Featured Research

from universities, journals, and other organizations

Experts call for prison health improvements

Date:
March 3, 2014
Source:
Brown University
Summary:
Experts unveil their recommendations to improve health care for prisoners both during incarceration and after release. From a public health standpoint, they argue, it's shortsighted to regard prison populations as separate from the community. More than 95 percent of prisoners will return to the community, often carrying significant health burdens and associated costs with them. "The general public doesn't pay attention to what's going on behind bars," said lead author. "But this is very important if you are concerned about the health of our population and health care costs."

Health care inside prison and continuity of care after release — particularly care that is responsive to the medical needs of former prisoners — would help break vicious cycles of recidivism and contribute to a stronger society overall.
Credit: Image courtesy of Brown University

The very premise of prison invites members of society to think of the people there as walled-off and removed. But more than 95 percent of prisoners will return to the community, often carrying significant health burdens and associated costs with them. In an article in the March issue of the journal Health Affairs, several experts who participated in a scientific workshop convened by the National Research Council and the Institute of Medicine recommend several steps and ideas consistent with health reform to improve care for prisoners while they are incarcerated and after they return to society.

Related Articles


"The general public doesn't pay attention to what's going on behind bars," said lead author Dr. Josiah Rich, professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights at The Miriam Hospital. "But this is very important if you are concerned about the health of our population and health care costs."

"The general public doesn't pay attention to what's going on behind bars, but this is very important if you are concerned about the health of our population and health care costs."Researchers have found that about two in five prisoners have a chronic medical condition (often first diagnosed in prison) and more than seven in 10 prisoners of state systems need substance abuse treatment. In fact, the illness of addiction is what lands many people in prison in the first place.

But four in five prisoners don't have health insurance when they leave.

"Prisons and jails are necessary for the protection of society," Rich and his co-authors wrote. "For decades, though, the U.S. health and criminal justice systems have operated in a vicious cycle that in essence punishes illness and poverty in ways that, in turn, generate further illness and poverty."

Within that bleak situation, however, lies opportunity because incarceration allows for diagnosis and delivery of care that, if continued in the community, would reduce the onslaught of health problems for individuals and ensuing costs for society, Rich said. The authors' recommendations, which build on discussion from a December 2012 joint workshop in which they participated, are meant to turn that vicious cycle into a virtuous one.

The recommendations could make the difference illustrated by two scenarios, Rich said. Both begin with the imprisonment of a 28-year-old man with severe hypertension. In one case the condition is diagnosed and treated in prison. Treatment with inexpensive medications continues after release a decade later because the man has health insurance and access to a doctor who understands his medical and personal history. In the other case, either the hypertension is left untreated in prison or it's not managed after he's released because he has no insurance or continuity of care. A decade later he develops kidney failure and goes on dialysis, costing the health care system a lot more money.

Recommendations for prison and after

The authoring group's primary recommendation is to find alternatives to imprisonment when possible, given that the United States incarcerated more than 2.3 million of its 313 million residents in 2012. While the group divided the rest of its recommendations between health care in prison and after release, in many cases the ideas are meant to improve integration of care between the two settings. Specifically they make the following recommendations.

In prison:

  • improved oversight and accountability of prison health care, including making accreditation of prison health care mandatory and enforceable;
  • inclusion of prisoners in accountable care organization health plans to increase provider incentives for providing good care;
  • medical profession advocacy for legislation and programs that would benefit prisoner health, such as programs that improve care as prisoners transition to the community.

After release:

  • employment of a "risk-needs-responsivity" model to triage prisoners, based on their personal history, to the most appropriate care;
  • assistance for released prisoners to help them enroll in Medicaid as it expands under the Affordable Care Act. In recent research, Rich has found that this activity may already be underway and is co-author of a separate paper in Health Affairs on what's needed to transition prisoners on Medicaid back into the community;
  • policies requiring electronic health records from within prison be available to community health providers;
  • incentives for community providers to deliver mental health care to released prisoners;
  • improved cultural competence among community physicians to understand the specific medical needs and risk factors of released prisoners. Transition Clinic medical homes provide a worthwhile example, the authors write.

In a separate paper in the journal, Rich and co-authors including Brown and Miriam researchers Brian Montague and Curt Beckwith also find that prisons could do more to test prisoners for HIV and ensure care after release, as the CDC recommends.

Recognizing that prisoners never stop mattering to the community from the standpoint of health could lead to better medical and economic outcomes, the experts argue.


Story Source:

The above story is based on materials provided by Brown University. Note: Materials may be edited for content and length.


Journal Reference:

  1. J. D. Rich, R. Chandler, B. A. Williams, D. Dumont, E. A. Wang, F. S. Taxman, S. A. Allen, J. G. Clarke, R. B. Greifinger, C. Wildeman, F. C. Osher, S. Rosenberg, C. Haney, M. Mauer, B. Western. How Health Care Reform Can Transform The Health Of Criminal Justice-Involved Individuals. Health Affairs, 2014; 33 (3): 462 DOI: 10.1377/hlthaff.2013.1133

Cite This Page:

Brown University. "Experts call for prison health improvements." ScienceDaily. ScienceDaily, 3 March 2014. <www.sciencedaily.com/releases/2014/03/140303163625.htm>.
Brown University. (2014, March 3). Experts call for prison health improvements. ScienceDaily. Retrieved December 18, 2014 from www.sciencedaily.com/releases/2014/03/140303163625.htm
Brown University. "Experts call for prison health improvements." ScienceDaily. www.sciencedaily.com/releases/2014/03/140303163625.htm (accessed December 18, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, December 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

UN: Up to One Million Facing Hunger in Ebola-Hit Countries

AFP (Dec. 17, 2014) Border closures, quarantines and crop losses in West African nations battling the Ebola virus could lead to as many as one million people going hungry, UN food agencies said on Wednesday. Duration: 00:52 Video provided by AFP
Powered by NewsLook.com
When You Lose Weight, This Is Where The Fat Goes

When You Lose Weight, This Is Where The Fat Goes

Newsy (Dec. 17, 2014) Can fat disappear into thin air? New research finds that during weight loss, over 80 percent of a person's fat molecules escape through the lungs. Video provided by Newsy
Powered by NewsLook.com
Why Your Boss Should Let You Sleep In

Why Your Boss Should Let You Sleep In

Newsy (Dec. 17, 2014) According to research out of the University of Pennsylvania, waking up for work is the biggest factor that causes Americans to lose sleep. Video provided by Newsy
Powered by NewsLook.com
Flu Outbreak Closing Schools in Ohio

Flu Outbreak Closing Schools in Ohio

AP (Dec. 17, 2014) A wave of flu illnesses has forced some Ohio schools to shut down over the past week. State officials confirmed one pediatric flu-related death, a 15-year-old girl in southern Ohio. (Dec. 17) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins