Formerly incarcerated women of color face worse health in later life

In 2021, Harlem-based activist Shawanna Vaughn stated during a Forbes interview: “Walking into prison at 17 was the most traumatic experience of my life…As a person who suffers from the remnants of mass incarceration, I am very clear that the trauma starts before prison and lingers forever until there is help.”  

Incarceration takes a heavy toll on one’s mental and physical health. The conditions of jails and prisons in the United States have long been known to increase risk of infectious disease and erode mental health. However, even among formerly incarcerated adults, we observe stark health disparities including higher rates of chronic diseases and premature mortality, which suggests that incarceration has far-reaching health consequences.  

Starting in the 1970s, major shifts in legal policies, including harsher drug penalties, led to an explosion in the penal population. In two short decades, the number of Americans incarcerated nearly quadrupled, with disproportionate representation of racial and ethnic minorities. This rapid growth in incarceration has since been dubbed “mass incarceration.” The US now holds the distinction of having the highest incarceration rates in the world—with the vast majority of incarcerated people being convicted of nonviolent crimes.  

As a result, a growing share of older adults are now aging with incarceration histories and poor health. We are just now seeing the long-term health consequences of mass incarceration policies—the “remnants” that Vaughn described. However, this trend will continue as the cohorts most affected by mass incarceration are growing older. Although men are incarcerated at higher rates, women experience greater health burdens following incarceration. This is doubly true for older women of color. 

Previous research posits that women’s health declines following incarceration are attributable to institutional sexism and racism within the penal system. These health declines have been well documented in younger samples, but little research has explored whether the effect of previous incarceration varies by gender and race/ethnicity among older adults. To fill this gap in the literature, we used data from a nationally representative sample of Americans over the age of 50 to examine differences in mental health, measured as number of depressive symptoms, and physical health, measured as number of physical limitations like difficulty walking, by incarceration status, gender, and race/ethnicity. With nearly 12,000 respondents from the 2012/2014 waves of the Health and Retirement Study (HRS), we were able to document important health disparities among older adults. 

We found that formerly incarcerated older adults had worse mental and physical health than their peers who had not been incarcerated. Moreover, formerly incarcerated women reported worse mental and physical health than formerly incarcerated men—even after controlling for a host of social, economic, and early life factors. When we investigated differences by gender and race/ethnicity, we observed startling disparities among formerly incarcerated women of color. On average, formerly incarcerated women of color experienced an additional depressive symptom and physical limitation to the next highest group (formerly incarcerated white women) and more than triple the number of depressive symptoms and physical limitations as the healthiest group (non-incarcerated white men).  

In Figure 1, we present the age-adjusted marginal means for depressive symptoms (range=0-8) by respondents’ incarceration, gender, and race/ethnicity status. Controlling for age, formerly incarcerated women of color reported nearly three-and-a-half depressive symptoms when surveyed; whereas, formerly incarcerated white women and formerly incarcerated men of color reported about two-and-a-half depressive symptoms. A similar pattern emerged for physical limitations (range=0-9). In Figure 2, formerly incarcerated women of color reported having approximately 4.7 physical limitations. For context, the average number of physical limitations for the entire sample was two physical limitations. These high levels of depressive symptoms and physical limitations put formerly incarcerated women of color at greater risk for clinical depression and self-care disability. 

This research highlights how sexism and racism lead to unequal health following incarceration. The results of this work indicate that older adults aging with incarceration histories experience worse health; however, formerly incarcerated women of color face the greatest health disadvantage among all the formerly incarcerated groups. These health inequities are the result of decades of policy choices that have disproportionately harmed women of color.

The implications for public health policy are clear. By specifying those groups that are rendered especially vulnerable, we can better direct resources, such as targeted mental and physical health interventions for formerly incarcerated women of color. Because men are incarcerated at higher rates than women and more attention is paid to early-life incarceration experiences, formerly incarcerated older women may be an overlooked population who have not benefitted from current initiatives aimed at improving the health of formerly incarcerated adults.

Furthermore, we encourage policymakers, healthcare providers, and community organizations to take a life course perspective to incarceration and health. Re-entry or transitional programs for post-incarcerated people are often short in duration and do not recognize the need for consistent care and support into later life—possibly long after incarceration has taken place. Our work also suggests that decarceration and abolition should be key priorities for public health. Critical scholarship in the social sciences has only confirmed what post-incarcerated people like Shawanna Vaughn know from experience: that prisons do not (merely) punish crime, but also exacerbate inequality through the production of poor health.

_{Featured image by Ye Jinghan via Unsplash, public domain}