There are high rates of communicable disease, mental illness and chronic disease within incarcerated populations. In a major study published in 2002,1 it was found that in 1996, 12,000 of the 34,000 tuberculosis cases in the United States were reported among released inmates, and as many as 145,000 releasees were infected with HIV. Further, there were an estimated 465,000 cases of sexually transmitted diseases among releasees in 1997, and some state correctional systems reported hepatitis C virus infection rates of 17-40 percent based on random seroprevalence studies. This is consistent with the disproportionate rates of disease among poor and minority populations, who are over-represented among the incarcerated. While the vast majority of individuals affected by these conditions develop them prior to incarceration, the period of incarceration provides a window of opportunity to serve the broad public health interest by providing testing, treatment, counseling, health education and health promotion to an otherwise disenfranchised population prior to their ultimate release back into the community.1
In 1976 APHA published its first standards for health services in correctional facilities2 and in 2003 published its most recent update.3 With the tremendous burden of disease in these institutions, APHA’s standards are more important today than ever. Nearly concurrent with that early effort and at APHA’s urging,4,5 the National Commission on Correctional Health Care (NCCHC) developed an accreditation program that provides an independent, expert review of health services in our nation’s jails, prisons, and juvenile confinement facilities. The NCCHC accreditation program has been instrumental in effecting significant positive change in numerous correctional institutions.6,7
While much still needs to be done, even the progress made to date is currently threatened. Threats to correctional care are: state and county budget cuts, a national shortage of nurses and other health professionals, and federal legislation making it more difficult for inmates to sue for their constitutional rights8 to necessary health care. Such threats have contributed to a climate where some correctional systems are opting out of an independent, expert medical accreditation process.
Therefore, the American Public Health Association:
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