Healthcare Barriers Faced by Incarcerated Individuals

By: Skyllar Kuppinger

The United States has the highest incarceration rate in the world (3). The number of incarcerated individuals has risen from 500,000 in the 1970s to 1.7 million in 2020, with a disproportionate percentage of this population being lower income and people of color (4). Incarcerated individuals present unique circumstances and health needs that must be met. While it is no surprise that inmates are cut off from outside healthcare, the specific issues that incarcerated individuals face must still be addressed within the prison system in order to promote equality in medicine.

Dr. Wang, director of the Yale University SEICHE Center for Health and Justice, researches the impact of incarceration on inmates and their families (1). As a former primary care physician for death row inmates in San Quentin State prison, she reports that due to the lack of longitudinal care inside the prison system, inmates often leave in much worse physical condition than when they entered. This is in part due to difficulty obtaining an appointment with a physician in the first place: to visit one, an inmate must first appeal to a correctional officer, who then refers the inmate to a nurse, who finally refers the inmate to a physician. In addition, inmates often must pay a $3 fee to see the physician, which is a large financial barrier considering that prison jobs only compensate about $0.75 a day (1).

There are a number of health conditions that disproportionately affect incarcerated people. For example, inmates have higher rates of infectious diseases, including HIV, AIDS, hepatitis C, and tuberculosis, than the general population (3). Despite the fact that incarcerated people are 3 times more likely to have HIV or AIDS, screening and treatment are not consistently available at prison institutions (2). Also, these institutions do not frequently provide immunizations for infectious diseases (3).

65% of inmates have alcohol or drug dependence disorders, but only a mere 11% of them receive treatment. This creates a high risk of withdrawal and subsequent overdose upon being released from incarceration (2).

Pregnant people in prison face an added risk due to inadequate prenatal care (3). In fact, incarceration during pregnancy has been found to be associated with reductions in both maternal and newborn health (2).

It is not surprising that the negative health effects of incarceration also extend to the family of the inmate– families of incarcerated people experience higher rates of cardiovascular disease, which may be tied to emotional and financial stress (1).

Not only is care lacking within institutions of incarceration, but there is a lack of integration of formerly incarcerated individuals into the healthcare system after their release. For example, when one possesses a criminal record, it is more difficult to obtain housing, food stamps, and employment, which in turn makes it difficult to access health care (2). Additionally, some states have a policy whereby the inmate’s Medicaid eligibility is suspended during their incarceration and must be reactivated after release, which is not a simple feat (1). Inmates also lack the proper knowledge on how to manage their health conditions, according to Dr. Wang, even though 80% of incarcerated individuals have a chronic health condition that warrants longitudinal care (i.e. diabetes, hypertension, COPD). For example, people with diabetes were not taught how to draw their own insulin.

Although prisons and detention centers are constitutionally required to provide healthcare to inmates, there is no universal standard for the care that they must provide (4). This means that the quality of healthcare varies widely between prisons and between states. For example, as of October 2021, the dehumanizing practice of shackling pregnant women during labor was only prohibited in 35 out of 50 states (4). The Justice for Incarcerated Moms Act of 2021 advocated for better health care services and more respectable conditions for mothers in the prison system, but this bill is still in committee. More standardized oversight is direly needed in order to provide adequate healthcare for all incarcerated individuals.

The American Academy of Family Physicians (AAFP) supports healthcare reform for incarcerated people. The AAFP especially recommends increased access to substance use disorder treatment, reproductive healthcare, and mental health services for these individuals (2). They also emphasize the need for not only improved healthcare services within correctional institutions, but also for better coordination of services following the release back into society (2). It is important to recognize on a societal level that incarcerated individuals are human beings deserving of healthcare. After all, imprisonment is often the result of trauma, poverty, addiction, mental illness, and structural racism (4).

Skyllar graduated from UCLA in 2023 with a double major in Physiological Science and Spanish, and is a current THINQ fellow.

Sources
https://ldi.upenn.edu/our-work/research-updates/the-flaws-of-u-s-prisons-and-jails-health-care-system/
https://www.aafp.org/about/policies/all/incarceration.html
https://www.aafp.org/pubs/afp/issues/2018/1115/p577.html
https://gpsslvpn.mednet.ucla.edu/https/www.ncbi.nlm.nih.gov/pmc/articles/PMC9021469/