Thirty Years Since Estelle v Gamble Looking Forward Not Wayward

Robert B. Greifinger

How far have we come in the 31 years since the Supreme Court issued its landmark decision in Estelle v. Gamble (Estelle, 1976)? And how much will correctional health care develop in the next three decades? For all of these years, correctional health care has been isolated from public health and isolated further from community health care, two systems that are already remote from each other. How do we make the argument that medical care interventions behind bars have so much to do with the health of the communities to which the inmates return? How do we make the argument that public health is a piece of public safety? How easy is it to identify the barriers that prevent the application of public health and community health approaches to correctional medicine? How easy is it to break down these barriers and build bridges to enable timely access to reasonable and humane health care? Where exactly is the low-hanging fruit?

There are additional questions that need thought and analysis: how can we understand and empower correctional professionals? How can we link correctional health care with public health and community health providers? How can we increase the health literacy of public policy makers and correctional administrators?

The purpose of this book is to tackle these questions. The intent is to help develop a persuasive rationale to direct public policy toward seizing the public health opportunities that present themselves in a captive population beset by an extraordinary burden of illness. Much of this burden derives from poverty and drug abuse. This book is:

• an exploration of the next evolutionary steps in public health practice, from the perspective of the criminal justice system;

• about the implications on public health when prevention opportunities are seized behind bars;

• about reentry and the public health impact of the cycle of incarceration.

The chapters of this book are authored by some of the foremost experts in correctional health care, public health, criminal justice, and civil rights law. The objective is to outline the elements of an infrastructure for improving the health of the community through attention to prisoners' medical care. If we want to protect the public health, the time is ripe to develop public policy that takes advantage of the period of incarceration. In this introductory chapter, I will describe:

1. constitutional requirements to provide access to medical care;

2. the growing population behind bars;

3. the burden of illness in correctional populations;

4. the effects of Estelle;

5. eight conundrums of public policy, medical care, and public health behind bars; and

6. a preview of the later sections of the book.

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