Public health, criminal justice, and economic justice are inextricably linked. Health in prisons and jails is a matter of ongoing public concern, as the vast majority of incarcerated people will return to the community at the end of their sentences. In this blog post, I want to draw further attention to incarceration as a public health issue and also urge that we respond to it as a labor issue.

Nearly 7 million people in the United States live under the jurisdiction of the criminal justice system, with more than 2.3 million people currently in prisons or jails, another 820,000 people on parole, and 3.8 million people on probation. The United States has the highest incarceration rate in the world, at more than 700 incarcerated persons per 100,000 of the national population.

Health disparities encountered in incarcerated populations are stark. The health of incarcerated people is almost always inferior to that of the general population. People in state and federal prisons and jails are more likely than the general population to report ever having a chronic medical condition or infectious disease. An estimated 40 percent have a current chronic medical condition, and more than 65 percent meet the medical criteria for substance abuse addiction. The rate of HIV infection among people in state and federal prisons is more than five times greater than the rate among people who are not incarcerated. Hepatitis C infections are also much higher in prisons and jails than in the general community. In addition, currently and formerly incarcerated people lack access to good health care.

The health and health care in prisons and jails are sometimes regarded as being of little concern to the general population, but over 95% of incarcerated individuals will eventually return to their communities and their health problems and needs will return with them. Adding to the public health challenge, incarcerated people often lack education and work experience and return to communities with weak connections to the formal labor market. Stigma associated with incarceration as well as outright employment bans further limit employment opportunities. These challenges lead to poor health outcomes and are barriers to seeking and accessing health and other services. Not surprisingly, employment challenges also perpetuate a vicious cycle of incarceration and re-incarceration.

Given this reality, it is important to look at prisons and jails through the lens of public health, but incarceration also needs to be understood as a labor issue. Incarceration is a labor issue in a number of ways. Not only do formerly incarcerated people find themselves locked out of the job market by employers who screen applicants for felony convictions, but they also work for pennies while in prison. Furthermore, correctional officers endure staggering downsides on the job, including modest pay for high-stress employment and a life expectancy around 59 years, compared with 77 years for the general population.

In fact, advancement on the labor front may be the key to prison reform and better health outcomes. The issue of incarceration has drawn the attention of the labor movement. The AFL-CIO, one of the largest unions in the United States with a long history of fighting for social justice, has pledged to reform the unfair criminal justice system and recently teamed up with John Legend to change the national conversation about mass incarceration. The outcome of the labor movement’s involvement is uncertain, but two things are clear.

First and foremost, labor unions represent correctional officers. While this can mean opposition to commonsense policies, it can also provide an opportunity for change. Improving the financial and job security of correctional officers could be a step toward changing the culture of prisons. With the support of labor unions, it may be possible to pursue models of correctional employment that discourage rather than encourage the mistreatment and dehumanization of incarcerated people. One potential model could be to rotate correctional officers to work placements outside of prisons and jails, possibly in social services, to promote a broader perspective and combat entrenched stigma.

Second, labor unions can support training programs for currently and formerly incarcerated people that result in union jobs. The Trades Related Apprenticeship Coaching (TRAC) program in Washington State involves unions and helps incarcerated people learn the building and constructions skills they will need to earn a union wage after they have served their time. Such programs are essential to preparing people for and linking them to jobs.

Incarceration must be recognized as one of the major public health challenges facing the United States. The need for innovative solutions to this pressing health concern necessitates addressing issues of labor and employment.