Inmates suffer from chronic illness, poor access to health care

The nation’s prison and jail inmate population struggles with high rates of serious illness and poor access to care, according to the first nationwide study of inmate health and health care.

The research, conducted by Harvard physicians at the Cambridge Health Alliance and Harvard Medical School (HMS) and published today by the American Journal of Public Health, analyzed data collected from U.S. inmates in the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

Nationally, more than 800,000 inmates — 40 percent of the total prison and jail population — reported a chronic medical condition, an illness rate far higher than other Americans of similar age. More than 20 percent of these sick inmates in state prisons, 68.4 percent of jail inmates, and 13.9 percent in federal prisons had not seen a doctor or nurse since incarceration.

The authors also analyzed mental illness care among inmates, both before and during incarceration. While about a quarter of inmates had a history of chronic mental illnesses such as schizophrenia, bipolar disorder, depression, or anxiety, two-thirds of them were off treatment at the time of their arrest. Only after incarceration did most of these people receive treatment.

Other key findings include:

• Compared to other Americans of the same age, the 1.2 million state prison inmates are 31 percent more likely to have asthma, 55 percent more likely to have diabetes, and 90 percent more likely to have suffered a heart attack.

• Access to care was worst in local jails and best in federal prisons; one-quarter of jail inmates who suffered severe injuries received no medical attention, vs. 12 percent in state prisons and 8 percent at federal prisons.

• Inmates with medical problems such as diabetes that require drug treatment often had vital medications stopped after their incarceration, including one-quarter of chronically ill state prisoners and 36.5 percent of ill local jail inmates.

Study co-author Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and a primary care physician at Cambridge Health Alliance, stated, “The U.S. incarcerates more people per capita than any other nation. For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration.”

“A substantial percentage of inmates have serious medical needs yet many of them don’t get even minimal care,” said lead author Andrew Wilper, who currently teaches at the University of Washington School of Medicine. “These prisoners are denied their constitutionally guaranteed right to care.”

Improved management of chronic conditions in prisons and jails may have important implications for community health and the reduction of health care disparities, explained Wilper. “Twelve million Americans are released from incarceration each year. These individuals and the communities to which they return suffer, as many carry with them the costs of untreated illness and preventable disability. Inmates are overpaying their debt to society when they are