The historian writes about her research on jail conditions and mortality
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Tuesday, June 13, 2023 | The Latest Research, Commentary, And News From
Health Affairs

Dear John,

Health Affairs was named as a "Highly Commended" finalist for The Drum
Awards for Marketing for our strategic innovation and implementation of
digital transformation. Read more about it here
<[link removed]>!

Today's newsletter is a special essay by Jessica Adler from Florida
International University.

Jail Conditions and Mortality

In an article published in the June issue of Health Affairs
<[link removed]>,
my colleague, Weiwei Chen and I analyze relationships between jail
conditions and jail mortality. How do facility characteristics, we ask,
relate to death rates?

Although the question may appear relatively simple, data on the health
of the justice-involved population
<[link removed]>
is notoriously inaccessible, so researchers aiming to study care and
outcomes in jails must be creative about marshaling information and
statistics.

Some conduct examinations of one facility
<[link removed]>
with particularly detailed available records. Studies focused on
COVID-19
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have relied on data made publicly available by clinicians, lawyers, and
advocates working to shed light on conditions inside.

Informed by this pathbreaking work, and aware that in the two decades
before the onset of COVID-19 (2000-2019), mortality in jails increased
11 percent
<[link removed]>,
we were eager to draw conclusions about numerous facilities across the
country.

As we note in the paper, we wanted to conduct what one scholar called
<[link removed]>
an "apples-to-apples comparison" of circumstances and deaths in multiple
jails-to examine how "environmental and personal risk factors" could
relate to mortality.

To do so, we relied on a combination of data sets.

One was compiled by Reuters reporters, who placed a Freedom of
Information Act request
<[link removed]>
to access mortality information from the largest jails in the United
States; others came from the Bureau of Justice Statistics, which is
charged with gathering and disseminating data related to jails and
prisons.

Ultimately, we assessed mortality rates and conditions in approximately
450 US jails between 2008 and 2019 and found that certain facility
characteristics were associated with more deaths.

Our most robust findings: high turnover rates - relatively large
numbers of people cycling in and out of a jail weekly - were
associated with higher death rates overall, as well as due to suicide,
drugs and alcohol, and homicide.

Also, the presence of greater proportions of non-Hispanic Black people
in jail populations was associated with more deaths due to illness.

Heavy reliance on incarceration and the prevalence of free world health
disparities, these results suggest, shape mortality risks inside jails.

We also found an association between higher death rates due to accidents
and large shares of juveniles (children under 18 years old) in jail
populations, as well as a marginally significant association between
higher proportions of women and higher mortality.

While the presence of large shares of non-US citizens in jail
populations was associated with lower overall mortality rates, we found
that in relatively small jails (with capacities of less than 365
people), higher proportions of non-US citizens was related to more
deaths.

We examined, too, mortality rates related to facility health care
management and found that oversight by a public provider, as opposed to
a private provider or a hybrid of the two, was related to lower
mortality due to suicide.

In our paper, we offer perspective on individual findings, but here,
it's worth recapping perhaps the broadest takeaway point: risks
related to jail mortality are rooted in policies and practices of the
free world.

The complex factors undergirding the United States' heavy reliance on
incarceration - and high jail turnover rates - include structural
racism <[link removed]>, decades' worth of cuts in social
welfare programs
<[link removed]>,local
<[link removed]> and national
<[link removed]> political
trends, policing practices, and an over-reliance on cash bail.
<[link removed]>

These points help explain why the US continues to have the highest
incarceration rate of any country
<[link removed]> for which data is
available; why jail detainees are disproportionately likely to be
impoverished, from marginalized groups, and physically and/or mentally
ill
<[link removed]>;
and why approximately two-thirds of the 700,000 people confined in jails
each day are unconvicted and awaiting trial
<[link removed]>.

Ongoing programs geared at reducing incarceration rates focus on these
complex forces.

Some limit the use of cash bail
<[link removed]>.
Others enhancecommunity-based services
<[link removed]>
intended to address mental illness, drug use, and homelessness, so jails
are less likely to be sites of first resort for people in need of social
support and health care.

An additional means of addressing deeply rooted health disparities and
improving outcomes among people who may be vulnerable to incarceration,
scholars note, is to expand access to Medicaid and eliminate the
program's "inmate exception."
<[link removed]>

Our results suggest that stakeholders aiming to reduce mortality in
jails should likewise focus on broad contexts, including alleviating
conditions that lead to the facilities' over-use, as well as the
inequities shaping what happens inside them.

-
Jessica Adler

Read Jessica's Article
<[link removed]>


 

 

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Community & State
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is the business segment of UnitedHealthcare that provides health care
coverage for the economically disadvantaged, the medically underserved
and those without the benefit of employer-funded health plans.

These state-based health plans meet local needs, while leveraging the
national resources of UnitedHealthcare.

Sponsored by UnitedHealthcare Community & State
<[link removed]>

 

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Elsewhere At Health Affairs

Today in Health Affairs Forefront, Lisa Harootunian and colleagues
discuss a means to alleviate the direct care workforce shortage
<[link removed]>.

Wasan Kumar and co-authors share what they view as a paradigm shift on
benefit determination for single gene defect diseases
<[link removed]>.

And, Paul Ginsburg and others share their take on the state of Medicare
Advantage payment reform.
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Advertise with Health Affairs this month to take advantage of our
current promotions. Learn more about advertising opportunities here.
<[link removed]>


 

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Dana Mukamel on How Widespread Dementia Is In Nursing Homes

Editor-in-Chief Alan Weil interviews Dana Mukamel
<[link removed]>
from the University of California, Irvine on her recent paper examining
whether residents diagnosed with Alzheimer's disease and related
dementias are spread out across nursing homes or concentrated in a
subset of nursing homes.

Daily Digest

A Multipronged Approach To Alleviating The Direct Care Workforce
Shortage
<[link removed]>
Lisa Harootunian et al.

Diseases Benefit Determination For Single Gene Defect Diseases: A
Paradigm Shift
<[link removed]>

Wasan Kumar et al.
<[link removed]>

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Medicare Favorable Selection Ups The Ante On Medicare Advantage Payment
Reform
<[link removed]>

Paul B. Ginsburg et al.
<[link removed]>

Jail Conditions And Mortality: Death Rates Associated With Turnover,
Jail Size, And Population Characteristics
<[link removed]>
Jessica Adler and Weiwei Chen

 

 

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During June, we're highlighting influential voices and organizations who
have made an impact on LGBTQ+ health equity and policy.

In a May 2020 article, David Tuller discusses the challenges LGBTQ
patients face
<[link removed]>
when accessing health care in rural areas. Tuller then highlights how
UnityPoint Health expanded services for the  community by opening a
LGBTQ clinic in Iowa."

 

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mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
<[link removed]> at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
<[link removed]>, and Health Affairs Sunday
Update <[link removed]>.  

Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States

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