Mass Incarceration: The Culprit of the Inmate Healthcare Crisis

Chloe Li

Over the years, the American healthcare crisis has unraveled to expose the various cracks within the healthcare system. As hospitals across the nation continue to grapple with nursing shortages and poor distribution of scarce resources, marginalized groups have been significantly disadvantaged by high barriers to access. In particular, incarcerated people, effectively cast out of society by imprisonment, have borne the brunt of the crisis. While the American government has attempted to solve the brimming issues of incarceration, the efforts are merely a facade. The government deprives incarcerated people of basic human rights and perpetuates the disproportionate harm of mass incarceration by refusing to uphold health and safety standards. In fact, American leaders’ limited engagement on the pressing crisis sends an implicit message that incarcerated people do not hold value or equal rights as disengaged members from society.

While the prison crisis encompasses a wide scope, many of the issues’ roots lie in the systemic problem of mass incarceration. Mass incarceration has exacerbated pre-existing overcrowding, causing poor, inhumane treatment and increased medical problems for incarcerated people.1 The efforts of various non-profit organizations work towards reducing overcrowding and decarceration are futile in creating remarkable change, and incarcerated people continue to be subject to the country’s worst conditions. The Bureau of Prisons maintains very little transparency in its handling of prisons, making evaluating their adherence to moral standards extremely difficult.2 While a 25% population decrease was seen in 2020, this dramatic change was attributed to pandemic-related slowdowns in the criminal legal system, rather than reform.3 Despite the initial improvement, numbers returned to 87% of original populations. Rikers Island remains one of the most notorious prisons for its abysmal conditions; yet, Rikers has actually proven itself closer to the norm than the exception. Its inability to sufficiently respond to requests for constitutional rights has resulted in countless preventable deaths. Much of the abuse across the country’s prisons has been hidden by lack of proper documentation and data, allowing similar conditions to go unnoticed in other states.4 In fact, current efforts for reform have only worsened health conditions, and short term fixes fail to recognize that incarcerated populations’ health affects greater public health.

With the problem hidden from the public eye, the pressure is lifted from the government to truly target health conditions within prisons. Stigma that characterizes incarcerated people as dangerous and violent further contributes to the lack of societal pressures to fix inhumane standards. Minimal societal attention translates to limited emphasis on uncovering true, performative governmental efforts. A greater focus on accountability is needed before governments will truly make an effort to address incarcerated people as humans living in America.

Historically, the government has shown little regard for incarcerated people’s lives and has failed to prioritize one of the most vulnerable groups in terms of health and safety. A prime example of such neglect is the global COVID-19 crisis, where daily operations around the world were strained.5 While certain reports find that prisons utilized responsive policy decisions and collaborative problem solving to successfully mitigate the health crisis, others report that overcrowding made instituting protective measures almost impossible.5,6 In comparison to the general population, the COVID-19 death toll was six times higher within prison.6 Mistrust in the criminal legal system only grew. Incarcerated people were deprived of legal rights and medical treatments, causing lasting trauma and fear. However, the government’s mishandling of the COVID-19 pandemic in prisons was not an outlier. Similar mistreatment was displayed during the influenza and tuberculosis epidemic. Pandemic responses in prisons were historically limited to extreme social distancing measures and extremely limited availability of vaccines, despite an estimated surplus of over one billion doses of COVID-19 vaccines at the end of 2021.7 With resources readily available, it is clear that the government had the means to distribute vaccinations to many more people. Still, incarcerated people were not only deprioritized, but they were actively discriminated against and deprived of basic health measures. While there is no doubt that all communities suffered greatly from the widespread impacts of the pandemic, incarcerated people were greatly neglected by the American government.

From a legal aspect, while the government upholds its general moral standards through its Supreme Court rulings, it fails to maintain such principles. In the case of Estelle vs Gamble in 1976, the Supreme Court ruled that the “deliberate indifference by prison personnel to a incarcerated person’s serious illness or injury constitutes cruel and unusual punishment contravening the Eighth Amendment”.8 Yet, the definition of “indifference” and “punishment” remains rather vague, making this ruling extremely difficult to put into practice. Without the explicit stating of clear regulations, cases will continue to remain biased against incarcerated people, subject to judicial interpretation, and ambiguous in their ruling. Furthermore, with Brown vs Plata in 2011, the Supreme Court ruled that overcrowding was the main source of inadequate health care; therefore, prison population sizes should be dramatically decreased. Yet, overpopulated prisons remain, contributing to extremely poor quality of life. Time and time again, the government has shown little accountability for its refusal to engage with the prison healthcare crisis, quelling incarcerated people and their families’ voices through performative action.

