 46:250–278

By Emily D. Buehler

This report describes substantiated incidents of inmate sexual victimization by another inmate or by staff. It presents data on the incidents of sexual victimization, such as location and time of day. It also provides characteristics of the victims and perpetrators of the victimization. The report details services provided to the victim and consequences for the perpetrator. In part, it fulfills BJS’s mandates under the Prison Rape Elimination Act of 2003 (PREA; P.L. 108–79).

Highlights

• During 2016–18:

• Half of both inmate-on-inmate and staff-on-inmate sexual victimization incidents occurred in an area not under video surveillance.

• There were 2,886 victims of inmate-on-inmate sexual victimization and 2,496 victims of staff-on-inmate sexual victimization in adult correctional facilities.

• About 25% of victims of inmate-on-inmate nonconsensual sexual acts and 43% of victims of abusive sexual contact were female.

• The victim was given a medical examination in 61% of inmate-on-inmate nonconsensual sexual act incidents and in 36% of abusive sexual contact incidents

Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. 2023. 36p.

By The Independent Monitoring Boards

Independent Monitoring Boards (IMBs) monitor and report on the conditions and treatment of those detained in every prison in England and Wales. The government recently rejected the Justice Select Committee’s recommendation for a resentencing exercise to take place for anyone serving an IPP sentence. IMBs submitted current findings on the impact of this decision, and the sentence itself, on IPP prisoners’ wellbeing. This briefing summarises findings from 24 IMBs submitted between 17 February and 9 March 2023 and references two 2021-22 annual reports from IMBs at HMPs Hewell and Moorland, which conducted surveys with IPP prisoners. Key findings The findings indicated: • Serious safety implications were heightened by the recent announcement, with assessment, care in custody and teamwork (ACCT) documents being opened for several IPP prisoners. Three apparently self-inflicted deaths of IPP prisoners occurred in three prisons in the four weeks following the announcement. • IPP prisoners had increased feelings of hopelessness and frustration following the announcement, which IMBs noted could act as a catalyst for poor mental health, violence and disruptive behaviour. • Variable and often inadequate staff engagement both pre- and post-announcement, with some prisoners only learning of the decision through a letter. • Progression pathways were poor and unclear to prisoners, which meant many prisoners questioned whether they would ever be released following the announcement. Some prisoners were being held in inappropriate establishments, often without access to required courses. The increasing difficulty of transferring to open conditions has left some prisoners ‘institutionalised’. • Insufficient preparation for parole hearings and for release, with reports of inadequate care plans and ‘through the gate’ provision. This lack of provision contributed to recall: for example, some prisoners were recalled only because of issues arising from the loss of accommodation.

London: Independent Monitoring Boards, 2023. 6p.

By Jill Curran, Brendan Saloner, Tyler N.A. Winkelman, et al

Question: How commonly are medications for chronic conditions used in jails and state prisons compared with community settings in the US? Findings In this cross-sectional descriptive study of incarcerated and non-incarcerated populations in the US from 2018 to 2020, use of prescription medications for chronic conditions was consistently lower in jails and state prisons compared with community settings. After adjusting for disease prevalence, the relative disparity was 2.9-fold for diabetes, 5.5-fold for asthma, 2.4-fold for hypertension, 1.9-fold for hepatitis B or C, 3.0-fold for human immunodeficiency virus, 4.1-fold for depression, and 4.1-fold for severe mental illness. Meaning This analysis suggests that prescription medications for chronic conditions may be substantially underused in jails and state prisons in the US relative to the non-incarcerated population, after accounting for the differential burden of disease in these settings.

