Rural Communities Need More Health Care, Not More Jails

Nicholas Turner President & Director
Apr 27, 2022


Sullivan County, a shade under 160,000 people and tucked in the Appalachian Mountains of northwest Tennessee, is poor and mostly rural. It has a jail incarceration rate that is double the statewide average. In the last few years, hospitals across Tennessee have been shuttered, the majority in rural communities. In 2018, for example, the trauma center and NICU in Sullivan County closed. Meanwhile, the county spent more than $10.1 million—17 percent of its total budget—on its three local jails in fiscal year 2019. And in 2020, county commissioners approved $80 million in municipal bond debt to expand one of them.

This dynamic—millions spent on new jails instead of on much-needed infrastructure like education, affordable housing, and health care—is evident across the United States. But it is particularly pronounced in rural counties, where jail populations have grown at an alarming rate over the last several decades. Vera’s research shows that jail incarceration in rural Tennessee increased 87 percent from 2000 to late 2021, while incarceration in the state’s biggest city declined 41 percent. This echoes a national shift in the geography of incarceration.

Mayors, commissioners, and sheriffs are spending scarce local resources to increase jail capacity—building more and bigger jails—and then quickly filling up those jails. The vast majority of people in jail—approximately two-thirdshaven’t been convicted of a crime. They are awaiting trial, and often, they are stuck behind bars because they can’t afford bail. They spend days, weeks, months, years—even the rest of their lives—incarcerated, awaiting trial.

Many of them have been charged with offenses related to poverty or public health issues, like loitering or drug possession. In rural Kentucky and small town Texas, for example, drug-related charges are among the most common offenses that land people in jail.

Sheriffs and other local officials often use jails as a catchall for a wide range of social issues, locking up people experiencing mental health conditions and substance use issues. For Christina Dawn Tahhahwah, this was a death sentence. She was taken to an Oklahoma jail instead of the local mental health facility after her family called the police for help when she was experiencing a mental health crisis. She died in restraints in the Lawton City Jail.

Jail stays are profoundly destabilizing, leading to poorer health outcomes, chronic economic hardship, and homelessness. Even a few days in jail causes people to lose their jobs and their homes, making it much harder for them to care for themselves and loved ones. Even one day in jail leads to a higher likelihood of future arrest, undermining the safety and stability of our communities.

And communities of color and women are disproportionately impacted by the rising rates of rural incarceration. Vera’s research shows that racial disparities in incarceration are often most pronounced in smaller communities. Although the gap in incarceration rates for Black people and white people has narrowed in the nation’s biggest cities, that’s not the case in rural communities, where both are on the rise. Incarceration rates for Indigenous people are also high. In South Dakota, for example, Indigenous people make up 9 percent of the population but 41 percent of the jail population. And it’s the nation’s smallest communities that are driving the increase in women’s jail incarceration. Nationally, the women’s jail incarceration rate was 6.6 times higher in 2019 than in 1970. In rural communities, women’s jail incarceration increased 24-fold.

Counties across Tennessee spent a staggering $534.2 million locking people up in jails in 2019. That’s $47 per incarcerated person per day—and hundreds of millions that could have been invested in countless other ways that benefit communities. But state and local officials too often neglect investments in education, health, housing, jobs, and transportation—which we know improve public safety—in favor of building out infrastructure to incarcerate—which we also know undermines safety.

For some county leaders, the potential revenue to be gained by renting out jail beds to federal agencies is incentive enough. But these arrangements tie struggling communities’ economic futures to continued incarceration. And the consequences of this misguided prioritization impact generations, leaving people in rural counties without access to much-needed care. Even in cases in which resources like mental health care and drug treatment services are available, they are too often linked to the criminal legal system. But access to care should never be dependent on system involvement.

Local organizers are fighting to stop this quiet and mostly unseen jail boom and calling for those funds to be invested in the infrastructure that actually promotes safe and thriving communities. It’s time local officials listened to their constituents and let them determine what their communities need.