Public Health Behind Bars.

“Inmates and ex-inmates are part of the communities that we live in. What happens to them is vital to the health of the community and to public health” writes David Satcher, former US Surgeon General in the foreword to Public Health Behind Bars. What follows is a comprehensive, provocative volume of articles edited by Robert Greifinger that explores correctional health interventions and their impact on greater public health. The five sections of the book draw on a broad range of expertise, including public policy and law, management of communicable and chronic diseases, and inmate reintegration into the community. The result is a multi-faceted, invaluable resource that should be required reading for anyone interested in correctional health. The book appropriately begins with an overview of the social and legal issues related to correctional health care. The first few chapters lay the foundation for the remainder of the book, explaining the rapid rise in incarceration rates over the last 30 years and emphasizing pivotal court cases that have influenced contemporary public policy related to correctional health services. Several statistics immediately shock the reader: approximately 5% of Americans will become incarcerated in their lifetimes, two million Americans are behind bars on any given day, and millions of others cycle through the correctional system throughout the year. The most compelling of the introductory chapters is Todd Clear’s piece on community public safety and public health, which explains the social and public policy roots of the fourfold increase in incarceration rates since the 1970s, and how the USA became the country with the world’s highest incarceration rates. He attributes the precipitous rise to several causes, including fluctuating crime rates, a decline in probation for felony offenses, and lengthier sentences for inmates over the years. Worthy of note is his fascinating overview of the detrimental impact of rising incarceration rates on social capital in poor communities and in turn, the impact of declining social capital on negative community health outcomes. Joseph Bick’s chapter on HIV and viral hepatitis sets an important tone for the rest of the book, reminding the reader that providing correctional health services is an opportune time to provide health care to low-income populations who may otherwise not have access to care. This useful chapter links the high prevalence of hepatitis and HIV to poor immunization, injecting drug use, and limited access to health services for individuals of low socio-economic status. In spite of the enormous challenges in addressing these communicable diseases, Bick and authors of subsequent chapters on other communicable diseases offer practical suggestions for how best to monitor, manage, and potentially reduce prevalence of hepatitis B and C, tuberculosis, HIV, and other sexually transmitted diseases (STDs) in correctional settings. This optimistic perspective is a key theme and virtue of the Bick chapter and indeed the entire book: most chapters of Public Health Behind Bars provide a thorough review of the evidence base for niche issues with concrete, feasible recommendations for improving the quality of correctional health care. Although a large section of this book is dedicated to communicable diseases, it also incorporates chapters on controversial topics such as the medicalization of lethal injection, inmate suicides and sexual predators, with normative policy recommendations for each issue. In addition, the volume provides important insights a lay reader might not immediately think about but that nevertheless contribute to the correctional disease burden, such as oral health care, aging inmate populations, co-morbidities, chronic disease management, and mental illness. The book’s section on primary and secondary prevention begins somewhat underwhelmingly; the chapter on Health Promotion in Jails and Prisons is less compelling than the other important prevention chapters. Authors Ramaswamy and Freudenberg too frequently use jargon that may be unfamiliar to the naive reader such as “creating supportive environments, developing personal skills, and strengthening community action for health.” However, subsequent prevention chapters are grounded in concrete discussions of implementable interventions such as HIV and STD screening, mental health screening, gender-specific health interventions, and suicide prevention. Tertiary prevention, or prevention of disease progression and provision of rehabilitation, is introduced in two chapters on mental illness. The reader is reminded that many inmates have serious mental disorders, necessitating the development of entire mental health delivery services systems, including screening, suicide prevention, and coordination of long-term psychiatric treatment. Substance abuse is another critical area of tertiary prevention; the challenges associated with implementing pharmacological treatment for substance users are examined by Bruce, Smith-Rohrberg, and Altice. Untreated substance abuse is a primary cause of recidivism and ongoing drug use post-release. In spite of decades of medical research that confirm the efficacy of pharmacological treatment for substance abuse (cataloged extensively in the chapter), correctional institutions have largely neglected to implement opiate replacement therapies such as methadone and buprenorphine, or pharmacological treatment for alcoholism. The authors attribute this failure to an outdated moral rather than medical approach to treating substance abuse. The authors sharply critique American correctional culture for failing to overcome stigma associated with drug abuse, and conclude with calls for implementing more progressive and cost-effective pharmacological treatments as a way to manage substance abuse in correctional settings. This terrific chapter’s best asset is that it takes the reader to the frontier of important health interventions being explored in correctional settings. In its final section, Public Health Behind Bars moves beyond the correctional setting to address the critical issue of inmate reintegration into the community. Because inmates often have both physical and mental health ailments, they frequently face unique challenges with housing, family support, employment, and addiction services when they return to communities. Visher and Mallik-Kane emphasize that these challenges call for client-specific reentry interventions. In a subsequent chapter, Woodward emphasizes how using electronic medical records facilitates continuity of care post-release. Since most inmates are released back into the community, the interventions that address individual inmates’ health care needs also have a positive impact on greater community health. The chapter by Lincoln, Miles, and Scheibel calls on the corrections and public health systems to collaborate in order to better utilize available resources to meet both systems’ goals: creating a healthier environment in prisons and improving surveillance and prevention of disease. Overall, Public Health Behind Bars provides an interdisciplinary, up-to-date, and comprehensive review of the medical and public health challenges and opportunities associated with healthcare delivery in correctional settings. The primary strength of this powerful volume is its unusual and balanced attention to identifying common health problems in correctional settings, reviewing the existing literature, and using that evidence base to clearly define a forward-looking policy agenda for improving the health of underserved populations. This book is suitable for a wide audience and is an indispensable reference for correctional health students, professionals, and scholars; criminal justice experts; and particularly for new practitioners in the field of correctional health.