People behind bars are a lot sicker. New efforts aim to help
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Compared to the rest of the world and compared to earlier generations, vast numbers of Americans are behind bars. And, by many measures, those people are far sicker than most others, several health professionals who are trying to address the issue said Monday.
With a 500% increase over the past 40 years, more than 2 million Americans are now locked up at an annual cost of $182 billion, according to a health policy brief in Health Affairs. At the same time that prison and jail populations have exploded, those people have shown far worse health outcomes.
- The imprisoned are significantly more likely to have chronic diseases such as diabetes, hypertension, and asthma than the overall population.
- Former inmates in Washington state were 129 times more likely to die of overdoses than the population as a whole within two weeks of being released, according to a 2007 article in the New England Journal of Medicine.
- Inmates also have been five times more likely to get COVID-19, two to seven times more likely to get HIV, and eight to 21 times more likely to get hepatitis C, Lauren Brinkley-Rubenstein, who runs Duke University’s Re-Envisioning Health and Justice Lab, said Monday during a webinar by the National Institute for Health Care Management Foundation.
- Incarcerated men are six times more likely to have a serious mental illness than men are generally. For women, the increased likelihood is even a little higher, according to slides Brinkley-Rubenstein presented.
Those disheartening statistics come on a highly skewed playing field. Black people make up just 13% over the overall population, but they make up 40% of the nation’s inmates. White people, meanwhile, make up 64% of the population, but are just 39% of the people in American prisons and jails.
And no. It’s not because minorities commit more crime, Brinkley-Rubenstein said.
“It’s impossible to focus on this discussion without talking about racial disparities,” she said. “If we take the example of drug use, lots and lots of studies have shown that white people use a lot more drugs than these other groups. It really is where police are at, where they’re deployed, how these (law enforcement) resources are allocated.”
Two of the speakers in the webinar described their efforts to improve health care for the many millions of Americans who leave incarceration in a given year.
“It’s clear that the way we’re responding to the health needs of people as they (are freed) is not moving the needle and it’s holding the health system back from achieving some commonly shared goals,” said Vikki Wachino, executive director of the Health and Reentry Project, an effort that was launched in February.
Her group is working with health care experts, prison and jail officials and people who have been incarcerated to develop a framework to improve care as people are freed.
Also, a piece of federal legislation known as the Medicaid Reentry Act would restart Medicaid benefits to incarcerated people 30 days before their release with the goal of maintaining continuous care. It’s been passed twice by the U.S. House of Representatives and is now before the Senate, said Wachino, a former deputy administrator for the U.S. Centers for Medicare and Medicaid Services.
In addition, 11 states have applied for Medicaid waivers to devise systems of their own, she said.
Divya Venkat is a Pittsburgh physician whose clinic takes services to where the people who need them are. Doctors, nurses, a pharmacist and health navigators not only help the newly free get on health care, they also help with health-related needs such as housing.
“Most of the week, our team is not even in a clinical setting,” she said. “Two half-days per week, our team is parked literally outside of the jail, welcoming people who have been released from jail.”
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