By Jingxuan Zhao; Jessica Star; Xuesong Han, et al

IMPORTANCE People with a history of incarceration may experience barriers in access to and receipt of health care in the US. OBJECTIVE To examine the associations of incarceration history and access to and receipt of care and the contribution of modifiable factors (educational attainment and health insurance coverage) to these associations. DESIGN, SETTING, AND PARTICIPANTS Individuals with and without incarceration history were identified from the 2008 to 2018 National Longitudinal Survey of Youth 1979 cohort. Analyses were conducted from October 2022 to December 2023. MAIN MEASURES AND OUTCOMES Access to and receipt of health care were measured as self reported having usual source of care and preventive service use, including physical examination, influenza shot, blood pressure check, blood cholesterol level check, blood glucose level check, dental check, and colorectal, breast, and cervical cancer screenings across multiple panels. To account for the longitudinal study design, we used the inverse probability weighting method with generalized estimating equations to evaluate associations of incarceration history and access to care. Separate multivariable models examining associations between incarceration history and receipt of each preventive service adjusted for sociodemographic factors; sequential models further adjusted for educational attainment and health insurance coverage to examine their contribution to the associations of incarceration history and access to and receipt of health care. RESULTS A total of 7963 adults with 41 614 person-years of observation were included in this study; of these, 586 individuals (5.4%) had been incarcerated, with 2800 person-years of observation (4.9%). Compared with people without incarceration history, people with incarceration history had lower percentages of having a usual source of care or receiving preventive services, including physical examinations (69.6% vs 74.1%), blood pressure test (85.6% vs 91.6%), blood cholesterol level test (59.5% vs 72.2%), blood glucose level test (61.4% vs 69.4%), dental check up (51.1% vs 66.0%), and breast (55.0% vs 68.2%) and colorectal cancer screening (65.6% vs 70.3%). With additional adjustment for educational attainment and health insurance, the associations of incarceration history and access to care were attenuated for most measures and remained statistically significant for measures of having a usual source of care, blood cholesterol level test, and dental check up only. CONCLUSIONS AND RELEVANCE The results of this survey study suggest that incarceration history was associated with worse access to and receipt of health care. Educational attainment and health insurance may contribute to these associations. Efforts to improve access to education and health insurance coverage for people with an incarceration history might mitigate disparities in care.

JAMA Health Forum. 2024;5(2):e235318. doi:10.1001/jamahealthforum.2023.5318

By Polly Wright (P. Wright Consultancy).

For the purposes of this report we refer to the individual in custody as the ‘patient’, as their experiences are considered in terms of their health and wellbeing needs. Families’ experience of the impact of the criminal justice system on the health and wellbeing of patients.

Messages from families Where patients present complex and/or significant mental health needs, alternative diversionary treatment should be more readily considered (in line with Public Protection requirements). This should be informed by all agencies currently working with the patient, as well as their family/ significant others (where appropriate). Care not custody required Many of the families consulted felt that their loved ones’ involvement in the criminal justice system was as a result of persistent, systemic failure of services (education, social care, health and/or criminal justice) to meet their needs. Almost a third of families described their loved one as having an acute mental health crisis immediately prior to their contact with the criminal justice system. While families acknowledged patients had committed a criminal offence, many felt that the criminal justice system had failed to effectively consider alternative diversionary treatment appropriate to the patients’ needs. Potential for positive health outcomes Families acknowledged that when the criminal justice system works well, positive health outcomes can be achieved and for some patients, contact with the criminal justice system had had a positive impact as it had provided: consistent access to ongoing support the opportunity to receive mental health diagnosis and treatment that had not been forthcoming in the community removal of risks associated with previous lifestyle quicker access to healthcare access to peer support. Custody as a barrier to positive health outcomes The majority of families witnessed a significant decline in their loved ones’ mental and physical health during their custodial sentence. They attributed this to numerous and inter-related systemic factors including: the pr

London: PACT (Prison Advice and Care Trust) 2023. 80p.

Institute of Medicine and National Research Council.

Over the past four decades, the rate of incarceration in the United States has skyrocketed to unprecedented heights, both historically and in comparison to that of other developed nations. At far higher rates than the general population, those in or entering U.S. jails and prisons are prone to many health problems. This is a problem not just for them, but also for the communities from which they come and to which, in nearly all cases, they will return.

Health and Incarceration is the summary of a workshop jointly sponsored by the National Academy of Sciences(NAS) Committee on Law and Justice and the Institute of Medicine(IOM) Board on Health and Select Populations in December 2012. Academics, practitioners, state officials, and nongovernmental organization representatives from the fields of healthcare, prisoner advocacy, and corrections reviewed what is known about these health issues and what appear to be the best opportunities to improve healthcare for those who are now or will be incarcerated. The workshop was designed as a roundtable with brief presentations from 16 experts and time for group discussion. Health and Incarceration reviews what is known about the health of incarcerated individuals, the healthcare they receive, and effects of incarceration on public health. This report identifies opportunities to improve healthcare for these populations and provides a platform for visions of how the world of incarceration health can be a better place.

Washington, DC: The National Academies Press. 2013. 67p.