Journal of Correctional Health Care - April 2023 - 122

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DAVIS ET AL.
trend toward diminishing crime rates (Pew Charitable
Trusts, 2014; Viano, 2008), the number of incarcerated
individuals increased from fewer than 300,000 in 1978
to 2,086,600 incarcerated individuals in 2019 (Minton
et al., 2021). The growth in the U.S. prison system was
largely attributable to ''changes in sentencing guidelines,
a more punitive approach to crime reduction, and
the privatization of prison-related industries and services''
(Golembeski & Fullilove, 2008, p. 1701).
The privatization process has been particularly contentious.
Critics have branded the shift toward privatization
of prison services, and in some cases entire prisons, the
''prison-industrial complex'' (Davis & Shaylor, 2001).
The argument has been made that large corporations
that make their profits by holding incarcerated people
have perverse incentives to both spend as little as possible
on those individuals and keep as many people imprisoned
as possible (Wakefield & Uggen, 2010). The
privatization of prisons lessens the availability of data
on people incarcerated because private companies
lobby to keep their data private (Viano, 2008).
The U.S. prison population tends to skew toward
young males, racial and ethnic minorities, and those of
low socioeconomic status (SES; Pew Charitable Trusts,
2008). As of 2019, non-Hispanic Black males comprised
the largest portion of incarcerated people (39%) under
state or federal jurisdiction (Kang-Brown et al., 2021).
At midyear 2019, about two in five people incarcerated
identified as White (39%) or Black (39%) and one in
five Hispanic (19%; Maruschak & Buehler, 2021).
In 2013, the most recent year for which data are available,
local, state, and federal governments spent a total
of $82.9 billion on corrections in the United States
(Bronson, 2018). U.S. penal institutions are publicly
funded environments containing nearly 2% of the U.S.
population, at significant cost to taxpayers. Despite the
billions of dollars spent annually on corrections, relatively
little is known about people in prisons and the
effects of incarceration on their health (Leddy et al.,
2009). Several studies suggest the social and structural
environments of prison contribute to or exacerbate a variety
of chronic diseases, including obesity (Binswanger
et al., 2009; Ginn, 2012; Harner & Riley, 2013).
Data demonstrate that, compared to the general population,
people in U.S. prisons have higher rates of
noncommunicable diseases (NCDs; Binswanger et al.,
2009; Maruschak et al., 2015), mental illnesses (Reingle
Gonzalez & Connell, 2014; Wilper et al., 2009), and
communicable diseases (Binswanger et al., 2009;
Cropsey et al., 2012). Many illnesses are preexisting
conditions, prevalent in low SES populations and exacerbated
by a lack of regular access to the health care system
(Leddy et al., 2009).
Although correctional systems are constitutionally
responsible for the health of people in their care (Estelle
v. Gamble, 1976), access to health care in U.S. prisons is
lacking (Harner & Riley, 2013; Wilper et al., 2009).
Incarcerated people with chronic diseases often do not
receive treatment (Wilper et al., 2009). Formerly incarcerated
individuals regularly report difficulty accessing health
care upon release from prison (Cropsey et al., 2012; Wang
et al., 2013), which may contribute to their higher rates of
inpatient hospitalizations and death immediately following
release (Binswanger et al., 2007; Wang et al., 2013).
One study (Binswanger et al., 2007) reported that
within the first 2 weeks of release from prison, a person's
risk of death was 12.7 times higher (adjusted for age,
gender, and race) than the general population. The average
age ofthis sample (n=30,237) was 33.4 years (standard
deviation -9.8) and the most common causes of death
among those aged 25-44 years included overdose, homicide,
and suicide (Binswanger et al., 2007). Incarceration
is linked to decreased life expectancy for unclear reasons
even when controlling for age (Patterson, 2013).
Incarcerated people have overall poorer health outcomes
compared to the general population. A small
number of studies bring attention to the tendency for
individuals to gain weight and develop NCDs while
incarcerated (Binswanger et al., 2009; Clarke & Waring,
2012; Elwood Martin et al., 2013; Khavjou et al., 2007).
Data from previous studies indicate that the prevalence
of OW/OB in incarcerated people is likely a reflection
of the regional rates of OW/OB among the general population
(Leddy et al., 2009).
The Bureau of Justice Statistics (BJS) noted that in
2012, the majority of individuals in prison (74%) and
individuals in jail (62%) were OW, OB, or morbidly
OB by self-reported heights and weights (Maruschak
et al., 2015). The rates of OW/OB in this report were calculated
using self-reported data collected during the
2011-2012 National Inmate Survey via a computerassisted
self-interview. These data provide a national
overview of self-reported OW and OB in jail and prison
populations, including morbid obesity by gender, age,
and race. Lack of regional data in this report makes
comparison to regional prevalence of OW and OB in
the general population difficult (Maruschak et al., 2015).
A literature search was performed due to the paucity
of independent data specifically focused on rates of OW/
OB in prison populations to investigate the health implications
of imprisonment.
Method
Study Settings and Population
The settings of this study were U.S. correctional institutions
(jails and prisons). The study population includes
adult males and females incarcerated in the correctional
system. IRB approval was not sought for this project as
it was not required per federal regulations, being nonhuman
subject research.
Journal of Correctional Health Care - April 2023

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