In 1976, the US Supreme Court established that incarcerated people have a constitutional right to health care, ratifying lower court decisions. Corresponding professionalization and standardization initiatives included the advent of third-party certifications of individual correctional health care (CHC) practitioners. Drawing on historical evidence about CHC reforms and contemporary data on certifications, incarcerated people’s lawsuits, and incarcerated people’s mortality rates, this study assesses relationships between certifications and key outcomes of incarceration. We find that corrections actors tend to adopt certifications when directly threatened by elevated rates of litigation in their states. This finding suggests that corrections actors are legally reactive, responding to filed lawsuits’ salient threat, rather than legally proactive, attempting to manage risk through anticipatory certification adoption. While early standardization and professionalization interventions reflected the legally proactive logic, our results indicate that contemporary corrections actors tend to “wait and see” about legal liability. Barriers to settlements or court rulings favoring incarcerated people—particularly the Prison Litigation Reform Act—help explain this tendency. Lawsuits’ observed influence on standardization and professionalization offer some support for litigation’s capacity to impel changes; litigation’s failure to predict mortality, however, gives pause regarding this capacity’s extent.
Background and Objectives Although most strokes occur in later life, recent studies reveal that negative exposures decades earlier are associated with stroke risk. The purpose of this study was to examine whether accumulated and/or specific domains of early misfortune are related to stroke incidence in later life. Research Design and Methods A decade of longitudinal data from stroke-free participants 50 years or older in the Health and Retirement Study were analyzed (N = 12,473). Incident stroke was defined as either self-reported first incident stroke or death due to stroke between 2004 and 2014. Results Analyses revealed that accumulated misfortune was associated with increased stroke risk, but the relationship was moderated by wealth. Examining specific domains of childhood misfortune revealed that stroke incidence was greater for persons with behavioral/psychological risks, but that this relationship also was moderated by higher wealth for those with only one behavioral/psychological risk. Discussion and Implications Accumulated childhood misfortune and adolescent depression heighten the risk of stroke in later life, but the influence is remediable through adult wealth. Reducing poverty in later life may decrease stroke incidence for persons exposed to negative childhood exposures.
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