The article “Enduring Stigma: The Long-Term Effects of Incarceration on Health” by Jason Schnittker and Andrea John, published in the Journal of Health and Social Behavior in 2007, addresses the often-neglected health consequences of imprisonment within medical sociology.
The study argues that incarceration can have powerful and enduring effects on health, particularly after release from prison. Despite a sharp increase in incarceration rates since the 1970s, medical sociology has paid surprisingly little attention to its health impacts. The authors highlight that a prison record can lead to various disadvantages, such as unemployment, slow wage growth, and poor social integration, all of which are known risk factors for poor health. A central theme explored is the role of stigma, suggesting that it is a key mechanism through which incarceration impacts health.
To rigorously test these propositions and address concerns about “selection bias” (where poor health might be a cause of crime rather than a consequence of incarceration), the researchers utilized data from the National Longitudinal Survey of Youth (NLSY). They employed fixed-effects regression models, which allow them to control for stable individual characteristics, effectively making each person their own control and strengthening causal claims.
Key findings from the study include:
- A history of incarceration strongly increases the likelihood of severe health limitations after release.
- Any contact with prison is generally more important than the amount of contact, a finding consistent with a stigma-based interpretation. This implies a significant impact even from short sentences.
- While diminished wage growth and marital instability partly explain the link between incarceration and poor health, a substantial portion of the effect remains unexplained even after controlling for various factors, including intelligence and using fixed effects.
- The study found that incarceration contributes only modestly to racial disparities in health and that there are few synergistic interactions between incarceration and other forms of inequality, such as schooling.
- Interestingly, the evidence for a causal effect is much weaker among persistent recidivists and those serving exceptionally long sentences, suggesting that for this specific group, underlying characteristics might be more influential than the incarceration itself.
- The analysis indicated that for some recidivists, current incarceration might even have short-term “health-promoting” effects, possibly due to access to healthcare within the prison system, but this benefit does not endure post-release.
The article concludes that incarceration is an important addition to sociology’s research agenda, particularly for understanding health disparities. It suggests that exploring incarceration could lead to a fruitful synergy among studies on fundamental causes of health, stigma, and stress, proposing that incarceration exemplifies “stress proliferation,” where a single event leads to subsequent stressors and undermines coping abilities. The authors also note the need for future research to explore a wider variety of health outcomes and intervening pathways.
Schnittker, J., & John, A. (2007). Enduring Stigma: The Long-Term Effects of Incarceration on Health. Journal of Health and Social Behavior, 48(June), 115–130
