Prison healthcare

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Military and MONUSCO medical staff performing medical consultations at a Kabare Territory prison in the Democratic Republic of the Congo

Prison healthcare is the medical specialty in which healthcare providers care for people in prisons and jails. Prison healthcare is a relatively new specialty that developed alongside the adaption of prisons into modern disciplinary institutions. Enclosed prison populations are particularly vulnerable to infectious diseases and mental health issues, which links prison healthcare to issues of public health, preventive healthcare, and hygiene. Prisoner dependency on provided healthcare raises unique problems in medical ethics.

Scope of field

Prison populations create specific medical needs, based on the communal nature of prison life and differing rates of imprisonment for different demographics. For example, general population ageing has increased the number of elderly prisoners in need of geriatric healthcare.[1]:223 In addition, treatment for mental health, sexually transmitted infections like HIV, and substance abuse are all important elements of prison healthcare,[2]:122 as well as knowledge of public health methods.[3]:317

The separation of prison healthcare from other medical specialties and healthcare systems leads to its isolation and stigmatization as a field,[2]:120 despite some countries' promise for "equivalence" in healthcare between prison and non-prison patients.[1]:224


Print from John Howard's An Account of the Principal Lazarettos in Europe, 1791, showing the floor plan of a prison with a designated infirmary at bottom left

Before 1775, imprisonment was rarely used as a punishment for crime. Since that year, however, incarceration rates have grown exponentially, creating the need for physicians in correctional institutions. Aside from medical care, prisoners were often used by doctors to conduct medical research and conduct teaching, a practice amenable to allopathic medical practices that prefer scientific analysis of pathology rather than relying on patient accounts.[4]:3,11[5]:22 Prison medicine began, in its most rudimentary form, in Victorian England, under the health reforms promoted by wealthy philanthropist and devout ascetic John Howard and his collaborator, well-to-do Quaker physician John Fothergill.[6]

Another early development in the history of prison healthcare was the work of Louis-René Villermé (1782–1863), a physician and pioneering hygienist whose study, Des Prisons, was published in 1820.[7][8] Doctors often had to pass judgment on whether patients were malingering to avoid labor—a practice continued on slave plantations in the US.[4]:12 The work of Villermé and other French hygienists was an inspiration to German, American, and British public health leaders and spurred an overhaul in the conditions in which prisoners were held.


Prison healthcare is not currently a primary component of medical education, although academic medical centers are major providers of prison healthcare.[4]:2 In the 21st century, little has been published on curricula for prison healthcare, and few textbooks exist.[3]:310 Prisons are a complicated, stigmatized environment to practice medicine, which makes it difficult to develop specific training programs for them.[9]:125 In one pilot prison-healthcare rotation in the United States, students believed they benefited from exposure to a diverse patient population although the prison's remote location and lack of organized schedule made the experience difficult.[9]:127

Ethics and rights

The secondary status of healthcare in prisons and the marginalization and dependency most prisoners experience as a "captive population" pose medical ethics dilemmas for doctors practicing in prisons.[3]:312,316[4]:2,8 Feminist theorist and prison abolitionist Andrea J. Pitts argues that the punitive purpose of prisons prevents most doctors from adequately treating and caring for prisoner patients.[5]:14,27 Doctors' and medical centers' increased reliance on prisons for providing access to patients ultimately creates a dual loyalty problem, as doctors are forced to balance the medical needs of their patients against the institutional needs of prisons and hospitals.[10]:2 These dilemmas, like organ donation in the United States prison population, make it difficult for doctors to provide patient-centered care in prisons.[10]:4

The UN Nelson Mandela Rules hold that prison healthcare should be provided by national health services and not by "prison authorities or judicial institutions".[11]:349



Like other countries, prisoners in Ghana are at high risk for HIV and Hepatitis C.[11]:350 The relationship between prisons and the national Ghana Health Service is also weak, leading to disorganized care.

United Kingdom

Health care in prisons has been commissioned by NHS England since 2013. Before that it was locally commissioned by primary care trusts. Guidelines produced in 2016 by the National Institute for Health and Care Excellence recommended that on admission there should be a health check with confidential testing for hepatitis B, hepatitis C and HIV. In 2016 there were more than 4,400 prisoners aged 60 or over in England and Wales, and the number was increasingly rapidly. “They are sicker and more likely to have complex health needs than people of an equivalent age who are living in the community”.

