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Populations at Special Health Risk: Incarcerated
Abstract
The level of disease and illness among prison populations worldwide tends to be much higher than in the general population. In particular, the resurgence of communicable diseases poses enormous challenges for prison systems internationally. Reducing disease transmission in prisons is an integral part of reducing the spread of diseases in the community. States have an obligation to implement policies consistent with good public health and human rights practice and to ensure that prisoners are provided with a standard of health care equivalent to that in the broader society. Based on empirical evidence, this article examines key medical and penal policy issues raised by the transmission of infectious diseases in prisons. It analyzes the policy directions and alliances that are effective in improving the health of prisoners in light of their practical applications.
Background
Until today, inadequate attention has been paid to the distinguishing attributes of healthcare provision in prisons. It has been conceived either as ancillary or as a core component of imprisonment. While the former idea prevailed in the past, leading to a bio-medical approach to care in prisons, the latter is currently arising.
Method
This paper discusses the change in the approach to care in Italian penal institutions, examining their inertia. The design of the research consisted of a mixed approach: at the beginning, a desk study of law documents was realized; then, a semi-structured 48-item questionnaire was addressed to the health managers operating in the penal institutions of a southern Italian region.
Results
The study suggests that penitentiary health areas are prone to change and they are willing to establish inter-organizational relationships with healthcare organizations operating within the National Health Service. Notwithstanding, they have to cope with the institutional inertia of penal institutions, that favour organizational monism. The legislative efforts are not sufficient to foster a process of change in prisons; healthcare professionals usually act as catalysts of change, championing it and encouraging the reorganization of penitentiary healthcare.
Conclusions
This study paves the way to both further theoretical developments and to practical implications. On the one hand, it suggests a reconceptualization of healthcare provision within penal institutions, claiming the belonging of penitentiary health to public health. On the other hand, penal institutions are unwilling to change, due to their nature of total institutions: the involvement of healthcare professional in fostering the reorganization of healthcare provision is thus crucial to legitimate the process of change.
Throughout most of the world, the primary response to problems associated with illicit injection drug use has been to intensify law enforcement efforts. This strategy has contributed to an unprecedented growth in prison populations and growing concerns regarding drug-related harm within prisons. Despite the presence of international laws and guidelines that call for the protection of the health of prisoners, prison authorities have generally been slow to implement activities that have been proven effective in reducing drug-related harms in community settings. While a limited number of countries have made progress by implementing educational programmes, methadone maintenance therapy, bleach distribution and needle exchange, in most areas of the world, a substantially greater effort is needed to ensure that prisoners receive the same level of care offered in community settings. The current emphasis on security and abstinence from drugs within prisons is often regarded as incongruent with the goals and methods of harm reduction. However, available evidence indicates that most harm-reduction programmes can be implemented within prisons without compromising security or increasing illicit drug use.
The proportion of tuberculosis (TB) cases diagnosed among residents of correctional facilities in Arizona increased from 2.7% in 1993 to 8.0% in 2000, while the national average remained at approximately 4%. The purpose of this study was to determine the proportion of TB cases in Maricopa County, Arizona with a history of incarceration in the local county jail, and to describe missed opportunities for the prevention and early detection of active TB cases in this population.
A cross-match was used to identify persons reported to have TB in Maricopa County in 1999 and 2000 who also had a history of incarceration in the county jail. Jail medical records of cases were reviewed to determine if they had been screened for TB while incarcerated and the type of screening received. TB isolates for cases who had been in jail were genotyped using IS6110 restriction fragment-length polymorphism (RFLP) with secondary spoligotyping.
Nearly one quarter (24.3%) of TB cases had a history of incarceration in the county jail. Most (82.8%) received no TB screening while in jail. Of 34 cases with available isolates, six shared a single genotype by RFLP and spoligotyping.
Increased screening and treatment of latent TB infection in jails might assist with TB control in the community.
Objectives. This article develops and tests a concise multi-stage approach for assessing the impact of social construction on the implementation of public programs designed to benefit negatively constructed groups. The framework suggests that negative constructions lead to policy choices that create problems in the implementation process. These problems prevent the accomplishment of key subobjectives necessary for ultimate program success.
Methods. We test the utility of the framework in an analysis of a key public health issue—the spread of HIV/AIDS and tuberculosis in prisons. Despite great strides in the treatment and prevention of these diseases outside prison walls, the incidence and severity of both in the incarcerated population has increased dramatically over the last five years. We hypothesize that the problem of inadequate funding, arising from the negative social construction of this unique target population, is to blame.
Results. In an analysis of 50 state correctional systems, we find that states with the most negative constructions of criminals and potential criminals spend dramatically less on inmate health, relative to other states.
Conclusions. Our analysis suggests that inadequate funding levels in states with negative constructions of criminals and potential criminals jeopardizes the implementation of prison programs targeted at the prevention and treatment of HIV/AIDS and tuberculosis.