Prison and Health

How does imprisonment affect health? Valerio Bacak, a doctoral candidate in sociology, is developing new ways to find answers.

“With the typical methods we use in the social sciences, it’s almost impossible to say anything causal about incarceration,” says Bacak. The majority of inmates come from disadvantaged backgrounds, so teasing out the effect of incarceration on their health versus other issues they may have—victimization, childhood abuse, drug use, gang membership, or simply being poor—is difficult. 

Some inmates’ health may improve in prison, where they are treated for chronic or infectious illnesses, and often for mental health issues. “For many people it’s the first time they have access to healthcare,” says Bacak.

Even for them, however, imprisonment has harmful side effects. People are separated from their families and friends and are placed in a very stressful space. Bacak says that violence in prison is not as prevalent as some think, but the threat is always there. “This experience is not common on the outside, but it becomes central in prison, and exerts psychological and physical pressure on people, which may translate into mental health problems or physical health issues.”

Bacak just completed a research project looking at why the mortality rate in prisons is lower than the rate among comparable adults who are not incarcerated. His results disproved the “Healthy Prisoner Hypothesis,” which theorized that people in prison had to be healthier to begin with to commit the crimes they’re convicted for. Bacak is looking at another theory: that compassionate release programs are not only done out of kindness for very sick prisoners, but also to save health care costs for the prisons. 

In his dissertation, he’s also approaching the issue of crime and health in a different way. “People tend to look in the opposite direction: whether mental health problems cause crime,” he says. “But I think there are many reasons to think it could be the reciprocal: that committing a crime affects your health.” He’s found that there is an effect on mental health, and it’s twice as large in female offenders as in male offenders. Literature in criminology and medical sociology show some evidence that women respond to stress differently. While men respond with aggression, violence, and anti-social behaviors, women tend to internalize, which Bacak believes can create mood disorders. 

Bacak hopes to help inform the way society thinks about crime and decides how to punish individuals. He believes very few criminal justice policies over the past three or four decades have been evidence-based. For now, he’s in the right place—the U.S. has the highest incarceration rate in the world, he says. “Unfortunately, it’s a great place to study prisons.”