July 13, 2009

Prisons & Public Health: Why Should You Care?

By Bernice Yeung | Crowdfund this with Spot.Us
Part of the Prisons & Public Health news blog

Ron Sanders, a community-health worker serving former prisoners at San Francisco’s Transitions Clinic, struggles to keep his clients from being among the 66 percent of parolees who eventually return to prison.

No easy task, as many are dealing with addiction, chronic illness, mental health problems — or all of the above. I first became interested in these issues when writing for the San Francisco Chronicle about Sanders, himself a former prisoner who is all to aware of the challenges parolees face.

But why should Californians care about chronically ill prisoner and parolee health? What’s the connection between prison reentry, medical care and our communities?

In fact, there’s a growing awareness of the public health and safety implications of ignoring this population. About 95 percent of the people in prisons or jails will eventually be released. Nationwide, that’s roughly 13 million releases each year — and when they get back home, these men and women aren’t exactly paragons of health.

More than 80 percent of 1,100 parolees from Texas and Ohio reported a chronic illness, according to a 2008 Urban Institute study, and more than 60 percent had no health insurance for nearly a year after release. A third sought medical care in emergency rooms, and 20 percent were hospitalized at one point during their first year out, creating costs that are passed on to taxpayers.

In Rhode Island, a program called Project Bridge connects the dots between parolees and public health, by hooking up HIV-positive parolees with medical care once they’re released.

Writing for Miller-McCune magazine about the program, I note that the moral issue of providing ex-inmates with health care is also a public health imperative:

In February, the Journal of the American Medical Association published the results of a four-year study of 2,000 HIV-positive Texas inmates and found that only 5 percent of parolees filled their prescription soon enough to avoid interrupting their treatment regime. The lack of medical continuity had dire consequences.

“If people are not getting their meds when they get out of prison, there’s a greater risk of medical complications for the patient, that the virus will spread and that drug-resistant strains will develop,” said Josiah Rich, the Project Bridge doctor and one of the authors of the study.

As one physician argued, connecting parolees to care is simply good public policy:

“The strongest argument at the moment (for post-incarceration health care) is not a humanitarian one, it’s an economic one,” said Dr. Robert Greifinger, a distinguished research fellow at John Jay College of Criminal Justice and the editor of the 2007 book “Public Health Behind Bars.”

“If we’re going to drive change in the costs of criminal justice and health care systems,” he said, “one very substantial area to look at is by providing through care for inmates.”

These are the issues I’ll be looking at through this blog, by telling the human stories behind the research, policy and news on inmate reentry and health care in California.

24 thoughts on “Prisons & Public Health: Why Should You Care?

  1. Good article, but you haven’t gone far enough.

    Healthy young men and women are entering prison only to come out with life threatening diseases. This is due in part to the treatment they receive while incarcerated.

    High blood pressure, diabetes and Hep C are just 3 of the illnesses.

    The diet that inmates in California are fed is partially responsible for some of these problems. High in salt and carbohydrates and not enough fresh fruit and vegetables – the diet breeds disease.

    If inmates were fed a healthy diet, it would not only reduce the cost of medical care while in prison, it would lessen the need for immediate care upon leaving prison, thereby lessening the drain on public health resources.

    CDCr will tell you they feed the inmates a healthy diet that is prepared by registered dieticians and follows the RDI and the California Daily Food Guide, but when compared to actual prison menus, there is no comparison to these guides. Not only that, but prisoners are not even fed the amounts that are shown on the prison menus.

  2. @Madhatter
    This is the first in a series of articles. I think in the future posts will continue to delve into the issue. The beauty of blogging a beat.

  3. The blogger says that healthy young men and women are entering prison only to come out or prison with diseases such as diabetis, high blood presure, and Hep-C. I have a tough time believing this nonsense. These so called heathly youngsters and thier families all have choices. The Inmate chooses to eat Ramein noodles every day. The inmate is given the oppertunity to purchase so called decent food from the canteen, yet they order candy bars by the box, they order large bags of chips and chicharones, cookies by the box, Large Quanties of Nacho cheese sauce and tortillas chips so they can have a “SPREAD” with thier hommies every sat. nite. or on holiday. Thier taking the fruit and juices that the state does give them and letting it rot so they can make inmate manufactured alchol “Pruno” Then they sit back watch T.V drink thier alchol and watch for the officers so that thier hommie can get a tatoo from a tatoo gun they all share,the same needle, ink and the inmate manfactured tatoo gun. So I say “cry me a river”, but untill you really know whats going on in the California State Prison System; Save you breath.

