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Understanding How Prison Profits Impact Health

September 16/2021

By Heidi Singer

A DLSPH PhD student is applying lessons learned from the tobacco wars to improve understanding of health in the isolated world of North American prisons.

“We have 50 years of strong information on how the tobacco industry operates, and we find that the playbook in these other industries – places where public health and profits are in direct conflict – is surprisingly similar,” says Daniel Eisenkraft Klein, a Social and Behavioural Health student.  “Even talking about health is often considered a second thought when discussing prisons; but we’re trying to push back at this tacit acceptance that incarcerated individuals’ health is inevitably poor.”

Eisenkraft Klein recently co-authored a commentary in the American Journal of Public Health, calling on researchers to delve into the lobbying and political influence of private prisons and the multi-billion dollar industries that provide food, health and other services to all prisons in North America. He asserts that mass incarceration should be considered a fundamental, structural determinant of health for many communities, particularly in the United States. And, he points out, the high level of incarceration is big business.

Understanding the ‘commercial determinants of health’ may prove crucial to improving the health of people who are incarcerated, Eisenkraft Klein believes. While it’s well understood that people in prisons suffer worse health than the general public, the specific mechanisms – and economic pressures – for that remain poorly understood.

Corner-cutting on food quality, medical treatment, staffing levels — all could be exacerbated by private prisons looking to maximize profits, he says, or the commercial suppliers profiting from indifference around prisoner wellbeing.

“Whether it’s about mental or physical health, we’re trying to make the world of public health interact with the world of mass incarceration,” says Eisenkraft Klein, adding that racial inequities further drive the need for understanding prison health conditions. “We’re starting to do a better job talking about racial disparities in public health, but somehow prisons and mass incarceration seem to be missing from the conversation. This is particularly important when one in three Black men in America are incarcerated at some point in their lives, and Indigenous individuals remain deeply over-represented in Canadian prisons.”

Public health researchers are starting to apply lessons learned from fighting tobacco companies to other industries with the potential for public health harm, such as firearms, certain alcohols, and prescription opioids. The tools of the trade that need close examination include political donations and other forms of lobbying that lead to influence on policies, Eisenkraft Klein says.

“We focus a lot on the ground, but it’s also how they directly work with policymakers,” he says. “It’s important that we understand how structures of power influence health outcomes, and that’s why we need to pay attention corporate practices and the broader economic structures that enable these inequities – or the commercial determinants of health. Most of us are comfortable with the idea that the tobacco industry shouldn’t have a seat at the decision-making table. We argue that it should be the same with private prisons and suppliers.”