Capsule Commentary on Rich et al., Higher Standards in Correctional Healthcare Could Improve Public Health
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KeywordsBirth Cohort Societal Perspective Nutritional Examination Survey Delivery Model Service Delivery Model
Anne C. Spaulding MD MPH, FACP
In this opinion piece, a trio of authors call for “proactive, evidence-based correctional healthcare” in the areas of hepatitis C, mental health, and geriatric care. They advocate for a system that aspires to optimize both individual health and that of the community as a whole.1 Currently, too many jurisdictions engage in a “race to the bottom,” where the budget, rather than the well-being of patients, dictates the type of health services delivered to inmates. From the societal perspective, substandard healthcare may not be the best purchase. In order to identify the best return on the investment in the management of hepatitis C, mental illness and aging among prisoners, research is needed. A similar argument has been made in the past for HIV treatment in jails and prisons.2 Unfortunately, correctional health is an area of medicine with a thin evidence base.
This lack of research into the needs of the incarcerated, a highly stigmatized population, is short sighted. The US incarcerates at a higher rate than any other nation on the face of the earth.3 If present trends continue, one out of 15 Americans and one out of three black men in the 2001 birth cohort will spend time imprisoned.4 Yet, by congressional mandate, public health surveys refrain from including inmates, and thereby distort the scope of health problems. For example, by not counting the incarcerated and recent releasees, the NHANES (National Health and Nutritional Examination Survey) ignores 30 % of the US hepatitis C epidemic.5
General internists need to join others in advocating for the health of their patients who become incarcerated. The Academic Consortium on Criminal Justice Health (www.ACCJH.org) has recently produced the “Chicago Declaration,” asserting the necessity of increasing knowledge and understanding of health care needs, optimum service delivery models, and health disparities in justice-involved populations through increased, rigorous scientific investigation. In the opinion of the ACCJH research committee, increased focus must be placed on relevant issues by investigators, funding agencies and policy-makers. Without dedicated human capital and funding, critical advances will not be forthcoming. Without such resources, the ideals espoused by Rich, Allen and Williams in their commentary will not be realized.
- 1.Rich JD, Allen S, Williams B. Higher standards in correctional healthcare could improve public health. J Gen Intern Med. 2014. doi 10.1007/s11606-014-3142-0.
- 3.World prison brief, webpage of the International Centre for Prison Studies, Kings College London, University of London. Available at http://www.prisonstudies.org/. Accessed 23 January 2015.
- 4.Bonczar T. Prevalence of imprisonment in the U.S. Population, 1974–2001. Bureau of Justice Statistics Bulletin 08/03 NCJ 197976. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/piusp01.pdf. Accessed 12 October 2009.