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Am J Public Health. 2006 July; 96(7): 1148–1149.
PMCID: PMC1483859


The theme of the October 2005 issue of the Journal was the public health consequences of imprisonment. This issue illuminated the wide-ranging health care needs of the more than 2.2 million men—most of whom are African American—who are incarcerated in the United States. Persistent health disparities characterize impoverished communities with large numbers of men who are locked away with limited access to quality health care and treatment,1 and these disparities are fueled by cycles of recidivism. Each year more than a half million offenders move back and forth between their communities and prison.2

The 1990s prison boom was associated with increased wage inequality for young, poorly educated African American men with prison records.3 The high rates of incarceration of young African American men result in racial and ethnic wage disparities (low wages, unemployment, family instability, recidivism, and restrictions on political and social rights)4 that exacerbate their lack of access to health care, treatment, and prevention. These are the people for whom the mission of public health is intended. Jails and prisons are gateways for public health professionals, whose research and practice help ensure conditions in which all people can be healthy.5

Burgeoning HIV infection rates among African American men, many of whom have been incarcerated, make this disease the most potent symbol of health disparity in the United States. Furthermore, disparities in incarceration rates for African American men lower the ratio of men to women in African American communities. This situation promotes partner concurrency, which is a known risk factor for the transmission of HIV and other sexually transmitted diseases.6 Incarcerated populations, therefore, constitute the new public health mission field for evidence-based interventions and comprehensive case management. Fortunately, collaborations between correctional health and community organizations, including faith-based programs, are producing promising prevention and prisoner reentry programs.7(p1682),8

A nationwide conversation must begin to challenge correctional practices and legal policies that exacerbate health disparities. Broad questions must be asked about the relationships between causes of crime, sentencing policies, and health care delivery in correctional settings and about the aggregate influence of these factors on the health of African American communities. Answers to these compelling questions are possible if we make a national commitment to public health and to correctional policies that protect the most vulnerable people among us.


Note. The views expressed in this letter are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.


1. Golembeski C, Fullilove R. Criminal (In) Justice in the City and Its Associated Health Consequences. Am J Public Health. 2005;95:1701–1706. [PMC free article] [PubMed]
2. Travis J. But They All Come Back: Facing the Challenges of Prisoner Reentry. Washington, DC: Urban Institute Press; 2005:xi.
3. Western B. The impact of incarceration on wage mobility and inequality. Am Sociol Rev. 2002;67:526–546.
4. Pettit B, Western B. Mass imprisonment and the life course: race and class inequality in U.S. incarceration. Am Sociol Rev. 2004;69:151–169.
5. Committee for the Study of the Future of Public Health, Division of Health Care services, Institute of Medicine. The Future of Public Health. Washington, DC: National Academy Press; 1988. Available at: http://www.nap.edu/openbook/0309038308/html. Accessed March 20, 2006.
6. Adimora AA, Schoenbach VJ. Sexual networks, components, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;19(supp 1): S115–S122. [PubMed]
7. Myers J, Zack B, Kramer K, Gardner M, Rucobo G, Costa-Taylor S. Get Connected: An HIV Prevention Case Management Program for Men and Women Leaving California Prisons. Am J Public Health. 2005;95:1682–1684. [PMC free article] [PubMed]
8. Project START Study Group. The effects of a multisession intervention on the sexual risk of young men released from prisons in 4 US states. Am J Public Health. 2006:96. In press.

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