Correctional populations account for about 2% of persons in the United States, who have a unique right to health care guaranteed by the Constitution per court decisions. However, the quality and breadth of this care is not standardized, and incarceration itself creates risk factors for one’s health. A review of the literature was done to evaluate the health and access to care of prison populations. Prison populations are largely minorities from poor neighborhoods with low socioeconomic status who usually have limited engagement with health services prior to incarceration; there is a large amount of morbidity of chronic diseases in prisons, and prisoners are at increased risk for communicable diseases, substance abuse and mental illness. Former inmates are also at increased risk of death following release. While advances such as telemedicine help to bridge the gaps in correctional health, more research needs to be done to assess the needs of this population, and more education and linkage to care should be accomplished to do right by these populations and ensure they get the care they need. This will in turn lead to better health outcomes in this population and may have a beneficial effect on the communities from which these prisoners come. / Urban Bioethics

The following report is an assessment of the privatization of health care in prisons. It attempts to better understand the industry, the leading companies, and to determine whether they are providing adequate and constitutionally mandated levels of care. The report begins with an overview of prison health care in the United States, covering its history and its current state. It then examines the private correctional health care industry by looking at industry structure, market share, and leading companies. In an attempt to analyze the impact this industry has on people behind bars, several research approaches were utilized, including a literature review, a review of government reports and court documents, a review of case studies, a narrative report of one individual's experiences, and an assessment of mortality rates. Research findings suggest that the current privatization model incentivizes limiting services rather than improving oversight and access to care. Mortality rates were found to be the highest in privately run care facilities. Case study findings further suggest that private correctional care is routinely inadequate and exposes prisoners to harm and risk of harm, including inhibited access to care, severe medical conditions, amputations, suicide, and death. The propensity of this harm compared to publicly run care remains inconclusive. Increased independent oversight and population reduction over privatization are recommended. / text

Long-standing health and social inequalities associated with minorities have increased their risk for infection, hospitalization, and death related to COVID-19. This disparity is further exacerbated with incarcerated individuals, yet little attention, both prepandemic and presently, has been devoted to collecting up-to-date data. This study uses the 2004 Survey of Inmates in State Correctional Facilities (SISCF), the most recent data, to explore the general offender population and self-reported chronic and medical health conditions to highlight how COVID-19 will impact marginalized populations. Results from the four binary regression models found that minority males are more likely to have chronic illnesses which increase in probability with longer sentences, number of incarcerations, and advancement in age. Our findings advocate for the development of recent data sets on inmate health, particularly minority individuals, as well as the construction of more precise health measures to address these health disparities, including COVID-19.

No / The purpose of this paper is to present the findings of one part of a larger study, funded by the National Institute for Health Research, which explored the management of pain in adult male prisoners in one large category B prison in England. In this paper, the authors focus on the attitudes and perceptions of prison staff towards pain management in prison. A qualitative design was utilised to explore the staff perceptions of pain and pain management in one adult male prison. Questionnaires were provided for all staff with prisoner contact, and a follow up focus group was undertaken to further explore questionnaire data. The questionnaire and focus group findings demonstrated that staff had a good awareness of pain and pain management in prison, with both physical and emotional pain identified. The frequency of approaches by prisoners to staff for pain relief was noted to be high, whilst awareness of how the prison environment could potentially exacerbate pain was discussed. The acquisition of analgesia by prisoners for secondary gain was identified as a challenge to both assessing levels of pain and providing pain relief in prison, illustrating the complexity of providing care within a custodial culture. The effect on staff of caring for prisoners found to be confrontational and deceitful was significant for participants, with feelings of anger and frustration reported. This study was undertaken in one adult male category B prison with a very high turnover of prisoners. Staff working in other types of prison, for example, higher security or those more stable with longer sentenced prisoners could provide alternative views, as may staff caring for younger offenders and women. The challenges to undertaking research in prison with staff who can understandably be reluctant to engage in reflection on their practice cannot be underestimated and impact significantly on available methodologies. This qualitative research is the first of its kind to offer the perspectives of both health care professionals and prison staff working with prisoners complaining of pain in an English prison. It provides the groundwork for further research and development.