The House of Commons Health Select Committee produced a report on prison healthcare in November 2018. They found that difficulties in getting prescribed medication had led to prisoners being hospitalised. They had to make an appointment for medication which outside prison was freely available and they could only get one day's supply at a time. Possession of medication could lead to bullying.[12] Transfers from prison to secure beds in psychiatric hospitals in London were taking up to a year in 2019.[13]

The UK has practiced some privatization for its prison healthcare. For example, Care UK provides healthcare for people in about 30 prisons.[14] LloydsPharmacy won a contract for pharmacy services in the 15 Scottish prisons in May 2019. The contract for £17 million runs until April 2022.[15]

United States

The Confederate Libby Prison, infamous for its overcrowding and poor health conditions

Before the 1960s, prisons determined what healthcare they would provide with little state or federal oversight, due to the US' "hands-off" doctrine.[5]:15 Psychological treatment often included moral-uplift bibliotherapy from prison libraries.[16] Modern US prison healthcare arose after events like the Arkansas prison scandal of 1968 revealed the corruption of the Trusty system and unethical medical research conducted on prisoners.[17][18] Spates of prison uprisings and campaigns for prisoners' rights pressured the US prison system to change.[5]:15–16 In the 1970s, widespread intervention by federal courts improved conditions of confinement, including health care services and public health conditions, and stimulated investment in medical staff, equipment, and facilities to improve the quality of prison and jail medical services.[19] Guidelines issued by the American Public Health Association and the creation of the National Commission on Correctional Health Care also improved prisoner healthcare.[5]:16

With increased care came increased costs.[5]:17 Compared to the UK, the US now uses more partnerships with universities and the private sector to provide healthcare to prison populations.[2]:125 Cutting costs from public health crises, like mental health, AIDS, tuberculosis, and other infectious diseases within American prisons is a primary motivation.[18] These partnerships are supported for the improvements they make to public health and the training opportunities they provide for medical students, although specialized medical training in prison settings is rare.[4]:2 The outsourcing of prison healthcare has lead to controversies with companies like Corizon or Prison Health Services providing substandard or negligent care to prisoners.[20][18]

Prison is often the first place that people in the USA are able to receive medical treatment that they couldn't afford outside.[21][22] Although US prisoners are entitled to medical care, the marginal nature of prison healthcare and US mass incarceration means that prisoners often go untreated.[5]:17 Following the mass closure of mental health hospitals in the 1960s, Mental health services in US prisons often aren't available for criminals; most prisoners have an untreated mental disorder and psychiatric care or treatment is expensive for the mentally ill.[4]:2 64 percent of jail inmates, 54 percent of state prisoners, and 45 percent of federal prisoners in the US report having mental health concerns.[23] Health care in American women's prisons often does not met the needs of women prisoners, such as in the areas of pregnancy and prenatal care, menstrual hygiene and gynecological services, and mental health, especially associated with past trauma or sexual abuse.[24] Furthermore, prison clinics often presume the continuation of the US prison–industrial complex.[10]:4

The Society of Correctional Physicians is a non-profit physician organization founded in August, 1992 as national educational and scientific society for the advancement of correctional medicine, and became the American College of Correctional Physicians in 2015.[25]

