Pandemics and Prisons

The incarceration rate in the U.S. is higher than any other country in the world, and about five times higher than the median worldwide. The health consequences of incarceration are legion.  Disability Adjusted Life Year (DALY) rates linked to incarceration are more than double that attributed to other conditions commonly experienced in the general population. Death rates are high and are the result of overcrowding, inadequate mental health care, lousy sanitation, freezing temperatures and delayed medical treatments. Half of prison suicides result from solitary confinement.

Further compounding the horrors of the American incarceration system, its burdens are deeply and unevenly felt. African Americans are incarcerated at five times the rate of whites. Nearly half of all Black women have a family member in prison. One in three Black males born today will end up in the correctional system at some point. The bias against people of color is operationalized at many levels: through police arresting minorities at higher rates than whites, prosecutors charging them more often and more severely, leading to longer sentences. The “justice system” is notably unjust.

And onto this landscape then came Covid-19, and those trapped in prisons and jails, suffered. Social distancing and quarantines were impossible. The jail on Rikers Island had one toilet for every 29 people. The Covid-19 case rate is four times higher in state and federal prisons than in the general population — and twice as deadly. Despite reductions in state prison populations (mostly due to decreased admissions over the past year), prisons and jails have been the sites of the majority of large, single-site outbreaks of Covid-19. Yet only 10 states explicitly put incarcerated people in phase 1 of vaccine distribution at the start of the vaccination roll-out, and eight states did not list them in any phase of vaccine distribution at all.

Can anything alleviate this national disgrace?  Pandemics create moments for change. The reallocation of funds from policing and incarceration to the work of public health—violence prevention programs, community mental health care, housing and education—may reduce prison populations.  It is possible that the moment carries enough momentum that we will see movement on many of these areas.  But even before then, we suggest that simple acts of compassion first tested during Covid-19 can be an important first step to alleviate the daily hardships experienced by the 2.3 million incarcerated Americans.

In many states incarcerated persons are expected to pay $2 – $5 co-pays for physician visits, medications and testing, part of the reason for their delayed medical treatment. This should be eliminated permanently, extending the temporary policy put in place to ensure persons with Covid-19 symptoms came forward. Another humane act would be to stop charging incarcerated people and their families the cost of communication. During Covid-19, most prisons and jails reduced or eliminated family and friend visitation; some waived fees for phone calls or videoconferencing. This too should be continued.  Nationwide, 1 in 3 families with a loved one in prison go into debt to cover the cost of phone calls and visits.

These are simple and inexpensive policies to carry past Covid-19. The opportunity has been presented and should not be missed.


Michael Stein & Sandro Galea

As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.