Running Head: PROMOTING HEALTH TO PRISONERS 1

Promoting Health to Prisoners

Faith Walker

Professor Kathy S. Faw RN, MSN

Bon Secours Memorial College of Nursing

NUR 3113

November 3rd, 2016

Honor Code “I pledge..”

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Promoting Health to Prisoners

Health matters. Health is defined by the World Health Organization as “a complete state

of complete mental, physical and social well-being and not merely the absence of disease”

(WHO, 2016). Access to affordable healthcare is major determinant in promoting health. One of

the objectives of the Patient Protection and Affordable Care Act is to provide access to quality

health care for vulnerable populations. Vulnerable populations are social groups that experience

limited resources; therefore, resulting in high risk for morbidity and premature mortality.

Prisoners are often looked at as seeming to be of no concern, inconsequential or do not matter

like the rest of society; therefore, are considered a vulnerable population. With the rising

number of prisoners in the United States and their increased risk for substance abuse and mental

illness, this population’s limited access to health care and decreased health literacy has become a

public health issue that must be addressed.

Social Determinants of Health

“Prisoners have higher rates of chronic diseases such as substance dependence, mental

health conditions and infectious disease, as compared to the general population” Rosen,

Grodensky, and Holley (2016). Social determinants of health are factors that contribute to this

distinct health inequity. One of these social determinants is race. Incarceration has become a

disturbingly more common experience for African American males, especially for those without

any college education. “By middle age, black men in the United States are more likely to have

spent time in prison than to have graduated from college or joined the military” Rich, Wakeman,

and Dickman (2011). Another social determinant is access to affordable and quality health care.

In the United States healthcare facilities are not the largest housing facilities of psychiatric

patients but are the jails. Over half of inmates have symptoms of psychiatric disorders as defined
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by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). With this

being said less than 25% of prisoners receive mental health treatment while incarcerated.

According to Dr. Josiah Rich, more than 50% of prisoners meet the DSM-IV criteria for drug

dependence or abuse. This vulnerable population of prisoners have a much more significant rate

of infectious diseases such as HIV and Hepatitis C (Rich et al. 2011). Often times the length of

incarceration can be unpredictable. This can significantly impact treatment planning (Gergelis,

Kole, & Lowenhaupt, 2016). This can attribute to poor or questionable quality of care that is

provided during incarceration. Once prisoners are released back into the community their access

to health care is uncertain (Espinosa & Regenstein,2014). This lack of health care stability and

health insurance coverage after release has been associated with increased rates of re-

incarceration and poor health outcomes (Young & Weinert, 2016). “Existing research suggests

that prior to 2014, most released prisoners did not have health insurance in the eight to ten

months after release” Rosen et al. (2016). Generally, prisoners are released with no more than a

two week supply of medications and no primary care follow-up set up (Rich et al. 2011). This

can negatively affect the prisoner’s ability to reintegrate into society and even complicate their

chances at employment, ultimately increasing their changes of re-incarceration and increasing

their risk of premature death.

Evidence-based Interventions Addressing Health Needs

“The Affordable Care Act (ACA) presents new opportunities to increase initial and

ongoing access to health care for the entire justice-involved population” Espinosa and

Regenstein (2014). Because the ACA is so new there is little research that provides evidence of

addressing the health needs of this vulnerable population, but providing affordable and

accessible health care is a crucial first step in addressing the health challenges that this
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population faces. Medicaid expansion in all states is an essential for this to occur. According to

research “sixty-nine thousand male prisoners with selected chronic conditions would be

ineligible for healthcare coverage under the ACA because of states that chose not to expand their

Medicaid coverage to impoverished adults without disability or dependents” Rosen et al. (2016).

This supports the notion that Medicaid expansion in all states is essential to providing insurance

to the majority of this vulnerable population. Access to affordable quality health care deters

those with chronic conditions from the circling effects of the criminal justice system; therefore,

improving overall public health. This will also decrease the cost of re-incarceration due to

untreated addiction and mental illness. Right now five states spend more money on corrections

than higher education. Evidence shows that alternatives to incarceration such as addiction and

mental health treatment programs are more cost-effective and efficient in tackling the underlying

issues (Rich et al. 2011).

One of the millennium development goals is to combat HIV/AIDs, malaria and other

diseases (United Nations Millennium Development Goals, 2016). As stated earlier, prisoners

have higher rates of chronic disease such as infectious disease compared to the general

population; therefore, by addressing this millennium development goal it would directly impact

the prisoner and improve their health outcomes.

Global Approach in Addressing “Health for All”

Health barriers extend outside the united states. It is imperative to focus on eradicating

these health barriers not just on a national level, but on a global level as well. Healthy People

2020 strives to improve the health of all people. One of their overarching goals is to achieve

health equity. They define this as “attainment of the highest level of health for all people.

Achieving health equity requires valuing everyone equally with focused and ongoing societal
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efforts to address avoidable inequalities, historical and contemporary injustices and the

elimination of health and health care disparities” Disparities (2014). Another one of Healthy

People 2020’s overarching goals is to eliminate preventable diseases. Infectious diseases are a

major global health problem and are preventable. It is imperative that countries work together to

decrease risks from disease outbreaks or health hazards. This can be done by public health

awareness of the signs and symptoms of disease and how to prevent disease. By eliminating

preventable disease such as infectious diseases, optimal health can be obtained for all.

Conclusion

Access to affordable quality health care matters. With the rising number of prisoners, it

is even more imperative to promote health equity and access to affordable quality health care.

Ridding this population of these health barriers will help promote optimal health outcomes, help

this population reintegrate into communities and cutback on re-incarceration rates. One of the

first steps in helping this become a reality is to have all states expand Medicaid funding for the

Affordable Care Act. By doing so, affordable health care will become accessible to this

vulnerable population.
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References

About Healthy People. (2014). Retrieved November 02, 2016, from

https://www.healthypeople.gov/2020/About-Healthy-People

Disparities. (2014). Retrieved November 03, 2016, from

https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

Espinosa, J. F., & Regenstein, M. (2014). How the Affordable Care Act Affects Inmates. Public

Health Reports, 129(4), 369-373.

Gergelis, K., Kole, J., & Lowenhaupt, E. A. (2016). Health Care Needs of Incarcerated

Adolescents. Rhode Island Medical Journal, 99(9), 24-26.

Rich, J. D., Wakeman, S. E., & Dickman, S. L. (2011). Medicine and the Epidemic of

Incarceration in the United States. New England Journal Of Medicine, 364(22), 2081-

2083. doi:10.1056/NEJMp1102385

Rosen, D. L., Grodensky, C. A., & Holley, T. K. (2016). Federally-Assisted Healthcare

Coverage among Male State Prisoners with Chronic Health Problems. PLOS ONE PLoS

ONE, 11(8). doi:10.1371/journal.pone.0160085

United Nations Millennium Development Goals. (2016). Retrieved November 03, 2016, from

http://www.un.org/millenniumgoals/bkgd.shtml

WHO | Health Systems Strengthening Glossary. (n.d.). Retrieved November 01, 2016, from

http://www.who.int/healthsystems/hss_glossary/en/index5.html

Young, D., & Weinert, C. (2016). Promoting Health Insurance and Enrollment Literacy With Jail

Inmates. Corrections Today, 78(5), 74-80.