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Inmate Health and Public Safety: Researchand Policy Implications
Rebecca E. BlantonSenior Policy Analyst
California Research Bureau
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CA-based Releasee Health, 2009
134,564 inmates paroled/discharged in CA
32,300 people with mental illnesses 17,870 with active or inactive
tuberculosis 9,900 people with Hepatitis C 2,400 people with diagnosed HIV or
AIDS
Debates About Prisoner Health Care
Current Arguments– Morally obligated– Constitutionally obligated – Tax payers should get a good ROI– Prisoners are being punished and
deserve only the most basic health care New Arguments
– Inmate health is a public safety and public health issue
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Overview
Introduction Opening the policy window Prisoner/parolee health and public safety Prisoner/parolee health and public health Future research Conclusions Question and Answer session
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Opening the Policy Window
Problem: (1) Large number of ill inmates released each year, (2) Illness impacts public health and public safety, (3) Costs for not treating illnesses rising.
Policy: Non-prison programs demonstrated to work at reducing crime and benefiting public health.
Political: (1) Public wants criminal justice reform, (2) Public okay with non-prison solutions, (3) New Administration championing evidence-based government, (4) Need to solve CA’s budget crisis.
.
New Policies on Prison Healthcare
Policy Window
New Public Position on Prisons
Prison System Needs Reform
NR, 6%Disagree,
14%
Minor Reform, 31%
Major Reform, 49%
0
20
40
60
80
100
Perc
enta
ge o
f Sa
mpl
ePrevention
WorksNo prison fornon-violentoffenders
Californian's Accept Prevention Premise
Totally Agree
Strongly Agree
Excerpted from Tulchin, Ben. “Public Safety by the Numbers.” Presented at the American Association of Political Consultants Annual Meeting. March 10, 2011. Washington, DC.
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Key Sources of Inmate Health Information
NCCHC. 2002. The Health Status of Soon-To-Be-Released Inmates: A Report to Congress. Volumes 1 and 2.
BJS. 2004. Survey of State and Federal Prisoners.
Rand. 2009. Understanding the Public Health Implications of Prisoner Reentry in California.
Inmate Health
50% of men and 67% of women have chronic health conditions
TB: 4x higher than public Hepatitis C: 10x higher than public HIV: 8-9x higher than public Schizophrenia: 5x higher than public Bipolar Disorder: 3x higher than
public
Disease Transmission to Public
1989: Multi-drug resistant TB spreads from prisons to NYC
1993: Meningitis outbreak spreads from LAC to Los Angeles
1996: 22 percent of all new syphilis cases in Chicago traced back to Cook County Prison.
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HIV/AIDS, Incarceration and the African-American Community
Lifetime HIV infection rates in the African-American Community: 1 in 16 men; 1 in 32 women
28.5% of Black men will enter the criminal justice system sometime in the life
Between 0.9 and 2.4 percent of inmates infected with HIV
Impact on HIV Rates Due to Imprisonment of Black Men
11Johnson, Rucker C. and Steven Raphael. (2006). “The Effects of Male Incarceration Dynamics on AIDS Infection Rates among African-American Women and Men.” National Poverty Center Working Paper Series, #06-022.
Tuberculosis
CA prevalence rate: 13.28 percent 500 inmates with active TB released
each year Evidence TB is transmitted from
inmates to the general public
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Physical Health, Mental Health and Substance Abuse Problems
Among Returning Prisoners
15
30
12
18
72
8
30
1
46
25
14 3
Mental Health Condition15%
Substance Use >1x/wk.66%
Physical Health Condition, 49%
WOMEN MEN
Urban Institute Study (Malik-Kane and Visher, 2008)
Conclusion: Any type of health condition amongst parolees was associated with engaging in criminal activity or a higher likelihood of being reincarcerated.
Ill Releasees Experience…
Less stable housing More difficulty holding a job Women are more likely to live with a
“negative influence” Low income: Men: $900/mo.
Women: $650/mo.
Programs that Help Ill Releasees
Transitional Case Management Program– Reduced Recidivism
Prevention Case Management Program– Reduced Recidivism– Increased condom use and abstinence
among HIV+ participants Mental Health Services Continuum
Program– Reduced Recidivism
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Future Research Questions
Connections between prisoner health and public health
Benefits of continuity of care Risk reduction strategies Cost-Benefit analysis of programs
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Conclusions
Clear public health and public safety implications of prisoner reentry established.
Changing the frame of the debate will get policy people on the same page.
Researchers and policy workers necessary to shift the debate.
Recommended