Source: The Troubling Relationship Between Juvenile Detention and Long-Term Health

In the weeks before they leave the juvenile detention center, incarcerated children in Connecticut meet with counselors from the Wheeler Clinic, a nonprofit that works with high-risk youth as they transition back into their community. They talk about social connections, they talk about family support. They also talk about vaccinations.

Justice involvement is intertwined with other factors that are more likely to affect black and other non-white communities, which also contribute to the overall health care gap.

“If their immunizations aren’t up to date, they can’t go back to school,” says Kim Nelson, senior vice president for services at the Wheeler Clinic. That’s a big reason the transition includes a medical plan, she says. Counselors know that incarceration puts young people at risk for bad health outcomes down the line, and they hope a relationship with a doctor can ease that chance.

“We want to keep the kids healthy,” says Nelson.

That can be harder for populations disproportionately represented in the juvenile detention system. Indeed, black children in Connecticut are five times more likely to be arrested than their white counterparts — and they are more than twice as likely to be sentenced to a correctional facility. Across the country, non-whites account for only one-third of the population of adolescents, but two-thirds of the adolescents in juvenile detention.

That’s why some researchers are now beginning to suspect that juvenile detention, which fragments health care during key preventative windows, may actually play a role in the long-running and well-documented health gaps that exist between white and non-white adults in the United States. Any young person under 18 years old in contact with the criminal justice system, from arrest to incarceration, is grouped under the umbrella of “justice involved youth,” and the United States has more of them than any other country: Each year, roughly 2 million kids are arrested, and just over half are placed on probation, while nearly 90,000 are placed in correctional institutions.

In general, research has suggested that even one arrest leads to about a 50 percent increased risk of dying young. And when youth are detained, the risk increases again, and long-term incarceration increases it even more. “The deeper they get into the system, the more at risk they are for health problems,” says Matthew Aalsma, who studies health in the juvenile justice system at the Indiana University School of Medicine.

Those involved with the juvenile justice system are more likely to go for long stretches without health insurance. They use preventative health care services less frequently, and they are about 16 percent more likely to use emergency departments than their peers. As they get older, they are more likely than the general population to engage in sexual behavior that puts them at risk for HIV, AIDS, and other sexually transmitted infections. As adults, they show more symptoms of depression, and have worse overall health.

Socioeconomic factors, which include justice involvement, account for about 40 percent of the variance in health care outcomes between racial groups, says Deena Chisolm, who studies pediatric minority health at Nationwide Children’s Hospital in Columbus, Ohio. “Breaking out how much of the 40 percent is [justice involvement], that’s difficult,” Chisolm says.

That’s because justice involvement is intertwined with other factors that are more likely to affect black and other non-white communities, which also contribute to the overall health care gap. Poverty, low food and housing security, and poor school systems are also clustered in areas with aggressive policing, which in turn leads to greater arrest rates, and involvement with the criminal justice system.

However, research shows that the social and environmental issues that push people into the justice system aren’t totally responsible for the health care repercussions of incarceration. Spending time in prison is its own independent factor contributing to poor health, concluded a longitudinal study in the general prison population on incarceration and health care. “The process linking incarceration to poor health is distinct from the process leading to incarceration,” the authors wrote.

That result was surprising to some in the field, says sociologist Jason Schnittker, one of the authors of that study. “The forces that we characterize as selecting [people] into prison are strong,” he says. But it was clear from the study, Schnittker says, that incarceration itself had serious health consequences.

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