Social Policy and
Correctional Health Care
Martin Donohoe

• “The mood and temper of the public in regard to the treatment of crime and criminals is one of the most unfailing tests of any country. A calm, dispassionate recognition of the rights of the accused and even of the convicted criminal, ...
[and] the treatment of crime and the criminal mark and measure the stored-up strength of a nation, and are the sign and proof of the living virtue within it.”
Winston Churchill

Lockdown:
US Incarceration Rates
• World prison population 8.75 million
• US: 6.5 million under correctional supervision (behind bars, on parole, or on probation) - 1/32 adults
–2 million behind bars (jail + prison)
• 1.25 million in jail; 0.75 million in prison
• Includes 180,000 women

Lockdown:
US Incarceration Rates
• 6-fold increase in # of people behind bars from 1972-2000
–And rising
• # of women behind bars up 750% from 1980

Lockdown:
US Incarceration Rates and Costs
• US incarceration rate highest in world
–Russia close second
–6X > Britain, Canada, France
• Costs: $30,000/yr for prison spot;
$70,000/yr for jail spot

• African-Americans: 1815/100,000
–More black men behind bars than in college
• Latino-Americans: 609/100,000
• Caucasian-Americans: 235/100,000
• Asian-Americans: 99/100,000

• 22 states and federal prison system at 100%+ capacity in 2000
• 1/11 prisoners serving life sentence
–¼ of these without possibility of parole

• “War on Drugs”
• Mandatory Minimums
• Repeat Offender laws
• Truth in Sentencing regulations
• Decreased judicial independence

Corporate Crime:
Silent but Deadly
• $200 billion/yr. (vs. $4 billion for burglary and robbery)
• Fines for corporate environmental and social abuses minimal/cost of doing business
• Some corporations linked to human rights abuses in US and abroad
• Most lobby Congress to weaken environmental and occupational health and safety laws

• “The [only] social responsibility of business is to increase its profits.”
Milton Friedman
• “Corporations [have] no moral conscience.
[They] are designed by law, to be concerned only for their stockholders, and not, say, what are sometimes called their stakeholders, like the community or the work force…”
Noam Chomsky

• “Corporation: An ingenious device for obtaining individual profit without individual responsibility.”
Ambrose Bierce
• “A criminal is a person with predatory instincts who has not sufficient capital to form a corporation.”
Howard Scott

• Private prisons currently hold just under
10% of US prisoners
• Private prison boom over past 15 years
– Reasons:
• Prevailing political philosophy which disparages the effectiveness of (and even need for) government social programs
• Often-illusory promises of free-market effectiveness
– Despite evidence to contrary (e.g., Medicare/Medicaid, water privatization, etc.)

• Leading trade group: American
Correctional Association
• For-profit companies involved:
– Corrections Corporation of America
– GEO Group (formerly Wackenhut)
– Correctional Medical Services
– Others (Westinghouse, AT&T, Sprint, MCI,
Smith Barney, American Express, and GE)

• Aggressive marketing to state and local governments
– Promise jobs, new income
• Rural areas targeted
– Face declines in farming, manufacturing, logging, and mining
• Companies offered tax breaks, subsidies, and infrastructure assistance

The Prison-Industrial Complex:
2001 Bureau of Justice Study
• Average savings to community 1%
• Does not take into account:
– Hidden monetary subsidies
– Private prisons selecting least costly inmates
• c.f., “cherry picking” by health insurers
– Private prisons attract large national chain stores like Wal-Mart, which:
• leads to demise of local businesses
• Shifts locally-generated tax revenues to distant corporate coffers

The Prison-Industrial Complex:
Politically Well-Connected
• Private prison industry donated $1.2 million to 830 candidates in 2000 elections
– $100,000 from CCA to indicted former House
Speaker Tom Delay’s (R-TX) Foundation for
Kids
– Delay’s brother Randy lobbied TX Bureau of
Prisons on behalf of GEO

Jails for Jesus:
Faith-Based Initiatives
• Increasing presence
• Politically powerful
• Most evangelical Christian
• Supported financially by George W Bush’s
Faith-Based Initiatives Program
– e.g., Prison Fellowship Ministries – founded by Watergate felon Charles Colson in 1976

