The federal Bureau of Justice Statistics released a new report (PDF) this month on the health of incarcerated people in state and federal lock-ups from 2011-12. The study focused on both prisoners (i.e. people serving longer sentences) and jail inmates (i.e. people awaiting trial or serving shorter sentences), and found they were not only more likely to have had chronic medical conditions and/or infectious disease than the general population, but were also often denied prescription medication after admission. The report also mentions that incarcerated women and prisoners over 50 suffered at disproportionately higher rates from chronic and infectious medical conditions than the rest of the population.
Over 40% of prisoners and inmates surveyed by the bureau reported current, chronic medical conditions, defined as “noninfectious medical problems, such as cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma and cirrhosis of the liver.” Specifically, prisoners and jail inmates were 1.5 and 2 times more likely to report high blood pressure, diabetes or asthma than the general public (respectively) and their rate of diabetes and high blood pressure had nearly doubled from 2004. Around 24% said they had more than one chronic condition.
Additionally, about 21% of prisoners and 14% of jail inmates reported “ever having tuberculosis, hepatitis, or other STDs excluding HIV or AIDS, compared to 5% of the general population.” The bureau found that, across the board, incarcerated people were more likely to have had an infectious disease at some point in their life than others.
The bureau also found that 36% of prisoners stopped taking their prescribed medications upon incarceration because a doctor “did not think medication was necessary or that the facility would not provide the medication.” 20% said they had yet to even see a doctor in prison. These numbers were even higher for jail inmates: nearly 40% of those off their medication had not yet seen a doctor, and 36% had seen a doctor but had been told they wouldn’t be continuing their prescription while behind bars.
Women and prisoners over 50 years of age were more likely to suffer from chronic conditions and infectious disease than the rest of the population, according to the report. Specifically, women prisoners were found to be more likely than men to suffer from chronic medical conditions, and prisoners over 50 were three times more likely to have an infectious disease than those aged 18-24.
For women, reproductive healthcare is often rare commodity behind bars. According to The Nation, incarcerated women in New York state “use newspaper and magazines while on their periods because they are not provided an adequate number of pads.” Pregnant prisoners in that state encounter especially torturous conditions that directly threaten the health of both mother and child. As one report by the Correctional Association of New York explains:
Sitting in shackles for long periods of time is uncomfortable for any person and particularly so for pregnant women. These conditions are also dangerous as pregnant women are advised to stretch and walk periodically to reduce swelling and improve blood flow. ACOG states that “limited mobility caused by shackling” can increase the risk of blood clots, a leading cause of maternal death in the U.S. Using the bathroom on a moving bus while fully shackled is simply not safe for pregnant women.
Incarcerated people over the age of 50 also face unique obstacles to staying healthy behind bars. In addition to their higher risk and rate of chronic and infectious medical conditions, elderly prisoners are less-mobile and require a higher guard-to-inmate ratio to move and perform normal activities. They also require longer and more-frequent hospital stays and visits than their younger counterparts, and their healthcare is more expensive. According to a report by the ACLU, “In some states, like North Carolina, the average annual cost of healthcare for prisoners 50 and older is four times higher than the cost for prisoners younger than 50.” 50 years old might seem pretty young to consider someone elderly, but the stress of incarceration actually accelerates the aging process.
There are several contributing factors to America’s unhealthy prison population. First, the United States disproportionately incarcerates poor people. The Vera Institute of Justice found that three out of five people in jail are too poor to post bail. For many of them, prison medicine may be their first exposure to healthcare. This might explain why significantly more incarcerated people reported ever having infectious diseases than the general public.
It also might explain why prisoners reported general satisfaction with their healthcare despite the constitutionally bare-minimum services that are provided to them. BJS found that, “Nearly half (48%) of prisoners and 43% of jail inmates reported that the health care received while incarcerated was better than or about the same as the care they received in the 12 months prior to admission.” (It says quite a bit about the healthcare opportunities many Americans have on the outside, too.)
Another factor is overcrowding. Not only do cramped and squalid living conditions increase the risk of developing a chronic condition or transmitting infectious disease, but the surplus of prisoners also puts a strain on the already-spartan prison medical system. More sick prisoners and less doctors means a self-perpetuating cycle of longer waiting times to receive care and stressed, overwhelmed staff. It also places a major burden on prison medical budgets. Together, these conditions might explain why so many prisoners and inmates report never having seen a doctor in prison, or why so many have seen their prescriptions cancelled upon admission.
The BJS report notably does not include drug addiction or mental health issues, and is therefore missing a major part of the story of prison healthcare. For instance, a 2006 report from BJS found more than half of prisoners and jail inmates had a “mental health problem,” and around 75% suffered from drug addiction. These groups were not included in this study, but the associated costs and institutional stress of imprisoning large numbers of mentally ill and drug-addicted people in already-crowded prisons surely complicates the delivery of care to other inmates with health needs.
In an effort to control skyrocketing costs, some states and municipalities have privatized medical services, relying on for-profit companies like Corizon Health Services with ‘cost-reduction strategies’ that cut back on prescriptions and trained staff at the expense of prisoners’ well-being. In other places, correction departments are trying to transform some of their facilities into specialized prison-hospital hybrids as mental health services disappear on the outside.
But in nearly every case, governments have chosen to put costs before the concrete, individual healthcare needs of the incarcerated. By resisting efforts to reduce prison populations through structured release programs and failing to provide adequate medical care to people on the outside, governments across the country are setting themselves up for even more severe public health problems down the road.