  4. Big Mo you seem to have an insider’s knowledge of what happens in prison. Are you an ex inmate? I will grant that some of what you say is most likely true but I think we are talking about two different food groups. You are talking about what can be bought at the canteen and I am talking about the quality and amount of food they are served at scheduled meals. I know that some of the food supplied to the prisons has been in warehouses for years and is old and degraded and can make people sick. Very little is supplied that is healthy like fresh fruit, vegetables or milk. Even water at some of the prisons has arsenic in it and no fresh, clean healthy water is brought in for the inmates. The prisons are overcrowded. This all leads to deplorable conditions that foster illnesses.
    This needs to be changed. We need to start by releasing the sick and dying and paroling lower level prisoners to community based programs that cost less to operate. Two things will be accomplished: overcrowding will be eased and money will be saved at this time when we really need to save it!

  5. I so wish it was as you say big Mo but my husband is currently sitting in a prison hospital with only half a brain and not recieving the needed medical care due to budget constraints. He hasn’t eaten anything in 10 days because his stomach can’t handle that prison food. I worry that he won’t last the month. I talk to staff cry on counslors shoulders leave whimpering messeges on doctors machines that never get returned not everyone in prison gets to do spreads and homies and nacho cheese my husband I am sure would salivate at the thought of a spread but no spreads in his future if there is a future for him left thanks to medical neglect and budget constraints and folks that just think inmates all should be executed but tell that to my babies and my grandbabies who all look just like him and they will stone you they love him and so do I.

  6. I have to agree 110% with the two posters besides big Mo. My husband too is an inmate in a California prison. They do not even get to go to the canteen to order quality food unless they have a loved one in the free world willing to send them $ to do so. We often order them food through vendor/s that supply “goods” only approved by the CDCr and at 50% high than we would normally be able to buy these “goods” for ourselves. The vendors are not allowed to sell many quality foods at that. Fresh fruits & vegetables are a luxury while incarcerated. And they are not all ‘hommies” making spreads and drinking “pruno”. Are you a guard?

  7. do not even get to go to the canteen to order quality food unless they have a loved one in the free world willing to send them $ to do so. We often order them food through vendor/s that supply “goods” only approved by the CDCr and at 50% high than we would normally be able to buy these “goods” for ourselves. The vendors are not allowed to sell many quality foods at that. Fresh fruits & vegetables are a luxury while incarcerated. And they are not all ‘hommies” making spreads and drinking “pruno”. Are you a guard?

  8. As pointed out so well in the article, taking care of our prison population makes economic sense. It does no one any good to look the other way when the spread of disease is so rampant. Not only will it necessitate care once they come back to us, but they will infect people in the society they have reentered. How shortsighted it is to vent anger and frustration against inmates, blame them for being imprisoned, hope they will just die, and “wish” the whole problem away. We need prison reform, as sane approach to rehabilitation and a release of thousands of men and women who pose no threat to us.

  9. The diseases running through the prisons will be brought back into the communities. We all better care and provide clean safe conditions in prisons or we will all pay the ultimate price

  10. Since the prisons are so overcrowded because of the three strikes and mandetory sentencing and the budget has gone dry, the prisoners are the ones that are being punished for this. The CDC union has negotiated with crooked judges and politians to send as many people as posible to prison and now dose not want the responsibilty to take care of them, and no they are not fed properly or enough because the money that is alotted for there food is being used for whatever reason by the ones running the prison. As for health care that also is the states responsibilty to provide them with proper health care.Every one is so ready to put the blame on the prisoners, well put the blame where it really belongs with the Gov and his speacial interest groups that got him elected, he’s going to take care of them and not anyone else, so if all of you are fed up with hearing that prisoners are so well kept then you need to get rid of the Gov and his special interest groups, and the three strikes and mandetory sentencing, because guess what these are actually the ones stealing your money,I dare anyone of you holier than thou to do something, talk is cheap so take action for once in your life ok!!!!!!! PUT BLAME WHERE BLAME BELONGS!!!

  11. Since the prisons are so overcrowded because of the three strikes and mandetory sentencing and the budget has gone dry, the prisoners are the ones that are being punished for this. The CDC union has negotiated with crooked judges and politians to send as many people as posible to prison and now dose not want the responsibilty to take care of them, and no they are not fed properly or enough because the money that is alotted for there food is being used for whatever reason by the ones running the prison. As for health care that also is the states responsibilty to provide them with proper health care.Every one is so ready to put the blame on the prisoners, well put the blame where it really belongs with the Gov and his speacial interest groups that got him elected, he’s going to take care of them and not anyone else, so if all of you are fed up with hearing that prisoners are so well kept then you need to get rid of the Gov and his special interest groups, and the three strikes and mandetory sentencing, because guess what these are actually the ones stealing your money,I dare anyone of you holier than thou to do something, talk is cheap so take action for once in your life ok!!!!!!! PUT BLAME WHERE BLAME BELONGS!!!

