By The Praxis Project Team:
Last week, the SF Gate published an article detailing the wrongful incarceration of Ed Easley, a man who spent nine years in prison for molesting his girlfriend’s niece. Two years after his conviction, the niece recanted her confession and testified in his support.

Although Easley maintained his innocence, prosecutors threatened a 32-year sentence if he went to trial and was convicted, pushing him to plead no contest. Two years after his conviction, the niece recanted her confession and testified in his support. Despite the recantation, his convictions weren’t voided until two decades later, when a new law passed allowing formerly incarcerated people to show that it’s “more likely than not” that evidence discovered after their conviction would have changed the verdict.

 

Two years after his conviction, the niece recanted her confession and testified in his support. Despite the recantation, his convictions weren’t voided until two decades later, when a new law passed allowing formerly incarcerated people to show that it’s “more likely than not” that evidence discovered after their conviction would have changed the verdict.

 

While stories such as Easley’s frequently draw attention to the judicial failure that surrounds them, equal scrutiny is rarely given to long-term consequences of wrongful imprisonment for those who have served time. Exonerees and victims of prosecutorial misconduct regularly suffer from negative health effects of incarceration, which exacerbate the injustice by forcing the victim to be exposed to the “overcrowding, violence, sexual victimization, use of solitary confinement, and lower standards of medical care,” that are common in prisons and jails. For example, although individuals held in correctional facilities have the constitutional right to healthcare, the inhumane conditions of confinement and the legal and social barriers they experience after release can have a lasting impact on their health and well-being.

 

 

From a health justice perspective, the impact of incarceration is profound–especially on those who have been falsely imprisoned.  Many studies show that a long healthy life requires some very concrete ingredients, or “determinants.”  These are a collection of health and life-affirming social and environmental conditions whose presence or absence can give and take away days of life [see box]. When someone lives in a place where they feel valued, safe, protected, well-nourished, and loved they live longer, experience fewer health problems, and have better mental health.  But when these determinants of health are absent or present in very stunted ways, poor health, shortened life expectancy, and trauma can ensue.  The presence or absence of these determinants is usually rooted in historical and structural discriminatory policies or practices.  

 

Social Determinants of Health

  • Food Security

  • Parks & Recreational Space

  • Natural Environment

  • Hope & Efficacy

  • Community Interconnectedness

  • Cultural Identity

  • Access to Transportation

  • Affordable & Safe Housing

  • Promoting Healthy Products & Services

  • Community Infrastructure

  • Economic Justice

  • Educational Equity

  • Equitable Health Care Access

  • Immigration Climate

In the Praxis model, race and identity are major, recognized intersectional factors that have historically and structurally impacted levels of discriminatory effects and shape how robustly present or absent the social determinants are in our communities. Many policies that are currently in place still carry the legacy of structural racism that continue to affect opportunities for good health.

 

The “determinants of health” lens challenges traditional narratives that define health solely as a matter of personal choice and responsibility. Punishment culture and mass incarceration are determinants of health outcomes, life expectancy, and mental health for millions of people living in the US.

 

For example, imprisonment often harms a person’s physical health. Incarcerated individuals have disproportionately high rates of infectious and chronic diseases. Some of these, such as hypertension and diabetes, directly correlate to the low-quality food, conditions, sugary drinks, and poor healthcare in prisons. A report examining the nutritional labels and menus in Washington prisons found that “incarcerated people do not receive minimum requirements for fruits, vegetables, whole grains, lean protein, or milk,” and “are fed more than the recommended amounts of refined starches, added sugars and sodium.” Similar findings have been replicated in prisons across the country.

 

The effects of these unwholesome diets are far-ranging. Over three-quarters of people in state and federal prisons are overweight, 30% have hypertension, 10% have heart problems, and 9% suffer from diabetes. Once individuals in prison develop these conditions, it’s unlikely that they will receive proper treatment. The Marshall Project reports that the rate of prisoners with diabetes or high blood sugar has nearly doubled in recent years, but few receive modified meals or appropriate healthcare. This has led to hyperglycemia-induced sickness, heightened risk of amputations, and in some cases, death.

