Social Justice Matters: Health Care and the Prison System

As a society, we have collectively decided that it’s important to put people in prison when we have decided they have done bad things. In previous posts in this series, I’ve discussed the structural inequalities that contribute to certain classes of people being more likely to end up in prison than others, regardless of guilt, and today I’ve like to delve into the health care situation in the US prison system.

It is not pretty. The great myth about prison is that people get ‘three hots and a cot,’ so they have nothing to complain about. In strict point of fact, even this idiom isn’t true. Many prisons do not actually offer three meals a day as a result of funding cutbacks. And in overcrowded prisons, sleeping arrangements are…not ideal, shall we say. Prisoners may be forced to share bunks with others, for example.

‘Three hots and a cot,’ assuming they are provided, is not actually the highest standard of living, either. After all, prisoners also deserve access to fresh air. To communication with each other and with people on the outside. To newspapers, books, and other media. To education. To a safe environment where they are not at risk of physical and sexual assault. None of these things are guaranteed to prisoners in the United States.

And there’s something else that gets left out of this idiom: Health care. It’s my opinion that if people are going to be locked up in my name, ‘on my behalf,’ that those people are owed health care services. Not least because of the intersections between prison and mental illness. As it turns out, prisoners have a lot of health problems. Prisoners are more likely to have health problems, sometimes very serious ones like HIV/AIDS, hepatitis C, and kidney failure, than the general population. They are more likely to have substance abuse problems. Many prisoners have disabilities. So, the health care needs of prisoners are higher than that of the general population.

And the prison health care system, to put it bluntly, sucks. Despite repeated warnings and criticisms, multiple states have failing prison health care systems. Prisoners die of treatable conditions. Simple conditions become much more complicated. Prisoners receive inconsistent care and die after routine procedures performed in unsafe environments.

Prisons are supposed to provide health care, but many of them lack the capacity to offer anything other than rudimentary health services to their inmates. Unlike those of us in the population outside, prisoners can’t decide to go to a different doctor when the service they are getting does not meet their needs. And prisoners rarely have success when appealing for better care unless they are assisted by someone on the outside. Usually a big someone, like the ACLU.

Imagine this. You wake up in the middle of the night because you are in excruciating pain. It’s an emergency. You are afraid you are going to die. What do you do? You call for help. Maybe you go to the emergency room. Maybe you call 911 for emergency transport.

If you’re in prison, everything changes. You clamour for the attention of a guard. You hope the guard believes you and doesn’t think you are malingering. You hope the guard arranges for immediate medical attention and doesn’t leave it for the morning. You hope you don’t get left to die while writhing in agony in your cell. If you are treated, you hope that the prison doesn’t withhold your medication. That you are provided with your meds on time, and in consistent doses.

Prisoners with chronic conditions requiring followup treatment and consistent care die in prison because these services are not provided. Prisoners with mental illness get worse in prison not just because the conditions are not conducive to mental health, but because they are not diagnosed, not provided with psychiatric services, not offered therapy. Because they are isolated in solitary confinement by prison officials who cannot decide what else to do with them.

Here in the United States, we seem to have trouble identifying health care as a human right, which is a pity, because it absolutely is a human right. People who are incarcerated are uniquely vulnerable. Their only hope to access health care is through the people who are supervising their ‘care.’ But because prisoners are deemed in need of punishment, often, that care is provided indifferently and too late.

It is an outrage that people die in US prisons as a result of lack of access to health care. It is an outrage that prisoners with relatively simple conditions are left untreated so long that their conditions develop major complications. It is an outrage that prisoners are denied access to medications and prescribed treatments, and that for other prisoners, there’s never a chance to get a prescription, because they never see a doctor. To be sentenced to prison, for some people, can end up being a sentence of death.

The Constitution of this country includes a ban on what is labeled ‘cruel and unusual punishment.’ I would argue that denying access to health care is unfortunately not unusual in this country, but it is most definitely cruel. It is utterly inhumane. And it is utterly wrong. If we are going to be putting people into the prison system, we need to have mechanisms in place to provide them with health care services. If we cannot provide health care, we need to release them, so that they can access it on their own.

There are so many barriers to health care access in this country. The bars of a jail cell should not be one of them. Safe, reliable, high quality health care needs to be provided in prisons and jails in this country. I do not want to read about fully preventable deaths of people in custody ever again. Their blood is on my hands, and your hands too.