Political Determinants of Health

Data sourcing

We gather our information on incarcerated individuals (including children) in the U.S. from trusted sources:

Bureau of Justice Statistics (BJS)

Provides comprehensive reports on people under correctional control. Our insights are based on combining data from their “Prisoners in 2020” and “Census of Jails 2005-2019” reports.

Vera Institute of Justice

Offers detailed research on incarceration trends at the county level.

Breakdown of Our Reports

By Age

• Nationwide data: From BJS's "Prisoners Table 10"
• State-specific data: From BJS's "Prisoners Table 2".

By Race

• Nationwide & State-specific data: From BJS's "Prisoners Appendix Table 2".

By Sex

• Nationwide & State-specific data: From BJS's "Prisoners Table 2".

Special Reports

• Information on children in prison: From BJS's "Prisoners Table 13".
• Data for all territories: From BJS's "Prisoners Table 23".
• County-level data: Sourced from Vera Institute's Incarceration Trends.

Understanding Jails vs. Prisons

Jails

Jails are local facilities that primarily house individuals awaiting trial or sentencing, or those sentenced to less than a year. Our data on jails doesn't include those under supervised release outside of the facility or weekend-only inmates. For county-level data, we focus on individuals aged 15-64 using data from the Vera Institute.

Prisons

Prisons generally house individuals sentenced to over a year.

"Jurisdiction" refers to the legal authority over an incarcerated person, not necessarily where they're held.

Our data varies slightly based on the location and type:

• National report: Includes all under the jurisdiction of a state or federal adult prison. Excludes territorial, military, or Indian Country facilities.
• State reports: Focuses on individuals within a state's prison system. Age-specific data is not available.
• Territory reports: Covers individuals in a territory's adult prison facilities. No specific demographic breakdown.
• County reports: Considers those under state prison systems but charged in a specific county.

Children in Adult Facilities

We highlight the total count of children in adult facilities rather than a "per 100k" rate for a few reasons:

• Varying state and federal laws make it challenging to get an accurate base population of minors in adult facilities.
• Using the entire child population for rate calculations dilutes the actual rate of incarcerated minors.
• Our prison data for juveniles includes those confined to a specific facility, unlike other reports which consider jurisdictional populations.

Combined Systems

Some states, like Alaska, Connecticut, Delaware, Hawaii, Rhode Island, and Vermont, integrate both prison and jail systems. For our reports, these are categorized as prison facilities only.

Political Forces and Incarceration

Incarceration is influenced by a blend of political forces, laws, and public opinion. Sentencing policies and the disenfranchisement of convicted felons are among the key political forces that determine voter participation in the justice-involved population.

Voter Disenfranchisement

The ability to vote is described as the singular most powerful, non-violent tool in American democracy. However, as of 2020, an estimated 5.17 million people lost this right due to a prior felony conviction. Minority populations of voting age are disproportionately affected by this disenfranchisement (Sentencing Project).

Health Impact of Incarceration

Immediate Health Consequences

Studies indicate that incarceration heightens the risk of chronic health conditions, infectious diseases like HIV/AIDS, mental illnesses, and substance use disorders.

Life Expectancy

Each year spent in prison is associated with a reduction of 2 years in life expectancy.

Post-Incarceration Challenges

The health impact of incarceration extends beyond the confinement period. Upon reentry into society, justice-involved individuals often face limited access to healthcare and essential resources such as health insurance, housing, and employment. These challenges, coupled with limited opportunities for advancement, intensify the health inequities experienced by this group.

Women in Legislative Office and Health Impacts

Having women in government has been linked to improvements in population health. Women in legislative roles advocate for vital social and political determinants of health, such as education, social welfare, reproductive and maternal health, and family life. These policies significantly advance health equity.

Data Metrics and Methodology

We use data from the Center for American Women in Politics (CAWP) to present metrics on the representation of women in legislative roles:

• Women in State Legislature
• Women in U.S. Congress

Both data types cover state, territory, and national levels. Our national level calculations include legislators from U.S. territories, leading to variations from the CAWP website's data. All gender and race/ethnicity categorizations are self-reported. A legislator might appear in multiple race groups based on their identification.

County-Level U.S. Congress Data

Women in U.S. Congress data is also available at the county level. County figures are derived by mapping congressional districts to counties using the U.S. Census Bureau TIGER 2022 county-to-congressional-district crosswalk (118th Congress boundaries). Every Congress member whose district overlaps a county is counted for that county.

Because each county shares two U.S. senators with every other county in its state, the denominator is typically 3 members (2 senators + 1 representative). This produces only four possible percentages: 0%, 33%, 67%, or 100%. Counties that span multiple House districts will have a higher denominator and proportionally more gradations. Members from multi-county districts are counted once in each overlapping county.

Note: county-level data reflects 118th Congress district boundaries and will not automatically update when new boundaries are certified after a redistricting cycle.

For each of those data types we calculate and present two metrics to study the proportion of women legislators:

1. Intersectional Representation: For example, the percentage of the entire Georgia State Legislature who identify as Black women.
2. Race/Ethnicity Distribution Among Women Legislators: For instance, the percentage of self-identified women in the Georgia State Legislature who also identify as Black.

