"The Health Status of Soon-to-Be Released Inmates" is available on the Web site of the National Commission on Correctional Health Care, which worked with the government on the project.
It offers a sobering view of the corrections system, which has clearly become a major conduit for infectious disease. The rate of transmission for sexually transmittable disease behind bars is roughly 10 times that in the world outside.
In any given year, 17 percent of people with AIDS, 35 percent of people with tuberculosis and nearly a third of those with hepatitis C pass through the corrections system.
This system represents a gaping hole in the public health network, thanks in part to the fact that prisoners become ineligible for Medicaid assistance while they're behind bars. I
nmates who have the misfortune of being housed in jails and prisons without serious medical programs often have no choice but to cease treatment, which means that they get sicker and continue to pose an infection risk to others.
Once released, these same inmates spend months trying to re-enroll in the Medicaid program and get care.
The US would experience less infectious disease -- which means fewer deaths and less strain on the health system - if the public health apparatus were fully extended into the jails and prisons.
The health status report argues convincingly for a rigorous program of testing, treating and counseling that would slow the spread of disease and alert inmates to illnesses before they reached the crisis stage and became prohibitively expensive to handle.
These ideas are perfectly consistent with what we know about the importance of preventive medicine. But applying them to prison inmates will be difficult until we begin to see them not as outcasts who deserve to be cut off from the public largesse, but as fellow citizens with whom we will eventually share a common fate.
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