September 16, 2015 - 13:59
Research Question:
What factors (social, physical and ethical/philisophical) impact the breakdown of medical care in prison systems?
My major interests and career goals have always been focused on public health and accessibility to health care. Over these past few years I have been increasingly concentrating on health accessibility in marginalized communities around the world and the greater global impact of the general lack of health care for certain communities. However, I have most often been absorbed with communities of low socio-economic status who live in very rural areas and how they cope with health issues when the closest health provider is anywhere from 30-100 km by bike. I have yet to examine the ethical debates surrounding health care access in prisons and what that might look like.
Major Questions:
- It is a well-studied notion that vast majority of people who are incarcerated do not receive the health care they need. One of the major questions that I hope to address focuses on the social (both inside and outside the prison), physical and ethical/philosophical components that perpetuate this problem and whether or not there is a solution that can be prescribed.
- One of the main ethical questions concerning health care in prisons is whether or not the health care that covers incarcerated people should be the same health care that covers un-incarcerated people, and then who should pay for it?
- How is the aging prison population affecting the way that we pay for healthcare in prisons, the relevance of the healthcare available, and how is it perpetuating the massive gaps in prison health care?
Sources:
The Health and Health Care of US Prisoners: Results of a Nationwide Survey
Andrew P. Wilper, MD, MPH, Steffie Woolhandler, MD, MPH, J. Wesley Boyd, MD, PhD, Karen E. Lasser, MD, MPH, Danny McCormick, MD, MPH, David H. Bor, MD, and David U. Himmelstein, MD
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661478/
This article quantifies the prevalence of chronic illness, including mental illness in prison systems in the United States. It then examines whether or not inmates who are affected by chronic illness receive care. This paper concludes that the vast majority of inmates do not receive the care that they need while incarcerated.
Paying the Price: The Pressing Need for Quality, Cost and Outcomes Data to Improve Correctional Healthcare for Older PrisonersCyrus Ahalt, MPP,1 Robert L. Trestman, PhD, MD,2 Josiah D. Rich, MD, MPH,3,4 Robert B. Greifinger,5 and Brie A. Williams, MD, MS1,6
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661478/
Because the United States incarcerates such mass quantities of people, and because the prison system is often an incredibly inefficient and long process often compounded by erroneously long sentences, there is an aging crisis among prison populations. This article examines the cost effectiveness of providing adequate and relevant care to elderly inmates while asserting that this would reduce the burden of paying for the over-use of acute health-care resources that are so often the default in communities that former inmates often return to.
Nursing care of prisoners: staff views and experiences.
Powell J1, Harris F, Condon L, Kemple T.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2010.05296.x/epdf
Nurses are the lynchpin of medical care in prisons. They provide the majority of care that imamates receive and often have insights into the prison medical care system that others are not privy to. This article examines the experiences of the nurses who provide care to inmates in an attempt to glean a better understanding of how the system could be made better, and what it is doing well currently.
Additional Reading
TRANSGENDER MILITARY INMATES' LEGAL AND CONSTITUTIONAL RIGHTS TO MEDICAL CARE IN PRISONS: SERIOUS MEDICAL NEED VERSUS MILITARY NECESSITY
Tasha Hill
Medical Care in Prisons
Douglas C. McDonald
Questions that remain:
Specifically what type of health care do I want to focus on? HIV healthcare, MDR TB healthcare, trans health care, geriatrics health care etc. Are there multiple types of health care that feed into one another and can be studied in conjunction. (ex: HIV and TB co-infections in prisons are in incredibly pervasive issue)
Once I have chosen a more focused part of the health care system, which types of factors should I be focusing on? Physical barriers to health care, social barriers to health care, or philosophical or ethical barriers.