Social Determinants of Health

Mass Incarceration and COVID-19: The intersection of American policy failures

Today, American prison systems stand at the intersection of multiple public health disasters. Mass incarceration has led to millions of people living in dismal, overcrowded arrangements — conditions that left prisoners particularly susceptible to infectious spread. At the onset of the pandemic, policymakers had a chance to create effective safety regulations but failed to do so. The convergence of these factors created a perfect storm but one that is all-too-often ignored in conversations surrounding public health.

The pandemic has disproportionately impacted people in prison. From a study published at the Journal of the American Medical Association, the rate of infection among the incarcerated population is five times greater than the general population, which is likely an underestimate because many facilities don’t test people who have died from COVID symptoms after death. This disproportionately high rate of infection can be attributed to the overcrowding of prison facilities and the vulnerability of imprisoned populations, 

First, the overcrowding of prison systems increases opportunities for viral spread. Over the past year, state prisons have reduced the number of paroles granted and the number of prisoners they released; as a result, nearly 20 states have prison systems that are at 90% capacity or greater. In these nearly-full prisons, rates of COVID-19 spread are incredibly high: a recent Stanford study found that the R0 factor in an urban prison (the number of individuals one person is expected to spread the virus to) was 8.44, which is “3.6 times higher than … the Princess Diamond [cruise liner].” These worrisome numbers can be partly explained by crowded living quarters; many prisons follow the American Correctional Association’s guideline of housing 2 prisoners in 5×5-foot rooms, which were found to be completely ineffective for social distancing — even more so than the ‘dreaded’ cruises.

While these living conditions have become problematic since last March, other aspects of the carceral state have been so for centuries. According to the Prison Policy Institute, racial disparities are “evident in every stage of the criminal justice system” — a fact that extends to prisons. Due to systemic bias in arrests and sentencing, prison populations are disproportionately racial and ethnic minorities, who are more vulnerable to dying from COVID-19 than white Americans. Additionally, thanks to long sentences and low chances of parole, prisoners are disproportionately middle-aged and elderly men; this population is vulnerable due to their old age and sex. As a result, the prison population is much more vulnerable to COVID-19 than the general population.

Additionally, prisoners’ vulnerability to COVID-19 is furthered by lifestyle factors. Study after study has concluded that the food served in prisons is inadequate to fulfill nutritional needs, which leads to comorbidities and worse overall immunological health. The general lack of sanitation and availability of PPE in prisons (during the first few months of the pandemic) created conditions ripe for viral spread.

The impact of these conditions extends beyond prisons into the communities surrounding them. Prisons don’t exist in isolation; they frequently interact with their surrounding cities and neighborhoods, whether through interactions between visitors, staff, or vendors. As a result, a study by the Prison Policy Institute found strong correlations in counties across America between the number of incarcerated individuals and the growth of COVID-19 in summer 2020; mass incarceration was responsible for “560,000 additional COVID-19 cases nationwide in just three months.” The cause to improve prison health conditions is thus one of national concern. 

Unfortunately, last spring, state lawmakers and policymakers were unreceptive to calls for prison reform. Releasing early at-risk individuals and those who had committed minor offenses may have mitigated the drastic spikes in cases we observed last summer. Now, such policies may be too little, too late; because a significant proportion of prisoners have already been exposed to COVID-19, releasing them back to their communities could actually catalyze new mass waves. 

Thankfully, since last summer, progress is steadily being made. Police departments at Los Angeles, Philadelphia, and Denver have reduced their number of arrests in an effort to reduce the incarcerated population. Additionally, jails in Ohio and Alabama have refused to admit people on minor misdemeanor charges. While these efforts are heartening, regulations must be implemented at the state and federal levels for more thorough improvements. 

As the conversation surrounding COVID-19 and at-risk communities continues to evolve, we must not forget to address the needs of the imprisoned population.

Further Reading

“Criminal Justice Responses to the Coronavirus Pandemic.” Prison Policy Initiative, 18 May 2021,

Saloner, Brendan, et al. “COVID-19 Cases and Deaths in Federal and State Prisons.” JAMA, vol. 324, no. 6, Aug. 2020, pp. 602–03, doi:10.1001/jama.2020.12528.

Sawyer, Wendy. “Food for Thought: Prison Food Is a Public Health Problem.” Prison Policy Initiative, 3 Mar. 2017,

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