SAN ANTONIO, Texas -- Inadequate healthcare in U.S. correctional facilities poses a serious threat to the nation's public health, announced the National Commission on Correctional Health Care (NCCHC) today at this year's National Hepatitis Coordinators' Conference, calling for improved healthcare delivery and access in the corrections system. The findings are part of a landmark report commissioned by Congress to assess the health status of prison inmates, which concluded that serious diseases affecting inmates, such as hepatitis, if left undiagnosed and untreated, can be easily transmitted to the thousands of daily visitors, the half million correctional employees, other inmates, and members of the larger community once infected inmates are released.
"Prisons and jails offer uniquely important opportunities for improving disease control in the community by providing healthcare and disease prevention programs to a large and concentrated population of individuals at high risk for disease," noted Robert B. Greifinger, MD, co-author of the report. "We are confident that if all state correctional facilities implement certain improvements in the delivery of healthcare, such as instituting vaccination programs to prevent hepatitis and other communicable diseases, it will have a profound effect on the overall public health."
The NCCHC recommends that correctional facilities conduct surveillance of communicable and chronic diseases and mental illness. Prisons and jails should follow nationally accepted clinical guidelines for preventing, diagnosing, and treating diseases among inmates. They should link with programs that support continuity of care on release to reduce costs and limit the transmission of disease in the community. Moreover, in order to protect prison inmates and the public from vaccine-preventable communicable diseases, such as hepatitis A and B, the NCCHC calls for a federally funded national vaccine program in corrections facilities.
With more than 11.5 million inmates released in 1998 alone, Congress instructed the U.S. Department of Justice to determine whether existing concerns that ex-offenders may be contributing to the spread of communicable disease in the community was well founded. The resulting study, which was conducted under a cooperative agreement between the National Institute of Justice (NIJ), the research and evaluation arm of the U.S. Department of Justice, and the NCCHC, revealed disturbing findings:
-- A significant proportion of prisons and jails do not adhere to the recommendations of the Centers for Disease Control and Prevention (CDC) with regard to screening for communicable diseases and most systems do not follow nationally accepted guidelines for chronic disease and mental illness.
-- Despite the 1982 recommendations of the CDC's Advisory Committee on Immunization Practices to vaccinate all long-term inmates against hepatitis B, few state systems have implemented vaccination programs. As a result, in 1996 alone, more than 155,000 prison inmates with current or chronic hepatitis B were released into the community.
Many correctional agencies are not doing enough to address communicable disease, chronic disease, and mental illness.
-- Despite the fact that the prevalence of AIDS is five times greater in jails and prisons than in the U.S. population, few systems have implemented comprehensive HIV prevention programs.
-- On average, less than one quarter of jail inmates undergo routine laboratory testing for syphilis while incarcerated. In some jails, only 2 to 7 percent of inmates are actually tested.
-- More than 90 percent of State and Federal prisons, and about half of jails, routinely screen at intake for latent TB infection and active TB disease. However, particularly in jails, many inmates are released before skin tests can be read. Most prisons and jails report they isolate inmates with suspected or confirmed TB disease in negative pressure rooms. However, some facilities do not test the rooms to ensure that the air exchange is working properly or continue to use the rooms even when the air exchange is known to be out of order.
Less than half of the state departments of corrections surveyed reported having surveillance data on the number of inmates with chronic diseases.
-- The NCCHC estimates that the prevalence of asthma among Federal,
State, and local inmates to be between 8 and 9 percent, for a total
that exceeds 140,000 cases nationwide, making the prevalence rates
for asthma higher among inmates than in the total U.S. population.
-- The prevalence of diabetes is estimated to be about 5 percent, for a
total of nearly 74,000 inmates with diabetes.
-- Over 18 percent of inmates are estimated to have hypertension, or a
total of over 283,000 inmates.
Prevalence of mental illness is significant among incarcerated persons.
-- An estimated one percent of offenders booked into jails have
schizophrenia or other psychotic disorders; about 8 to 15 percent
have major depression
-- An estimated 2 to 4 percent of inmates in State prisons have
schizophrenia or other psychotic disorders, over 18 percent have
major depression and between 22 and 30 percent have an anxiety
A significant proportion of prisons and jails neither measure nor
adhere to national standards for access and quality care.
-- Only 24 state correctional systems reported they had protocols for
diabetes, 25 for hypertension, and 26 for asthma. A content analysis
revealed that many of these "guidelines" were incomplete or
-- In addition, 40 percent of jails and 17 percent of prisons do not
provide recommended mental health evaluations.
-- Approximately 58 percent of jails do not provide psychiatric
medications, 57 percent do not have crisis intervention services,
and 28 percent of jails do not have access to inpatient
The NCCHC is a not-for-profit, 501 (c)(3) organization committed to improving the quality of care in our nation's jails, prisons, and juvenile detention and confinement facilities. The Commission is supported by 36 national organizations representing the fields of health, law, and corrections.
Source: National Commission on Correctional Health Care