Preparing the public health workforce for the implications of incarceration

Preparing the public health workforce for the implications of incarceration

As incarceration rates increase worldwide, public health education must expand to address implications both for detainees/prisoners and communities to which they return upon release.  Data are uneven, but in many countries incarceration and health disparities follow similar tracks along fault lines of social and economic privilege.  Just as the poor are more likely to suffer negative health outcomes, socioeconomically disadvantaged persons have greater likelihood of incarceration.  Among the challenges for the public’s health are communicable diseases, like MRSA, multiple-drug-resistant TB, facility-acquired HIV, and other diseases, crossing boundaries between detention facilities and the general community.

To prepare the public health workforce for the challenges of incarceration to the well-being of growing inmate populations and communities at large, a strong public health curriculum must cultivate competencies and knowledge of:

• Links between likelihood of incarceration, poverty, and other categories of social marginality;
• diseases and conditions associated with confinement;
• experiences associated with confinement (e.g., exposure to violence, risk of injury, resulting physical and mental disability);
• incarceration’s collateral impacts (e.g., loss of security for already-vulnerable families with a member’s extended absence due to incarceration, documented generational risk of incarceration);
• how to influence health standards and practices within correctional facilities; and
• how to prepare inmates, communities, detention facility staff, and community organizations to manage risks associated with incarceration.

Global public health organizations can issue standards and develop model curricula to prepare the workforce.  Differences among countries in approaches to incarceration present opportunities for global exchange of data and lessons, enabling context-specific educational curricula and public health program development.  The public health field is uniquely situated to link corrections and law enforcement authorities, community development and planning bodies, social service providers, health care facilities, and social policy-makers; to recognize incarceration as a global health emergency; and to shape appropriate action.