 

Although the Federal Bureau of Prisons and the American Diabetes Association publish guidelines for ensuring the safety of individuals living with diabetes behind bars, corrections staff do not always follow them.The potential for neglect is worsened by the expansion of privatized prison healthcare. Correctional facilities in more than 20 states outsource to companies that promise medical services at a lower cost, often through fixed-rate contracts. This allows administrators to cut down on the amount they spend on the individuals living in the prisons they operate. In addition, healthcare services are not always financially accessible–a recent study found that in most states, imprisoned individuals may be required to pay for their medical care. Costs range from a few dollars to as much as $100. Since people in prison are either not paid or paid $0.86 to $3.45 per day for their mandatory work, this may deter many from seeking the care they need, allowing treatable conditions to go unchecked and worsen.

 

The harmful impact of the inadequate food and healthcare options in correctional facilities is exacerbated by limited opportunities to move around or exercise. In the United States, more people are placed in solitary confinement than any other country and at the end of 2013, over 17 states had overcrowded prisons. Individuals in segregation units have minimal access to natural sunlight or movement for 23 hours a day. A 2013 study of New York City’s Rikers Island Jail found that, on average, “fewer than 1 in 10 [Central Punitive Segregation Unit] prisoners engage in recreation on any given day.” The study also showed that four out of five people never had the chance to verbally sign up for recreation, which automatically disqualified them from participating. As a result, the majority of CPSU incarcerated individuals go for days without access to the outdoor recreational area, leading to forced idleness that damages their physical and mental well-being.

 

The physical impacts of imprisonment are compounded by the prevalence of mental illness among incarcerated and formerly incarcerated individuals. Despite the fact that individuals in state prisons are two to four times more likely to experience serious mental illness than the general population, comprehensive mental health treatment is rarely available in prisons. Mental health and social reintegration services are even scarcer for exonerees, who frequently “get the worst of both worlds–the stigma of prison, with none of the support services available to those who served time.” Exonerees have high rates of PTSD, hypervigilance, and anxiety disorders–conditions commonly experienced among trauma victims. These feelings can be magnified when exonerated individuals return home to family members with whom their relationship is “complicated by feelings of estrangement and loss of intimacy and cohesion.” In other cases, exonerees lose all of their family members during an extended wrongful incarceration and are left to navigate feelings of loss, resentment, fear, and an unjust loss of years of life with little to no support. For exonerees who don’t receive a formal apology or declaration of innocence, mental illness is compounded by intense societal stigmatization.

The difficulties of readjusting to society while suffering from physical and/or mental health problems are worsened by the financial insecurity many exonerees face. Exonerated individuals are frequently disqualified from traditional re-entry programs and left “entirely on their own, with no guidance for finding jobs or housing, or even transportation.” In addition to a lack of social services, exonerees are not officially guaranteed any monetary restitution for their imprisonment. Many states do not have any compensation statutes for people who have been wrongfully convicted. Those that do make the process extremely complicated: “it takes exonerees three years on average to receive any compensation after their release. More than a quarter get nothing. Among those who do receive settlements, 81% get less than $50,000 for each year of wrongful imprisonment.” Wrongfully convicted and exonerated individuals who do qualify for compensation must file court proceedings to obtain a ruling of actual innocence, a complex and expensive process that discourages many from applying at all.  

 

Exonerated and formerly incarcerated individuals face many health challenges as they begin the process of re-entry. Despite the short and long-term effects of incarceration, those affected by wrongful conviction and imprisonment demonstrate extraordinary resilience by caring for themselves and each other, and powerful resistance by organizing together, sharing their stories, and envisioning an alternative to the carceral state.   

 

The Praxis Project Team Authors: Mia Lopez-Zubiri, Xavier Morales, Ph.D., and Caitlin Dunklee