Death, Disease, & Dehumanization: The Lack of Care in Prison Healthcare

Photo by Astrid Riecken/The Washington Post/Getty Images

The United States is a nation of mass incarceration. With nearly two million people imprisoned, the nation has the highest incarceration rate in the world. These incarcerated individuals are predominantly Black and Brown and poor (Sawyer and Wagner, 2023). Many of those in prison face chronic illness before entering the system, which only exacerbates any pre-existing afflictions (Bolas, 2023). As a result of the expensive, inadequate, and often outright negligent healthcare systems within the nation’s prisons, many incarcerated individuals leave prison sicker than when they entered. Each year that an individual spends in U.S. prisons reduces their life expectancy by two years. The life expectancy of the U.S. would be five years higher if not for mass incarceration (McCann, 2022).  It is imperative that the United States prioritize improving the healthcare system within its prisons, ending the lack of care that imprisoned individuals currently face. 

Like most of the population, incarcerated individuals in the United States must pay a copay—a fee paid by a patient to cover the cost of their treatment—to see a physician. All federal prisons and 40 states charge an average of $2 each time a prisoner wants to see a physician (Avila, 2022). While this price seems low, within the context of the abysmal paychecks prisoners receive for their labor, the cost balloons rapidly. Average prison wages are between 13 and 52 cents per hour, and seven states don’t pay imprisoned workers at all. Prisoners are additionally taxed up to 80% to pay for “room and board,” essentially paying for their own imprisonment (Avila, 2022). As these fees add up, without outside help, accessing care is often out of prisoners’ reach. Not everything is covered by these copays, with medications and additional treatments costing even more. As a result, many incarcerated people refrain from attempting to access care until it is too late (Avila, 2022).

Even if an inmate is able to afford regular access to healthcare in prison, the quality of care is poor. Medical neglect kills hundreds of incarcerated people every year, with prison healthcare staff accusing inmates of lying or exaggerating their symptoms (McCann, 2022). While people outside of prisons already face this issue, the dehumanization of incarcerated people only increases medical neglect. Additionally, incarcerated individuals frequently miss medical appointments, with guards painting this as a deliberate action on the part of the individual. However, often corrections officers refuse to escort them to their appointments, making it impossible for them to attend. In state facilities, more than 20% with a medical condition go without care. In local prisons, the number is over 68% (McCann, 2022). 

Many of those employed in prisons as healthcare staff are unlicensed or barred from practicing medicine. States often allow medical staffers employed in prisons to work even when they have restricted medical licenses (Blakinger, 2021). These employees are barred from working in private practices but are allowed to work in prison medical facilities across the nation. Prisoners are aware that those meant to treat them are unqualified, resulting in many hiding signs of illness or refusing treatment due to a lack of trust in care providers (Blakinger, 2021).

The COVID-19 crisis only exacerbated these issues. At the peak of the pandemic, guards were pressured to come into work sick and knock-off N-95 masks that do not offer protection from the virus were distributed (Blakinger, 2020). Additionally, when the COVID-19 vaccine was first released, people living in congregate settings were given priority. However, some states initially excluded those living in prisons from vaccine eligibility. Overall, nearly 3,000 incarcerated people died from COVID between 2020 and 2022, with many of these deaths attributed to the neglect and lack of care present in prisons (McCann, 2022). Standards for prison health care do exist, but enforcement has been incredibly lax. Organizations like the National Commission on Correctional Health Care set the healthcare service standards for jails and prisons, but participation in their program is optional, with only 17% of facilities in the nation obtaining accreditation (McCann, 2022). 

The current state of the healthcare system within prisons is unacceptable; incarcerated people are left with limited access to care, and those with the means to see a physician are often met with lackluster and negligent care. To improve the living conditions of the incarcerated, the United States must first eliminate the requirement for incarcerated people to pay for their medical treatment. This would expand access and reduce the need for those in prison to choose between necessities and medical attention (McCann, 2022). In Norway, for example, incarcerated individuals never lose access to the universal healthcare available to the rest of the nation (Alcorn, 2021). It is clear that the way Norway conducts its prison healthcare system is far more effective than that of the United States with 66% of Norway’s prison population using the healthcare system (Nesset et al., 2011). 

Oversight should also be improved, ensuring that there is a universal standard for federal, state, and local jails and prisons (McCann, 2022). Finally, the nation’s prison population must be reduced. Many of the most significant health threats come from overcrowding in prisons, which allows for disease to spread easily and overwhelm the already limited healthcare systems, a fact made especially evident during the peak of the COVID-19 virus (Montoya-Barthelemy et al., 2020). By placing an emphasis on the health and wellbeing of prisoners, the United States can adopt a more humane prison system.  

The views expressed in this publication are the author’s own and do not necessarily reflect the position of The Rice Journal of Public Policy, its staff, or its Editorial Board.

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References

Alcorn, Ted. “How Norway’s Prisons Have Weathered a Pandemic: Think Global Health.” Council on Foreign Relations, 12 Mar. 2021, www.thinkglobalhealth.org/article/how-norways-prisons-have-weathered-pandemic. 

Avila, Cecille Joan. “Prison Health Care Is Only Available If You Can Afford It.” Prism, 31 Oct. 2022, prismreports.org/2022/10/31/prison-health-care-hidden-costs/. 

Blakinger, Keri. “Prisons Have a Health Care Issue - and It Starts at the Top, Critics Say.” The Marshall Project, 1 July 2021, www.themarshallproject.org/2021/07/01/prisons-have-a-health-care-issue-and-it-starts-at-the-top-critics-say. 

Blakinger, Keri. “Texas Prison Officers: We Asked for Face Masks in 2017. Covid-19 Got Here First.” The Marshall Project, The Marshall Project, 30 Apr. 2020, www.themarshallproject.org/2020/04/30/texas-prison-officers-we-asked-for-face-masks-in-2017-covid-19-got-here-first. 

Bolas, Mackenzie, et al. “Reviewing the Flaws of U.S. Prisons and Jails’ Health Care System.” Penn LDI, 21 Mar. 2023, ldi.upenn.edu/our-work/research-updates/the-flaws-of-u-s-prisons-and-jails-health-care-system/. 

McCann, Sam. “Health Care Behind Bars: Missed Appointments, No Standards, and High Costs.” Vera Institute of Justice, 29 June 2022, www.vera.org/news/health-care-behind-bars-missed-appointments-no-standards-and-high-costs. 

Montoya-Barthelemy, Andre G, et al. “Covid-19 and the Correctional Environment: The American Prison as a Focal Point for Public Health.” American Journal of Preventive Medicine, U.S. National Library of Medicine, June 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7164863/. 

Nesset, Merete Berg, et al. “Health Care Help Seeking Behaviour among Prisoners in Norway.” BMC Health Services Research, U.S. National Library of Medicine, 4 Nov. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3221636/. 

Sawyer, Wendy, and Peter Wagner. “Mass Incarceration: The Whole Pie 2023.” Prison Policy Initiative, 14 Mar. 2023, www.prisonpolicy.org/reports/pie2023.html.