Prison Health is Public Health
By: Doraly Blanton
Tags: Prison, Healthcare

Today in America, there exists a problem in the massive health issues of prisoners with no medical treatment. The recent rise of American incarceration stems from two movements; the 1980s “War on Drugs” that led to harsher, sentences for possession of minuscule amounts of illegal drugs, and the deinstitutionalization of in-patient mental health facilities that saw many untreated patients left homeless more susceptible to committing crimes such as petty theft, substance abuse, and disruptive behavior. These two occurrences have led to increased stress on unfunded, understaffed, and underdeveloped incarceration facilities that are not able to address the needs of their populations, particularly health needs. Inmates in both state and federal correctional facilities have significantly higher rates of disease and other health issues than the general population with a fraction of the services available to the public.

The demand for increased healthcare access comes from the fact that incarcerated populations are much more likely than the general population to suffer from mental health disorders, drug dependence, infectious disease, and chronic conditions. Individuals in correctional facilities are three times more likely to have HIV or AIDS, but access to screening and treatment is not available in many prisons. More than 65% of incarcerated individuals meet the Diagnostic Statistical Manual (DSM)-IV criteria for drug dependence, but only 11% of individuals who suffer from substance abuse receive drug treatment while incarcerated. Almost 40% of all inmates are estimated to have at least one chronic condition such as diabetes, hypertension, and asthma as a result of the aging prison population and the general rise of obesity of the United States. While incarcerated, inmates have limited resources to protect their expanded healthcare rights administered in the 1976 Estelle v. Gamble case as they must provide evidence that healthcare professionals demonstrated “deliberate indifference,” which is difficult to prove and could cost many years and dollars. Essentially, correctional facilities are the sole providers of medical treatment to the nation’s most medically dependent. As almost 95% of the incarcerated population will return to their communities upon release, the health issues they face in prison will follow them to their communities, which can add more burdens to their families in an already stressful transition period.

There are many groups and individuals involved in the correctional health crisis, which often finds its start outside of the incarceration period. Statistically, incarcerated populations come from impoverished communities, which are plagued with a lack of health insurance, high co-pays, and dependency on expensive emergency room services. As these communities are less able to handle public health issues such as mental disorders and chronic diseases, ⅔ of boys and more than ⅘ of girls who are incarcerated in juvenile programs meet the criteria for at least one mental health disorder. The lack of proper funding, qualified healthcare providers, and treatment programs for youth in impoverished societies is somewhat responsible for strain on healthcare facilities in adult correctional programs. These neighborhoods that inmates hail from and return to are the most negatively affected by the lack of sustainable healthcare in prisons; as they are overwhelmingly low-income communities of color, they are not equipped to handle the fact that relative risk of all-cause mortality within 14 days of release from prison is 12.7 times the risk of non-incarcerated individuals. Many of these community members and inmates are at the whim of public healthcare and drug treatment programs, which are notoriously underfunded and inaccessible without insurance. Another group involved in this crisis are the prison healthcare providers themselves. Correctional healthcare is administered in one of three ways: public correctional care, private industries, or academic medical centers. In 2005, 40% of all correctional health care was administered by for-profit, 3rd party vendors. These vendors are impacted positively by the higher rates of diseases among prison populations because it provides a steady flow of patients to treat. However, standardized performance requirements and financial penalties for substandard care are not monitored by national accreditation organizations such as the National Commission on Correctional Health Care, leaving the nation’s sickest people in the care of unregulated health care contractors. While privatized health care providers have limited decision-making powers due to county and federal prison budgets, they are directly responsible for the lack of proper care while inmates are in custody and the lasting effects once they are released.

There have been many efforts to improve inmate health and healthcare accessibility within the correctional system. A CDC survey found that 30 of the 45 states that responded to the survey used telemedicine services, which allows doctors and patients in prison to connect without in-person meetings, aids in mental healthcare accessibility, and the management of chronic illnesses. Many correctional facilities are now focusing on mental health and screening inmates upon admission; some states such as Illinois are creating treatment centers that exclusively cater to mentally ill inmates. One viable solution to improving inmates’ health conditions is by offering better dietary options as a cost-effective way to combat chronic diseases. In 2018, a correctional institution in Baltimore found that by swapping out the calorie and carb-dense menu with fresher and more nutritious content, they have seen a decrease in their medical expenses and an overall improvement in the morale of the inmates, who have new knowledge about nutrition they can bring home to their families upon release. Another potential approach is to protect people’s insurance coverage when they are moved into a correctional facility. The current recommended protocol is to suspend an individual’s Medicaid enrollment upon incarceration, but many states terminate it altogether without any effort to re-enroll inmates upon their release. To counter this phenomenon, state Medicaid programs need to collaborate with correctional organizations to update systems so that inmates are re-enrolled upon release and covered when they reenter their communities.