Understanding and Addressing Health Disparities and Health Needs of Justice-Involved Populations

Abstract

In the early 1980s, former US Department of Health and Human Services (HHS) Secretary Margaret M. Heckler convened the first federal group of experts to conduct a comprehensive study of the health status of racial/ethnic minority populations. The 1985 Report of the Secretary’s Task Force on Black and Minority Health, also known as The Heckler Report, helped place minority health on the national stage. For the past 30 years, the report has served as a driving force for monumental changes in research, data, policies, programs, and legislation to address health disparities. For example, as a result of The Heckler Report, HHS established the Office of Minority Health (OMH) in 1986 and charged it with improving the health of racial/ethnic minority populations through the development of health policies and programs that eliminate health disparities. Since the publication of The Heckler Report, much progress has been made to understand and address the health disparities of racial/ethnic minority populations. These disparities, which range from disease prevalence to health care access to health outcomes, are often linked to social, economic, or environmental disadvantages, such as unemployment, unsafe neighborhoods, and lack of affordable transportation options—conditions known as the social determinants of health. Less is known about involvement in the justice system (eg, arrests, court hearings, pretrial detention) including incarceration as factors that affect health, and limited federal funding is available to understand and address the health of persons involved in the justice system. Attention to incarceration trends and criminal justice reform by researchers and advocates, however, has driven efforts by more researchers and policy makers to understand linkages between justice involvement and individual, family, and community well-being. This supplemental issue of Public Health Reports focuses on the justice-involved population and health. Articles in this supplement examine the health of the justice-involved population and their families, propose policies and interventions to address health needs of the justice-involved population and their families, and assess how population health surveys can provide better information about the justice-involved population and identify opportunities for bridging knowledge gaps on health disparities and health needs of the justice-involved population. The rate of incarceration in the United States is among the highest in the world. Despite decreasing crime rates, the number of incarcerated persons increased by almost 350%, from 503 600 in 1980 to 2 225 100 in 2014. In 2016, a total of 6.6 million persons were involved in the US criminal justice system, including 1.5 million in state and federal prisons, 740 700 in local jails, and 4.5 million on probation or under parole supervision. And racial/ethnic minority groups are disproportionately represented in the justiceinvolved population, according to the most recent data (Table). Although non-Hispanic black persons composed 12.3% of the US population in 2016, they constituted 37.0% of the federal prison population, 33.8% of the state prison population, and 34.4% of the jail population. Similarly, although Hispanic persons composed 17.3% of the US population in 2016, they composed 32.0% of the federal prison population, 20.8% of the state prison population, and 15.2% of the jail population. Numerous health disparities exist between persons involved in the justice system and the general US population. Persons in state or federal prisons are 1.5 times more likely than persons in the general US population to report ever having a chronic condition, and half of all persons in state or federal prisons report having a chronic condition such as