Jails’ and Prisons’ Poor Healthcare Burdens Communities

By David Eugene Archer Sr.

Poor medical care in jails and prisons is contributing to poor health in some communities, the Vera Institute of Justice reports.

“The burden of disease behind bars is unacceptably high and largely invisible to the health system, and the negative impacts of incarceration on the health of communities is a serious issue,” the report says.

“The millions of people who cycle through the nation’s courts, jails and prisons experience chronic health conditions, infectious diseases, substance use and mental illness at much higher rates than the general population,” the November 2014 report says.

When released, these former prisoners bring their health problems into their home communities, the report adds.

Between 1980 and 2000, people in higher socioeconomic groups experienced larger gains in life expectancy than those in poorer groups, according to the report.

Those living in poverty have faced more barriers in accessing care, received poorer quality care, and experienced worse health outcomes than the rest of the population, the report states.

Over the last 40 years the criminal justice system has expanded to such a degree that, today, mass incarceration is one of the major contributors to poor health in communities, reports David Cloud with the institute.

Since the 1970s, the correctional population in the U.S. has grown by 700 percent. From 1982 to 2001 state expenditures on corrections increased each year, swelling from $15 billion to $53.5 billion, the report says.

It concludes that mass incarceration is one of the factors contributing to diminished educational opportunities, fractured family structures, stagnated economic mobility, limited housing options, restricted access to essential social entitlements, and reduced neighborhood cohesiveness.

The institute reported the following factors

  • HIV/AIDS is two to seven times more prevalent in jail or prison, and an estimated 17 percent of all people with HIV living in the U.S. pass through a correctional facility each year.
  • Hepatitis C occurs at rates eight to 21 times higher among incarcerated people and accounts for more deaths in the community than HIV/AIDs.
  • Tuberculosis is more than four times as prevalent in the incarcerated population.
  • Common sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, are more prevalent, especially among incarcerated women who have significant histories of sexual trauma and/or engage in sex work.
  • One-third of women admitted into jails who receive a screen for STDs test positive for syphilis.
  • Syphilis rates among women incarcerated in New York City are 1,000 times that of the general population.
  • Diagnosable substance use disorders in the general population are 9 percent; in state prisons, 50 percent; in all jail inmates, 68 percent.
  • Serious mental illnesses in jails and state prisons are two to four times higher than in the community.
  • Suicide accounts for one-third of deaths in jails. 15 percent of state prisoners reported violence-related injuries and 22 percent reported accidental injuries.
  • 72 percent of people in jail with a serious mental illness also have substance use disorders.
  • Between 39 and 43 percent of people in custody have at least one chronic medical condition.
  • People aged 55 years and older are among the fastest growing segments of the incarcerated population. This rate from 1992 to 2012 grew by 550 percent. Older adults have higher rates of chronic conditions and mental and physical disabilities.
  • Overcrowding underpins many of the poor living conditions in jails and prisons. Decades of sustained prison growth created significant risks to the health and safety of people living and working in these institutions.
  • Today, at least 84,000 individuals live in conditions of solitary confinement, isolation, sensory deprivation, and idleness in U.S. jails and prisons. This grew 40 percent between 1995 and 2005.
  • Since passage of the Prison Rape Elimination Act (PREA) in 2003, sexual victimization remains a serious problem inside jails and prisons. A 2012 BJS survey found that 10 percent of former state prisoners reported being sexually victimized while incarcerated.
  • The continuous cycling of people with high rates of disease between corrections and communities poses risks to the health of people living where incarceration is most endemic.
  • For people with a history of injection drug use, failure to promote continuity upon release increases risk of relapse, overdose and risky behaviors that spread HIV/AIDs and HCV disease in communities.
  • Researchers from the Justice Mapping Center compared neighborhoods where incarceration is most concentrated. It reported that the highest rates of incarceration and the greatest rates of disease are concentrated in the same neighborhoods. For example, Central Brooklyn, the South Bronx, and Upper Manhattan – where incarceration is most prevalent – also have STD prevalence, asthma rates, disproportionately high infant mortality rates, HIV incidence, and high hospitalizations due to assault.
  • 2.7 million children under the age of 18 are living in the U.S. with at least one parent in prison.
  • Some of the financial burdens for the families of incarcerated individuals are:
  • Depositing money into prison commissary accounts for use by incarcerated family members.
  • Traveling costs and wages lost related to visiting correctional facilities that are often located in rural locations hours outside metropolitan centers.
  • The high cost of staying in touch by phone, which can force families to choose between paying to stay in touch and other basic living expenses.
  • The emotional stress and financial commitment can foster familial conflict that is damaging to marriages and parental-child bonds.

The institute said human health is determined by a range of social, economic and political forces beyond the control of the individual. The current laws, policies and practices that sustain overcrowded jails and prisons are undermining the prospects for economic security and causing families and communities an unwarranted degree of suffering and need to be examined and overhauled, the report concluded.


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