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Life on the Inside and Death on the Outside: Complexities in Health Disparities Inside and Outside U.S. Prisons

by Evelyn J. Patterson, Ph.D.

As a scholar of criminology and demography (the study of how and why populations change), I seek to contribute to the discourse on inequality through researching different issues in the demography of incarceration. One astonishing thing that I discovered some time ago was the difference in mortality levels of black men inside versus outside of prison.

At every age during a person’s working years, black men outside of prison die at a higher rate than black men in prison. Further, at every age during working years, black men not in prison die at a higher rate than white men outside of prison. However, in the period of 1996-98, black men inside prison had comparable death rates to white men outside of prison.

The most common explanation for this trend is that black men are safer when incarcerated. While part of the story, particularly in people’s younger working years, this is not the story. That is, it does not completely explain the disparity in life expectancy.
Rather, some of it likely has to do with access to adequate nutrition and health care. Another piece has to do with the unequal lives that black and white men experience outside of prison.

As stated in a 2010 article I authored:
From these results, scholars and policymakers could reach the conclusion that because mortality is lower in prison, we help people, especially African Americans, when we incarcerate them. However, I caution against such an interpretation because studies on prison morbidity suggest that prisoners are at risk for more diseases before, during, and after interaction with the criminal justice system.... In contrast, what the findings do suggest is that even in hostile environments such as prison, there is potential to greatly reduce racial and sex disparities in mortality. Such findings speak to the depth of deprivation some groups suffer in U.S. society – a place with such deprivation that prison, in some cases, is a lesser enemy in life.1

One of my recent studies, published in the American Journal of Public Health in March 2013, speaks to a different piece of the equation.2 What happens when a person is released from prison? I looked at parolees in New York and examined the relationship between the length of time they served in prison and their life expectancy. Although there were many factors that I wanted to include in this investigation, such as post-release social and financial support, I was unable to do so. Nevertheless, the findings were shocking.

The study indicated that, on average, every year served in prison was accompanied by a two-year reduction in life expectancy. Moreover, while the risk of death declines over time once a person is released, it takes approximately two-thirds of the length of time served for someone to eliminate the life expectancy deficit. For example, after exiting prison, the life expectancy of a 30-year-old male who served 5 years is decreased by 10 years. The current life expectancy of males in the United States is 76;3 based on the study findings, the life expectancy of a former prisoner who served 5 years would be only 66 years. Nevertheless, during the 7 years after his release, his risk of death will decline to pre-incarceration levels.

The increase in likelihood of death post-incarceration and the finding that black men in prison have death rates very similar to white men not in prison are truths we must continue to research and understand. One finding suggests hope in terms of eliminating disparities, while the other poses a rather large challenge to sentencing practices and the very core of how we define and apply punishment to those convicted of crimes. As a society, we have the privilege to ignore our past and even the facts of the present – including the fact that people sent to prison have diminished life expectancies upon their release. The use of that privilege, however, is not only a crime; it is the very definition of inhumanity.

Evelyn Patterson is an Assistant Professor of Sociology at Vanderbilt University; she provided this article exclusively for Prison Legal News.


1 Patterson, Evelyn J. 2010. “Incarcerating Death: Mortality in U.S. State Correctional Facilities, 1985-1998.” Demography 47(3): 587-607.

2 Patterson, Evelyn J. 2013. “Living Beyond Confinement: An Examination of the Dose Response of Prison on Parole Mortality in New York, 1989-2003.” American Journal of Public Health 103(3): 523-528.

3 Miniño AM. “Death in the United States, 2011.” NCHS data brief, no 115. Hyattsville, MD: National Center for Health Statistics, 2013.

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