RWJF Physician Faculty Scholar Tackles Crisis in Care for Women in the Justice System

Continuity and access issues in prison health care increase lifelong health risks for people who pass through the system.

More than seven million Americans are currently in the criminal justice system in the United States, whether they are incarcerated, on probation or on parole. And while the majority of people under correctional control are male, the Bureau of Justice Statistics reports that 1 in 82 American women are in the system. The health and health care challenges faced by these women are part of the ongoing research of Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholar 2008-2011 Ingrid Binswanger, M. D., M. P. H.

Her work not only breaks new ground, it helps to shed light on a population that goes uncounted in existing national health data. “There are very few surveys of the health of people in the prison system as they are generally excluded from large, national health surveys,” Binswanger said. Yet, she emphasizes, “these people return home and are a part of our community and we should think of caring for them as we do other groups in the community.”

In an effort to better understand the quality of health among these women as well as how they access care, Binswanger used data from a federal survey of 6982 jail inmates and published the results in “Gender Differences in Chronic Medical, Psychiatric and Substance-Dependence Disorders among Jail Inmates," in the March 2010 issue of the American Journal of Public Health.

“We found that women in jail had a higher prevalence of chronic medical disorders, psychiatric disorders and drug dependence than men in jail, including some conditions found more commonly in men in the general population. And when it came to cancer, there was a sevenfold difference in cancer prevalence among the women,” said Binswanger, who is also an assistant professor of Medicine at the University of Colorado, Denver School of Medicine. Even though the disparity was attributed almost solely to cervical cancer, it showed that women in prison had far higher rates of that disease than women in the general population. Cervical cancer does not create a similar disparity when men and women in the general population are compared.

“After adjusting for age, race, marital status, drug or alcohol dependence, the differences still held,” she said. “In general, these women have a more complex health picture than the men, including a higher risk of physical, drug and mental health issues. In addition, their death rates after release from prison are relatively higher compared with women in the general population,” Binswanger explains.

“The gender difference in chronic health conditions is new to the research,” she said, adding, “the results of the survey suggest that at least part of the problem is that these women need comprehensive and coordinated preventive care and treatment for substance abuse, chronic and mental health problems.”

An Emphasis on Transitional Care

Examining the problems faced by women in the system is only a part of Binswanger’s work. “A large part of my project under my RWJF award is to examine the mortality risk of all people released from prison, so the findings from this research are helping me to understand the full scope of the health and health care issues for this group,” Binswanger said. “Overall, I’m working on improving the transitional care that people in the justice system receive when coming back into the community. I am looking at ways to bridge care.”

Binswanger’s research also highlights the inadequacy of the patchwork of care plans that exist throughout the prison system. “Many prison medical care systems operate like HMOs, so there are ways of limiting the care inmates can receive. They often have to be able to pay to access care while incarcerated,” she said.

“But the larger problem is still that once they are released, people face major barriers to accessing care and experience gaps in needed treatment. I also suspect there’s a relationship between being unable to maintain good physical and mental health and whether people return to the system. We interviewed people just after release and found that they were overwhelmed by the challenges of accessing care when out of prison and that included a lack of continuity in medication, along with psychiatric medications,” Binswanger said.

“In an effort to address these issues, we are currently trying to develop an intervention—a pilot program in Denver—to ease the transition into the community for people coming out of the justice system,” Binswanger said. “We also have a study underway to determine the risk factors for the higher rates of mortality in this group after release. The women and men in the system have a real need for interdisciplinary and fully integrated health care and working toward that is our goal.”

The Robert Wood Johnson Foundation Physician Faculty Scholars program provides opportunities for physicians in junior faculty positions to gain valuable research experience and become academic leaders in their fields. By offering mentors and protected time, the award gives young faculty members support at a critical point in their academic careers.

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