Historical Tracking

• Historical Intersectional Representation: The percentage of U.S. Congress members identifying as black women each year since 1915.
• Historical Relative Inequity: The over- or under-representation of black women compared to their overall representation among female Congress members. This measure traces back to 2019, using the 2019 ACS 5-year estimates for population comparison.

For U.S. Congress, we track data back to before the first woman's election in 1917. However, for state legislators, our data reliably goes back only to 1983.

Race/Ethnicity Groupings and Challenges

The U.S. Census and CAWP use varying race/ethnicity classifications, complicating direct comparisons. We've adjusted our methods to address these discrepancies:

• Women identifying with multiple races appear in each corresponding race visualization.
• The combined group "American Indian, Alaska Native, Asian & Pacific Islander" represents our effort to visualize these under-represented groups.
• The U.S. Census doesn't collect data for Middle Eastern & North African (MENA). Currently, MENA individuals are counted as White by the ACS.

Missing data for women in legislative office

• The Center for American Women in Politics (CAWP) dataset uses unique race/ethnicity groupings that do not correspond directly with the categories used by the U.S. Census. For this reason, Middle Eastern & North African (Women), Asian American & Pacific Islander (Women), and Native American, Alaska Native, & Native Hawaiian (Women) are presented without corresponding population comparison metrics.
• We are currently unable to locate reliable data on state legislature totals, by state, by year prior to 1983. For that reason, we cannot calculate rates of representation historically before that year.
• Legislature seat totals (denominator): Annual seat counts for all 50 states and DC are scraped from CAWP's state information pages. Seat totals for territories (American Samoa, Guam, CNMI, Puerto Rico, and the U.S. Virgin Islands) are sourced from NCSL (National Conference of State Legislatures) and updated manually each year. Note: Puerto Rico's Legislative Assembly has a constitutional baseline of 78 seats (27 Senate + 51 House), but a minority-protection clause can temporarily expand it following certain election results; the current 20th Assembly (2025-2029) sits at 81 seats.

• People in prison: race/ethnicity: Available; age: Available; sex: Available
• People in jail: race/ethnicity: Available; age: Available; sex: Available
• Voter participation (U.S. citizens, Ages 18+): race/ethnicity: Available; age: Available; sex: Available
• Women in US Congress (US Congress members incl. Territorial Delegates): race/ethnicity: Available; age: Not available; sex: Not available
• Women in state legislatures (State and Territorial Legislators): race/ethnicity: Available; age: Not available; sex: Not available

People in prison

Measurement definition: Individuals of any age, including children, under the jurisdiction of an adult prison facility. ‘Age’ reports at the national level include only the subset of this jurisdictional population who have been sentenced to one year or more, which accounted for 97% of the total U.S. prison population in 2020. For all national reports, this rate includes both state and federal prisons. For state number of people incarcerated under the jurisdiction of a state prison system on charges arising from a criminal case in that specific county, which are not available in every state. The county of court commitment is generally where a person was convicted; it is not necessarily the person’s county of residence, and may not even be the county where the crime was committed, but nevertheless is likely to be both. AK, CT, DE, HI, RI, and VT each operate an integrated system that combines prisons and jails; in accordance with the data sources we include those facilities as adult prisons but not as local jails. Prisons are longer-term facilities run by the state or the federal government that typically hold felons and persons with sentences of more than one year. Definitions may vary by state.

Clinical importance: Incarceration has a negative impact on health. People who are incarcerated are more likely to experience chronic diseases, mental illness, and substance use disorders. They are also less likely to have access to quality healthcare. Studying incarceration in regard to health equity can help us to understand how to improve the health of people who are incarcerated and to prevent people from being incarcerated in the first place.

People in jail

Measurement definition: Individuals of any age, including children, confined in a local, adult jail facility. AK, CT, DE, HI, RI, and VT each operate an integrated system that combines prisons and jails; in accordance with the data sources we include those facilities as adult prisons but not as local jails. Jails are locally operated short-term facilities that hold inmates awaiting trial or sentencing or both, and inmates sentenced to a term of less than one year, typically misdemeanants. Definitions may vary by state.

Clinical importance: Incarceration has a negative impact on health. People who are incarcerated are more likely to experience chronic diseases, mental illness, and substance use disorders. They are also less likely to have access to quality healthcare. Studying incarceration in regard to health equity can help us to understand how to improve the health of people who are incarcerated and to prevent people from being incarcerated in the first place.

Voter participation

Measurement definition: U.S. citizens ages 18 and older who voted in the last presidential election.

Clinical importance: Voter participation is important for ensuring that all voices are heard in the political process. People of color and people with low incomes are less likely to vote. Studying voter participation can help us understand why these disparities exist and how to address them.

Women in US Congress

Measurement definition: Individuals identifying as women who have served in the Congress of the United States, including members of the U.S. Senate and members, territorial delegates, and resident commissioners of the U.S. House of Representatives. Women who self-identify as more than one race/ethnicity are included in the rates for each group with which they identify.

Clinical importance: The number of women in government has increased in recent years. However, women are still underrepresented in government, especially at the highest levels. Studying women in government in regard to health equity can help us to understand how to improve the health of women and to ensure that all voices are heard in the policymaking process.

Women in state legislatures

Measurement definition: Individuals identifying as women currently serving in their state or territory’s legislature. Women who self-identify as more than one race/ethnicity are included in the rates for each group with which they identify.

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