Correctional Health Care: Barriers, Solutions and Public Policy

Article excerpt

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 health care has been a labor-intensive and resource-demanding issue that corrections professionals have been wrestling with for years. Speaking at the 2007 Winter Conference of the American Correctional Association (ACA) on the future of correctional medicine, David Thomas of Nova Southeastern University summarized the recent history of how corrections has tried to meet that constitutional obligation. Thomas noted that meeting the challenge to provide inmates with appropriate health care during their incarceration and upon reentry into their communities has required both sweeping reforms and incremental changes in how corrections delivers health care to inmates. As a result of the advancements that were made under the activist courts of the 1970s through the 1990s, inmate health care has undergone significant across-the-board change. At the local level, some individual correctional systems and administrators have been forward thinking in recognizing the problems associated with correctional health care and have taken steps to address the barriers to improving health care services for inmates. (2)

Although corrections has made some progress in meeting its obligation to provide appropriate health care to inmates, many--probably most--venues and facilities continue to face significant barriers to their delivery of such services. The National Academy of Public Administration (NAPA) notes the that a quality gap exists because there is no universal, effective public policy strategy as it relates to inmate health care: "This public policy strategy is carried out effectively by federal correctional institutions. It is implemented effectively in many state prisons, but across some state prisons and in county and local jail systems there are great variations in the extent to which such a policy is implemented." (3)

Many reasons, if not excuses, are given for the absence of a fully realized universal public policy strategy and for the variations that exist in providing appropriate health care to inmates, with insufficient funding often blamed for those variations. …