The delivery of health care to people in prison and jail-a population that is largely underinsured and generally has limited access to health care in the community-provides a significant opportunity to affect the ongoing health and well-being of medically needy individuals. (See Policy Statement 35, Physical Health Care Systems, for further discussion on health insurance in low-income communities.) Both treatment professionals and community-based organizations can play a role in counseling people in prisons and jails to improve current health problems and facilitate future prevention.

First, when treating a prisoner for a particular ailment, health care providers should make sure to educate him or her about how to manage that illness. A patient with a communicable disease, for example, should receive information about preventing transmission of the disease to other people. Research supports the notion that people in prison or jail are interested in treatment and compliant with medical directives. For instance, patients treated for high "bad cholesterol" levels in the New Hampshire Department of Corrections were found to have a 95 percent compliance rate with drug therapy, and 71 percent of patients achieved clinical results consistent with national guidelines. ^[1]   A Rhode Island study of treatment for chronic hepatitis C infection among inmates also demonstrated patient compliance with treatment and clinical response rates comparable to those in the community. ^[2]   All state departments of corrections should have standardized clinical protocols for the evaluation, treatment, and education of inmates with chronic diseases, some of which disproportionately affect prison populations. In the absence of such protocols, it is impossible to measure and assure quality of care for persons suffering from chronic illnesses.

In addition, correctional health care programs should include instruction on general wellness issues. Health care professionals or their partners from community-based organizations can teach inmates about the importance of good nutrition, compliance with medication regimens, and protection from sexually transmitted diseases. Even in the absence of system-wide protocols, informal counseling from physicians on health issues can have significant results. For example, a number of community-based studies have shown that physician counseling can influence smokers to quit, a benefit that saves both lives and money. According to one University of California Department of Medicine study, the cost-effectiveness of brief, anti-smoking advice during routine office visits ranges from $705 to $988 per year of life saved for men and from $1,204 to $2,058 for women. ^[3]   Among prisoners, who smoke at a rate more than three times the national average, the opportunity for such savings is dramatic. Given the likely benefits of such education, communities are wise to invest in providers who can seize the public health opportunity of educating incarcerated patients about health, well-being, and any diagnosed illness.

Significantly, however, such education need not come only from doctors. Departments of corrections can partner with other government agencies (including public health departments) or community-based organizations to educate inmates about a range of health issues.

Example: HIV Coordinators, Massachusetts Department of Public Health/County Sheriffs Departments (MA)

In this partnership, the Massachusetts Department of Public Health and sheriffs from all counties in the state each pay one half of the cost of providing HIV program coordinators to work with people in jail living with HIV/AIDS. Along with case management and testing services, the program coordinators facilitate counseling and education groups for program participants at county correctional institutions. Where appropriate, program coordinators also contact and engage other community-based stakeholders to work with inmates.

Inviting community-based, non physician providers to counsel inmates can be an efficient use of time and money. These providers may include former prisoners, or peers, who may be even more effective than professionals in educating people in prison or jail about health issues. (See Policy Statement 9, Development of Programming Plan, for more on building cultural competency by incorporating former prisoners into institutional programming.)

Example: Get Connected, Centerforce (CA)

Centerforce staff (73 percent of whom have been incarcerated or have a family member who was incarcerated) provide 30 hours of health and skill-building training to people in correctional facilities who are interested in becoming peer health educators. Trained inmate health educators lead daily health education workshops for individuals newly admitted to San Quentin State Prison, Central California Women's Facility, and Valley State Prison. Program participants who received HIV counseling reported a preference for peer educators over other types of educators. Peer educators and Centerforce staff members also develop educational brochures, fact sheets, and videos for people who are incarcerated and their families to help both populations to address a number of family and health issues.