On September 8, 2023, Natasha Holoman rushed from Louisiana to Atlanta after officials notified her that her son was on life support in Grady Memorial Hospital’s intensive care unit. She was too late: her son, 24-year-old Shawndre Delmore, had been found unresponsive in his cell the night before and had no brain activity by the time she arrived.
As of this writing, Delmore is the 10th person to die in custody in Atlanta’s Fulton County Jail this year alone. His death continued a decade-long increase in carceral mortality that motivated the US Department of Justice to launch an investigation into conditions at the Rice Street jail in July 2023. Georgia is not alone in being an unsafe place to be jailed. People detained in the United States face significantly greater public health risk than the general population as evidenced by the mortality data in both the jailed and supervised populations.
A Nationwide Problem
Local jails across America are the “gateway to the criminal justice system,” as the 2015 Vera Institute of Justice report puts it (Subramanian 2015). Jails see almost 19 times more admissions on an annual basis than state and federal prisons- turnover that is costly in far more than administrative burden alone. A recent BJS report measured all-cause mortality in local jails at 167 deaths per 100,000 people (Carson 2021).
Note: Some people might read this data and conclude that jail is safer for people but for the wrong reasons - more than anything, this data is an indictment of the inaccessibility of the American healthcare system.
An independent study of US jails found that weekly turnover rate and overall jail size were found to have a statistically significant effect on increased jail mortality rate (Adler 2023). That study also found that over 60% of the observed jail population were detained pretrial. By the same token, the BJS local jail mortality analysis found that 77% of the 1,200 people who died in local jails in 2019 had not been convicted of a crime at the time of their death.
An additional risk factor for the jailed population is private ownership of facility healthcare management. Reuters published investigative reporting that found jails using the five “leading [private] jail healthcare contractors” saw worse mortality than facilities with government-managed healthcare (Szep 2020). NaphCare, one of the five correctional healthcare companies examined by Reuters, currently owns the Fulton County Jail healthcare management contract. In June 2023, the Atlanta Journal-Constitution reported that Fulton County extended its contract with NaphCare despite the numerous deaths preceding the DOJ investigation (Gaines 2023).
The Bureau of Justice Statistics (BJS) reported approximately 10.3 million jail admissions nationwide in 2019 (Zhen 2021). At any given time, nearly 2 million people are confined nationwide, and over 25% of them are in local jails (Maruschak 2021). A BJS examination of mortality in local jails found that the 2019 local jail mortality rate, 167 deaths per 100,000 inmates, represents an 11% increase from 2000 (Carson 2021). That same study found the suicide rate of the jailed population to be 2.2 times higher than the overall US population.
Probation & Public Health
The public health of the probation population has seen less research scrutiny than any other supervised group despite the volume. Of the 5.5 million people in the US correctional system at year-end 2021, 68.7% were on probation or parole. Public health studies of the correctional population typically focus on morbidity and mortality of either detained or recently released people as opposed to the millions under community supervision.
In 2019, researchers from Cornell University conducted the first age-standardized mortality examination of the probation population (Wildeman 2019). The results were significant: “Persons on probation died at a rate 3.42 times higher than persons in jail, 2.81 times higher than persons in state prison, and 2.10 times higher than the general US population.” The authors standardized for age due to the higher likelihood of interaction with the criminal justice system in early adulthood versus older ages. While it might be counterintuitive that jailed and imprisoned populations have lower mortality rates than the general US population, this is consistent with previous research that associates better health care outcomes under confinement due to better services, access, and nutrition than what is typically available for America’s socioeconomically disadvantaged communities (Patterson 2010).
Conclusion & Next Steps
The Adler study examining jail mortality argues that turnover and higher-capacity jails have a stronger association with mortality than the oft-cited overcrowding concerns. While overcrowding of jails has negative effects on both jailed populations and correctional departments, this issue is typically used to argue for a greater carceral capacity instead of better supporting social services on the ground to reduce crime risk, behavioral health incidents, and addiction. Given that 77% of the 1,200 people who died in American jails in 2019 were not convicted of a crime at their time of death (Carson 2021), critical work needs to be done to reduce the rate of pretrial detention and its associated public health risks.
Although Wildeman’s examination focused on probation mortality, the conclusions are similarly aligned. Wildeman wrote that “it is important to implement patient-centered interventions that reflect the unique circumstances of the lives of persons on probation.” Given the mix of public and private stakeholders involved in the American carceral system, deeper and more direct collaboration between departments of corrections and community supervision, departments of public health, and community support organizations is necessary to address the public health problem at hand.
Additionally, understanding the public health impact requires going deeper than mortality alone. The intersectionality of race and gender combines with the inherent imbalance of the justice and healthcare systems to significantly impact quality of life in the US. Further examination of maternal health impact, substance use disorders, and behavioral health issues along with the exacerbation of the standard US chronic disease issues around hypertension, cardiac disease, and diabetes is necessary to fully outline the public health risk for the millions of people in the American correctional system.
Author’s Note
While any mortality related to the carceral system is deeply tragic, pretrial death in a country that supposedly affords the right to trial and the presumption of innocence until proven guilty is particularly unacceptable. While community stakeholders and government agencies can work together to improve conditions on the ground, legislative reform around probation and cash bail can serve to reduce the harm faced by the population at hand.