  12. I attempted to post my rebuttal this morning, However, I failed in posting it and I lost the blog. I will try again tomorrow. “My Apology to the people and families I may have offended.” Untill tomorrow. The devils advocate.

  13. “The devils advocate”??? Must be a crooked guard. I personally do not want any part of hearing his posts.

  14. Big Mo
    all the canteens and monopoly of package vendors offer is junk food. The prisoners at KVSP are being served casseroles. The diet is made up of too much white flour, potatoes, macaroni and rice. In nutritional terms that all translates to glucose. Then everyone wonders why the prisoners are so ill. There is no oversight and no consequences,not to mention the lack of a loud enough public outcry. But we are all paying for this train wreck

  15. My rebuttal.
    Good Morning. Here is a little clarifacation. I agree that Calif. Prison Medical Health Service needs reform. I agree the connection between prison re-entry, Medical care and our communities are important. I agree that connecting parolees to care is good public policy, and I agree strongly that not only is prison reform a moral issue, but a economic issue.(The strongest argument is)”The strongest argument at the moment (for post-incarceration health care) is not a humanitarian one, it’s an economic one,” said Dr. Robert Greifinger…. Yes, I see much behind the walls of a level three prison yard and the most disturbing thoughts I recall are the faces of the new prison youngsters who are scared but cannot show it, Then There are the elderly and/or chronically ill, and/or mentally ill. Then there are the gang affiliates a.k.a “The Hommies” I referred to in the blog. These gang affiliates young and old are a significant amount of the Population in the Calif. Prison system. One common thread all these groups experience in prison is inadequacies in Prison Medical. Yes it exists, We all know some of the obvious factors that are affecting prison medical reform such as prison overcrowding, lack of funds, misappropriated funds, bad food or lack of nutritious foods, but before you point your finger at any one or any body, do not forget “We the people of California voted on laws that supported and demanded that we be tough on crime. When these laws passed,

  16. “We the people of California voted on laws that supported and demanded that we be tough on crime. When these laws passed, we demanded they be enforced; we demanded they be followed through. Now our past has come back to bite us. Now, to add insult to injury a recent decision of the state to hirer cheaper doctors for all CDCR prisons “To Save Money”. These economic based decisions will affect efforts in prison medical reform. These types of decisions are irresponsible and are not for the betterment of any one. It is a clear indication that as a state “WE” still have not learned from our past mistakes. We are still not handling our business when it comes to Prison Medical Health Reform. I agree taking care of the prison population makes economic sense. I argue that better nutritional food will help the health of inmates in turn will lower medical costs, but this reality is just not happing right now in the current prison system. Now our Gov. Arniee is talking with The Michigan Gov.Jennifer Granholm contemplating a deal to send our inmates (Calif. responsibilities) to Michigan to be housed. People it sounds like a good idea to reduce the inmate population therefore, overcrowding. However, it does not make good economic sense. Forget, the cost for transport or extra staff needed to pull off this stunt. This is not Hollywood. In the end we still have approximately One- hundred and seventy thousand inmates in the care of the CDCR budget. Michigan Gov. says they can house them for aprox. 30-35 thousand dollars a year –vs. – Calif. Average of forty six thousand per year. Is the Michigan Gov. Taking our inmates that need higher level of care or The “Hommies? Is Michigan going to meet there needs for 30,000 yr? I think not. Mich. state corrections will take all our low level offenders that have less than 5year sentence, nonviolent, nonsexual, and no predatory and, non gang affiliated. Calif. Already has over seven thousand inmates housed in private prisons outside of Calif. Every single one of those inmates is a low level offender. No wonder they can house them for 30-35 thousand per year. In the end .We will still have the same amount of prisoners, and California will still have the high cost of medical and the cost to house them “Where is the Savings? Maybe I am short sighted and yes I am frustrated with the whole Prison Medical Disaster. This I call C.D.C.Rrmagedon. I am most definitely not blaming the inmates for the prison medical disaster we have created; We all have choices, Inmates have choices not

