Prison Health Care Conclusion

A high incarceration rate comes with both an economic and social price. Housing prisoners is expensive regardless of whether the public or private sector is responsible for providing prison health care. The social costs to the prisoner as well as to his or her family is also substantial. New research focusing on the long-term harm to the children of the incarcerated parent shows that these children are more likely to be adversely affected psychologically. Physically aggressive behavior, social isolation, depression, and problems in school are frequently seen among children with an incarcerated parent. Among five-year-old urban boys, almost half of those who had a father in prison within the previous 30 months were found to have physically aggressive behaviors compared with 38 percent of those who did not have a father imprisoned.[45]

Christopher Wildeman, who has been studying the “incarceration generation,” has sounded the alarm that parental imprisonment is a new U.S. childhood risk, particularly so among minority children and children of parents with low education.

It is estimated at more than 1.5 million children have a parent in prison (usually a father, but it not uncommon for the mother to be in prison). A child born in 1990, for example, was more likely to have had a parent in prison by age 14 than one born in 1978. This is particular1y so for black children compared with white children.

One in four black children compared with 1 in 25 white children had a father in prison by the time they were 14 years old.[45]

Another equally disturbing trend is the record number of inmates serving life sentences. The Sentencing Project, a group that calls for the elimination of life sentences without parole, looked at increases in life sentences from 1974 to 2008. In 2008, 140,610 of the 2.3 million inmates incarcerated in the United States were serving life terms. This translates into one in every six inmates in the United States serving a life sentence; and in California, the number is one in every five prisoners.

In Alabama, Massachusetts, Nevada, and New York, the number is one in six prisoners serving a life sentence.[46] The rising number of inmates serving life terms is placing a strain on the corrections’ budgets. As prisoners serve longer sentences, the number of aging inmates has risen sharply, and these older inmates cost more than younger prisoners because the former have more health needs. This trend seems to indicate a retreat or even an abandonment of the rehabilitative or “corrective” function of prison.

Addressing the serious issues surrounding the provision of prison health care will take economic as well as political will. The public health case for action is clear, but the political commitment seems weak or nonexistent. In 1995, the WHO Health in Prisons Project (HIPP) tried to address the gap between public health and prison health. HIPP’s main objective is to reduce the public health hazards associated with prisons along with protecting and promoting health in prisons by facilitating links between prison health and public health systems at the national and international level. In 2003, a Steering Group for Prisons and Health was established to act as an international steering committee for HIPP and to enhance international cooperation within the network. While laudable, much still remains to be done.

In 2005, WHO distributed what an editorial in the Lancet called one of the most important documents on prison health ever published.[47] The report, “Status Paper on Prisons, Drugs, and Harm Reduction,” showed that infectious disease transmission in prisons can be prevented by simple and inexpensive harm-reduction strategies. Harm-reduction efforts in prisons aim to prevent or reduce the negative health effects associated with prison (overcrowding, spread of infectious diseases, mental health problems). Although intuitively simple and logical, sadly there is little political pressure to at least try these initiatives. Out of sight, out of mind seems to be the prevailing thinking when it comes to prison health reform. Certainly the provision of health care to inmates has improved, but much more still needs to be done.
Whether privatization of prison health care will be successful is yet to be shown.

Whether harm-reduction efforts will be introduced in prisons also remains to be seen. Meanwhile, infectious diseases transmitted or exacerbated in prisons have the potential to become full-blown public health problems when prisoners return to their communities.


The United States has the highest documented incarceration rate in the world. As of year-end 2009 the rate was 743 adults incarcerated in prisons and jails per 100,000 population. At year-end 2007 the United States had less than 5% of the world’s population and 23.4% of the world’s prison and jail population (adult inmates).

By comparison the incarceration rate in England and Wales[clarification needed] in February 2011 was 154 people imprisoned per 100,000 residents; the rate for Norway in May 2010 was 71 inmates per 100,000; Netherlands in April 2010 was 94 per 100,000; Australia in June 2010 was 133 per 100,000; and New Zealand in October 2010 was 203 per 100,000.

A 2008 New York Times article points out:

  Still, it is the length of sentences that truly distinguishes American prison policy. Indeed, the mere number of sentences imposed here would not place the United States at the top of the incarceration lists. If lists were compiled based on annual admissions to prison per capita, several European countries would outpace the United States. But American prison stays are much longer, so the total incarceration rate is higher. ... “Rises and falls in Canada’s crime rate have closely paralleled America’s for 40 years,” Mr. Tonry wrote last year. “But its imprisonment rate has remained stable.”

Historically, incarceration rate in the USA for federal and state prisons in 2007 was the highest on record. It was 5.5 times greater than the sharp peak that occurred during the Great Depression at 137 per 100,000 in 1939.



Madelon L. Finkel, PhD
Madelon L. Finkel, PhD, is professor of clinical public health and director of the Office of Global Health Education at the Weill Cornell Medical College in New York City, NY. Dr Finkel is an epidemiologist whose work focuses on women’s health issues. Her interests also include global public health issues with ongoing research projects in rural India and Peru. Dr. Finkel has published extensively, including Praeger’s Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening and Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide.



  1. Walmsley R. World prison population list. 7th ed.
  2. Wikipedia. Prisoner population rate 2007-2008.
  3. Mauer M. Comparative international rates of incarceration: an examination of causes and trends: Presented to the US Commission on Civil Rights; June 20, 2003; Washington, DC.
  4. US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Correction statistics.
  5. Ibid.
  6. Federal Bureau of Investigation. FBI uniform crime report.
  7. Maruschak LM for US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Medical problems of prisoners.
  8. Griefinger RB, Heywood NJ, Glaser JB. Tuberculosis in prison: balancing justice and public health. J Law Med Ethics. 1993;21:332-341.
  9. World Health Organization. Tuberculosis in prisons.
  10. Shalit M, Lewin MR. Medical care of prisoners in the USA. Lancet. 2004;364:34-35.

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