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.

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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.