ass incarceration in the United States is unique both historically and internationally. In the past thirty-five years, the incarceration rate has increased fivefold. 1 While the U.S. has 5% of the world's population, it has 25% of its prisoners. 2 Significant racial disparities exist in the incarceration rate: Black and Hispanic men are incarcerated at 6.6 and 2.5 times the rate of White men, respectively. 3 For those who are or have been incarcerated, the social, economic and health implications are enormous. As Schnittker and Massoglia point out, current and former prisoners constitute a status group, meaning that they "share a negative credential that affects their life chances irrespective of their social origins." 4 Health risks of incarceration are "'fundamental' in the sense that they may be linked to health through a variety of different mechanisms, not unlike socioeconomic status itself." 5 The role of stigma in the life chances and health outcomes for current and former prisoners is a new area of research. Stigma has been defined as a process in which the "elements of labeling, stereotyping, separation, status loss, and discrimination co-occur together in a power situation that allows the components of stigma to unfold." 6 Researchers are exploring the pathways between social stigma and poor health and some argue that it is an important driver of mortality and morbidity as well as a key social determinant of health. 7 This article describes the multiple syncretic links between and among incarceration, poor health, race, and stigma. We begin by describing the overlapping and mutually enforcing stigmatizing conditions associated with incarceration: lower socioeconomic status and the burden of increased prevalence of mental health problems, substance use and infectious disease. Next, we turn to the important intersections among race, incarceration and health disparities and the role that law and public policy have played in shaping these disparities. Then we explore post-incarceration reentry, highlighting the growth of legally sanctioned post-incarceration collateral consequences, their role in stigma and their impact on the health of the formerly incarcerated, their families and their communities. Finally, we offer policy recommendations to reduce the impact of incarceration and stigma on the health of individuals, families, and communities.

Medical-legal partnerships (MLPs) embed civil legal services lawyers into health care settings and interprofessional health care teams delivering care to low-income or otherwise vulnerable patients and communities. MLPs present the opportunity to instill in residents a practical understanding of the social determinants of health and provide them with concrete tools to address them. MLP training helps residents develop structural competency and build the skills necessary to address barriers to health at the patient, institutional, and population levels. Through a case study, this Perspective explores how residents can address health-harming legal needs working in partnership with interprofessional health care teams that include lawyers, and illustrates how such MLP experiences can relate to competency-based Milestones that are applicable to training residents in all specialties.

Medical-legal partnership (MLP) is a health care delivery innovation that embeds civil legal aid expertise into the health care team to address health-harming legal needs for vulnerable populations at risk for poor health. The MLP approach focuses on prevention by addressing upstream structural and systemic social and legal problems that affect patient and population health. Because many unmet legal needs affect health (such as residing in substandard housing; wrongful denial of government income supports, health insurance, or food assistance; family violence; and barriers to care based on immigration status), lawyers are important members of the health care team. This review describes the MLP approach to addressing the social determinants of health, examines its benefits for improving the delivery of primary care for vulnerable patients and populations, and explores new opportunities for MLP in primary care with the advent of systems reforms driven by the Affordable Care Act.

This article reviews recently promulgated Internal Revenue Service regulations for nonprofit hospitals seeking tax exemption and a new estimate of national hospital community benefit spending, and analyzes how they point to the value of hospitals working with community partners to address the social determinants of health. It then explains how unmet legal needs function as health determinants, and suggests how hospitals' participation in medical-legal partnerships can address those needs. This article was published on