  17. This I call C.D.C.Rrmagedon. I am most definitely not blaming the inmates for the prison medical disaster we have created; We all have choices, Inmates have choices not many but some. I say it again, we need to take responsibility for this Prison Health Care Disaster we have created and call prison medical. I do not have the answers, but I do see were some of the problems are: overcrowding, three strikes law, state budget gone dry, CCPOA, misappropriated funds Arniees refusal to cooperate with The Federal Judges orders to fix medical and many more; I do not claim I have the answers, and for what it is worth…My thoughts on prison medical health reform: * I support the following: Release the elderly and sickly that no longer pose a threat to society and upon release give them the same medi-cal or medi-care and/ or welfare services the rest of low economic Californians receive. No programs, we cannot afford another program; give the inmates back to their families .* we can support legislation to reform laws that force prison medical reform on CDCR./. It is public record that Judge Lawrence Karlton a federal Judge has ordered Gov. Schwarzengger to come up with a plan to fix prison medical or release thousands of inmates to allow Medical to do their job and give the inmates the proper and adequate health care they are entitled to under the constitution. *Give all the illegal aliens to the feds let the feds house them and care for them for free., *Take the final parole board decision away from the Gov. and his influences, *and today, instead of shipping the low level inmates to Mich. Send them home. These inmates are usually not problem inmates or a threat to society. (Aka/ programmers). Again I apologize to any person and/or their families, if I have offended them in any way. The mist of the worst economic meltdown in Kalifornia in history is here. Our prisons are over flowing with inmates, the sick, the chronically ill, mentally ill inmates. We have no more money to throw at the problem, and to hide the problem. The problem is inadequate health care for California’s inmate population. We need real solutions. I am not talking about Arnold’s solutions or big corporate Hollywood solutions and stunt shows. I am talking about real people solutions like bringing home your loved ones from prison solutions. We must take back California. I am willing to begin with me. How about you?
    End of my thoughts.

  18. Most of the sources (doctors/public health officials) I’ve been talking to about this issue say that the poor health of inmates starts before prison — it’s a reflection of the health disparities that exist within the communities from which these inmates come. It’s also likely a reflection of drug use/drug addiction among
    the inmate population since Hep C and some cases of AIDS/HIV are likely a result of dirty needles.

    On the other hand, as one commenter noted, it’s also more than possible that some prison behavior — drug use, shared tattoo needs, dining on Ramen noodles — may contribute to an unhealthier prison population. But it’s also likely true that some inmates have to supplement their prison diet with whatever they can find in the canteen.

    These comments have definitely got me thinking, and they’re a good jumping-off
    point for a future post. Thanks for reading and stay tuned…

  19. I have done a little home work. I cannot give any specific details, but I will speak of what I personaly observed while seeking for some truths. First, I found it to be true that the canteen foods, and the foods ordered through outside venders is trash. I personally sat down and browsed through mutiple vender(s)-food catalogs to personally see the choices of food items inmates have to choose and order from. I found it to be true that the choices of healthy foods from these catalogs are few to none. second, I checked the canteen list for last months food order list, and all trash foods. thirdly, I walked down to the dinning hall and observed the meal. I found there was a vegi or something that was suppose to be a vegi. A main item entree, dessert, some type of drink and pkg. coffe. I observed that sometimes the trays looked like they were short an item. I observed sometimes the meal consisted of triple starch. I asked, where is the vegi, Someone responded.., It’s right there the corn. The most disturbing to me was the amount of food the inmate was receiving. Not much for a growing youngster? or for some of the much bigger inmates,/for elderly may-be ok. Newsflash, I am finding it diffacult to believe that inmates are meeting the daily nutritional requirements for a healthy body. I thought I shouls share my observations with you.

  20. I am Canadian therefore my knowledge of the american justice system is limited to Law and Order. It seems a little ridiculous to me to think that all crimes are boiled down to incarceration. I think that people are far more complex. It seems to me that it costs hundreds of thousands to incarcerate one person. Non violent, non predatory, criminals could be taught a lesson in a much more affective manner. The prison system itself, overpopulated creates jobs, some part of this is marketing. If More people are being sent to prison for longer periods of time, whats your solution? Boys love to play cops and robbers. I think the whole system needs to grow up.