JAMA Health Forum. 2023;4(4):e230482. doi:10.1001/jamahealthforum.2023.0482

By Terry Schuster, Kristin King

During a summer marked by record-setting heat waves, the state of New Jersey housed roughly 3,500 people in prison housing units with no air conditioning. About 3,000 correctional police officers were also assigned to these non-temperature-controlled spaces. On July and August site visits, the Office of the Corrections Ombudsperson measured temperatures in 80 percent of the state’s populated housing units and conducted brief interviews with incarcerated individuals and staff. Temperatures inside individual prison cells were as high as 88 degrees Fahrenheit during the July site visit and 94 degrees during the August visit. People in state prisons described temperatures in their living spaces as “unbearable,” “beyond hot,” and “like Hell.” The Ombuds office heard reports of people engaging in assaultive behavior in order to be transferred to air-conditioned disciplinary housing assignments. The office also heard reports from staff and labor leaders that high heat increased irritability and slowed responses to prison security incidents. Three prisons—Bayside State Prison, East Jersey State Prison, and Garden State Correctional Facility— account for more than three-quarters of the state’s non-air-conditioned prison beds. Another three prisons, including the two largest facilities, are fully air-conditioned. And the remaining three state prisons have a mix of temperature-controlled and non-temperature-controlled housing units. Because people detained in prison facilities cannot leave of their own accord and have limited control over their movement, possessions, and environment, the state assumes a responsibility for their humane treatment, including a responsibility to protect them from potential harms associated with extended exposure to heat and cold. Department of Corrections executive and facility leaders have taken proactive and reactive steps to mitigate the heat and have worked closely with the Office of the Corrections Ombudsperson to address areas of concern. They should be applauded for their efforts, utilizing the resources they have, to reduce the risks of heat stroke and other heat-related illnesses and security risks. These risks, however, will continue to surface each summer absent state appropriations for major building repairs.

Trenton: New Jersey Office of the Corrections Ombudsperson, 2022. 14p.

By Amanda Chan and Anna Nathanson

Prison food is poor quality. The regulations which govern prison food are subpar and unenforceable by prisoners, due in large part to Sandin v. Conner and the Prison Litigation Reform Act. This Article aims to draw attention to the dire food conditions in prisons, explain the lax federal administrative law that permits these conditions, highlight the role of Sandin v. Conner and the Prison Litigation Reform Act in curtailing prisoners’ rights, and criticize the role of the private entity American Correctional Association in enabling mass neglect of prison food. The authors recommend that the Prison Litigation Reform Act be repealed, that Sandin v. Conner be overturned, and that Food Service Manual standards be improved to provide prisoners with more calories, more options, and more variety. Prisoners will be better positioned to enforce food rights in the courts under the recommended regime.

29 Wm. & Mary Bill Rts. J. 1009 (2021),

By Leslie Soble, Kathryn Stroud, and Marika Weinstein,

A person sentenced to prison in the United States serves three years on average. That’s more than 3,000 meals behind bars (far more for people serving longer sentences), all typically high in salt, sugar, and refined carbohydrates and low in essential nutrients—a diet that for decades everyone else has been advised to avoid. The food itself and the conditions under which it is served are harmful to physical and mental health and can erode self-esteem, with immediate and long-term impacts. The damaging and degrading prison food experience is a symptom of a larger systemic malady: our dependence on a dehumanizing criminal justice system to address harm. Like every other aspect of mass incarceration, this is an issue of racial and economic injustice: Lower-income communities of color, where affordable healthy food is scarce, disproportionately lose members to prison and then struggle to support them when they return home in worse health. In this way, prisons function as out-of-sight food deserts, perpetuating patterns of poor health in communities that already experience profound inequities. This six-part report, the first national investigation of its kind, explores these and other troubling trends in prison food. Resulting from 18 months of fact-finding by Impact Justice, our report centers the perspectives of people who have been incarcerated while also examining food service policies and practices that affect 1.3 million people incarcerated in state prisons nationwide. The report also highlights some promising emerging efforts in a handful of prisons where nourishing food is becoming a priority, illuminating the potential for change. The broadening awareness that access to good food is a fundamental human right has spawned urban farms, mobile farmers’ markets, and land co-ops, revitalized school lunch, and more. This report makes clear that the growing food justice movement must incorporate the millions of people inside prison walls, and shows how diverse stakeholders can work together in common purpose.

Oakland, CA: Impact Justice, 2020. 137p.

