Incarceration Case Study Analysis

Mass Incarceration as a Public Health Issue

Mass incarceration is a public health issue, and it aggravates health inequity in the United States. Jails and prisons are high-risk places for the transmission of infectious diseases because they are congested, offer poor health care, and are dirty. The COVID-19 epidemic uncovered the weaknesses, and some of the most affected infection rates in the United States are in the corrections. The prisoners also suffer from more episodes of chronic diseases, such as diabetes, hypertension, and psychiatric illness, and are offered substandard care in comparison to the general population: Incarceration Case Study Analysis.

Racial minorities, such as Blacks, Latinos, and Native Americans, who already face significant healthcare barriers, are disproportionately affected by mass incarceration (Cloud et al., 2022). After prison, individuals suffer from reintegration issues, having no health care coverage, regular housing, and employment, and their health outcomes are also negatively affected. The solution to mass incarceration as a public health issue lies in decarceration, quality improvement in the health care in the corrections, and the continuance of care after prison.

Implications of Compassionate Release

Compassionate release is a program allowing the release from prison, prior to the end of the sentence, of terminally and medically at-risk prisoners to offer them compassionate end-of-life care. The program, aimed at balancing public security and morality, remains highly restrictive regarding application. The process requires evidence of a life expectancy of six months or less, causing significant barriers to prisoners who are incapacitated by diseases.

During the COVID-19 pandemic, compassionate release was an effective and ineffectual tool to slow the virus transmission in the prison populations, releasing only 156 among 10,940 applicants (James et al., 2022). The program’s ineffectiveness identifies the inefficiencies in the healthcare and prison systems. The eligibility criterion, the approval process, the integration into society, and the appropriate medical and social care in the community could all be streamlined to enhance the efficacy of compassionate release and ease the morality concerns in the processing of prisoners who are severely ailing.

Actions that Will Have the Most Significant Impact on Public Health

Among the proposed strategies to promote public health among the prisoners, the most effective strategy would be to increase discharge planning. Many people released from prison are at higher risks of hospitalization and death because they are denied medical care, medication, and support. Research has found that ex-convicts are 3.6 times more likely to die from complications arising from drug overdoses and other chronic diseases as compared to the normal population.  Consistently, pre-release screening for COVID-19, 90-day medication, and linkage to primary care and mental health care immediately are some effective discharge planning strategies.

Giving them consistent housing, food assistance, and job support would also increase long-term health and well-being. Further, greater access to telehealth care among the released individuals would also increase the use of healthcare services (Haleem et al., 2021). By treating immediate and long-term healthcare problems, comprehensive discharge planning decreases recidivism, emergency hospitalization, and overall public health outcomes among at-risk populations.

Policies that Could be Enacted to Address the Gap in Coverage

The Medicaid Inmate Exclusion Policy excludes the inmates from getting the coverage and the benefits under Medicaid and Medicare, leaving them uncovered during the prison period. This disproportionately affects individuals living in poverty and the pre-charge detainees who are unable to pay the necessary bail, leading to a vast healthcare coverage gap. Reforms to suspend and not terminate the coverage during the prison period and to resume immediately at the end are the required solutions.

A few states have already used this strategy and have reported significant savings in emergency care by reducing the associated expenditure. Extending the coverage under the eligibility under Medicaid to the period 30 days before a discharge from prison also ensures healthcare continuity and the necessary treatments and care become accessible to them at the point of reintegration (Albertson et al., 2020). Automatic re-enrollment in case of discharge from prison also ensures timely medical care.

Improving the Health of Incarcerated or Recently Released Individuals

The COVID-19 epidemic exposed the glaring loopholes in prison healthcare infrastructure and provided valuable lessons in the improvement in the health status among the incarcerated and the recently released. The prison overcrowding propagated the virus at a high rate, highlighting the need to decarcerate through diversion from prison to community-based care and compassionate release. The epidemic also highlighted the need to control infection in the prison, including improved hygiene, frequent disease screening, and appropriate medical personnel (Waddell et al., 2024).

The increased deployment of telemedicine among prisoners also seemed to be an effective tool for providing healthcare, and it should be included in the prison healthcare infrastructure forever. Improvement in reentry through the provision of housing, employment, and social services at the point of prison discharge is another necessary lesson in light of the majority having faced reintegration problems during the epidemic. Further enhancing mental health and substance use disorder treatment programs would aid in the improvement of this vulnerable group’s health milestones.

References

Albertson, E. M., Scannell, C., Ashtari, N., & Barnett, E. (2020). Eliminating gaps in Medicaid coverage during reentry after incarceration. American Journal of Public Health, 110(3), 317–321. https://doi.org/10.2105/ajph.2019.305400

Cloud, D. H., Garcia-Grossman, I. R., Armstrong, A., & Williams, B. (2022). Public health and prisons: Priorities in the age of mass incarceration. Annual Review of Public Health, 44(1). https://doi.org/10.1146/annurev-publhealth-071521-034016

Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2(2), 100–117. https://doi.org/10.1016/j.sintl.2021.100117

James, J. E., Foe, M., Desai, R., Rangan, A., & Price, M. (2022). COVID-19 and the reimaging of compassionate release. International Journal of Prisoner Health. https://doi.org/10.1108/ijph-08-2021-0072

Waddell, C., Meehan, A., Schoonveld, M., Kaplan, Z., Bien, M., Bailey, C., Mosites, E., & Hagan, L. M. (2024). Lessons learned from COVID-19 response in correctional and detention facilities. Emerging Infectious Diseases (Print), 30(13), 5–12. https://doi.org/10.3201/eid3013.230776

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Assignment #5

PH 528

Directions: Read the “Incarceration Case Study”, which outlines policy efforts to address public health in prisons and among incarcerated populations. Respond to the following questions, with each response a minimum of 150 words.

Due Date: Upload your assignment to Blackboard as a .doc or .docx file by 11:59 PM on Sunday 2/26.

Incarceration Case Study Analysis

Questions:

1. Is mass incarceration a public health issue? Does it contribute to/exacerbate health inequity in the U.S.? Provide reasoning for your responses.

2. Discuss the implications of compassionate release, which is a policy that allows people with terminal illnesses to be released from prison before their sentences are served.

3. The article discusses the role of clinicians, correctional health systems, and community health systems in improving public health in this vulnerable population. Which action discussed do you think will make the biggest public health impact?

4. When Medicare or Medicaid beneficiaries are incarcerated, they are ineligible for benefits because of their incarceration status. What policies could be enacted to address this gap in coverage? You may discuss your personal opinions or the suggestions by the article authors.

5. How can we use lessons learned from the COVID-19 pandemic to better the health of individuals who are currently incarcerated or recently released?

Case Study Source: Wang, E.A., Western, B., & Berwick, D.M. (2020). COVID-19, decarceration, and the role of clinicians, health systems, and payers: A report from the National Academy of Sciences, Engineering, and Medicine. JAMA, 324(22), 2257-2258.