Evidence Based Public Health Policy and Practice in Correctional Health Care

Correctional health care has undergone dramatic change since 1960s. This paper will focus on the public health principles used to create systems of correctional health care, and the standards for quality, which have allowed governments to adopt policies that meet Constitutional requirements for prison health.

In the mid-20th century, when the health of prisoners was the responsibility of jail and prison wardens, a few public litigators recognized that inmates were being deprived of fundamental rights. Their lawsuits bore fruit; judges found for the plaintiffs, forcing jails and prisons to provide adequate health care. In 1976, the Supreme Court ruled, in Estelle v. Gamble, that prisoners had a Constitutional right to the health care that would be available to them were they not incarcerated.

Estelle v. Gamble obligated every prison system to establish systems of care that met constitutional quality standards. Lawyers brought lawsuits. Public health professionals built systems. Their knowledge of health care administration, epidemiology, the physical environment, and the sociology of the prison community, created programs to provide competent, coordinated quality to prisoners, which continue to evolve.

Three case studies will demonstrate how these principles created correctional health care. The first, prior to Estelle, describes the formation of a state policy and health system for the Massachusetts Correctional Department; a policy based upon inmate needs, service utilization, estimated costs for care, and the medical resources available within the institutions, the outside medical community, and, where necessary, regional academic resources; a system which continues today.

The second describe the evolution of standards. Beginning under the auspices of correctional physicians, they grew with American Public Health Association support. The American Medical Association produced guidelines that become the basis for the National Center for Correctional Health Care Certification, now accepted as the quality standard for care in corrections. As the epidemiology of prisoner health began to unfold, showing that significant public health problems, tuberculosis, HIV/AIDS, hepatitis B, and C, mental health and addiction, etc., were prevalent, the measures of quality evolved apace.

Our third case study expands upon the use of health systems research, environmental health, behavioral health, and the principles of epidemiology to describe a modern state juvenile correctional system in Arizona, surviving amidst expanding admissions, diminishing resources, and exploding costs.