Health Wanted: Health of Incarcerated People

The Episode

The topic: The U.S. has the highest population of incarcerated people in the world, but quality health care is severely limited in correctional facilities. This week on Health Wanted, host Laurel Bristow and guests Mark Spencer, MD, and Wanda Bertram discuss the current state of health services for incarcerated people in the U.S., the decline in care due to cost-cutting measures, and how improving these services could benefit public health.

LISTEN TO THE EPISODE NOW

The takeaway: Although the United States has the highest incarcerated population in the world, access to quality health care within correctional facilities is severely limited. This not only harms the health of incarcerated individuals but also the well-being of the communities they come from and return to.

• Overcrowded prisons create an environment where infectious diseases can spread rapidly, mental health is put at risk, and suicide rates increase. Many facilities do not have air conditioning, which puts incarcerated people at risk of developing heat-related illnesses and complications from pre-existing conditions.
• Although medical care is technically required by law in correctional facilities, it is often difficult to access. Incarcerated individuals must first go to corrections officers with a health complaint, who then relay the information to medical staff, who determine whether care is “medically necessary.” This process leads to long wait times, untreated conditions, and significant suffering.
• Many prisons have moved from federally or state-run health care systems to privatized systems to cut costs. These third-party companies cut costs by denying prescriptions, delaying care, and hiring staff with questionable records. Studies have shown that mortality rates are higher in prisons with privatized health care than in those with government-run systems.
• Money plays a major role in the health of incarcerated populations. Some states still require copays for medical visits, and essential personal items like glasses or hearing aid batteries are sold at inflated prices. Video calls, which are increasingly becoming the only way to see family, can be costly as well. This financial strain adds emotional stress and further undermines mental and physical well-being.

The Interview

The guests: Mark Spencer, MD, and Wanda Bertram

The key takeaways: 

• The health outcomes of incarcerated people are also community health outcomes. Most incarcerated individuals return to their communities, and millions cycle through the system each year. Community health systems are directly impacted and must manage the long-term health needs of these individuals. Children of people in prison are also left with limited support and are more likely to experience poverty, homelessness, and developmental delays.
• Social determinants of health also influence risk of incarceration. These factors include housing, economic stability, education, and access to health care, and they significantly affect the likelihood of becoming involved in crime. Addressing these issues from the ground up can improve public health and reduce incarceration rates.
• Diversion programs in the criminal justice system offer alternatives to time in jail or prison. They usually emphasize rehabilitation and provide services like counseling, community service, and access to treatment programs. An individual may be eligible for diversion programs if they are a first-time offender or engaged in a non-violent crime. Many diversion centers already exist but are underutilized by local law enforcement. 
• Investing in alternatives to incarceration can promote public health and safety. Diversion programs and non-police responses offer less punitive, more supportive pathways, especially during pre-arrest when individuals are most vulnerable. These alternatives can reduce trauma from being in jail or prison and lead to better long-term outcomes for people and communities. 

The Listener Questions 

Is it safe to eat bagged salads?

This question is inspired by an article that was published in The Atlantic in May of this year about harm reduction in the age of limited food safety inspections.

The budget for food inspections was cut by the Biden administration and now with the Trump administration’s job cuts, both people who were integral to food safety inspection and people who communicated about recalls have been cut.

The argument here is that switching from bagged salads (particularly those that contain romaine lettuce) to whole heads of lettuce can reduce the likelihood that you get a tainted batch. This is because, if you pick up a head of romaine, that particular piece of produce would have to be contaminated to get you sick. But if you pick up a bag of salad that contains chopped romaine, it could be that a few tainted heads of romaine got chopped up and then put into hundreds of bags of salad, increasing the number of people who could get sick from it.

Washing your produce can reduce, but not eliminate, your risk of foodborne illness, and avoiding bagged salad could be a reasonable change that could lower your risk by a fraction.

The lack of funding for and focus on food safety testing is worrying, but just as worrying is the lack of communication around outbreaks.  There’s a very real risk we’ll have more outbreaks but less information about them when they do happen, which will make it harder to know your risk.

Why does ketamine seem so popular?

Ketamine may have become more popular because it currently lives in a regulatory grey area.

Ketamine is a Schedule 3 drug, meaning it has moderate to low potential for physical or psychological dependence. It was originally developed and used as an anesthetic because it causes a sort of dissociative state. 

More recently, ketamine has gained attention for its potential when it comes to treatment-resistant depression. In 2019, Spravato, which is chemically related to ketamine, was approved by the FDA for treatment-resistant depression. So, as typically happens when something shows potential, people ran with it, and outpatient ketamine treatment clinics have been popping up all over the country.

The problem is that ketamine itself isn’t approved for the treatment of any mental health issues, so there are no standards when it comes to dose amount, frequency, or monitoring.

The federal regulations are limited to the fact that providers have to register with the Drug Enforcement Administration, but the rules about clinics vary from state to state. Now with telehealth, it’s unclear if the prescribers have to follow the rules set by the state they operate from or the state where the patient resides.

While ketamine overdoses are rare (they typically happen when it’s mixed with other drugs), long-term ketamine use has been associated with bladder and gastrointestinal issues and pain. 

Not knowing where to report adverse events means that those events could be underreported, and not having a standard of care means that people could get different experiences from ketamine clinics within the same state.

There’s not currently a science-backed practice for how much to give someone or for how long to give it, which makes it appealing to some people who may see it as adventurous to try.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
• Watching on WABE's YouTube channel