How Can Health Systems Effectively Serve Minority Communities? Part of the Solution is Improving Care for Those in Correctional Facilities.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Raymond Perry, MD, MS, medical director of Los Angeles County Juvenile Court Health Services, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Perry is an alumnus of the RWJF Clinical Scholars program (UCLA 2009-2012).
Racial and ethnic minorities are significantly overrepresented in the U.S. correctional system. As these men, women, and adolescents spend days, weeks, months, or years detained in jails, prisons, and juvenile detention facilities, the health care system must recognize the health implications of the disproportionate incarceration of minorities, as well as the opportunities for addressing minority health issues in our society—namely, inequitable health care access and disproportionately negative health outcomes.
Health care provided in the correctional system should be more than a legal requirement or a moral imperative; it should also be acknowledged as a means of eliminating societal health and health care disparities. The correctional system must recognize the significance of addressing health disparities by providing access and care to many people who have previously been underserved and who face an unequal burden of poor health outcomes. Ensuring optimal health care in correctional facilities, providing appropriate and comprehensive health education, increasing health literacy, and facilitating access to care upon inmates’ transition home are all means of improving the health of minorities and the communities in which they reside.
While one can argue about the reasons for disproportionate incarceration rates and the fairness of incarceration for many minorities, the time spent detained offers an opportunity to screen and treat many who have previously had limited access to care or who may not have sought or obtained health care for both acute and chronic conditions prior to incarceration. The incarcerated population faces greater risks of and prevalences of infectious diseases (tuberculosis, sexually transmitted infections, HIV, hepatitis), acute injuries, and some chronic conditions (hypertension, asthma, cervical cancer). While detained, people with conditions that were previously undiagnosed, untreated, or inadequately treated can and should receive the appropriate treatment and begin plans for long-term treatment if needed.
Transitional planning, which should be a standard component of correctional rehabilitative services (especially in prisons or long-term detention facilities), should include insurance enrollment and links to community-based primary care. For minorities, this can increase the use of primary care in vulnerable and at-risk groups and, ultimately, may translate into better health of both individuals and their larger communities. In order to further facilitate the transition to community-based services and long term personal health management, community clinics must ease access to care for former inmates and provide sensitive and comprehensive care, including appropriate risk-based assessments and continuation of any care plans initiated during patients’ incarceration periods.
In Los Angeles County, home of one of the nation’s largest juvenile detention systems, we are focused on providing all necessary components of health care for incarcerated adolescents. By giving any necessary immunizations, offering universal STD (sexually transmitted disease) testing, dental screening, and mental health screening, conducting full physical exams on all detainees, and providing referrals to community clinics run by the County Department of Health Services, we hope to increase health awareness among high-risk youth, manage any previously unmet health needs, and help the youth and their families to connect with community primary care partners from whom they will hopefully continue to receive care. Our youth are mostly Latino and African American adolescents, and many live in medically underserved neighborhoods with comparatively poor public health outcomes. Our goals are to give youth the complete medical care they need while detained and to give them the knowledge and skills to continue positive health-seeking behaviors once they return home and as they enter adulthood.
While I would much prefer for these youth to receive all of these important health services and information without ever having to be detained, it is essential that we meet their health needs and encourage responsible, healthy lifestyles wherever and whenever we can. Similar missions should drive health care services offered to adults in jails and prisons. Hopefully, this will better the health of the incarcerated youth and adults, as well as the health of their families and communities.
Enhancing the health services provided in correctional facilities and strengthening the connections between correctional systems and community health systems can positively impact minority health. In order to fully address health disparities, we need to include correctional efforts in any work toward improving health promotion, health care access, and health outcomes among minority communities.