A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.

Social determinants of mental health

This article examines the relationship between incarceration and health functioning. Using data from the National Longitudinal Survey of Youth, the relationship between incarceration and more than 20 different measures of health are tested. Using multiple analytic procedures, a distinctive pattern of association emerges. Individuals with a history of incarceration appear consistently more likely to be afflicted with infectious disease and other illnesses associated with stress. In contrast, no consistent relationships were observed between incarceration status and ailments unrelated to stress or infectious disease. The results suggest that exposure to infectious disease and stress are important to understanding the lasting impact of incarceration on health.

https://journals.sagepub.com/doi/pdf/10.1177/002214650804900105

Incarceration as Exposure: The Prison, Infectious Disease, and Other Stress-Related Illnesses∗:

Although Black gay and bisexual men have written eloquently about the intersections of race, gender, and sexual identity in anthologies such as Brother to Brother and In the Life, empirical studies of intersectionality with men, and Black gay and bisexual men in particular are rare. This qualitative study examined descriptions and experiences of intersectionality in individual interviews with 12 U.S. Black self-identified gay (n = 9) and bisexual (n =3) men in Washington, DC. Participants ranged in age from 21 and 44 (M = 36.33) and were predominantly highly educated and middle income. Research questions were: (1) How do participants describe and experience intersections of race, gender, and sexual identity?; (2) How do social processes shape their social identities?; (3) What are their challenges due to intersections of race, gender, and sexual identity?; and (4) What are the perceived benefits of these intersections? Analyses highlighted four key themes: (1) explicit and implicit descriptions of intersectionality; (2) the primacy of identities as Black and/or Black men first; (3) challenges such as negative stereotypes, racial microaggressions in mainstream and White LGB communities, heterosexism in Black communities, and gender role pressures to act “masculine”; and (4) perceived benefits such as psychological growth, liberation from traditional gender role or heteronormative expectations, and the freedom that being outsiders or “never being comfortable” confers in terms of exploring new opportunities and experiences. These findings imply that intersectionality can be expanded to incorporate the strengths/assets of intersectional identities in addition to oppression based on interlocking social identities.

“Once You’ve Blended the Cake, You Can’t Take the Parts Back to the Main Ingredients”: Black Gay and Bisexual Men’s Descriptions and Experiences of Intersectionality

An unprecedented number of Americans have been incarcerated in the past generation. In addition, arrests are concentrated in low-income, predominantly nonwhite communities where people are more likely to be medically underserved. As a result, rates of physical and mental illnesses are far higher among prison and jail inmates than among the general public. We review the health profiles of the incarcerated; health care in correctional facilities; and incarceration's repercussions for public health in the communities to which inmates return upon release. The review concludes with recommendations that public health and medical practitioners capitalize on the public health opportunities provided by correctional settings to reach medically underserved communities, while simultaneously advocating for fundamental system change to reduce unnecessary incarceration.

https://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-031811-124614

Public Health and the Epidemic of Incarceration

The author addresses two issues raised in Moradi, DeBlaere, and Huang's Major Contribution to this issue: the intersection of racial/ethnic and lesbian, gay, and bisexual (LGB) identities and the question of stress and resilience. The author expands on Moradi et al.'s work, hoping to encourage further research. On the intersection of identities, the author notes that LGB identities among people of color have been construed as different from the identities of White LGB persons, purportedly because of an inherent conflict between racial/ethnic and gay identities. The author suggests that contrary to this, LGB people of color can have positive racial/ethnic and LGB identities. On the question of stress and resilience, hypotheses have suggested that compared with White LGB individuals, LGB people of color have both more stress and more resilience. The author addresses the competing hypotheses within the larger perspective of minority stress theory, noting that the study of stress and resilience among LGB people of color is relevant to core questions about social stress as a cause of mental disorders.

/pdf/identity-stress-and-resilience-in-lesbians-gay-men-and-3foz6pkt02.pdf

Identity, Stress, and Resilience in Lesbians, Gay Men, and Bisexuals of Color:

Each year, more than 10 million people enter US jails, most returning home within a few weeks. Because jails concentrate people with infectious and chronic diseases, substance abuse, and mental health problems, and reentry policies often exacerbate these problems, the experiences of people leaving jail may contribute to health inequities in the low-income communities to which they return. Our study of the experiences in the year after release of 491 adolescent males and 476 adult women returning home from New York City jails shows that both populations have low employment rates and incomes and high rearrest rates. Few received services in jail. However, overall drug use and illegal activity declined significantly in the year after release. Postrelease employment and health insurance were associated with lower rearrest rates and drug use. Public policies on employment, drug treatment, housing, and health care often blocked successful reentry into society from jail, suggesting the need for new policies that support successful reentry into society.

/pdf/coming-home-from-jail-the-social-and-health-consequences-of-2l4mo11cn0.pdf

Coming Home From Jail: The Social and Health Consequences of Community Reentry for Women, Male Adolescents, and Their Families and Communities

Reducing drug use, human immunodeficiency virus risk, and recidivism among young men leaving jail: evaluation of the REAL MEN re-entry program.

Two landmark publications during the mid-1970s, Thomas McKeown’s The Modern Rise of Population (1976) and John Cassel’s “The contribution of the social environment to host resistance” (1976), helped rekindle interest in how social factors influence health. Realization that communities and social structures affect the health of populations and affect them differentially was not new. Associations between poverty and ill health are centuries old and were key to the activist-oriented U.S. public health movement at the turn of the twentieth century. However, the ascendancy of the germ theory during the last decades of the nineteenth century dampened interest in poverty and other socially constructed conditions as significant pathways to ill health. However “wrong” the theory of miasma—that disease was caused by the fetid air produced by the overcrowded and unsanitary conditions of the urban poor—the theory at least focused public health initiatives on improving the lives of economically marginalized people. With its decline, health initiatives moved from living conditions to the laboratory.

Black LGB Health and Well-Being

This article describes the life circumstances and risk behaviors of 552 adolescent males returning home from jail. Most young men reported several sources of support in their lives and many had more tolerant views toward women and intimate relationships than portrayed in mainstream media. They also reported high levels of marijuana and alcohol use, risky sexual behavior, and prior arrests. Investigators designed the Returning Educated African American and Latino Men to Enriched Neighborhoods (REAL MEN) program, a jail and community program to reduce drug use, HIV risk, and rearrest. By helping participants examine alternative paths to manhood and consider racial/ethnic pride as a source of strength, REAL MEN addressed the assets of these young men as well as their challenges. Our findings suggest that interventions that emphasize the assets of these young men may be better able to engage them than programs that seek to impose adult values.

https://journals.sagepub.com/doi/pdf/10.1177/1524839909331910

Martha Crum

Papers

Coming Home From Jail: The Social and Health Consequences of Community Reentry for Women, Male Adolescents, and Their Families and Communities

Reducing drug use, human immunodeficiency virus risk, and recidivism among young men leaving jail: evaluation of the REAL MEN re-entry program.

Black LGB Health and Well-Being

Creating REAL MEN: description of an intervention to reduce drug use, HIV risk, and rearrest among young men returning to urban communities from jail.