It is safe to say that recent efforts are far from sufficient, but certain action plans provide promise in bettering incarcerated people’s lives. For example, Medicaid Reentry provides hope for formerly incarcerated people to receive better healthcare upon release. The enactment of the Medicaid Inmate Exclusion Policy in 1965 prevented federal money from being used on medical care for incarcerated people, yet only six states as of November 9 have applied for waivers allowing inmates to receive coverage.9 Providing Medicaid coverage not only reduces recidivism, but also increases the stability and safety of lives. Unfortunately, this legislation only targets Medicaid for incarcerated people once they have been released or once they are close to being released. The problem continues to persist within prisons, and little can be done to improve circumstances with current efforts. Mass incarceration is a systemic issue. Until the entire prison system is completely reformed, the same issues will only worsen.

The burden remains on the government to mitigate the effects of a broken system. For one, decarceration at a large scale would largely open up resources.4 Investing in decriminalization would improve prison conditions and provide hopeful opportunities. Only until all individuals are recognized with the same respect can the health and safety of the entire country be finally uplifted. Ignoring a large portion of the community will inevitably prove harmful for all; thus, a greater emphasis needs to be placed on improving prison healthcare. The US government’s duty is to serve its people and to promote general welfare, and the active discrimination against an entire group cannot be tolerated, especially from the decision makers of today’s world.10

References

  1. Krajik K, Gettinger S. Overcrowded Time - Why Prisons Are So Crowded and What Can Be Done | Office of Justice Programs [Internet]. Ojp.gov. 2024 [cited 2024 Jan 1]. Available from: https://www.ojp.gov/ncjrs/virtual-library/abstracts/overcrowded-time-why-prisons-are-so -crowded-and-what-can-be-done
  2. Anderson M. Lawmakers push for federal prison oversight after reports of inadequate medical care [Internet]. NPR. 2023 [cited 2024 Jan 1]. Available from: https://www.npr.org/2023/12/12/1218627629/lawmakers-push-for-federal-prison-oversig ht-after-reports-of-inadequate-medical
  3. Miltonette Olivia Craig, Kim M, Beichner D. Incarcerated in a Pandemic: How COVID-19 Exacerbated the “Pains of Imprisonment.” Criminal Justice Review [Internet]. 2023 Jul 27 [cited 2024 Jan 1]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375228/
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  6. Miltonette Olivia Craig, Kim M, Beichner D. Incarcerated in a Pandemic: How COVID-19 Exacerbated the “Pains of Imprisonment.” Criminal Justice Review [Internet]. 2023 Jul 27 [cited 2024 Jan 1]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375228/
  7. Evenett SJ. How big of a vaccine surplus will the US have? [Internet]. Brookings. 2021 [cited 2024 Jan 1]. Available from: https://www.brookings.edu/articles/how-big-of-a-vaccine-surplus-will-the-us-have/#:~:text=Following%20that%2C%20a%20surplus%20of,be%20over%201%20billion%20doses
  8. Estelle v. Gamble, 429 U.S. 97 (1976) [Internet]. Justia Law. 2024 [cited 2024 Jan 1]. Available from: https://supreme.justia.com/cases/federal/us/429/97/
  9. Gardner TM. A New Medicaid Program Could Dramatically Improve Healthcare for Imprisoned People—If States Use It [Internet]. Theappeal.org. 2023 [cited 2024 Jan 1]. Available from: https://theappeal.org/how-states-can-use-medicaid-reentry-to-uplift-formerly-incarcerated -people/
  10. 108TH CONGRESS 1st Session [Internet]. 2003. Available from: https://www.govinfo.gov/content/pkg/CDOC-108hdoc94/pdf/CDOC-108hdoc94.pdf
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