This article reviews evidence linking incarceration and health, with a particular focus on African Americans, who are disproportionately affected by the incarceration system. Although inmates generally suffer from worse health than comparable, non-institutionalized adults, this comparison is not uniformly the case, and some of the strongest negative effects of incarceration emerge after release, suggesting that the struggles of reintegration into society are as important as the conditions of incarceration. We review evidence for the basic relationship between incarceration and health from individual-level and aggregate-level studies, as well as from evidence and speculation regarding potential mediating mechanisms. Many questions remain regarding these mechanisms and, by extension, which policies are most promising for reducing incarceration's impact on health. Among other issues, the incarceration-health connection also raises fundamental questions regarding the level of harm society is willing to accept as part of routine punishment for criminal behavior.

This article addresses two basic questions. First, it examines whether incarceration has a lasting impact on health functioning. Second, because blacks are more likely than whites to be exposed to the negative effects of the penal system—including fractured social bonds, reduced labor market prospects, and high levels of infectious disease—it considers whether the penal system contributes to racial health disparities. Using the National Longitudinal Survey of Youth and both regression and propensity matching estimators, the article empirically demonstrates a significant relationship between incarceration and later health status. More specifically, incarceration exerts lasting effects on midlife health functioning. In addition, this analysis finds that, due primarily to disproportionate rates of incarceration, the penal system plays a role in perpetuating racial differences in midlife physical health functioning.