  21. I am a student trying to get my associates in Criminal Justice, going to go further but will take time. When I started with these courses I knew that a lot of changes needed to be made in Correctional System but as the classes have progressed I see so much that makes me just want to cry! I do have somewhat of an inside as my fiancee is an ex-con. When he went to prison he had a mild blood disorder that was being controlled by diet and meds. This is things that were denied him while in prison. I met him as he was finishing his sentence and getting out and he asked me to marry him, one week after he asked me he died with a blood clot in his lungs that went from shoulder to shoulder, thank God they were able to bring him back to life. We got lucky. Here is what I know, he started to have trouble walking while still in prison and the doctors response was to put him in a wheel chair. He told them he was in pain and where the pain was and they ignored him, his legs were cold to the touch and the blood clots, they were in his legs, were causing large lumps that could be seen and felt. When he got to the half-way house the doctors continued to ignore him and he still didn’t get the proper diet or meds. The blood clot dislodged and went up through his heart and into his lungs. Since then they have put him on meds, God forbid he die on their watch, but they still continued to give him a poor diet. I asked the doctors what could be done to help him and they told me “we are just waiting for him to die” then told me he had about 5 years. Since then I have got him back on his feet and out of the wheel chair, even though I know in the end he will be back in it, and I monitor his meds and diet closely. If he ever had to go back I know that I would never see him alive again. Where is the fair treatment to prisoners that they like to say is there? It is not and the Department of Corrections has the public blind to that fact because it would look bad on them! It is time we all stood up and said “Enough of this! They are humans too and deserve better treatment than this!” I am tired of seeing the abuses in the correctional system and hope that someday everything I do can make a difference to change some of the problems. No the food is not healthy and no they do not give them very good health care. Why? Because, out of sight out of mind!

  22. Well myself being an ex inmate here in the uk can safely tell u that prisons cause alot of problems for inmates before they are released, all on the pretext of helping them beyond release, truth is the officers can’t be bothered, as some of the prison are gutter snipes but the majority have never lived a normal life, u know a father with a 9 till 5 job and mum at home cooking, alot of prisoners are ex abuse cases and their heads are in bits, thats why they are making such a mess of their lives, and on top of everything else the food is terrible, dripping in fat and additives and if u have Hep or aids ur screwed, unless u know how to work the sysytem but with that many trying to work the system and claw theirselves back to a “normal Life” it’s as it’s always been survival of the fittest, and thats just not fair is it? And to MAREROB I hope ur husband gets some respite and help, any human being no matter where they are desreves the right to be treated health wise just as equally as any other and Big Mo, U aint got a clue mate and u will carry on paying the cost with the rise in ur taxes mate….

  23. Oh and another thing is security that lax in ur prisons in america that ur inmates can get needles in? Because over here ur pounced if u so much as lean across the table on a visit and wether or not they had a good diet before they came isn’t an issue, the state were ever it may be as a duty of care that it aint fullfilling, I could go on and on…….

  24. Everything evens out in the end-the Universe is completely fair and just. Those who are in prison, those who are oppressed, enslaved, tortured and have no free will, or love from others, in their next life-become those who oppress, enslave, torture and have no love for the others who thought it so righteously good to oppress enslave and torture, these unfortunates are given better lives the next time around. Those who are treated the worst return as your politicians, like Bush and Cheney. Even Ron Paul was a prisoner in a past life, he was Eugene Debs. They get their chance to get even-and getting even is never good enough they go far past that to inflict even greater punishment as their revenge. Few human beings can develop a conscience and choose not to do to others the evil that was done to them, most seek retribution of the worst kind. That is why your country is being destroyed. Now that we are at the end of time for people to evolve and most have regressed, very soon when there is no more communication, electricity, water and the world is in its final insane last world war you will see bands of brutal demonic evil killers attacking families all over america-they will have drugs and weapons, and they will be taking their revenge on those who cared nothing for them but to punish and oppress them, they will rule over you in the future-with no regard for your feelings no love for any of you-When they kill you understand these are the prisoners out of the prisons who want revenge for the crimes committed against them, the tables always turn-what you do to others will be done to you. There is no need for prisons, God would never put anyone in prison and punish them, but satan would. Jesus said to forgive and love others as you love yourself. Then shall they also answer him, saying, Lord, when saw we thee an hungred, or athirst, or a stranger, or naked, or sick, or in prison, and did not minister unto thee? Then shall he answer them, saying, Verily I say unto you, Inasmuch as ye did it not to one of the least of these, ye did it not to me. And these shall go away into everlasting punishment: but the righteous into life eternal-if you are like satan and believe in punishment and prisons you will go to satan, only those who love others as they love themselves who forgive and love all others belong with God. People who think prisons are good worship satan not God. People who think war is good worship satan not God. What you do to others will be done to you. Those who smugly destroy other life-will be destroyed in the same way or probably worse because when people like you pay you back they also want to make their vengeance even more unpleasant than your original sin. There is not one person in prison whose crime equals or is even close to equaling the crimes committed against them in america’s brutal and evil prisons. That is why all your empires fall. It all turns around-the wheel of karma. Every cop was or will eventually be a criminal.