Prison Health, Public Health: Obligations and Opportunities

Abstract

Prison and jail populations are at record highs after twenty years of increasingly tougher sentencing laws. Simultaneously, government revenues are strained as a result of anti-tax sentiments. The result is too often inadequate and dangerous prison health care. The problem is very large, but not very new. American prisoners in all eras have suffered unhealthy conditions. Prison reformers from the founding of the Republic have argued for conditions reform on humanitarian grounds, and on the grounds that rehabilitation suffers when conditions are inhumane. Those arguments have not achieved significant improvements. More recently, the civil rights revolution of the 1960s and 1970s fostered a flowering of prison litigation based on the prisoners' own rights. After a brief period of expansion, the Court's and legislatures' anti-prisoner reactions have rendered prison litigation difficult to pursue and prisoners' rights difficult to vindicate. This paper argues for a new vision of prison health reform. It argues that reform arguments should couple humanitarian impulses with pragmatic concerns. Almost all prisoners are eventually released. Poor prison health care is increasingly creating public health risks to the general population, and in particular to the communities to which prisoners return. Failure to treat chronic conditions and mental illness creates strains on community health providers and families, and causes recidivism. Failure to properly treat communicable diseases such as tuberculosis, HIV disease, hepatitis C, and syphilis harms the public more directly by exposing them to infection. The danger of the infection can be enhanced by poor prison care, as inconsistent treatment can produce treatment resistant microbes, allowing extremely deadly tuberculosis and HIV microbes to spread on prisoners' release. Prison health reform is therefore a selfless and a selfish act, as it protects the health of both prisoners and society more broadly. The paper finally sketches out some legal theories that may be brought to bear in forcing reform of prison health services.