Posted on January 15, 2009

U.S. prisoners sicker than believed and have poor access to care


Harvard study also points to high social costs of undertreating mental illness

Embargoed until:
Jan. 15, 2009, 4:00 PM EST

Andrew P. Wilper, MD, MPH
Steffie Woolhandler, MD, MPH
Mark Almberg, (312) 782-6006

An article published today in the online edition of the American Journal of Public Health, based on the first-ever study of the health of all prison and jail inmates nationwide, reports high rates of serious illness and poor access to care among the nation’s inmate population.

The study, carried out by researchers at the Cambridge Health Alliance and Harvard Medical School, analyzed data collected from U.S. inmates in the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities.

Nationally, over 800,000 inmates - about 40 percent of the 2 million people in U.S. prisons and jails - reported having a chronic medical condition like diabetes, asthma or persistent heart or kidney problems, an illness rate far higher than other Americans of similar age. For example, the incidence of diabetes among federal inmates is 11.1 percent; among the age-adjusted general U.S. population, it is 6.5 percent.

The overwhelming majority of inmates surveyed were male, were younger than 35, and were disproportionately Black or Hispanic. About 10 percent were military veterans.

The researchers found that sick prisoners have poor access to care. For example, over 20 percent of sick inmates in state prisons and 13.9 percent in federal prisons had not seen a doctor or nurse since their incarceration. The same was true of 68.4 percent of jail inmates with persistent medical problems.

Besides care for physical illnesses, the authors also analyzed mental illness care among inmates both before and during incarceration. While about a quarter of inmates had a history of chronic mental illness like schizophrenia, bipolar disorder, depression or anxiety, two-thirds of them were off treatment at the time of their arrest. Only after their imprisonment did most of these inmates receive treatment.

Other key findings include the following:

  • Compared to other Americans of the same age, the 1.2 million state prison inmates were 31 percent more likely to have asthma, 55 percent more likely to have diabetes, and 90 percent more likely to have suffered a heart attack.
  • Access to care was worst in local jails and best in federal prisons. One-quarter of jail inmates who had suffered severe injuries had received no medical attention, versus 12 percent in state prisons and 8 percent in federal prisons.
  • Inmates with medical problems like diabetes, which requires drug treatment, often had their vital medications stopped after their incarceration, including one-quarter of chronically ill state prisoners and 36.5 percent of inmates in local jails.

Dr. Steffie Woolhandler, a co-author of the study, is an associate professor of medicine at Harvard University and a primary care physician in Cambridge, Mass. She stated: “The U.S. incarcerates more people per capita than any other nation. For many of them, treatment of their mental illness before their arrest might have prevented criminality and the staggering human and financial costs of incarceration.”

Dr. Andrew P. Wilper, the study’s lead author, is currently with the University of Washington School of Medicine. He remarked: “A substantial percentage of inmates have serious medical needs. Yet many of them don’t get even minimal care medical care. These prisoners are denied their constitutionally guaranteed right to care.”

Wilper added: “Twelve million Americans are released from prisons and jails each year. These individuals and the communities to which they return suffer as many carry with them the costs of untreated illness and preventable disability. Inmates are overpaying their debt to society when they are denied access to health care.”


Click here for the abstract of the study.

“The Health and Health Care of U.S. Prisoners: A Nationwide Survey,” Andrew P. Wilper, MD, MPH; Steffie Woolhandler, MD, MPH; J. Wesley Boyd, MD, PhD; Karen E. Lasser, MD, MPH; Danny McCormick, MD, MPH; David H. Bor, MD; and David U. Himmelstein, MD. American Journal of Public Health, Vo. 99, No. 4.

The research was supported by a National Service Research Award.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program.