Running head: HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

Health Care Disparities and Health Care Policy Effecting Jail and Prison Inmates
Stephanie Olson
Ferris State University

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

Abstract
There are many underserved populations, however, one that is often overlooked are the prisoners
of jails/prisons. Some people feel they should not get the same benefits as people who have not
been to jail/prison, however, this is a social stigma that affects how one treats these individuals.
Health care benefits should apply to everyone, not just certain people, and as nurses we need to
advocate for this population. Advocate for healthy lifestyles, proper treatments, and health
insurance are essentials in maintaining a better life, even if someone made mistakes, we should
not let them make mistakes with their health.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

Health Care Disparities and Health Care Policy Effecting Jail and Prison Inmates
Inmates who are servicing sentences in either jail or prison are a vulnerable population
because their health becomes compromised while being in the legal system. However it is true
that inmates do receive some health care while being incarcerated it is not enough to maintain a
healthy lifestyle. This group is an underserved population because, People who end up in prison
systems almost always struggle with chronic, difficult to change healthcare problems such as
chronic mental health issues, substance addiction, proclivity to violent acts, and risky behaviors,
leaving them vulnerable to STIs in general and HIV/AIDS in particular (Harkness & DeMarco,
2012, p. 346). Society needs to eliminate health disparities effecting inmates by coming together
and enhancing our efforts to provide healthier lifestyles for them while being incarcerated.
Population and Health Care Disparity
The inmate community is a growing population who suffers from health care disparities
and maintaining health care needs is a constant challenge. While jails and prisons may provide
access to care due to constitutional mandate, the quality of care in correctional facilities is
variable and has been poorly measured (Binswanger, et. al, 2011). For example, inmates may
experience multiple health care transitions, which can lead to multiple problems. If an inmate has
diabetes and is placed on medications by their community physician and are then detained in a
jail upon an arrest, they may be transferred to a prison. From there they can be transferred again
to another facility, serve time, released to a half-way house, and then are discharged back into
the community on parole. At which time they have seen multiple providers; whom may have
changed, over looked or stopped their medication, which in the end provides poor care to the
individual (Binswanger, et. al, 2011). Health care disparities inflicting on this population are the
following: they are likely to have exaggerated effects in the criminal justice system due to

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

poor transfer of medical, laboratory and pharmacy records, poor communication among
providers, variable access to care, limited family involvement, and inability to afford treatment
(Binswanger, et. al, 2011).
Social Determinants
Race
One would not think that race contributes to healthcare issues found among inmates who
are incarcerated, but this would be wrong. Today people of color continue to be
disproportionately incarcerated, policed, and sentenced to death at significantly higher rates than
their white counterparts (Kerby, 2012). Statistical facts state the following: 1 in every 15
African American men and 1 in every 36 Hispanic men are incarcerated in comparison to 1 in
every 106 white men (Kerby, 2012). Which as we know, African Americans have greater
health issues then white individuals. According to the CDC, Heart disease death rates are more
than 40 percent higher for African Americans than for whites (2013). In which case if an
individual needed medication to help with their heart disease, one would wonder if they will
truly get the proper treatment while incarcerated.
Social Stigma
Social stigma can have a great impact on an inmates health and can lead to
discrimination not only when they are released from jail/prison, but should they seek treatment
while being incarcerated. When an inmate enters the hospital in shackles many nurses and
doctors automatically portray these individuals as bad and will sometimes give limited care to
this individual. This is an unfortunate situation, because nurses and doctors take oaths to treat
everyone fairly, no matter the race, religion, or background.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

