There is no system that more completely dismantles a person's and a community’s ability to be healthy than the prison system in the United States. According to a study published in the American Journal of Public Health, for every year spent behind bars, a person’s life expectancy decreases by two years. This has tremendous relevance considering our prison population has quadrupled in the past 25 years to about 2.3 million in prison yearly. The US now has the highest incarceration rate in the world.

With incarceration rates almost six times higher among African Americans than Whites, the impact on our communities’ health is great. We already know alarming disparities in health exist for African-Americans. In addition, studies show that incarcerated people have higher rates of asthma, high blood pressure, cancers, mental health disorders, substance abuse, HIV, and other sexually transmitted infections. Why the disparities? Possibly, having poor health before entering the system, lack of good quality healthcare while in prison, and inconsistent healthcare due to multiple prison stays may all contribute to poor health outcomes of prisoners.

But what happens to the health of the 650,000 people released from prison yearly?

When answering this question, we must first consider what makes us healthy. Having consistent access to quality healthcare, in addition to having quality jobs, housing, education, food, and social support all help design a blueprint for how healthy you, your family, and your community will be. Our blueprint in health is strongly influenced by policies and laws that have created well-established systems in the environments that surround us. These policies determine our opportunities in health. For example, consider if you couldn’t buy food, get a place to sleep, find a job, or vote. How healthy do you think you would be? Several policies prevent the formerly incarcerated from building healthy lives, such as:

-A lifetime ban on the eligibility of welfare and food assistance for anyone convicted of a felony drug offense. This includes a single drug possession whether you are in drug recovery treatment or not, pregnant, or have a medical illness. Having access to affordable food is essential for sustaining life; not only for formerly incarcerated but for their families.

-Denied housing by federally assisted public housing authorities for those with criminal records. Private housing is costly, and many leaving prison cannot find a place to live. As Michelle Alexander explains in her book The New Jim Crow, “going home” becomes more a figure of speech than reality. What is the end result? People become homeless. Housing is important because it creates stability in our lives; stability for proper sleep, and for keeping families together.

-Being “boxed in” on applications for work when asked if you have ever been convicted of a crime. If the ‘yes’ box is checked, many employers in most states are allowed to deny that individual a job.  Also if someone formerly incarcerated considers starting his or her own business, barriers may arise in obtaining the proper professional licenses due to a previous arrest or conviction. Lack of employment may diminishes one’s ability of have health insurance, pay for basic needs, and possess a sense of belonging. Joblessness also nurtures high rates of violent crimes.

-Not being allowed to vote; not even for the formerly incarcerated in some states. Only two states – Vermont and Maine- allow inmates to vote. The United Nations Human Rights Committee says that these policies violate international law and are discriminatory. The inability to use our voice encroaches on one’s belief that they are a valid part of society. This is exacerbated by the existing shame and stigma of being labeled “a felon” with potential impact on one’s emotional and mental well-being.

Fortunately, many communities are developing community reintegration programs. These programs promote community health, protect public safety, and save taxpayer dollars. However, our gaps in understanding the direct or indirect affects on the health of those in prison and communities in which they come from and go back to are still great. It is imperative that we critically examine the policies that determine the health, become seriously engaged with our local elected officials, and begin to advocate for change so that our current cycle of establishing unhealthy communities ceases.

Dr. Aletha Maybank is a Board Certified physician in both Pediatrics and Preventive Medicine/Public Health. You can follow her on Twitter at @DrAlethaMaybank