By most measures, prisoners are burdened by health concerns at levels far higher than in the general population. They exhibit markedly higher rates of HIV and AIDS, tuberculosis, hepatitis C and mental illness. They have significant histories of alcohol and substance abuse, and higher levels of addiction. (See NCCHC’s report to Congress on the Health Status of Soon-to-be-Released Inmates.)

Yet, unlike most Americans, prisoners have access to a health care system, paid for by taxpayers, that attends to a wide range of their health needs. They are typically screened for a variety of illnesses at admission, and can call upon this health care system to respond to needs ranging from routine illnesses to kidney dialysis and even heart transplants.

There is a second reality of imprisonment in America that puts the health profile of prisoners in a unique relationship to the American system of health care: Virtually all prisoners return home, bringing with them their health concerns. Except for those few who die in prison, all prisoners return to live again in free society. In recent years, “prisoner reentry” has received substantial attention among policymakers, practitioners and researchers, generating a widespread interest in new approaches to managing the inevitable return of large numbers of prisoners.

Fourfold Increase
In a time called by some the era of “mass incarceration,” the phenomenon of prisoner reentry today is quite different than it was just 30 years ago. Since the early 1970s, the nation has witnessed a fourfold increase in the rate of incarceration, resulting in a prison population of 1.3 million.

Given the inevitability of reentry, it is not surprising that the size of the annual reentry cohort also has grown substantially. In 2002, an estimated 630,000 individuals left our state and federal prisons, more than four times the number who made similar journeys 25 years ago.

Once they return home, the odds are high that they will return to prison. Within three years, two-thirds will be rearrested for serious crimes and one-half will be returned to prison. The large numbers of individuals with high rates of health problems who are sent to prison, return home and then, in many cases, are sent to prison again, pose both challenges and opportunities for health care providers, both those in correctional settings and those in the community.

A primary shortfall in practice to date is the absence of mechanisms through which community and corrections providers can collaborate to provide continuity of care for returning prisoners. The absence of such systems disadvantages prisoners and providers alike. Moreover, with respect to prisoners entering the community with communicable diseases, opportunities to minimize the spread of disease have not been seized.

Three Themes
To explore the issues at the intersection of prisoner reentry and public health, the Urban Institute convened a meeting of the Reentry Roundtable. The Institute commissioned papers by some of the nation’s leading researchers and invited a rich mix of corrections administrators, corrections health care providers, community health care agencies, former prisoners, police leaders, state and local policymakers, and advocacy groups for a two-day meeting.

Three themes emerged from the discussions. First, a reentry perspective on the health burdens facing America’s prison population presents an opportunity to think differently about improving health outcomes for returning prisoners, their families and the communities to which they return. Given the inevitability of reentry, every prisoner should be viewed as a future member of free society. Accordingly, the period of time in prison should be viewed as an opportunity to provide health interventions that will yield better health outcomes not only in prison but, equally importantly, after the prisoner’s release.

This perspective places new obligations on prison health practitioners to factor in benefits incurred after release and to communities, rather than tailor treatment to address benefits realized only during incarceration. The reentry perspective also envisions different relationships between health care providers in prison and those in the community. For example, correctional health care professionals should work with their colleagues in the community to develop discharge protocols, fixed first clinic appointments after the inmate’s release, and sharing of medical records and treatment plans.

Finally, the reentry perspective would move the public health field toward different strategies for addressing a number of health issues in our society. For example, public health strategies to minimize the spread of hepatitis would start with the recognition that prisoners present high levels of that disease and would take advantage of their period of incarceration to provide screening and appropriate interventions.

A number of researchers and practitioners have embraced the notion that the twin realities of incarceration and reentry present what has been called a “public health opportunity,” but realizing this opportunity will require a new collaborative model between community health and correctional practitioners.

The second theme of the discussion was the value of a public health perspective on the phenomenon of prisoner reentry. The public health community brings valuable concepts, language and practices to the work of criminal justice professionals and others who think about the challenges posed by hundreds of thousands of returning prisoners. The idea of a discharge plan, the concept of continuity of care, the concern for a person’s well-being irrespective of his or her social status—all are useful additions to the criminal justice conversations about reentry.

More specifically, a public health perspective contributes a sharpened focus on mitigating the harmful effects of certain illnesses associated with heightened public safety risk, the touchstone of most criminal justice reform efforts. For example, a detailed discharge plan for a prisoner with mental illness that ensures continuity in medication and treatment could promote better mental health and reduce the likelihood of antisocial and criminal behavior. Similarly, a successful prison-based education program that helps inmates avoid risky behaviors associated with the transmission of HIV, such as needle injection, may also reduce the rate of return to drug use.

A third theme emerging from the roundtable discussion was more strategic than substantive. Meeting participants expressed the consensus that a merger of the public health and prisoner reentry perspectives could bring new policy interest and new allies to each policy domain.

The public health and correctional health care communities would benefit from alliances with their criminal justice counterparts who could help quantify, in public safety terms, the effects of evidence-based health interventions with the criminal justice population. The criminal justice professionals and allied community agencies would gain support in their efforts to raise public awareness about the impact of mass incarceration on American society by the language and concepts of public health.

Editor’s note: This article and updated versions of the papers described above are featured in a special issue of the Journal of Correctional Health Care, Vol. 10, No. 3 (click here for abstracts).