Federal prison records in 2000 showed that 4.4% of inmates suffered from asthma; 0.9% of inmates in the 1997 survey reported asthma as a medical problem; data for 1998 for the general public showed that 8.9% of the public suffered from asthma. Fewer prisoners report ailments than prison records show that they have, and, with the exception of HIV/AIDS, prisoners experience lower incidents of ailments than the general public. The data shown here are, of
TABLE 6.1
Inmate deaths in state prisons, by cause, 1995 and 2002
| Deaths of state inmates | ||||
| Number* | Rate per 100,000 inmates | |||
| Cause of death | 2002 | 1995 | 2002 | 1995 |
| Total | 3,105 | 3,133 | 246 | 311 |
| Natural causes other than AIDS | 2,405 | 1,569 | 190 | 156 |
| AIDS | 215 | 1,010 | 17 | 100 |
| Suicide | 166 | 160 | 13 | 16 |
| Accident | 41 | 48 | 3 | 5 |
| Execution | 70 | 56 | 6 | 6 |
| By another person | 53 | 86 | 4 | 9 |
| Other/unspecified | 155 | 204 | 12 | 20 |
| *Detail may not add to total due to rounding. | ||||
TABLE 6.2
Inmate deaths in federal prisons, by cause, 2001–02
| Deaths of state inmates | |||||
| Number* | Rate per 100,000 inmates | ||||
| Cause of death | 2002 | 1995 | 2002 | 1995 | |
| Total | 335 | 303 | 207 | 198 | |
| Natural causes other than AIDS | 289 | 247 | 179 | 162 | |
| AIDS | 17 | 22 | 11 | 14 | |
| Suicide | 17 | 18 | 11 | 12 | |
| Accident | 5 | 6 | 3 | 4 | |
| Execution | 0 | 2 | 0 | 1 | |
| By another person | 3 | 8 | 2 | 5 | |
| Other/unspecified | 4 | 0 | 2 | 0 | |
| *Detail may not add to total due to rounding. | |||||
course, for different years and are therefore only indicative of patterns. Asthma illustrates well the differences between the prison population—predominantly young adults—and the general public. The prevalence of asthma is much higher in the general public, which includes children and seniors; children are absent from prison, and seniors are underrepresented. Diabetes, heart disease, and high blood pressure (hypertension) are conditions that manifest later in life, hence the lower levels of such diseases in the prison population. The one sexually transmitted disease charted (HIV/AIDS) is substantially higher in prison than in the general public: 1% of federal inmates had been diagnosed with the condition compared with 0.18% of the general public as determined by the Centers for Disease Control and Prevention (CDC).
TABLE 6.3
Medical problems among federal inmates and in the general public, 1997, 1998, 2000
| Percent of federal inmates | |||
| Medical problem | Official records, midyear 2000a | 1997 survey data | Percent of general public, 1998b |
| Asthma | 4.4% | 0.9% | 8.9% |
| Diabetes | 3.6 | 1.5 | 6.2 |
| Heart | 2.6 | 1.3 | 11.4 |
| High blood pressure | 7.8 | 1.7 | 19.0 |
| HIV/AIDS | 1.0 | 0.5 | 0.178d |
| Mental health | 4.8 | 4.8 | — |
| a Based on the clinical status on July 29, 2000, except for asthma, which was counted on September 20, 2000. Inmate totals were based on average daily population in each month. | |||
| b Unless otherwise noted, values are from J.R. Pleis and R. Coles, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 1998, National Center for Health Statistics. Vital Health Statistics 10(209). 2002. | |||
| c Value is for 2000 from National Diabetes Information Clearinghouse, National Institutes of Health, obtained from http://www.niddk.nih.gov/health/diabetes/pubs/dmstats/dmstats.htm#7. | |||
| d Value is for 2001 from "Table 1: Persons reported to be living with HIV infection and with AIDS," in HIV/AIDS Surveillance Report, 2001; 13 (No. 2), Centers for Disease Control and Prevention, Atlanta, GA, accessible at http://www.cdc.gov/hiv/stats/hasr1302/table1.htm. Rate calculated using 2001 population projections, middle series, from the U.S. Census Bureau. | |||
| —Not reported. | |||
The prisoners, assessing themselves, significantly underestimated their actual medical problems compared with measurements taken in prison infirmaries and hospitals. The exception was mental health problems. The most common form of diabetes, late-onset Type II, takes a long time to result in symptoms and requires blood-sugar testing for early detection. Only prisoners who experienced acute heart episodes were likely to know they had problems. Similarly, high blood pressure does not have symptoms.
