In the United States, the Bureau of Justice surveys inmates in state and federal correctional facilities to quantify the incidence and prevalence of medical problems and conditions. These statistics clearly quantify the substantial burden of illness among those incarcerated.[7] It is no secret that prison inmates face health threats behind bars that equal anything they face in the streets. Violent assault, rape, or the outbreak of highly infectious diseases are much more common in correctional facilities than in the general population. Prison conditions can easily fan the spread of disease through overcrowding, poor ventilation, and late or inadequate medical care.

Not surprisingly, communicable diseases among prison inmates, including TB, HIV/AIDS, and hepatitis C, are an international problem. Studies document that prisons are conducive to the spread of TB; it is well known that TB in prisons poses a threat to the general population.[8] For example, globally, the level of TB among those incarcerated is significantly higher than that of the civilian population and may account for up to 25 percent of a country’s burden of TB.[9] TB among foreign-born inmates is particularly alarming in the United States. Furthermore, the World Health Organization (WHO) reports that high levels of MDR-TB have been reported from some prisons with up to 24 percent of TB cases being classified as MDR-TB.[9]

Clearly, the unregulated, untreated, or erratic treatment of TB in prisons is a huge issue not only for those incarcerated, but also for the general population.

That being said, in the United States, most state and federal inmates receive some type of medical service (medical exam, blood test, TB test) either at admission or while incarcerated. Perhaps as an acknowledgment of the high prevalence of HIV and AIDS among prisoners, the Bureau of Justice survey data show that almost three-quarters of inmates get tested for HIV at or after admission. In California, for example, within two weeks after incarceration in a state prison, an inmate will receive full dental and physical examinations, which include testing for TB and HIV.[10] Given California’s serious financial crisis, however, cuts in prison health care could be expected.

Inmate health and medial problems vary by nature of disease, age, gender, and ethnicity of the prisoner. In 2004, an estimated 44 percent of state inmates and 39 percent of federal inmates reported a current medical problem other than a cold or virus.

More than one-third of state inmates and nearly a quarter of federal inmates reported having an impairment (learning was the most commonly reported impairment, with many reported to have multiple impairments including speech, hearing, vision, mobility,  or mental impairment).  Impairments were most commonly reported among inmates who were homeless or who injected drugs in the year before arrest.[7]

The specific needs of female prisoners have received little attention. Women tend to serve shorter sentences and are imprisoned for nonviolent, property, or drug-related offences compared with men; but many female inmates enter prison with substance abuse dependencies, and reproductive diseases, as well as histories of physical and sexual abuse. Pregnancy is a reality in prison with many inmates being incarcerated while pregnant. Slightly less than 5 percent of state and federal female inmates said that they were pregnant at the time of incarceration, yet only half of these inmates received some type of pregnancy care.[7]

Worldwide, depression, anxiety, and tendency to self-harm also are more prevalent among women prisoners compared with male prisoners.[11] Yet, widespread gender insensitivity and the failure to meet the basic needs of women offenders dominate criminal justice systems. Although overall there are fewer female inmates, their health needs are such that they tend to utilize the prison medical system more frequently. In the United States, females were more than 1.5 times more likely to report two or more current medical problems than male inmates.[7]

Despite the fact that young people commit the majority of crimes, the prison population of older people is growing. Older prisoners have greater health needs than younger prisoners; multipathology is common. Among the adult prison population, arthritis and hypertension were the two most commonly reported chronic medical problems. It has been estimated that 85 percent of older prisoners have more than one major illness, including psychiatric illness.[12] The issue of the older prisoner has been highlighted in the United Kingdom. Older prisoners constitute a comparatively low percentage of the overall prison population; however, between 1990 and 2000, the prison population over the age of 60 tripled, giving clear indication of an aging prison population.[13] The United Kingdom does not have specialist facilities for older prisoners, unlike some U.S. states that have designed “nursing home prisons” and “geriatric prisons.”

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Madelon L. Finkel, PhD
Madelon L. Finkel, PhD, is professor of clinical public health and director of the Office of Global Health Education at the Weill Cornell Medical College in New York City, NY. Dr Finkel is an epidemiologist whose work focuses on women’s health issues. Her interests also include global public health issues with ongoing research projects in rural India and Peru. Dr. Finkel has published extensively, including Praeger’s Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening and Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide.

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REFERENCES

1. Walmsley R. World prison population list. 7th ed.
2. Wikipedia. Prisoner population rate 2007-2008.
3. Mauer M. Comparative international rates of incarceration: an examination of causes and trends: Presented to the US Commission on Civil Rights; June 20, 2003; Washington, DC.
4. US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Correction statistics.
5. Ibid.
6. Federal Bureau of Investigation. FBI uniform crime report.
7. Maruschak LM for US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Medical problems of prisoners.
8. Griefinger RB, Heywood NJ, Glaser JB. Tuberculosis in prison: balancing justice and public health. J Law Med Ethics. 1993;21:332-341.
9. World Health Organization. Tuberculosis in prisons.
10. Shalit M, Lewin MR. Medical care of prisoners in the USA. Lancet. 2004;364:34-35.

Full References  »