By Wendy Sawyer and Peter Wagner

Can it really be true that most people in jail are legally innocent? How much of mass incarceration is a result of the war on drugs, or the profit motives of private prisons? How has the COVID-19 pandemic changed decisions about how people are punished when they break the law? These essential questions are harder to answer than you might expect. The various government agencies involved in the criminal legal system collect a lot of data, but very little is designed to help policymakers or the public understand what’s going on. As public support for criminal justice reform continues to build — and as the pandemic raises the stakes higher — it’s more important than ever that we get the facts straight and understand the big picture. Further complicating matters is the fact that the U.S. doesn’t have one “criminal justice system;” instead, we have thousands of federal, state, local, and tribal systems. Together, these systems hold almost 2 million people in 1,566 state prisons, 102 federal prisons, 2,850 local jails, 1,510 juvenile correctional facilities, 186 immigration detention facilities, and 82 Indian country jails, as well as in military prisons, civil commitment centers, state psychiatric hospitals, and prisons in the U.S. territories. This report offers some much-needed clarity by piecing together the data about this country’s disparate systems of confinement. It provides a detailed look at where and why people are locked up in the U.S., and dispels some modern myths to focus attention on the real drivers of mass incarceration and overlooked issues that call for reform.

Easthampton, MA: Prison Policy Initiative, 2022. 58p.

By The Vermont Law and Graduate School, Center for Agriculture and Food Systems

Approximately 2 million people are incarcerated in the United States. While law- and policymakers have focused some attention on improving conditions for individuals who are incarcerated, the issue of food in prisons has not been at the forefront of prison policy reform. In recent years, there has been increased attention focused on this issue in New England—a region marked by some successful efforts that reduced costs, increased access to fresh local foods, and provided skills and training. Many correctional officials and food service managers in the New England region and beyond are working hard with limited means in a policy landscape that often makes it difficult to increase the quality of prison food. This report is intended to assist policymakers, correctional facility administrators, food service managers, food justice advocates, and the public in understanding the complex set of constitutional, federal, and state laws and policies impacting the prison food system to identify opportunities for reform in the New England region. People of color are disproportionately represented in the prison population; incarceration rates are 1.3 to 6 times higher for people of color than for white people. Notably, Black Americans comprise 38 percent of the prison population despite constituting 13 percent of the US population. In some New England states these disparities are even more stark. Both Connecticut and Maine maintain a disparity of 9:1 between Black and white individuals who are incarcerated, and Massachusetts leads the country in ethnic disparities. While poverty represents both a substantial cause and effect of incarceration, many individuals who are incarcerated also demonstrate additional factors of socioeconomic marginalization, including food and nutrition insecurity, low educational attainment, and high unemployment rates, as compared to the general population. In the US, rates of food insecurity and very low food security are “significantly higher than the national average” for non-Hispanic Black and Hispanic households. Consequently, for Black individuals who are incarcerated, food insecurity may present a challenge prior to, during, and after incarceration. Additionally, since many individuals continue to experience food and nutrition insecurity upon release due to difficulty securing employment, the health impacts can be ongoing. Much public attention focuses on privately owned prisons, yet less than eight percent of the prison population is housed in them. In fact, most individuals who are incarcerated are held in publicly operated federal or state prisons, facilities which are often required to follow procurement policies and guidelines for purchasing food. This provides an opportunity for states to consider developing procurement policies directed at the same goals as other institutional procurement policies: economic development through local preference and improved health.

South Royalton, VT: Vermont Law and Graduate School, 2023. 54p.

By Roger Grimshaw

Across the UK, an individual can find themselves detained, with no clear sense of when they might be released, under a number of different powers, laws and regulations. In the case of criminal justice detention, indeterminate detention takes three main forms. An unconvicted individual can be remanded in prison while awaiting trial. Given the current backlog of cases in the criminal courts, an individual can be left languishing in prison awaiting trial for months, in some cases years. Life imprisonment – mandatory in the case of a murder conviction – is the second form of indeterminate criminal justice detention. An individual subject to a life sentence has to serve a minimum period in custody (the so-called ‘tariff’) before they can be considered for release. Ongoing detention at the end of the tariff period is common. On release, a life sentence prisoner is subject to lifelong supervision, with recall to prison at any point a real possibility. The third form of indeterminate criminal justice detention are the three life sentence-like sentences: in England and Wales, the imprisonment for public protection (IPP) sentence; in Northern Ireland, the indeterminate custodial sentence (ICS); and in Scotland, the order for lifelong restriction (OLR). The IPP, ICS and OLR sentences work in a way similar to the life sentence: an indeterminate period in custody, followed by ongoing supervision on release in the community, if the prisoner manages to secure release. They can, though, be imposed for a far wider range of offences than is allowed for by the relatively narrow set of offences in the case of a life sentence. The subject of this briefing is the IPP, ICS and OLR sentences. The main conclusion it draws relates to the question of whether such sentences should be considered a form of psychological torture. With the failed abolition of the IPP sentences in England and Wales, and the ongoing operation of the ICS and OLR sentences in Northern Ireland and Scotland, the torturous and unfair aspects of these indeterminate sentences are likely to become ever more apparent.

