HEALTH DISPARITIES: RELEASED

FROM INCARCERATION
 
 

• BEATRICE G. LEWIS
YSU NURSING 6900 FALL-2 2020

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 Healthcare disparities have been in existence
nationally for some time. “Mass incarceration
in the United States is unique both
historically and internationally” (Tobin Tyler
& Brockman, 2017, p. 545). With the
unfortunate changes, chances and situations
in life that had fallen upon some individuals
many found themselves imprisoned.
However, for these people upon release is a
stigma in society that renders a label to those
who have been incarcerated and there is a
sense of loss for these individuals along with
their status in the community and a level of
trust from others.
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 There are 2.2 million people
incarcerated in the United States. (Hawks,
Puglisi & Shavit 2020, p.1262). In 2019
according to the Ohio Department of
Rehabilitation and Corrections there were
21,890 releases and out of those how many
have chronic conditions and have maintained
compliance or have had difficulty accessing
care to receive the benefits or have we set
them up for failure.

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 The implications of disparities have come more
into the forefront since the epidemic and has been
shared on the news and reports from sites such as the
World Health Organization and Centers for Disease
Control. One article describes prisons as “Generally
having well defined policies/procedures and in some
states, there are prisons that are specifically designed to
house specific populations of individuals with chronic
and skilled nursing needs” (Grametbaur, 2020, p.15).
However, this is the group of individuals who also
become lost in the mix of things therefore is my issue This Photo by Unknown Author is licensed under CC BY

of Concern.
 There are over 44,000 inmates that are housed in
Ohio prisons who have 24-hour access to a nurse
and medical services for exacerbation of symptoms
and emergency health care. The department reported
that medical services for each individual range at a
cost of $83.72 per person, it was also noted from
their 2019 Chronic Illness snapshot report that 9,485
inmates have some sort of chronic health condition.
With heart and blood pressure illness at the top, liver
and lipid disease was in second and third place at
over five thousand affected. Diabetes came in fifth
place and noted that over twenty-eight hundred
imprisoned individuals are treated for this chronic
illness. It was not clear if this cost is a generalized
amount for a person who otherwise may be healthy
with just occasional basic health service needs.
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CC BY-SA-NC
 The Covid-19 epidemic has expedited release of
incarcerated persons and increased the number
of individuals placed on probation in lieu of
incarceration, however, many of those on
probation will live in communities with
disproportionally high rates of Covid-19
infection and findings suggested that “those on
probation with higher rates of physical illness,
mental illness and substance use disorders may
face increased barriers to initiation and
continued out patient treatment, as most care in
light of the pandemic has transitioned to phone
This Photo by Unknown Author is licensed under
CC BY-SA-NC
or video visits” (Hawks et.al., 2020, p.1411)
 Individuals who have finished their court mandated
sentences and have been released regardless if on
probation to finish out the requirements of their sentence
are at a higher risk of death as compared with the public
and those individuals who are still incarcerated. (Hawks,
2020). A study of adult correctional facilities revealed that
“persons on probation often failed to receive medical care
for chronic conditions, substance use, mental illness or
infectious disease detection” (Hawks et. Al., 2020,
p.1411). Other research that had been done as well, found
high emergency room visits and hospitalization rates for
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licensed under CC BY-ND
those who had either been recently arrested or recently
released and out on parole.
 However, out of the 44,000 or so inmates that are incarcerated

and the reported 21,890 that have been released you have to

wonder how many out there have chronic disease conditions that

will also need the same type of continuation and continuity of care

upon release. This is concerning for nursing and healthcare system

in general as the burden for some individuals care lay solely on the

taxpayers and we as nurses are charged with the care planning and

educational needs during any office or emergency room care and This Photo by
Unknown Author is
licensed under
CC BY-NC-ND

or subsequent hospital admission with preparation for discharge.

 There is still a lot of work to be done and “the
creation of a more uniform system to understand the
health of persons once they are released and on
probation would help to elucidate their care needs”
(Hawks et. al., 2020, p.1416).
This is where is it is so important to adjust and
revise the care act in sections that could potentially work
negatively especially if income does not allow for
people to afford the cost or perhaps the penalty at years
end for not having coverage. This is where the
discussion on eliminating the mandate portion has come
into discussion among those in politics. This Photo by Unknown Author is licensed under CC BY-NC-ND
 Proposal
What I would like to see is a program that is developed just like the community
outreach programs that are out there for Infectious diseases like HIV to where
individuals with chronic health care needs such as Cardiac issues, diabetes,
uncontrolled hypertension that could potentially be detrimental to their life, have a
Medical Case Manager for a specified timeframe or until they are off the prison roster
listing as on probation. That Case Manager would function similar to the Parole officer
who would have specified timeframes such as a thirty- sixty- or ninety-day timeframe
up to and including a year post incarceration checking on the status of their healthcare
situation and if they are having difficulty with access to care and medications, serving
as a liaison for them and making sure that the offender remains compliant. I think this
would help in the ongoing educational and fostering of independence with the
responsibility of their own health thus decreasing the rising healthcare costs due to
emergency room visits and hospitalizations. This is a way to help track and move
forward the goals of decreasing health disparities as well. This Photo by Unknown Author is licensed under CC BY-NC-ND
Hawks, L., Wang, E. A., Howell, B., Woolhandler, S., Himmelstein, D. U., Bor, D., & McCormick, D. (2020). Health
status and health care utilization of US adults under probation: 2015–2018. American Journal of Public
Health, 110(9), 1411- 1417. https://doi.org/10.2105/AJPH.2020.305777

Albertson, E. M., Scannell, C., Ashtari, N., & Barnert, E. (2020) Eliminating gaps in Medicaid coverage during
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https://www.doi.org/10.2105/AJPH.2019.305400

Grametbaur, J. (2020). Catching the chain: Working on correctional cases. Journal of Legal Nurse Consulting, 31(3),
14-21. https://eps.cc.ysu.edu:8443/login?url=
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Huston, C. (2020). Professional issues in nursing: Challenges and opportunities (5thed.). Wolters Kluwer. American
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Kulkarni, S.P., Baldwin, S., Lightstone, A.S., Gelberg, L., & Diamant, A.L. (2010) Is incarceration a contributor to
health disparities? Access to care of formerly incarcerated adults. Journal of Community Health, 35(3), 268-274.
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Tyler Tobin, E., & Brockmann, B. (2017). Returning home: Incarceration, reentry, stigma and the perpetuation of
racial and socioeconomic health inequity. Journal of Law, Medicine & Ethics, 45(4), 545-557.
https://www.doi.org/10.1177/10773110517750595 This Photo by Unknown Author is licensed
under CC BY-SA

2020 Annual Report. (2020). The Ohio Department of Rehabilitation and Corrections. WWW.DRC.Ohio.Gov