More than 2 million people are incarcerated in the U.S. each year. They are more likely to have substance-use disorders with drugs, alcohol and cigarettes. They also are at increased risk of HIV, hepatitis C, sexually transmitted infections, diabetes, heart disease and strokes.
African Americans, who are most likely to be incarcerated, often have disproportionately high rates of many chronic and infectious diseases. Much of this has to do with the social determinants of health – the conditions in which people are born, live, work and age. Consider:
- Prior to imprisonment, their health may have already been adversely affected by poor housing, lack of access to healthy foods, and exposure to environmental hazards.
- While incarcerated, they likely received less-than-substandard health care, and experienced discrimination.
- After release, they find themselves trapped in the revolving door of incarceration. Some states ban them from housing, employment, Medicaid coverage, and social services, preventing them from getting substance-abuse treatment, finding housing, and landing a job.
To understand the complexities people face when entering or leaving incarceration − and how they affect their health − we must first define “good health.” Common Ground Health’s African American Health Coalition contends that the foundations of good health are the basic needs of affordable and nutritious food, access to quality health care, safe housing, living-wage employment and stable family and social supports. Many of these essential needs are not provided to the incarcerated population before or after they leave prison.
How do we address these issues? The African American Health Coalition believes we must think outside the box.
Developing holistic interventions that offer hope to formerly incarcerated individuals and their families requires a multi-faceted approach that concentrates on the individual, the family, and communities. Forming partnerships and fostering collaboration can help those who return home from prison, and need a host of services to repair their fractured lives. Interventions should focus on the social conditions that indirectly affect the health of incarcerated individuals, such as stigma, or loss of social support.
The Women’s Initiative Supporting Health (WISH) is an innovative project that employs formerly incarcerated women to improve the health of women recently released from prison. The employees help guide these women through the complex health care, re-entry and social services systems. This program also helps the women find a job, build self-esteem and find role models: they see others who have overcome this barrier, and often they follow their positive behaviors.
At the national level, the Obama administration highlighted the relationship between incarceration and poor health. In addition, the 2013 Blueprint for Drug Policy focused on alternatives to incarceration policies that recognize substance use disorders and mental health as chronic health disorders. This policy also called for more diversion courts, such as drug and mental health, probation and community service courts, to reduce the use of an already overcrowded prison system.
These are some of the measures we can undertake to assist the formerly incarcerated. By taking such steps, the African American Health Coalition’s vision is that incarceration won’t have to result in poor health.
Precious Bedell is devoted to improving the lives of people affected by incarceration. She is a specialist in providing resources in helping those re-entering from prison and jail. Currently, she is training community health workers, and co-teaching a class about incarceration at the University of Rochester. Precious Bedell is the health project coordinator of the Women’s Initiative Supporting Health (WISH), and she is a trainer for community health care workers for the health professional opportunities grant through the University of Rochester Medical Center.
Diane S. Morse M.D., is dedicated to improving the lives and health of justice-involved women, and the communities in which they live. She is a researcher, medical educator and clinical internal medicine physician with the Women’s Initiative Supporting Health at the University of Rochester Departments of Psychiatry and Medicine. Diane Morse investigates trauma-specific motivational strategies to increase needed health services with justice-involved women including those on probation, in drug treatment court, and recently released from incarceration.
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