Reintegration Starts With Us: Takeaways from Social Determinants of Health in Formerly Incarcerated Populations

On Thursday, February 20, the Hawai‘i Public Health Training Hui (the Hui) welcomed Francine Dudoit-Tagupa, Director of Native Hawaiian Healing with the Puʻuhonua Prison Program, for an insightful presentation on the social determinants of health affecting formerly incarcerated individuals. The Hui provides continuing education and workforce training to healthcare professionals and community members dedicated to improving population health, social welfare, and well-being. Trainings like Francine’s equip professionals with the knowledge and strategies needed to support vulnerable populations, such as individuals transitioning from incarceration. During the session, Francine provided an overview of correctional facilities across the state and led a discussion on the economic, social, and health-related challenges individuals may face upon release. She emphasized how systemic barriers—such as limited access to medical care, employment, housing, and essential services—often contribute to recidivism, the cycle in which individuals re-offend and return to the justice system. Many individuals struggle with navigating applications for Medicaid, SNAP, and financial aid, leading to setbacks that push them back into the system. 

From Francine’s training, here are five strategies public health professionals can apply in their practices to best support the re-entry of persons who have been previously incarcerated:

1. Recognize Incarceration as a Public Health Issue: Incarceration has long-term impacts on individuals, families, and communities, influencing mental and physical health, economic stability, and social cohesion. Furthermore, individuals released from correctional facilities often face challenges such as limited access to healthcare, which exacerbates pre-existing health conditions and can lead to higher rates of chronic diseases. It is important to address the root causes of incarceration, such as poverty, addiction, and lack of access to education and mental health services. By adopting a public health approach, we can begin to tackle these underlying issues.
2. Improve Access to Healthcare and Behavioral Health Services: Ensuring continuity of care for individuals transitioning from correctional facilities requires effective coordination between correctional institutions and community health providers. Advocating for Medicaid enrollment before release can prevent gaps in care. Expanding behavioral health and substance use disorder services is also critical for successful reintegration.
3. Reduce Health Disparities: Native Hawaiians and Pacific Islanders experience disproportionately high incarceration rates. Providing culturally competent healthcare and support services can address their specific needs. Public health interventions can also focus on managing chronic illnesses, such as diabetes, hypertension, and obesity, that often develop during incarceration.
4. Strengthen Interagency Collaboration: Developing partnerships with social services, legal aid organizations, housing authorities, and workforce programs creates a comprehensive support system. Establishing medical case management programs that begin pre-release and continue into the community can facilitate smoother transitions and improve overall well-being.
5. Enhance Workforce and Housing Support: Stable employment and housing are key determinants of health for formerly incarcerated individuals. Partnering with local employers, workforce development programs, and clean and sober housing can create opportunities for reintegration. Advocating for policy changes that remove employment and housing barriers for individuals with criminal records is essential.

By implementing these strategies, public health professionals can help reduce recidivism, improve health outcomes for formerly incarcerated individuals, and contribute to a more accessible healthcare system.

We want to thank Francine again for her incredible presentation. You can watch the training in full here and find all of the Hui’s past trainings on the Hawaiʻi Public Health Training Hui’s YouTube channel.  

Please join us on April 17, 2025 for our next training on Medical Aid in Dying — pre-register here. To stay up-to-date on future training opportunities, email publichealthhui@hiphi.org to join our listserv!