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January 21, 2007

Is going to state prison good for your health?

I just received news of a new publication from the Bureau of Justice Statistics which might force me to rethink my entire world-view as to the pros and cons of imprisonment.  The new publication is "Medical Causes of Death in State Prisons, 2001-2004" and can be accessed online here.  As explained in this press release (emphasis added), being sent to state prison might extend the average person's life:

The nation's state prison officials reported that 12,129 inmates died while in custody from 2001 through 2004, the Justice Department's Bureau of Justice Statistics (BJS) announced today.  The deaths over this four-year period constituted an annual mortality rate of 250 deaths per 100,000 inmates, which was 19 percent lower than the adult mortality rate in the U.S. general population.

Overall, 89 percent of all state prisoner deaths were attributed to medical conditions and 8 percent were due to suicide or homicide. The remainder of deaths were due to alcohol/drug intoxication or accidental injury (1 percent each). A definitive cause of death could not be determined for an additional 1 percent.  Two-thirds of inmate deaths from medical conditions involved a problem that was present at the time of admission to prison.

Of course, I suspect that, generally speaking, the baseline health of the population sent to state prison is better than the baseline health of the general population.  Thus, I really doubt that these statistics prove that state prison is good for one's health.  That said, I suspect that the populations in state prisons generally have healthier diets, exercise more and receive better basic medical care than much of the general population (given that, as noted here, someone pays attention to whether they are having too many donuts).

January 21, 2007 at 01:59 PM | Permalink


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You have to look at the statistics of inmate health care by State because there are large variations between
correction systems and also between State and private prisons. The BJS has been collecting data for a number of
years on deaths in custody but the only publications based of those data compilations are the one you referenced
and one based on data for State prisons and county jails for 2000, 2001 and 2002.

Some State prisons have contracted with private vendors for inmate health care with horrific results in some cases.
I think that practice may have contributed to the creation of a Federal Reporting Program on deaths in custody.
There are far more suicides in jail than in prison and there was a significant reduction in the rate of jail suicides
noted in the report based on the 2000-2002 data. On of the hallmarks of a well managed jail is a low suicide rate
so perhaps the reporting system may have motivated the jail administrators to clean up their act.

Posted by: John Neff | Jan 21, 2007 2:41:51 PM

The cost calculus of prison does not end at the prison door. The following study by Binswanger I. A., Stern M. F., Deyo R. A., Heagerty P. J., Cheadle A., Elmore J. G., Koepsell T. D. 2007. Release from Prison — A High Risk of Death for Former Inmates. N Engl J Med 356:157-165, Jan 11, 2007 shows that inmates face greater mortality rates postrelease than the general population.

(BTW: I am also highly skeptical that inmates eat better than the general population.)

Eric L Sevigny, Ph.D.

Posted by: | Jan 21, 2007 3:37:43 PM

The study doesn't appear to note how many, if any, inmates are granted a modification of sentence permitting them to die outside prison. That may never happen, but if it does the statistics are skewed.

Posted by: George | Jan 21, 2007 3:55:45 PM

Since the age profile of those in prison is presumably very different from that of the general population, at least until the effects of the insane incarceration terms of the last decades or so work through in a few years time, the difference in death rate is easily explained. I fear it has nothing to do with diet or quality of food!

Posted by: Peter B | Jan 21, 2007 3:58:35 PM

as interesting as the statistics might be, when one brings the anecdotal evidence into play, prison is generally a poor place to reside and fairly unhealthy. I have had clients who suffer from severe disabilities and illness and not until the situation is dire will they get to see and MD or go to a hospital. One client, aged 74 died due to the neglect of the BOP. Others who suffer from dental problems are rarely treated effectively. And things like eye glasses are a joke. Even federal judges know this; as I have seen them try to control their own laughter when the AUSA attempts to argue that medical treatment in the BOP facilities rivals that of the outside.

Posted by: Bernie Kleinman | Jan 21, 2007 5:02:09 PM

Lest we fall into making misleading generalizations (as the press release and the ensuing story that appeared in the Associated Press implicitly do), one simply needs to dig a bit into the report's data to recognize that this whole story is about young black men (and to some extent women), who as we all know comprise a disproportionate segment of the incarcerated population.......

The study shows that overall mortality rates for white and hispanic prisoners are in fact HIGHER than those in the general population. Moreover, the purported "health effect" of prison is inversely related to age -- it's most pronounced in the 18-24 age cohort, and goes down from there....if you're a prisoner 45 or over, your chances of dying are in fact higher than they are out in the general population.

So what's going on? Maybe some clues lie in the fact that homicide comprises just over 50% of the deaths of black males aged 20-24 (followed by unintentional injuries and suicide, which make up another 30% -- see the chart at this link http://www.cdc.gov/men/lcod/02black.pdf )

Simply put, medical deaths are a relatively rare event within younger populations.....the study's findings have nothing to do with health care, diet, or anything else other than the fact that prisons are tightly controlled environments and in some perverse way "safer" than many communities that the prisoners come from...

Regarding Doug's comment about inmates being healthier than the baseline population, this may be somewhat true in the aggregate (again, due to prisoners' age distribution), but once you control for age they are markedly less healthy......factors such as lifestyle-related stress, substance abuse, mental illness, and general socio-economic health care disparities all contribute to produce a group that is sicker than their counterparts in the general population.....correctional healthcare practitioners often draw a distinction between an inmate's "chronological age" and his/her "physical age"

Posted by: Andy Harris | Jan 22, 2007 12:08:36 PM

One source of information is the prisoner complaint logs kept by prisons. It is unlikely that a warden would make a summary of the complaint log available to the public because of the equivalent of ballot box stuffing. On the other hand the members of legislative oversight committees can ask to see the log or a summary of the log. They should be encouraged to do so.

The Iowa Dept. of Corrections Quick Facts data sheet give the following age distribution for Iowa prison inmates as;

under 31 40.8%
31 to 50 50.2%
over 50 9.0%

The BJS report for 2000 to 2002 indicates that Iowa prisons have a low death rate in comparisons to other State prisons.
For the younger prisoners AIDS is a significant cause of death. The doctors at University of Iowa Hospitals and Clinics report that the
general heath is good for the prisoners they see for medical problems that require the services of a specialist.

It appears to me that a fair amount of spin was applied to the newspaper report on the health of prison inmates.

Posted by: John Neff | Jan 22, 2007 5:39:17 PM

Note the following (substantial) correction, sent out by AP on Jan. 26:

"WASHINGTON - In a Jan. 21 story about prison deaths, The Associated Press erroneously reported that a government study said state prison inmates are living longer on average than people on the outside. The Justice Department study compared mortality rates among prison inmates and the general population, but not life spans for each group. It said prison inmates ages 15-64 have a lower death rate than people in the same age group living outside prisons."

Posted by: dept of corrections | Jan 26, 2007 12:48:48 AM

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