Improving Public Health Through Correctional Health Care

With our high rates of incarceration and high burden of illness, there are social policy conundrums that go beyond the authority of correctional administrators and correctional health practitioners. Public policy makers will be dealing with increasing costs for medical care, not just because of health care inflation, but because the inmate population is aging. What is the effect of our current policies on communities? Inmates are returning to their home communities without treatment, education, skills, housing, jobs, and self-confidence. Each of these topics is covered in this book. How do we make the expense of incarceration into an investment in our communities? Who do we lock up and who can we safely divert, perhaps in a more constructive manner? How to think about the potential effect of reentry for healthier communities? And, how do we improve the health literacy of public policy makers so as to improve the public health?

Inmates are beacons of public health opportunity. It is my hope that this book will provide a sound basis for a public health perspective on criminal justice policy and operations. It should provide information for policy analysis and direction for correctional medical care programs. Beyond the introductory materials, the book is divided into five sections. Within a section, each chapter is intended to provide both scholarly analysis and practical advice for public health interventions through the criminal justice system. Although I did distinguish communicable disease prevention with its own section, readers may note that I did not separate the psychiatric chapters in their own sectional cocoon. I did this to make the point that we need to reduce the barriers created by mind-body distinctions. Illness is illness. Illness can cause functional disabilities, whether it is somatic or psychiatric.

Section One of the book is about the impact of law and public policy on correctional populations, addressing the following questions: What is the impact of criminal justice policies on communities? What are inmates' constitutional rights to timely and appropriate medical care and how has litigation driven the standard of care? What are the rights of disabled inmates and which ones are disabled? How do we compare to other countries, especially with programs to minimize harm? What are the special needs of aging inmates and has anyone considered the cost of reasonable accommodation for a rapidly aging prison population? And, how does the medicalization of lethal injection contribute to a moral dilemma for physicians and pain and suffering for the condemned inmates?

Section Two is about categorical public health. From a prevention point of view, we address how to reduce morbidity, mortality, and transmission of diseases that are highly prevalent in inmate populations: tuberculosis, viral hepatitis, HIV, and sexually transmitted disease.

Section Three is about primary and secondary prevention. What can we do to prevent disease in the first place and how can we devise programs for early detection (screening) and treatment, using evidence-based protocols? How do we prevent suicides? How can we improve the diagnosis of mental illness? Why is oral health care important? How are women's health issues different from men's health issues? How are youth different from adults behind bars?

Section Four is about tertiary prevention. For patients with established diagnoses, how do we treat them for rehabilitation and prevention of mortality and end-organ damage? In this section, because of the high prevalence among prisoners, we focus on mental illness, addictive disorders, and coexisting disease. How can we do a better job at diagnosis, treatment planning, coordinating care and managing co-occurring disorders?

Finally, Section Five is about developing a better infrastructure for reentry. How can we improve communication, especially with electronic information systems? What research needs to be done? How do we manage sexual predators? And, how can we manage reentering patients with HIV and mental illness?

Public Health Behind Bars should be a provocative guide to developing the next evolutionary steps in public policy for a better future for our communities.

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