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Health care in U.S. prisons

GLENN ELLIS | 4/3/2017, 10:59 a.m.
Health care is a huge issue for people in jail and prison.
April Duncan, foreground, of Evergreen, spends time with fellow inmate Bonita Graham, of Tuscaloosa, in the HIV Ward at Julia Tutwiler Prison for Women in Wetumpka, Ala. Jamie Martin

Strategies for Well-Being

Health care is a huge issue for people in jail and prison.

There are currently 2.4 million people in American prisons. This number has grown by 500 percent in the past 30 years. While the United States has only 5 percent of the world’s population, it holds 25 percent of the world’s total prisoners. In 2012, one in every 108 adults was in prison or in jail, and one in 28 children in the U.S. had a parent behind bars.

Researchers estimate that 70 percent to 90 percent of the approximately 10 million individuals released from U.S. prisons and jails each year are uninsured, and about 40 percent of incarcerated people have at least one chronic health condition, such as diabetes or hypertension.

Inmates have high rates of chronic medical conditions, especially viral infections. In addition, substance abuse and mental illness are common among inmates. Prisoners with existing health care conditions may have their health needs ignored or neglected, and others may develop health problems whilst in prison thanks to unhealthy and unhygienic prison conditions and poor control of infectious diseases. Prisons can be a breeding ground for HIV/AIDS, tuberculosis and other infectious diseases.

Women prisoners have particular health needs that go far beyond their need for reproductive healthcare and pre- and post-natal health care. Women in prison are disproportionately likely to be victims of domestic or sexual abuse, to experience poor mental health and to have alcohol and drug dependency problems. The World Health Organization estimates that at least 75 percent of women entering European prisons are estimated to have problems with drug and alcohol use, for example. Women are also more likely to develop mental health problems while in prison and are more likely to self-harm or attempt suicide than male prisoners. Surprisingly to many, HIV and AIDS are more prevalent among incarcerated women than incarcerated men. With increasing numbers of women entering and exiting the prison system, there is a compelling need to ensure that provisions are in place that can adequately address these health issues.

Providing inmates with health care is politically unpopular. Indeed, during the Bush administration, former Surgeon General Richard H. Carmona stated that the administration had blocked the release of the surgeon general’s report, Call to Action on Corrections in Community Health, for fear that the report would increase government spending on inmates. However, the constitutional, public health and human rights imperatives of improving health care in prisons and jails are clear.

What’s the health care like in prison, anyway? It depends on the state.

At best, it’s about as good as a low-income health plan. At worst, it’s almost nonexistent. In general, when a prisoner gets sick, he tells the on-duty guard. Inmates who become ill typically submit “sick call” slips that are collected at an appointed time each day. If it’s not urgent – a sore throat, say, or an ear infection – the guard will put his name on a list, and an appointment with the prison’s in-house doctor may be set up for as soon as the next day. To handle emergencies, most prisons have a nurse on duty 24 hours a day. Most ailments are treated on-site, but inmates who are gravely ill can be taken to the nearest hospital.