Black women disproportionately experience signs of unhealthy aging, marked by elevated levels of morbidity, cognitive impairment, and accelerated biological aging. Notably, the magnitude of these health disparities varies across U.S. states. Efforts to quantify the origins of health inequalities overlook the structural violence produced by states’ public institutions—including welfare, healthcare, immigration, child welfare, and education—that employ coercive, surveilling, and disciplinary practices akin to the criminal legal system. By adopting these carceral logics, each institution operates as tentacles of the carceral state. The carceral state is a set of institutions, policies, and practices that use punitive social control to regulate marginalized populations by restricting access to resources. I develop a “structural carceral control” perspective to investigate the carceral state as a root cause of racialized, gendered, and spatial health inequalities. Using administrative, policy, and economic data, I construct novel state-level measures of punitive social control across institutions in the carceral state. These measures were linked to Black and White women’s health data from the Health and Retirement Study. Unhealthy aging was assessed using indices of cognitive impairment, epigenetic aging, and disability. Multilevel modeling was employed to assess how states’ mobilization of punitive social control shapes women’s health. My findings highlight the complexity of the carceral state and its health consequences. I find that exclusively focusing on the criminal legal system misrepresents how states mobilize the carceral state. Moreover, the carceral state emerged as a predictor of unhealthy aging, with several institutions being particularly deleterious for Black women. Altogether, this study develops methodological and theoretical tools that can be used to interrogate the multidimensionality of the carceral state and its downwind social consequences.