See also


  1. ^ a b Heidari, Raheleh; Wangmo, Tenzin; Galli, Serena; Shaw, David M.; Elger, Bernice S.; Handtkea, Violet; Bretschneider, Wiebke (November 2017). "Accessibility of prison healthcare for elderly inmates, a qualitative assessment". Journal of Forensic and Legal Medicine. 52: 223–228. doi:10.1016/j.jflm.2017.10.001.
  2. ^ a b c Watson, Roger; Stimpson, Anne; Hostick, Tony (February 2004). "Prison health care: a review of the literature". International Journal of Nursing Studies. 41 (2): 119–128. doi:10.1016/s0020-7489(03)00128-7.
  3. ^ a b c Haley, Heather-Lyn; Ferguson, Warren; Brewer, Arthur; Hale, Janet (2009-10-26). "Correctional Health Curriculum Enhancement Through Focus Groups". Teaching and Learning in Medicine. 21 (4): 310–317. doi:10.1080/10401330903228513.
  4. ^ a b c d e f Glenn, Jason E.; Bennett, Alina M.; Hester, Rebecca J.; Tajuddin, Nadeem N.; Hashmi, Ahmar (December 2020). ""It's like heaven over there": medicine as discipline and the production of the carceral body". Health & Justice. 8 (1): 5. doi:10.1186/s40352-020-00107-5.
  5. ^ a b c d e f g Pitts, Andrea J. (27 August 2018). "Examining Carceral Medicine through Critical Phenomenology". IJFAB: International Journal of Feminist Approaches to Bioethics. 11 (2): 14–35. doi:10.3138/ijfab.2017.08.11.
  6. ^ "Fothergill, John (1712-1780)". Dictionary of National Biography, 1885-1900. Retrieved 30 May 2021.
  7. ^ Villermé, Louis-René (1820). "On Prisons as They Are and as They Should Be by Louis-René Villermé 1820". Retrieved 30 May 2021.
  8. ^ "Louis-René Villermé". Catholic Encyclopedia. Retrieved 30 May 2021.
  9. ^ a b Alemagno, Sonia A.; Wilkinson, Margaret; Levy, Leonard (February 2004). "Medical Education Goes to Prison: Why?:". Academic Medicine. 79 (2): 123–127. doi:10.1097/00001888-200402000-00005.
  10. ^ a b c DiZoglio, Joseph David; Telma, Kate (23 April 2021). "Proposing Abolition Theory for Carceral Medical Education". Journal of Medical Humanities. doi:10.1007/s10912-021-09695-1.
  11. ^ a b Baffoe-Bonnie, Terrylyna; Ntow, Samuel Kojo; Awuah-Werekoh, Kwasi; Adomah-Afari, Augustine (5 December 2019). "Access to a quality healthcare among prisoners – perspectives of health providers of a prison infirmary, Ghana". International Journal of Prisoner Health. 15 (4): 349–365. doi:10.1108/IJPH-02-2019-0014.
  12. ^ "Prisoners hospitalised because of lack of access to medicines, MPs find". Pharmaceutical Journal. 5 November 2018. Retrieved 16 December 2018.
  13. ^ "Prisoners face 'year-long' waits for hospital beds". Health Service Journal. 28 May 2019. Retrieved 8 July 2019.
  14. ^ "Prisoners 'should get same healthcare as general population'". Guardian. 2 November 2016. Retrieved 3 December 2017.
  15. ^ "Lloyds given £17m contract to run pharmacy services in Scottish prisons". Pharmaceutical Journal. 3 May 2019. Retrieved 9 June 2019.
  16. ^ Sweeney, Megan (2010). Reading is my window : books and the art of reading in women's prisons. Chapel Hill: University of North Carolina Press. p. 33. ISBN 978-0807871003.
  17. ^ Woodward, Colin Edward (2018-03-22). "The Arkansas prison scandal". Arkansas Times. Retrieved 30 May 2021.
  18. ^ a b c Zielbauer, Paul von (27 February 2005). "As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence". The New York Times. Retrieved 30 April 2021.
  19. ^ Paris JE (February 2008). "Why Prisoners Deserve Health Care". AMA Journal of Ethics. doi:10.1001/virtualmentor.2008.10.2.msoc1-0802. Retrieved 14 July 2020. Cite journal requires |journal= (help)
  20. ^ Press, Matt York/Associated (26 February 2018). "How Bad is Prison Health Care? Depends on Who's Watching". The Marshall Project. Retrieved 30 April 2021.
  21. ^ Fraser, Andrew (2007). "Primary health care in prisons". In Møller, Lars; et al. (eds.). Health in Prisons: A WHO Guide to the Essentials in Prison Health. WHO Regional Office Europe. ISBN 9789289072809.
  22. ^ Drucker, Ernest (2011). A Plague of Prisons: The Epidemiology of Mass Incarceration in America. The New Press. pp. 115–116. ISBN 9781595586056.
  23. ^ Collier, Lorna (October 2014). "Incarceration nation". Monitor on Psychology. American Psychological Association. 45 (9). Retrieved 2017-01-18.
  24. ^ Sufrin, Carolyn; Kolbi-Molinas, Alexa; Roth, Rachel (December 2015). "Reproductive Justice, Health Disparities And Incarcerated Women in the United States". Perspectives on Sexual and Reproductive Health. 47 (4): 213–219. doi:10.1363/47e3115. PMID 26098183.
  25. ^ "American College of Correctional Physicians". Retrieved 2015-10-26.

Further reading