Journal of Correctional Health Care
Article Abstracts
Article Abstracts The preface below is from Volume 10, Issue 3 — Special
Issue: Inmate Reentry and Public Health.
Volume 10, Issue 3 — Fall 2003
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Preface Jeremy Travis, JD, MPA, and Anna S. Sommers, PhD By most measures,
prisoners are burdened by health concerns at levels far higher
than in the general U.S. population. They exhibit markedly
higher rates of HIV and AIDS, tuberculosis, hepatitis C, and
mental illness. They have significant histories of alcohol and
substance abuse, with addiction levels that exceed those found
in the general population (National Commission on Correctional
Health Care, 2002). Yet, unlike most Americans, prisoners have
access to a health care system, paid for by state and federal
taxpayers, that attends to a wide range of their health needs.
They are typically screened for a variety of illnesses at
admission, and can call upon this health care system to respond
to health needs ranging from routine illnesses to kidney
dialysis and even heart transplants.
There is a second reality of imprisonment in America that puts the health profile of prisoners in a unique relationship to the American system of health care: Virtually all prisoners return home, bringing with them their health concerns. Except for those few who die in prison, all prisoners return to live again in free society. In recent years, this process of “prisoner reentry” has received substantial attention among policy makers, practitioners, and researchers, generating a widespread interest in new approaches to managing the inevitable return of large numbers of prisoners.
The phenomenon of prisoner reentry is quite different today, in a time called by some the era of “mass incarceration” (Mauer & Chesney-Lind, 2002). Over the past generation, beginning in the early 1970s, the nation has witnessed a fourfold increase in the rate of incarceration in America, resulting in a population of 1.3 million in our state and federal prisons. Given the inevitability of reentry, it is not surprising that the size of the country’s annual reentry cohort also has grown substantially. In 2002, an estimated 630,000 individuals left our state and federal prisons, more than four times the number who made similar journeys 25 years
ago. Once they return home, the odds are high that they will return to prison. Within three years, two thirds will be rearrested for one or more serious crimes and one half will be returned to prison (Langan & Levin, 2002).
The large numbers of individuals with high rates of health problems who are sent to prison, return home, and then, in many cases, are sent to prison again pose both challenges and opportunities for health care providers, both those who work in correctional settings and those who provide services in the community. A primary shortfall in current practice to date is the absence of mechanisms through which community and corrections providers can collaborate to provide continuity of care for returning prisoners. The absence of such systems disadvantages prisoners and providers alike. Moreover, with respect to prisoners returning to the community with communicable diseases, opportunities to minimize the spread of disease have not been seized.
To explore the issues at the intersection of prisoner reentry and public health, the Urban Institute convened a meeting of the Reentry Roundtable devoted to this topic. With funding from the California Endowment and the Centers for Disease Control and Prevention, the Institute commissioned papers by some of the nation’s leading researchers, invited a rich mix of corrections administrators, corrections health care providers, community health care agencies, former prisoners, police leaders, state and local policy makers, and representatives of advocacy groups to meet for two days in Los Angeles.
Three themes emerged from the roundtable discussions. First, a reentry perspective on the health burdens facing America’s prison population presents an opportunity to think differently about improving health outcomes for returning prisoners, their families and the communities to which they return. Given the inevitability of reentry, every prisoner should be viewed as a future member of free society. Accordingly, the period of time in prison should be viewed as an opportunity to provide health interventions that will yield better health outcomes not only in prison but, equally important, following the prisoner’s release. This perspective places new obligations on prison health practitioners to factor in benefits incurred after release and to communities, rather than tailor treatment to address benefits realized only while incarcerated.
The reentry perspective also envisions different relationships between health care providers in prison and those in the community. For example, correctional health care professionals should work with their colleagues in the community to develop discharge protocols, fixed first appointments in clinics after the inmate’s release, sharing of medical records, and treatment plans.
Finally, the reentry perspective would move the public health field toward different strategies for addressing a number of health issues in our society. For example, public health strategies to minimize the spread of hepatitis would start with the recognition that prisoners present high levels of that disease and would take advantage of their period of incarceration to provide screening and appropriate interventions. A number of researchers and practitioners have embraced the notion that the twin realities of incarceration and reentry present what has been called a “public health opportunity” (Glaser & Greifinger, 1993), but realizing this opportunity will require a new collaborative model between community health and correctional practitioners.
The second theme of the roundtable discussion was the value of a public health perspective on the phenomenon of prisoner reentry. The public health community brings valuable concepts, language, and practices to the work of criminal justice professionals and others who think about the challenges posed by hundreds of thousands of returning prisoners. The idea of a discharge plan, the concept of continuity of care, the concern for a person’s well-being irrespective of his or her social
status — are all useful additions to the criminal justice conversations about reentry. More specifically, a public health perspective contributes a sharpened focus on mitigating the harmful effects of certain illnesses that are associated with heightened public safety risk, the touchstone of most criminal justice reform efforts. For example, a detailed discharge plan for a prisoner with mental illness that ensures continuity in medication and treatment could promote better mental health and reduce the likelihood of antisocial and criminal behavior. Similarly, a successful prison-based education program that helps inmates avoid risky behaviors associated with the transmission of HIV, such as needle injection, may also reduce the rate of return to drug use.
A third theme emerging from the roundtable discussion was more strategic than substantive. The conference participants left the meeting expressing the consensus that a merger of the public health and prisoner reentry perspectives could bring new policy interest and new allies to each policy domain. The public health and correctional health care communities would benefit from alliances with their criminal justice counterparts who could help quantify, in public safety terms, some of the effects of evidence-based health interventions with the criminal justice population. The criminal justice professionals and allied community agencies would gain new support in their efforts to raise public awareness about the impact of mass incarceration on American society by the language and concepts of public health.
This issue of the
Journal of Correctional Health Care publishes updated versions of the papers presented at the roundtable as new support for the efforts of researchers and practitioners alike to shed light on the nation’s twin challenges of poor health and high incarceration and reentry rates, particularly in disadvantaged communities that already face too many other burdens.
We would like to express our gratitude to a number of individuals and institutions that have contributed to this project. The California Endowment and the Centers for Disease Control and Prevention provided the funding that made the roundtable and this volume possible. Gwen Foster at the Endowment and Hugh Potter at the CDC provided intellectual guidance and substantive knowledge throughout the life of the project. Dr. Robert Greifinger helped conceptualize the roundtable process and solicit the involvement of public health researchers across the country. Within the Urban Institute, Michelle Waul and Dionne Davis provided analytical and logistical support to the roundtable meeting. Embry Howell, a principal research associate in the Institute’s Health Policy Center, was an enthusiastic collaborator and brought her formidable expertise in community health research to inform our work. Finally,
Journal editor John Miles provided significant editorial assistance and collegial encouragement during the production process. We thank all of them, and the participants in the roundtable itself, for their support and advice.
[Note:
Endnotes and references are omitted from this page.]