Inmates not only struggle with health care issues while being incarcerated; they also
struggle when discharged from jail/prison as well. It has been shown that Convicted felons are
routinely denied employment, housing, access to college, the right to vote, and public benefits
(Ending the Stigma, 2012). If an individual cannot obtain employment how are they expected to
obtain health care benefits and maintain a healthy lifestyle?
Health Care Policy
Health care policies play an important role to inmates in both jails and prisons. The
Eighth Amendment guarantees adequate medical care for prisoners often an expensive
undertaking because many battle addiction and have serious mental health issues. Currently,
counties and states pay for that care. But in January, when the Affordable Care Act expands
Medicaid coverage to men living below the poverty line, the cost of this care shifts to the feds
(Chrise, 2013). It is also being advised that state and county prisoner who need acute care outside
of a prison facility will have cost reimbursed by Medicaid; this is one of reasons that Republican
governors are supporting the Medicaid expansion. The republican governors will be able to
offload these costs to the federal government, who in the end will be paying for the Medicaid
that the prisoners receive.
Health care services are provided to prisons using a standard of medically necessary
care in accordance with court decisions, legislation, accepted correctional and health care
standards, and the MDOC (Michigan Department of Corrections) policies and procedures
(Michigan Department of Corrections, 2013). Those who do not follow these obligations will be
liable in federal court for not meeting the minimal standard of care and these individuals should
receive medical care, just like everyone else. Michigan Department of Corrections (2013) has
stated the following,

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

As a result of concerns over the quality of health care being provided to prisoners
by the MDOC, Governor Granholm ordered an independent comprehensive
review of prisoner health care to assure that the current health care delivery
system meets its commitments of providing quality, medically necessary health
care to prisoners that meets program goals, in an efficient, cost-effective manner.
Improvement is still needed, and prisoners still go without proper health care. A Comprehensive
Assessment of the Michigan Department of Corrections Health Care System identified 56
recommendations for systemic change to improve the effectiveness and efficiencies of MDOCs
health care system (Michigan Department of Corrections, 2013).
Conclusion
In conclusion work is still needed to be done, so that prisoners receive adequate health
care. Social stigma plays a role in how this population gets treated and as nurses we need to help
decrease this stigma, even if it is while they are under our care. Once an individual is discharged
from jail/prisons, the government, health care boards should strive to make sure each individual
get a proper examine and proper treatment should it be necessary. Inmates are a vulnerable
population; these people are around others who may have TB, HIV, Hepatitis, etc... and we need
to take care of them equally just like we would do for someone who has not been to jail/prison.

HEALTH CARE DISPARITIES AND HEALTH CARE POLICY

References
Chrise, M. (2013). ObamaCare to shift costs of some prisoner health coverage from states to feds.
Retrieved from: http://www.foxnews.com/politics/2013/10/09/obamacare-to-shift-costsprisoner-health-coverage-from-states-to-feds/

Center for Disease Control and Prevention (2013). Black or African American Populations.
Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/black.html
Binswanger, I., Redmond, N., Steiner, J., and Hicks, L. (2011). Health disparities and the
criminal justice system: An agenda for further research and action. Journal of Urban
Health: Bulletin of the New York Academy of Medicine, 89(1). doi:10.1007/s11524-0119614-1 Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3284594/pdf/11524_2011_Article_9614.
pdf
Ending the Stigma of Incarceration (Part One): Think Outside the Cell/ VII Photo Partnership
(2012). Retrieved from http://prisonphotography.org/2012/09/24/ending-the-stigma-ofincarceration-part-one-think-outside-the-cell-vii-photo-partnership/
Harkness, G. A., & DeMarco, R. F. (2012). Community and Public Health Nursing Evidence for
Practice. Philadelphia, PA, Lippincott Williams & Wilkins
Kerby, S. (2012). The top 10 most startling facts about people of color and criminal justice in the
United States. Retrieved from
http://www.americanprogress.org/issues/race/news/2012/03/13/11351/the-top-10-moststartling-facts-about-people-of-color-and-criminal-justice-in-the-united-states/
Michigan Department of Corrections. (2013). Health care. Retrieved from
http://www.michigan.gov/corrections/0,4551,7-119-9741_11776---,00.html