The Need for Higher Standards in Correctional Healthcare to Improve Public Health

Over the last 40 years, the United States has experienced an “epidemic” of incarceration, in which millions of Americans have spent days to years of their lives in jails or prisons. During this time, correctional medicine has undergone major changes.^1,2 In 1976, the U.S. Supreme Court affirmed that failure to provide basic medical care to a prisoner violates the Eighth Amendment to the Constitution banning cruel and unusual punishment.³ Over the ensuing decades, additional litigation or threat of litigation has forced correctional institutions to provide a minimum community standard of healthcare to prisoners. In response, accreditation bodies such as the National Commission on Correctional Health Care have codified these minimum standards for prison and jail-based health systems to follow through voluntary accreditation. However, a minority of the 4,575 correctional institutions across the U.S. have volunteered to become accredited using these standards. As a result, litigation remains the mainstay of enforcing correctional healthcare standards,⁴and correctional healthcare improvements have transpired piecemeal, typically with a focus only on reaching the minimum standards that have been established.

While meeting minimum standards is critical in protecting against Eighth Amendment violations, we argue that higher standards in correctional healthcare are capable of improving individual and public health while controlling overall costs. With 2.2 million Americans behind bars, and 10 million cycling through correctional systems each year,⁵ U.S. correctional healthcare has provided medical care to 1 in 30 living American adults, the majority of whom are from impoverished communities, where poor healthcare access is the norm.^6–10 Since more than 95% of prisoners eventually return to the community, correctional healthcare has the opportunity, and the obligation, to transform care for persons and communities most in need.¹¹Moreover, given that incarcerated populations are disproportionately from traditionally underserved and/or disadvantaged backgrounds and have a high burden of disease, these goals also hold the promise of reducing health disparities.^6,8,12

We delineate three areas—screening and treatment for hepatitis C, improved mental health care, including treatment for addiction disorders, and attention to geriatric care—that exemplify the critical need for proactive, evidence-based correctional healthcare that reaches beyond minimum standards and integrates prisoner healthcare into mainstream medicine in order to improve the health of individuals and communities.

Below:  Number of U.S. Prisoners, 1925–2012

Below:  Prevalence of Substance Abuse among State and Federal Prisoners

Below:  Prevalence of Any Mental Illness among State and Federal Prisoners and Jail Inmates

Below:  Prevalence of Hepatitis C in State and Federal Prisoners and Jail Inmates

Full article at:  http://goo.gl/ryrbUv

By:  Rich JD1, Allen SA, Williams BA.

• 1Warren Alpert Medical School, Brown University, Providence, RI, USA, jrich@lifespan.org.
• J Gen Intern Med. 2015 Apr;30(4):503-7. doi: 10.1007/s11606-014-3142-0. Epub 2014 Dec 19. 

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