Health and Incarceration A Workshop Summary (2013) / Chapter Skim
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1 Impact of Incarceration on Health
1 Impact of Incarceration on Health
Pages 7-14
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INMATE HEALTH As observed in the background paper, in the absence of systematic review, perhaps it can simply be said that overall physical health probably improves during incarceration in some ways but deteriorates in others. For people living especially chaotic lives, incarceration can provide a respite and stabilization: available meals, a structured day, and reduced access to alcohol, drugs, and cigarettes, in addition to access to healthcare, especially for black men who on average have lower access than white men outside of prison (Rich, Dumont, and Allen, 2012)
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He noted that jails provide a strategic public health opportunity to screen and diagnose infectious diseases among persons who often evade traditional healthcare systems and yet are at high risk for illnesses, such as HIV infection and viral hepatitis, and prisons provide an opportunity to diagnose and treat chronic diseases, such as diabetes, hypertension, addiction, and mental illness among persons who frequently have not sought or had access to treatment prior to incarceration. The structured life of prison provides an opportunity for better compliance with taking prescribed medications and eating a healthy diet as well as engagement in drug treatment services, frequent recreation, and increasingly a tobacco-free environment.
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"Obviously brutality has declined markedly in U.S. prisons in the last 20 years," Fellner observed, "but it still exists and it still has health consequences." Fellner also reviewed a range of other conditions in prisons that can be detrimental to inmate physical and mental health, including poor diets, poor sanitation, infestations with bugs and vermin, poor ventilation, tension, noise, lack of privacy, lack of family visits, and cross-gender pat searches (traumatizing especially for the high percentage of women in prison who have been previously sexually abused)
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Some correctional facilities have sought partnerships with community-based medical and public health practitioners to ensure that care begun during incarceration is continued following release. Overall, however, as discussed and documented in the background paper, a disconnect exists between correctional healthcare and state or local public health departments in planning and delivering care to inmates while incarcerated and upon release (Rich, Dumont, and Allen, 2012)
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This does not address the underlying addiction and leaves prisoners vulnerable to relapse and overdose upon release. As workshop participants discussed healthcare provided in different settings and to different populations, transitions were a recurring shared concern.
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And that, observed Haney, "cycles back oftentimes even in the best trained and most well-intentioned care providers to a change in attitude about the patient." However, it should be noted that the healthcare providers at the workshop welcomed the incarcerated population as patients in need of care. Furthermore, in Haney's view, some prison environments "are so inhospitable that it is impossible to deliver effective medical and mental health care." Citing particularly the "two extremes of confinement: hopelessly overcrowded prison systems and conditions of long-term segregation or isolation," Haney argued that the norms, policies, culture, and even architecture of prisons can worsen health problems among the ill, and even generate problems among the healthy.
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From page 13... ...
One is the lack of leadership, as "the commissioners, secretaries, and wardens often are not providing the leadership to allow the modern innovative value-driven physicians and other healthcare practitioners to do their jobs." Another is the pronounced isolation of healthcare providers in prison and jail settings, as they are often separated from their peers practicing in the general public. Above all, however, Greifinger underscored the adverse effects of the culture of correctional facilities, particularly the "stereotyping and cynicism that results in distrust." As Greifinger reflected, "I've been involved in a lot of litigation over the years, class-action suits and individual cases.
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From page 14... ...
." Haney puzzled over this situation, calling for "help figuring out how to operate effectively" in such adverse environments. Fellner agreed, noting that this is "something which medical professionals have to work on." She articulated a challenge to healthcare providers: "You're no longer guests in the house of corrections, you have as much right to be there as the guards, you're constitutionally required, and it means speaking up more." Healthcare professionals working within correctional facilities and those observing the situation from the outside have, in her view, "an obligation to inform themselves and speak out" on conditions of confinement and impediments to appropriate healthcare delivery.
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