Correctional Health Care: Barriers, Solutions and Public Policy

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Corrections faces many barriers in its efforts to deliver inmate health care, and these barriers contribute to the variation found across correctional venues in the quality of health care provided to inmates. The absence of a universal and effective public policy strategy for the provision of health care services to inmates, both during incarceration and after release, is a contributing factor to the "quality gap" that exists. This is not a new issue; however, addressing correctional health care from the perspective of the interests of the public is a relatively new approach.

Inmates suffer higher rates of communicable diseases than the general population, according to the National Commission on Correctional Health Care (NCCHC). (1) While this reality may generate little or no sympathy from the general public, it is not just a prison problem. The significance of correctional health care extends well beyond the walls of jails and prisons and into communities. Every year, more than 11.5 million inmates are released from U.S. jails and prisons. These individuals have the potential to carry life-threatening infectious diseases into the community, reports NCCHC. For instance, of the inmates released from U.S. prisons and jails in 1996, the commission reports that an estimated:

* 98,500 to 145,500 were HIV positive;

* 38,500 had AIDS;

* 155,000 were infected with hepatitis B;

* 1.3 million to 1.4 million were infected with hepatitis C; and

* 566,000 were infected with tuberculosis.

These are staggering numbers. The health status of inmates has a health, social and economic impact on the communities to which the inmates relocate after they are released. This puts the public squarely in the middle of the discussion of public policy in correctional health care. A public health perspective provides a political impetus for corrections to move forward in evolving an effective public policy on inmate health care.

The Challenge

The constitutional obligation for correctional facilities to provide inmate …