London: Centre for Crime and Justice Studies , 2023. 8p.

By Mia Schlicht

Australia’s imprisonment rate has increased sharply in the last four decades. In 1975, there were 8,900 people in prisons across Australia – there are now over 40,500. The number of prisoners has increased by 355 per cent despite the population of Australia increasing by just 86 per cent. This has resulted in an incarceration rate of 205 per 100,000 of the adult population which places Australia as one of the fastest growing incarcerators in the world amongst other OECD countries.

Of these 40,500 prisoners, 38 per cent have been imprisoned for non-violent offences. Alternative justice measures such as electronic monitoring, home detention, fines, tax penalties, restitution orders and other such measures may be preferable. These alternatives would better realise the interests of those who suffer the most from crimes, the victims, who have vocalised their discontent with the tough-on-crime rhetoric in Australia that has led to an over-reliance on incarceration as a form of justice.The crime landscape across Australia has seen a change in recent years. Offender rates have declined along with the number of victims of crime. Despite this notable shift, sentencing reform has not responded. Of those fewer non-violent offenders, more are being imprisoned for short lengths of time which is contributing to Australia’s high reoffence rate. More than 60 per cent of Australia’s prison population has been previously incarcerated which is one of the highest reoffending rates in the world. Over a third of convicted prisoners in 2021-22 received a prison sentence of less than six months. Short and frequent sentences are associated with high recidivism rates and 66 per cent of these short sentences are served by non-violent offenders.

Criminal behaviour must be punished. However, a distinction needs to be made between those we are afraid of and those we are mad at. For those who are low risk offenders, alternative justice measures should be imposed to punish behaviour whilst also incentivising criminals to make better decisions and foster their rehabilitation with the community.

This paper presents the case for reform to Australia’s incarceration policies by presenting the costs of the criminal justice system in Australia; investigating who is in the system and why; analysing the reasons behind the changing crime scene; and suggesting directions toward an improved system.

This paper finds that the policy surrounding incarceration has not changed for a long time despite obvious changes in the nature of offending and criminal behaviour. Prisons are being used for broader purposes than necessary. Of the aims of the criminal justice system – public safety, deterrence, retribution, and restitution – only public safety through incapacitation can uniquely be achieved by prison. Where public safety is not a concern, alternative methods should be introduced.

Melbourne: Institute of Public Affairs, 2023. 40p.

By Harry Annison and Thomas Guiney, with assistance from Zoë Rubenstein

Moments of crisis and scandal are an ever-present feature of the political cycle and the decisions taken in the heat of the moment can, and frequently do, have consequences and policy legacies that last for decades. The neat distinction sometimes drawn between ‘normal’ and ‘exceptional’ times is a convenient fiction that distracts us from how the criminal justice system operates.

This discussion paper, written by Harry Annison and Thomas Guiney, with assistance from Zoë Rubenstein, aims to shine a light on these important themes, and support those with a stake in the penal system to better understand the forces at work during these intense periods.

London: Prison Reform Trust, 2023. 27p.

By Essex County Civilian Task Force (NJ)

In 2019, the New Jersey Legislature enacted the Isolated Confinement Restriction Act (“ICRA”), significantly limiting isolated confinement in jails and prisons throughout the state. The impetus for the legislation was twofold: a responsive effort to address citizen complaints about the misuse of isolated confinement, as well as a proactive effort by legislators to mitigate the adverse impacts of isolated confinement. As part of its mandate to oversee the policies and practices of the ECCF and in response to concerns raised and explored at public meetings, the SHU Subcommittee has conducted an extensive review of the use of isolated confinement at the facility. The Subcommittee addressed four related issues: (1) whether the ECCF is complying with ICRA; (2) if not, what conditions prevent full compliance; (3) what recommendations the Task Force might make to alter the conditions preventing compliance; and (4) what steps ECCF administrators could undertake to improve operations and inmate conditions in the SHU. The answers remain incomplete. Although the ECCF has made substantial efforts to comply with ICRA, we cannot conclude that the facility complies entirely with ICRA’s prohibitions against excessive time in “isolated confinement”1 and the “isolated confinement” of vulnerable populations2. One of

Newark, NJ: Essex County Civilian Task Force, 2023. 478p.

