According to the report Drugs in Prison published by The Centre for Social Justice, “social justice and criminal justice go hand in hand. Not only does crime disproportionately affect poorer communities, but also those who have committed crime are also far more likely to suffer from the causes of social breakdown such as drug abuse, poor literacy rates and worklessness”. We explore this topic with Prof. Faye Taxman and Prof. Lior Gideon, Editors-in-Chief of the journal Health & Justice, taking the situation in the USA as an example.
The numbers
Which numbers best describe the current situation of health in criminal justice populations?
Pre-existing health conditions are often linked to other physical and mental conditions. One example is substance abuse and mental health problems; likewise, intravenous methods of self-administration of substances may increase the risk of contracting HIV or hepatitis B or C.
In the USA, approximately 20% of inmates in jails and 15% of inmates in state prisons have a serious mental illness
Based on the total number of inmates, this means that there are approximately 356,000 U.S. inmates with serious mental illness in jails and/or state prisons. Substance abuse among those on probation and/or parole is 7 times greater than the general population with nearly 39 percent of the population suffering for substance use disorders.
What about other physical conditions?
About 40% of all federal, local jail and state inmates have at least one documented chronic illness. Traumatic brain injuries in the jail and prison population range between 25% and 87%. Adults entering jails have much higher prevalence of both chlamydia and gonorrhoea; in particular, chlamydia infection among female jail inmates has been higher than that observed in the general population, and this also happens (about 23-30% higher) among incarcerated juveniles. State and federal prisons held 20,093 inmates diagnosed with HIV or AIDS. Anywhere between 15% and 40% of inmates incarcerated in US jails and prisons are infected with the hepatitis C virus.
What are the consequences?
According to a report by the U.S. Bureau of Justice Statistics (BJS), the leading cause of death in local jails is suicide (29%), followed by heart disease (22%), intoxication (7%), and HIV/AIDS—these are 5% of deaths in local jails. However, a newer report from 2016 by the BJS reports the following causes of death as documented by the DCRP (Death in Custody Reporting Program): heart disease – 3,917 (24.5%); AIDs eelated – 471 (3%); cancer – 3,487 (21.8%); liver disease – 1,296 (8.1%); respiratory disease – 943 (5.9%); suicide – 1,816 (11.4%); drug/ alcohol intoxication – 398 (2.5%). Overall, more than 50 different medical conditions were reported by local jail administrators as the causes of death among jail inmates.
The research
What are the real implications of social and policy research in this field?
Providing research protocols, evidence-based research and an overall holistic and multidisciplinary approach for the examination and dissemination of knowledge on the nexus between health and justice improves the health outcomes—both somatic and behavioral health—of affected individuals, community and the entire society.
Which are the most debated and urgent topics at the moment, in your opinion?
We think there are some pressing topics:
- Expanding the mission of justice organizations to include behavioral and somatic health;
- Understanding how social inequities and poor health conditions affect justice involvement;
- Identifying effective re-entry and seamless systems of care;
- In the US, implication of the Affordable Care Act on underprivileged populations who are also involved in the criminal justice system;
- Special needs populations pose a unique challenge to the criminal justice system, and in particular to probation and parole agencies and correctional facilities that are not adequately prepared to deal with such needs;
- Increasing elderly and geriatric population in jails and prison system;
- Health impediments of released prisoners during their reintegration process and community readiness and response to such needs;
- Community-based treatment modalities that are designed and designated to absorb released prisoners with substance abuse problems, health and mental health problems, as well as connecting care providers in the community with those in correctional facilities for better tailored discharge planning; and finally,
- Legal issues that revolve around health care for criminal justice-involved populations.
Special needs populations pose a unique challenge to the criminal justice system, and in particular to probation and parole agencies and correctional facilities
Aside from the above, we would also like to see studies on nutrition and diet management and education in correctional facilities and its effect on quality of life.
What led you to start Health & Justice back in 2013? Why were you interested in studying this particular topic?
There was a pressing need to have a clear publication outlet that would overcome the fragmented existing literature for multidisciplinary research on the nexus between health and justice, and the criminological discipline.
There is a pressing need for multidisciplinary research on the nexus between health, justice and criminology
In other words, most journals up to this point were discipline specific—criminology, substance abuse, pediatrics, internal medicine, and so on. As a result, interdisciplinary studies that address special populations or special processes were often difficult to publish because they did not fit within a single discipline. Health & Justice was conceived as fitting a need to have a place to examine the impact of health and functioning of individuals that are affected by the justice system—this includes those that are justice-involved, workers in the system, and citizens that are impacted by law enforcement, judiciary, corrections and other justice processes.
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