Build Healthy Public Policy

Healthy public policy makes it easier for individuals and institutions to choose behaviors that promote health. If we accept the premise that our correctional systems ought to contribute to improved societal well-being and improved public safety, then we need to ask what public policies will enable jails and prisons to realize these goals. To date, few elected officials or correctional systems have systematically considered the mission of prisons and jails from this perspective.

Such an analysis suggests both fundamental and more proximate policy changes that could improve the capacity of correctional systems to improve well-being. For example, incarcerating fewer people would reduce the many unintended consequences of the explosive growth in incarceration of recent decades. These include community and family disruption and a reduction in social cohesion (Rose & Clear, 2003), factors associated with poor public health; increased correctional costs reducing resources available for other needs such as education, health care, and housing; and, perhaps, widening disparities in health due to the long-term negative health consequences of incarceration (Freudenberg, 2002; Gaiter et al., 2006; Iguchi et al., Fain, 2005).

At another level, improved coordination of reentry services including health care, employment, job training, housing, and substance abuse treatment can contribute to improve criminal justice and health outcomes, yet few jurisdictions have established policies that ensure or encourage such coordination.

What role can correctional health professionals play in creating healthier public policies? As in other sectors, they can convene stakeholders to identify policy obstacles, provide evidence to support the value of policy change; advocate for specific policies that will promote health; and help to ensure that healthier policies are in fact implemented. For the most part, health professionals cannot achieve these goals on their own, but in our experience, the participation of health professionals often adds credibility and depth to advocacy efforts to change correctional and reentry policies (Freudenberg, Rogers, et al., 2005).

To support these changes in mission, policies, and practices, correctional health professionals will need to evaluate both incremental and more substantive reforms in order to develop an evidence base that can guide further changes. Other chapters in this volume describe some of the challenges evalu-ators face in documenting the impact and benefits of CHS.

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