Academic journal article International Journal of Men's Health

Jails as Public Health Partners: Incarceration and Disparities among Medically Underserved Men

Academic journal article International Journal of Men's Health

Jails as Public Health Partners: Incarceration and Disparities among Medically Underserved Men

Article excerpt

There were nearly 12 million admissions to U.S. jails in 2011, the majority of them Black or Hispanic. We analyzed data on men's health screenings from the last Bureau of Justice Statistics Survey of Inmates in Local Jails. Black and Hispanic men had the same or higher odds of reporting nearly all types of screenings compared to White male inmates. Because many prisoners are medically underserved, jails can be crucial public health partners in reducing disparities by identifying men in need of health care. The anticipated expansion of Medicaid eligibility in 2014 constitutes an important opportunity for correctional and public health authorities to work together to ensure linkage to care following release from incarceration.

Keywords: jail, incarceration, screening, disparities, men's health

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Incarceration in the U.S. appears to have plateaued, but the U.S. still incarcerates a higher percentage of its population than any other nation (Rich, Wakeman, & Dickman, 2011). The vast majority of inmates in the U.S. are male, and about 2/3 are Black or Hispanic (Minton, 2012; West, Sabol, & Greenman, 2010). Evidence is mounting regarding incarceration's adverse effects on life trajectories and family wellbeing (Freudenberg, 2001; London & Myers, 2006; D. Roberts, 2004; Wildeman & Western, 2010). At the same time, most inmates come from low-resource communities and lack employment, health insurance, and stable housing at higher rates than the general population. As a result, for some inmates incarceration provides their only access to non-emergency healthcare. Jails present a number of ethical dilemmas to providers and public health practitioners, but they are an underutilized public health opportunity to screen and test the medically underserved and to provide treatment for conditions that may have previously been undiagnosed. We present evidence on racial/ethnic patterns in screening inmates and discuss how jail-based medical screening provides one path to decreasing disparities in healthcare access among men in the community.

BACKGROUND

Incarceration rates in the U.S. escalated rapidly beginning in the 1970s and only stopped rising in the middle of the last decade (see Figure 1). During this time, the gap between White incarceration rates and Black/Hispanic incarceration rates also grew rapidly. In 1926, at the height of Jim Crow racial segregation, 21% of admissions to prisons were Black; by 1986, Blacks represented 44% and continued to rise (Langan, 1991). By comparison, Blacks represented less than 10% of the population in 1926 and fewer than 14% through the most recent censuses. The epidemic of incarceration resulted less from rampant criminality among Americans than a confluence of structural changes, such as the increased use of incarceration for minor offences, inadequate funding of community-based mental health services, and adoption of "tough on crime" political rhetoric. More recent studies suggest that well over 50% of inmates have a mental illness and/or addiction, reflecting insufficient community-based treatment for these conditions (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009; Baillargeon, Hoge, & Penn, 2010; Lamb & Weinberger, 2005; Taxman, Byrne, & Pattavina, 2005). A substantial number of admissions, and a large percentage of the racial/ethnic disparities, stemmed directly from the war on drugs. Although Blacks, Whites, and Hispanics use drugs at about equal rates, Blacks are 13 times more likely to be imprisoned on drug charges than Whites (Moore & Elkavich, 2008; SAHMSA, 2010). Several legal scholars have identified features of the law enforcement, legal, and criminal justice systems (for example, stop-and-frisk practices in which police target young men of color) that account for these discrepancies (Alexander, 2010; Fellner, 2009; HRW, 2009; Provine, 2007).

Research studies and interventions involving inmates tend to focus on prisons, but about 17 times as many people pass through jail, an initial and more temporary placement. …

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