Abstract
Geographical inequalities in life and death are among the world's most pronounced in the United States. However, the driving forces behind this macroscopic variation in population health outcomes remain surprisingly understudied, both empirically and theoretically. The present article steps into this breach by assessing a number of theoretically informed hypotheses surrounding the underlying causes of such spatial heterogeneity. Above and beyond a range of usual suspects, such as poverty, unemployment, and ethno-racial disparities, we find that a hitherto neglected explanans is prison incarceration. In particular, through the use of previously unavailable county-level panel data and a compound instrumentation technique suited to isolating exogenous treatment variation, high imprisonment rates are shown to substantially increase the population-wide risk of premature death. Our findings contribute to the political economy of population health by relating the rise of the carceral state to the amplification of geographically anchored unequal life chances.
Highlights
The unequal distribution of disability, disease, and death in the United States is among the most pronounced in the world and, as documented by a number of recent studies,[1] the health gap between the top and the bottom of the social order is rapidly increasing
Our analysis provides a unified account of substantial geographical variation in life expectancy at birth and premature mortality risk across the United States
We relate the distributional dynamics of mortality and life expectancy to a range of sociological factors, and we spotlight 1 of these—punitive social policy—that is rarely invoked in the existing population health literature, despite being a major object of social scientific inquiry
Summary
The unequal distribution of disability, disease, and death in the United States is among the most pronounced in the world and, as documented by a number of recent studies,[1] the health gap between the top and the bottom of the social order is rapidly increasing. In social scientific approaches to the study of population health, vital inequalities are usually explained with reference to fundamental social causes4—including cultural frames[5] and institutional arrangements6—rather than biological fixity or lifestyle[7]. A distinctively social scientific approach is to relate the distributional dynamics of population health to the wider determinants of unequal life chances These determinants, are typically used to account for disparities in individual-level outcomes rather than broader spatial configurations. We take our cue from this literature by viewing the prison as a potent force in the (re)making of vital inequality insofar as it molds, from above, the social relations that impinge on human welfare: it is a politically rooted institution that actively stratifies a population, delineates and aligns group boundaries, and “realizes”[12] material and symbolic divisions.[13]
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