Improving Health Care in State Prisons

By Marina Silbergleit



Silbergleit M. Improving health care in state prisons. HPHR. 2023;77.

Improving Health Care in State Prisons

An overlooked but severe public health issue is the poor healthcare in state prisons. The number of incarcerated people who have chronic health problems and mental health issues is disproportionally high. Despite this, healthcare in most prisons is difficult to access, of poor quality, and costly. Most people who pass through correctional facilities are eventually released, bringing with them their neglected health. Inconsistent and uncoordinated health services administration is common in prisons. Improving the organization of health services is the most crucial step to improving healthcare in prisons. Most prison health care is devoted to treating acute symptoms of health problems rather than preventing or treating the actual underlying illness. Prisons contain disproportionate numbers of people living in poverty, people of color, and LGBTQ+ people, populations that already struggle to access health care.


Many people who are incarcerated already suffer from a physical or mental illness or disability. However, these individuals are unlikely to receive care while incarcerated unless their condition worsens. About 9.5% of people in state prisons have been diagnosed with hepatitis C at some point, more than five times the estimated number of U.S. adults with the viral infection. The cause of this elevated rate is clear, drug use is common prior to (and sometimes during) a prison sentence which increases hepatitis C risk. Treatment for hepatitis C has a high cure rate but treatment is expensive, about $90,000 per patient. As a consequence, 80% of people in state prisons diagnosed with hepatitis C still have it. This reveals the common failure of state prisons to provide appropriate life-saving treatment. Incarceration negatively affects the life expectancy of incarcerated individuals as well as overall life expectancy in the United States. 


Health services are often poorly supervised. In many prisons, health services are managed under the same category as food, social, and educational services. The best way to improve healthcare services in prisons is to require every department of corrections to have a health services division. This division should be run by a health services director who is responsible for managing health services system-wide. Having an authority to decide policy for the entire prison system and ensure policy and professional standards of care are upheld would vastly improve many prison systems. For example, the existence of needle exchanges in prisons should be implemented to reduce the spread of hepatitis C. They have been shown to be safer for inmates and staff without increasing drug consumption. Additionally, since the director would have authority over unit health staff this helps prevent correctional officers from co-opting health services personnel and ensures health services are adequately provided.


If all health services are managed by a healthcare division of the department of corrections the efficiency of healthcare in prisons would be greatly improved. Improving the organization of healthcare services in prisons combats abuse of power and helps ensure that healthcare policy is decided by people who understand it. Poor healthcare in prisons is detrimental to general public health and should be addressed. Our society has a temptation to ignore prisons as much as possible and because of this most people are unaware of how bad conditions in prisons can be. We cannot afford to indulge in the temptation of ignorance. Educating people on how poor healthcare really is in prisons is the first step toward achieving reform.


  1. “Chronic Punishment: The unmet health needs of people in state prisons, Leah Wang,
    June 2022, Prison Policy Initiative. (Chronic Punishment)
  2. “Health Care Behind Bars: Missed Appointments, No Standards, and High Costs” Sam McCann Senior Writer, Jun 29, 2022, Vera Institute of Justice. (Health Care Behind Bars)
  3. Correctional Health Care: Guidelines for Management of Adequate Delivery System,
    U.S. Department of Justice, National Institute of Corrections, 2001 Edition. (Correctional

About the Author

Marina Silbergleit