By Julianne Skarha,Keith Spangler,David Dosa,Josiah D. Rich,David A. Savitz,Antonella Zanobetti

Rising temperatures and heatwaves increase mortality. Many of the subpopulations most vulnerable to heat-related mortality are in prisons, facilities that may exacerbate temperature exposures. Yet, there is scare literature on the impacts of heat among incarcerated populations. We analyzed data on mortality in U.S. state and private prisons from 2001–2019 linked to daily maximum temperature data for the months of June, July, and August. Using a case-crossover approach and distributed lag models, we estimated the association of increasing temperatures with total mortality, heart disease-related mortality, and suicides. We also examined the association with extreme heat and heatwaves (days above the 90th percentile for the prison location) and assessed effect modification by personal, facility, and regional characteristics. There were 12,836 deaths during summer months. The majority were male (96%) and housed in a state-operated prison (97%). A 10°F increase was associated with a 5.2% (95% CI: 1.5%, 9.0%) increase in total mortality and a 6.7% (95% CI: -0.6%, 14.0%) increase in heart disease mortality. The association between temperature and suicides was delayed, peaking around lag 3 (exposure at three days prior death). Two- and three-day heatwaves were associated with increased total mortality of 5.5% (95% CI: 0.3%, 10.9%) and 7.4% (95% CI: 1.6%, 13.5%), respectively. The cumulative effect (lags 1–3) of an extreme heat day was associated with a 22.8% (95% CI: 3.3%, 46.0%) increase in suicides. We found the greatest increase in mortality among people ≥ 65 years old, incarcerated less than one year, held in the Northeast region, and in urban or rural counties. These findings suggest that warm temperatures are associated with increased mortality in prisons, yet this vulnerable population’s risk has largely been overlooked.

PLOS One, March 1, 2023

By Britt Skaathun ,Francesca Maviglia,Anh Vo,Allison McBride,Sarah Seymour,Sebastian Mendez,Gregg Gonsalves,Leo Beletsky

Policing, corrections, and other carceral institutions are under scrutiny for driving health harms, while receiving disproportionate resources at the expense of prevention and other services. Amidst renewed interest in structural determinants of health, roles of race and class in shaping government investment priorities are poorly understood.

Methods: Based on the Social Conflict Model, we assessed relationships between city racial/ economic profiles measured by the Index of Concentration at the Extremes (ICE) and budgetary priorities measured by the novel Carceral Resource Index (CRI), contrasting investments in carceral systems with funding for health and social support across the 50 most populous cities in the United States (U.S.). Bivariate correlations, and unadjusted and adjusted polynomial regression models were used to assess the relationship between budgetary investments and population concentration at extremes in terms of income, racial/ethnic composition, and education, controlling for other demographic characteristics.

Results: In our sample, median CRI was -0.59 (IQR -0.64, -0.45), with only seven cities exhibiting positive CRI values. This indicates that most large U.S. cities spend more on carceral systems than on health and supportive services, combined. Adjusted polynomial models showed a convex relationship between the CRI and ICE-Education, and ICE-Race(White vs. Black)+Income, with quadratic terms that were positive and significant at p<0.05. After controlling for age, the strongest prioritization of carceral systems was observed in cities where the proportion of low-income Black residents approached or exceeded that of high-income white residents.

Conclusions: Municipal prioritization of carceral investments over health and social support is pervasive in the U.S and exacerbated by racial and economic disparities. The CRI offers new opportunities to understand the role of government investments as a structural determinant of health and safety. Longitudinal research is warranted to examine the relationship between budget priorities, structural racism, and health outcomes.

PLOS ONE 17(12): 2022.