These data are for the federal prison population, which is a small part (11%) of the total prison population. With the exception of data on HIV/AIDS, the absence of data for the larger state prison population (data such as those shown in Table 6.3) illustrates indirectly some of the problems with health care in prisons. However, there have been several selective studies done of health care in prisons nationwide or in particular state prisons. In 2004 the BJS released statistics about the screening for and treating of hepatitis C in state prisons. Hepatitis C is a virus that can cause lifelong infection, cirrhosis (scarring) of the liver, cancer, liver failure, and death. It is spread most often through infected blood transferred by shared needles when using illegal drugs. Allen J. Beck and Laura M. Maruschak of the BJS reported in Hepatitis Testing and Treatment in State Prisons (April 2004) that 1,209 of the 1,584 state public and private prisons had
TABLE 6.4
Testing for hepatitis C in state prisons, July 1, 1999–June 30, 2000
| Facilities | Inmates | |||
| Testing | Number | Percent | Number | Percent |
| Total | 1,584 | 100% | 1,194,279 | 100% |
| Tests conducted | 1,209 | 79.0% | 1,113,035 | 94.3% |
| Broad coverage | 132 | 8.6% | 71,208 | 6.0% |
| All at some time | 73 | 4.8 | 29,951 | 2.5 |
| At admission | 61 | 4.0 | 38,540 | 3.3 |
| Random sample | 27 | 1.8 | 29,117 | 2.5 |
| Targeted group only | 1,064 | 69.5% | 1,033,862 | 87.6% |
| High risk | 492 | 32.1 | 566,369 | 48.0 |
| Upon inmate request | 604 | 39.5 | 666,004 | 56.4 |
| Clinical indication | 1,000 | 65.3 | 1,023,368 | 86.7 |
| Other | 13 | 0.8% | 7,965 | 0.7% |
| Do not conduct tests | 322 | 21.0% | 66,822 | 5.7% |
| Not reported | 53 | 14,422 | ||
| Note: Detail may sum to more than total because facilities may report more than one policy. | ||||
TABLE 6.5
Confirmed positive hepatitis C tests among state and federal inmates, July I, 1999–June 30, 2000
| Hepatitis C tests | ||
| Testing policy | Number | Percent positive |
| Any | 57,018 | 31% |
| Broad coverage | 9,165 | 27 |
| Targeted group only | 46,479 | 33 |
| Other | 1,374 | 4 |
tested inmates for hepatitis C between July 1, 1999, and June 30, 2000. (See Table 6.4.) Of the 1,584 total state facilities, 69.5% of them tested only those prisoners who were targeted as being at high risk from the disease; 4.8% tested all prisoners in some way. Table 6.5 shows that regardless of approach, those state prisons where testing was done for hepatitis C found that an average of 31% of prisoners had the disease.
A more wide-ranging study of prison health was conducted by the Department of Pediatrics, University of Texas Health Science Center at San Antonio. The Disease Profile of Texas Prison Inmates (April 2002) examined 170,215 inmates who were in the Texas prison system any time between August 1997 and July 1998. Based on the initial medical examination each prisoner received upon entering the system, and any subsequent visits for medical treatment, the study showed that 29.6% of the prisoners had an infectious disease, 14% displayed a disease of the circulatory system, and 10.8% had a mental illness. The most common infectious disease was tuberculosis. (See Table 6.6.)
In 2002 the National Commission on Correctional Health Care, a nonprofit organization, identified some of the problems involved in measuring prisoners' health and delivering services. The following four items are quoted from the NCCHC's Report to Congress, taken from page xiv. The issues highlight barriers to effective prevention, screening, and treatment:
- Lack of leadership, such as failure to recognize the need for improved health care services, reluctance to consider that improving public health is a correctional responsibility, and unwillingness of public health agencies to advocate for improving correctional health care or to collaborate to promote improvement.
- Logistical barriers, such as short periods of incarceration, security-conscious administration procedures for distributing medications, and difficulty coordinating discharge planning.
- Limited resources that require difficult budgeting decisions to meet the high cost of many health care services and some medications, and that make it difficult to provide adequate space for medical services.
- Correctional policies, such as failure to specify minimum levels of required care in contracts with private health care vendors, delays caused by the need to escort inmates to medical treatment, poor communication between public health agencies and prisons and jails, and lack of adequate clinical guidelines.
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