1. Inmate Health and Public Safety: Research and Policy Implications
Rebecca E. Blanton
Senior Policy Analyst
California Research Bureau

2. CA-based Releasee Health, 2009
134,564 inmates paroled/discharged in CA
32,300 people with mental illnesses
17,870 with active or inactive tuberculosis
9,900 people with Hepatitis C
2,400 people with diagnosed HIV or AIDS

3. Debates About Prisoner Health Care
Current Arguments
Morally obligated
Constitutionally obligated
Tax payers should get a good ROI
Prisoners are being punished and deserve only the most basic health care
New Arguments
Inmate health is a public safety and public health issue

4. Overview Introduction Opening the policy window
Prisoner/parolee health and public safety
Prisoner/parolee health and public health
Future research
Conclusions
Question and Answer session

5. Opening the Policy Window.
Problem: (1) Large number of ill inmates released each year, (2) Illness impacts public health and public safety, (3) Costs for not treating illnesses rising.
Policy: Non-prison programs demonstrated to work at reducing crime and benefiting public health.
Political: (1) Public wants criminal justice reform, (2) Public okay with non-prison solutions, (3) New Administration championing evidence-based government, (4) Need to solve CA’s budget crisis.
Policy Window
New Policies on Prison Healthcare

6. New Public Position on Prisons
Excerpted from Tulchin, Ben. “Public Safety by the Numbers.” Presented at the American Association of Political Consultants Annual Meeting. March 10, Washington, DC.

7. Key Sources of Inmate Health Information
NCCHC The Health Status of Soon-To-Be-Released Inmates: A Report to Congress. Volumes 1 and 2.
BJS Survey of State and Federal Prisoners.
Rand Understanding the Public Health Implications of Prisoner Reentry in California.

8. Inmate Health
50% of men and 67% of women have chronic health conditions
TB: 4x higher than public
Hepatitis C: 10x higher than public
HIV: 8-9x higher than public
Schizophrenia: 5x higher than public
Bipolar Disorder: 3x higher than public

9. Disease Transmission to Public
1989: Multi-drug resistant TB spreads from prisons to NYC
1993: Meningitis outbreak spreads from LAC to Los Angeles
1996: 22 percent of all new syphilis cases in Chicago traced back to Cook County Prison.

10. HIV/AIDS, Incarceration and the African-American Community
Lifetime HIV infection rates in the African-American Community: 1 in 16 men; in 32 women
28.5% of Black men will enter the criminal justice system sometime in the life
Between 0.9 and 2.4 percent of inmates infected with HIV

11. Impact on HIV Rates Due to Imprisonment of Black Men
Johnson, Rucker C. and Steven Raphael. (2006). “The Effects of Male Incarceration Dynamics on AIDS Infection Rates among African-American Women and Men.” National Poverty Center Working Paper Series, #

12. Tuberculosis CA prevalence rate: 13.28 percent
500 inmates with active TB released each year
Evidence TB is transmitted from inmates to the general public

13. Physical Health, Mental Health and Substance Abuse Problems Among Returning Prisoners
Substance Use >1x/wk.
66% 30 15 8 25 4 30 6 18 14 1 2 3 12 7
Physical Health Condition, 49%
Mental Health Condition
15%
WOMEN
MEN

14. Urban Institute Study (Malik-Kane and Visher, 2008)
Conclusion: Any type of health condition amongst parolees was associated with engaging in criminal activity or a higher likelihood of being reincarcerated.

15. Ill Releasees Experience…
Less stable housing
More difficulty holding a job
Women are more likely to live with a “negative influence”
Low income: Men: $900/mo.
Women: $650/mo.

16. Programs that Help Ill Releasees
Transitional Case Management Program
Reduced Recidivism
Prevention Case Management Program
Increased condom use and abstinence among HIV+ participants
Mental Health Services Continuum Program

17. Behavioral Health

18. Substance Abuse

19. Future Research Questions
Connections between prisoner health and public health
Benefits of continuity of care
Risk reduction strategies
Cost-Benefit analysis of programs

20. Conclusions
Clear public health and public safety implications of prisoner reentry established.
Changing the frame of the debate will get policy people on the same page.
Researchers and policy workers necessary to shift the debate.

21. Discussion/ Q & A