Jails for Jesus:
Faith-Based Initiatives
• Offer perks in exchange for participation in prayer groups and courses
– Perks: better cell location, job training and post-release job placement
– Courses: Creationism, “Intelligent
Design”, “Conversion Therapy” for homosexuals

Jails for Jesus:
Faith-Based Initiatives
• Some programs “cure” sex offenders through prayer and Bible study
– Rather than evidence-based programs employing aversion therapy and normative counseling
• Highly recidivist and dangerous criminals may be released back into society armed with little more than polemics about sin

• At least 1/3 of state and ¼ of federal inmates have a physical impairment or mental condition
– Mental illness
– Dental caries and periodontal disease
– Infectious diseases: HIV, Hep B and C, STDs
(including HPV →cervical CA)
– Usual chronic illnesses seen in aging population

• 52% of state and 34% of federal inmates under influence of alcohol or other drugs at time of offenses
• Rates of alcohol and opiate dependency among arrestees at least 12% and 4%, respectively
– 28% of jails detoxify arrestees

• 12,129 inmates died in custody between 2001 and 2004
–89% - medical conditions
–8% - suicide or homicide
–3% - alcohol/drug intoxication or accidental injury

• Estelle v. Gamble (US Supreme
Court, 1976): affirms inmates constitutional right to medical care
(based on 8 th Amendment prohibiting cruel and unusual punishment)
• Amnesty International and AMA have commented upon poor overall quality of care

• 60% provided by government entities
• 40% (in 34 states) provided by private corporations
• Private care often substandard

• Some doctors unable to practice elsewhere have limited licenses to work in prisons
• Some government and private institutions require co-pays
–Discourages needed care; increases costs

Examples of Substandard Prison
Health Care
• Correctional Medical Systems
(largest/cheapest)
– Numerous lawsuits/investigations for poor care, negligence, patient dumping; opaque accounting of taxpayer dollars
• Prison Health Services
– Cited by NY state for negligence/deaths; subject of >1000 lawsuits

Examples of Substandard Prison
Health Care
• California’s state prison health care system placed into receivership
–1 unnecessary death/day
–$5 co-pays limit access

• 600,000 prisoners released each year
– 4-fold increase over 1980
• 1990s: funding for rehab dramatically cut
• Newly released and paroled convicts face restricted access to federally-subsidized housing, welfare, and health care

Ex-offenders have poor job prospects
• Little education and job skills training occur behind bars
– GED programs reduce recidivism, decrease costs
• Limited resumés, background checks
• 60% of employers would not knowingly hire an ex-offender
• High rates of criminal recidivism

• US world’s wealthiest nation
• Incarcerates greater percentage of its citizens than any other country
• Criminal justice system marred by racism
• Prisoner health care substandard
• Until recently, US executed juveniles and mentally handicapped

• US continues to execute adults
• Drug users confined with more hardened criminals in overcrowded institutions
– Creates ideal conditions for nurturing and mentoring of more dangerous criminals
• Punishment prioritized over rehabilitation

• Convicts released without necessary skills to maintain abstinence and with few job skills
• Poor financial and employment prospects of released criminals make return to crime an attractive or desperate survival option

• US criminal justice system marked by injustices, fails to lower crime and increase public safety
• Significant portions of system turned over to enterprises that value profit over human dignity, development and community improvement

Role of Health Professionals in
Creating a Fair Criminal Justice System
• Address social ills that foster substance abuse and other crimes
– Especially rising gap between rich and poor, haves and have nots
• Increase focus on magnitude and consequences of corporate crime

Role of Health Professionals in
Creating a Fair Criminal Justice System
• Speak out against injustice, racism, death penalty
• Improve provider education re criminal justice system
• Run for office

• Hold government accountable for creating fair system that combines reasonable punishment with restitution and smooth reentry of rehabilitated criminals into society

• “A society should be judged not by how it treats its outstanding citizens but by how it treats its criminals.”
Fyodor Dostoevsky

• Donohoe MT. Incarceration Nation: Health and Welfare in the Prison System in the
United States. Medscape Ob/Gyn and
Women’s Health 2006;11(1): posted
1/20/06. Available at http://www.medscape.com/viewarticle/520
251

Public Health and Social Justice
Website http://www.phsj.org
martindonohoe@phsj.org