Public Health as a Framework for Correctional Health Care
There are determinants of health that affect whether people are healthy or not. As we know, poor health conditions are exacerbated by lifestyle, and for many poor, uneducated, and unemployed individuals, they find themselves involved with criminal justice systems and incarcerated. Health conditions that remained unaddressed prior to incarceration now challenge corrections facilities, which only more recently (Estelle v Gamble), have been mandated to provide a standard of care that approximates a community standard of care. Although questions exist about whether health care behind bars could improve the health status of our communities, the reality exists that nearly 95 % of persons living in prisons will be released (Satcher, 2007). Combined with the statistics that report high rates of communicable and chronic diseases among inmate populations, the issue of re-entry highlights the importance of the need to apply principles of disease prevention and management. With the majority of inmates eventually released back to their communities, there is a tremendous public health opportunity to benefit the community with reduced illness rates, financial savings, improved public safety, and better use of existing health care system resources (Travis, Solomon & Waul, 2001). Acknowledging that what happens to the health of inmates and ex-inmates impacts the health of the public acknowledges correctional healthcare as an important component of public health care. Correctional health care standards for facilities now exist. And health professionals can become certified on these standards (NCCHC, 2008).
Public Health Defined
Public health is the art and science of preventing disease and injury, prolonging life, and promoting health through the organized efforts of society. Public health practice informs and empowers individuals and communities, and creates healthy communities through the use of evidence-based strategies and accountability mechanisms. The balance of health risks and health gains are essential issues when considering the public health impact of prisons, rates of incarceration, and effectsupon the community at large (Glaser & Greifinger, 1993). From a prevention perspective, the focus would be to reduce morbidity, mortality, and transmission of diseases that are highly prevalent in inmate populations: TB, viral hepatitis, HIV, and STD’s. From a primary and secondary prevention perspective, the focus would be to prevent these diseases in the first place, and implement evidence-based early detection programs and treatment protocols. Improving diagnosis and treatment of mental illness would be included. From a tertiary prevention perspective, for persons with established diagnoses, the focus would shift toward treatment, rehabilitation and prevention of mortality associated with disorders that occur in high prevalence among offender populations-such as addictive disorders and coexisting diseases.
Public Health-Correctional Health Collaboration
The missions of public health and correctional agencies are complimentary in that they are both integral to public safety. The IOM report, The Future of the Public’s Health in the 21st Century, describes a public healthcare system as a network of collaborating agencies and organizations that together can create a synergy to promote heath and reduce the burden of illness. The public health system includes the health care delivery system, which plays a vital role. Academic institutions train the workforce and conduct essential research. Communities function as sites where health is supported, or undermined. Through their various organizations and constituent entities, communities are major partners in delivery of essential public health services that maintain health and safety (IOM, 2002). Correctional settings play an essential role, and have become an ever more important venue in addressing gaps in health care services for inmates (Lincoln, Miles, Scheibel, 2007), but also from the larger perspective of burden attributed to unmet need associated with health disparities.
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