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date: 04 March 2021

Mass Incarceration in the United States: From Punishment to Public Healthlocked

  • Ernest DruckerErnest DruckerCollege of Global Public Health, New York University; Mailman School of Public Health, Columbia University; Professor Emeritus of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine


Mass imprisonment in the United States is an epidemic that has spread across five generations affecting millions of individuals, their families, and hundreds of communities. The United States imprisons more people than any other nation in the world—with over 2 million behind bars and another 5 to 7 million under community supervision on parole and probation. With 5% of the world’s population, the United States has 25% of all the world’s prisoners. This U.S. system imposes many punitive policies, holding more of its citizens in isolation and solitary confinement than all the other prisons of the world combined and imposing the highest rates of life sentences of any nation. This public health analysis of mass incarceration in the United States (first proposed in Ernest Drucker’s 2011 book, A Plague of Prisons: The Epidemiology of Mass Incarceration in America) must therefore also address the high rates of prisoner reentry that accompany it—with over 600,000 U.S. prisoners reentering society each year—with the highest recidivism rate of any nation. This population is disproportionally poor and members of America’s large minority populations (African Americans and Latinos). The public health model provides a new tool for ending the American epidemic of mass imprisonment and, of equal importance, healing those who have survived its blows. This stage of the American story of mass incarceration is covered in Drucker’s 2018 book, Decarcerating America: From Mass Punishment to Public Health. But releasing people from prisons is not enough—the taint of punishment has a long-lasting and debilitating effect on the millions who return from prison to their home communities—facing social stigma and the many restrictions placed upon them as part of the conditions of parole—including limits of their access to public education, healthcare, and housing—as well as convicted felons’ loss of the right to vote. The United States badly needs a paradigm shift that replaces these impediments to successful reentry after prison, creating instead a positive place and normal life for this population in the outside world.

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