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Social Determinants of Men's Health

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Focus on: Incarceration

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Incarceration is a phenomenon of growing influence in so many countries, and is arguably one of the most systematically crippling forces in poor communities worldwide. The existence of data is uneven, but in many countries incarceration and health disparities follow similar tracks along the social fault lines. Just as the poor are more likely to suffer negative health outcomes, socioeconomically disadvantaged persons have a greater likelihood of incarceration.

While incarceration of women is increasing in several nations, imprisonment is a particularly deleterious part of the experience of social and economic marginalization for men in many countries. In correctional settings and facilities of detention, the well-being of already-marginalized men is further jeopardized by exposure to a range of physiological and psychological risks that increase the likelihood of poor health outcomes. Those detained in correctional settings are frequently subject to communicable infections, injury by violence, sexual trauma, and to under-regulated clinical trials. Facilities' adherence to correctional health care standards is a matter of ongoing uncertainty and controversy around the world.

Additionally, psychological torment is a pervasive health risk inmates face. They are subjected to extreme custodial interventions such as "close management,” i.e., solitary confinement; injurious chemical, electrical, and manual control techniques; strip searches and invasive body cavity searches; and documented physical torture in many countries.

Strong evidence from many nations shows that it is socially marginalized men who have the greatest likelihood of incarceration. More than one-third of Italy's prison inmates are foreigners, and the nation's apprehension about its growing Romanian immigrant population would seem to be reflected in their disproportionate representation—nearly 6 percent—among Italy's incarcerated.[1]In the U.S., correctional populations are less-educated than the general population. The rate of failure to complete high school or its equivalent is more than double (40 percent) among U.S. prisoners compared to the general population (18 percent).[2]

Once they are incarcerated, men's jeopardies continue to predict poor health outcomes inside correctional facilities. U.S. prisoners who were homeless in the year before their arrest and who had received government assistance are more likely to report current medical problems than those who had not been homeless or who had not received government assistance.[3]Data show a higher prevalence of HIV, hepatitis B virus, hepatitis C virus, and syphilis among both prison inmates and officers in Ghana compared to the country's general population. The findings led the study's authors to affirm that prisons are high-risk environments for bloodborne and sexually transmitted infections.[4]A study of injection drug users in Bangkok yielded the conclusion that incarceration is related by multiple pathways to the incidence of HIV infection among them.[5]

Even after release from correctional facilities, the particular jeopardy of marginalized men remains in the form of sharply elevated risks of mortality. Elevated mortality was noted among a sample of male French prison releasees.[6]The French study findings resonate with U.S. evidence. A Washington State study found that newly released prisoners were 12.7 times as likely to die in the two weeks following their release compared to other state residents in the same demographic groups.[7]

Considering existing evidence, it is clear that incarceration is a phenomenon we must acknowledge as highly relevant to men's health around the world. Indeed, the evidence indicates that incarceration, which Collins Center researchers have described as "life rupturing,”[8]is an overwhelmingly male experience. As such, the field of men's health should assume leadership in the development of innovative intervention programs and an analytical discourse about the issue.

[1]Kimmelman M. Italy gives cultural diversity a lukewarm embrace. NYTimes 25 June 2008. (Available at http://www.nytimes.com/2008/06/25/arts/design/25abroad.html?ei=5070&en=77b6b43fe6, accessed June 2008).

[2]Bureau of Justice Statistics Special Report: Education and Correctional Populations. U.S. Department of Justice 2003, NCJ 195670.

[3]Bureau of Justice Statistics: Medical Problems of Prisoners. U.S. Department of Justice 2004, NCJ 221740.

[4]Adjei A A, Armah HB, Gbagbo F, Ampofo WK, Boamah I, Adu-Gyamfi C, Asare I, Hesse IFA, Mensah G. Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: a national multicenter study. BMC Infectious Diseases 2008;8:33.

[5]Choopanya K, Des Jarlais DC, Vanichseni S, Kitayaporn D, Mock PA, Raktham S, Hireanras K, Heyward WL, Sujarita S, Mastro, TD. Incarceration and risk for HIV infection among injection drug users in Bangkok. JAIDS 2002;29(1):86-94.

[6]Verger P, Rotily M, Prudhomme J, Bird S. High mortality rates among inmates during the year following their discharge from a French prison. J Forensic Sciences 2003; 48(3):614-6.

[7]Binswanger I, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD. Release from prison—a high risk of death for former inmates. N Engl J Med 2007 Jan 11;356(2):157-65. (Erratum in N Engl J Med 2007 Feb 1;356(5):536.)

[8]Young AMW, Perez LM, Northridge ME, Vaughn RL, Braithwaite K, Treadwell HM. Bringing to light the health needs of African-American men: the Overtown Men's Health Sutdy. jmhg 2007;4(2):140-8.