Justice & The Next 250: The Future of Criminal Justice Reform Must Focus on Public Health

by Dr. Aaron T. Kinzel

For decades, policymakers have treated incarceration as a matter of crime and punishment, largely disconnected from the health systems that shape—and are shaped by—the lives of those who move through jails and prisons. But this separation is artificial. The realities of incarceration reveal something far more complex: The criminal justice system is, in many ways, one of the largest and least accountable public health institutions in the United States, despite those incarcerated being the only population guaranteed by law to be provided healthcare.

I know this not just as a researcher, but as someone who has lived it.

Long before I was incarcerated, my life was shaped by decisions and conditions that would later affect my health in profound ways. Like many people who encounter the criminal justice system, I navigated environments in society marked by poverty, violence, stress, instability, and limited access to consistent healthcare. Diet, exercise, and long-term health planning were overshadowed by more immediate concerns about survival and stability.

When my peers were graduating high school, I entered prison, and those vulnerabilities did not disappear. They intensified.

We need a broader reimagining of what justice looks like—one that places human well-being at its center …

Correctional institutions are often not designed with health in mind. Food systems are built for cost-efficiency, not nutrition. Meals are often high in sodium, processed carbohydrates, and low-quality proteins, conditions that contribute directly to hypertension, diabetes, and other chronic illnesses. Opportunities for physical activity exist, but they are inconsistent, restricted, or dependent on institutional control. Access to healthcare is frequently reactive rather than preventive, meaning that individuals are often treated only after conditions have worsened.

Equally significant is the psychological and physiological toll of incarceration itself. Chronic stress, produced by surveillance, lack of autonomy, exposure to violence, and prolonged uncertainty, has well-documented effects on the body. It elevates blood pressure, disrupts metabolic functioning, and increases the risk of cardiovascular disease. In this way, incarceration is not just a social experience; it is a biological one.

By the time I returned home, I was not simply reentering society, I was carrying the accumulated health consequences of a decade spent in a system that deprioritized my well-being.

Today, I live with diabetes and high blood pressure. And my experience is far from unique.

Research consistently shows that incarcerated populations experience significantly higher rates of chronic illness than the general population. Cardiovascular disease stands out as a leading cause of morbidity and mortality among both currently and formerly incarcerated individuals. The disparities are stark, but they are also predictable. When people are confined in environments that limit autonomy, restrict healthy behaviors, and delay care, poor health outcomes are inevitable.

What is less often acknowledged, however, is how these outcomes extend beyond prison walls.

Most people who are incarcerated will eventually return to their communities. When they do, they bring with them not only the social and economic barriers associated with a criminal record, but also the physical and mental health conditions that developed or worsened during incarceration. This creates a ripple effect, one that impacts families, healthcare systems, and entire communities.

In this sense, correctional health is not a niche issue. It is a public health issue.

A public health approach to criminal justice reform requires a shift in both perspective and practice. It means recognizing that the conditions people experience before, during, and after incarceration are interconnected and cumulative. It means investing in prevention, not just in communities, but within correctional facilities themselves. And it means ensuring continuity of care, so that individuals are not forced to navigate fragmented systems upon release. We will need leaders in correctional systems to support this change, and we should not demonize them for inheriting a flawed system.

But incremental change is not enough.

We need a broader reimagining of what justice looks like—one that places human well-being at its center with both accountability and rehabilitation simultaneously.

Correctional health is not a niche issue. It is a public health issue.

This is part of the work I am now engaged in as a researcher. After my release, I pursued higher education, ultimately earning a doctoral degree from the University of Michigan and teaching criminal justice courses for over a decade at the same institution. Today, I work in partnership with JustLeadershipUSA and Yale University on a national research initiative examining cardiovascular health in American prisons. This project, known as InJUSTICE and FamJUSTICE, centers the voices of incarcerated individuals and their families to better understand how incarceration shapes health outcomes over time. They hope to partner with correctional systems to discover evidence that can be used to inform future policy reform.

What makes this work different is not just the focus on public health, but the emphasis on lived experience. Too often, research on incarcerated populations is conducted without meaningful input from those who have been directly impacted. Their approach challenges that model by positioning justice-impacted individuals such as myself as co-creators of knowledge.

The question is whether we are willing to act on that knowledge.

With the right interventions, support systems, and policy changes, many health outcomes can be improved. Chronic conditions can be managed more effectively. Preventive care can reduce long-term costs and even improve public safety. And individuals returning from incarceration can have a genuine opportunity not just to survive, but to thrive.

The future of criminal justice reform depends on whether we are willing to make these investments.

It depends on whether we are willing to see incarcerated people as part of our broader public health ecosystem. And it depends on whether we are willing to listen, to the data, to the research, and to the lived experiences of those who have been most affected.

Because the truth is simple: We cannot have justice without health equity. And we cannot build a healthier society while ignoring the millions of people who pass through our nation’s jails and prisons each year.

The future of criminal justice reform is not just about reducing incarceration. It is about recognizing that every policy decision, every institutional practice, and every missed opportunity for care have consequences that extend far beyond the razor wire.

I am living proof of that and change is possible.

Dr. Aaron T. Kinzel currently serves as a Research Fellow with JustLeadershipUSA. He is a criminologist and consultant specializing in corrections, public policy, and justice-impacted communities. He was trained as a researcher at the University of Michigan (UM) and earned a Master of Public Administration and Doctorate in Education.

Published in partnership with the Justice & The Next 250 campaign