Prison Health

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In the United States, prison health care, and the study of health and medical problems of prisoners, is a recent phenomenon. Prior to 1970, medical care in jails and prisons was under the direction of county sheriffs or prison wardens. Neither public health officials nor the outside medical community showed much concern for medical services in prisons or jails or for the health status of prisoners. With the exception of the Federal Bureau of Prisons, which staffed its medical service needs with Public Health Service physicians and provided hospital care in facilities accredited under the Joint Commission for Hospital Accreditation, no general standards for medical services in prisons existed in the United States.

Health care in American correctional facilities began to improve in the 1970s. The U.S. Department of Justice provided limited funds to certain states to improve medical care in prisons, and in 1972 the American Medical Association (AMA) surveyed medical services in U.S. prisons and jails, publishing a report that documented its inadequacy. The AMA and the American Public Health Association independently began writing standards for the care of incarcerated individuals. State and federal courts, responding to legal allegations that inadequate care for prisoners was "cruel and unusual punishment" under the U.S. Constitution, began to find against many correctional facilities.

In 1983 the AMA Correctional Health Care Program evolved into the National Commission for Correctional Health Care (NCCHC), whose standards, in 1999, served more than five hundred jails, prisons, and juvenile facilities and defined the level of health services available to inmates. These voluntary standards address environmental issues, intake screening and medical examinations, access to medical care, and the need for linkages between correctional health and public health. NCCHC standards have served as a significant factor in improving correctional health services in state and local facilities and reducing the risk of adverse litigation. In addition, the National Immigration Service Bureau of Prisons follows NCCHC standards and the National Immigration Health System is accredited by NCCHC.

The first Supreme Court decision to address prison health, Estelle v. Gamble (1976), determined that medical care in the Texas prison system was below a constitutional level. Estelle and subsequent decisions established that prisoners have a constitutional right to health care equal in quality to that available in the outside community. Today, many jurisdictions meet this standard through accreditation by the NCCHC.

In 1999, over 14.5 million individuals were processed into U.S. correctional facilities. Physical and mental illness is more prevalent in this population than in the population at large, and prisoners require more primary, secondary, and tertiary care than the outside community. The number of physicians, nurses, and other health professionals serving inmates is growing, but it is still insufficient to meet medical demand. Private corporations have moved into the correctional health field to fill the service gap and meet NCCHC or other acceptable standards of care.

The burden of disease in prisoners and the quality of their care are significant public health issues. Untreated disease is a risk not only to the prisoner, but to other inmates, to correctional officers, and to the outside community. The medical care and preventive services provided to inmates reduce the burden of illness in society, lower the probability of disease transmission, and enhance the economic potential of prisoners who try to become productive members of society upon release.

Jonathan B. Weisbuch

(see also: Access to Health Services; Ethics of Public Health )


American Medical Association (1973). Medical Care in U.S. Jails: A 1972 Survey. Chicago: Author.

National Commission on Correctional Health Care (1996). Standards for Health Services in Jails. Chicago: Author.

(1996). Standards for Health Services in Prisons. Chicago: Author.

Poster, M. J. (1992). "The Estelle Medical Professional Judgement Standard: The Right of Those in State Custody to Receive High-Cost Medical Treatments." American Journal of Law and Medicine 18 (4):347368.