I FOUNDED AND CO-DIRECT the Health Inequality Lab, and one of the projects that we’re really excited about is one that I’ve partnered on with Crystal Yang, a professor at Harvard Law School who is also affiliated with the Malcolm Wiener Center at HKS. The aim of the project is to improve health care standards and health care provision for the incarcerated population, particularly those who are incarcerated in our nation’s jails.
Over 600,000 people are in jails. It’s often the entry point to prison, but it’s also where a lot of individuals are pretrial. Jails are woefully under-resourced to deal with health problems. The system frequently involves individuals of low socioeconomic status, individuals with low education, minoritized individuals—primarily men—many of whom have never had positive encounters with the health care system. Many of them have never seen a dentist.
Sheriffs that run our county jails will tell you that they did not sign up to be the nation’s foremost mental health care providers. And yet the reality is that we have such woefully inadequate community mental health resources that individuals who are suffering from substance use disorders often end up in jail as well.
“Looking back at the experience of the United States through the COVID-19 pandemic, the fact that we performed poorly relative to other developed countries showed all the weaknesses in our current system for delivering health care.”
Despite all of this, incarcerated individuals have a constitutional right to health care through a decision that was made about five decades ago. An interpretation of the amendment against cruel and unusual punishment is that individuals who are incarcerated have a right to receive health care. And yet, how is that right enforced? What are the practical implications on the ground?
That’s really where research is needed because there’s very little transparency and there is very little oversight of what’s happening in our correctional facilities, particularly our nation’s jails. They’re run at the county level and tend to have the lowest level of resources, compared to state and federal prisons. And there are a lot of challenges that are unique to providing health care for individuals in custody.
It’s hard to think about health from the incarcerated population separately from the general state of the health care system in the United States. Americans lose their lives or livelihoods every day because they are reluctant to seek care or do so but are placed in debt. Our health care industry has been commercialized to the point where it’s almost hard to see the mission anymore. I think, looking back at the experience of the United States through the COVID-19 pandemic, the fact that we performed poorly relative to other developed countries showed all the weaknesses in our current system for delivering health care. We absolutely need a more inclusive system, a system that doesn’t have the churn and the administrative inefficiencies that bedevil our current landscape and generate gross inefficiencies and inequities.
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Marcella Alsan is the Angelopoulos Professor of Public Policy and a physician.
Photograph by Spencer Platt/Getty Images; Portraits by Martha Stewart; Photo illustration by Andrei Cojocaru