Prisons, healthcare...and tanning beds? By Andrea Blome

Previously famous for its torturous living conditions, Moscow’s Butyrka Remand Prison has been making headlines since announcing in 2010 that inmates are going to have access to tanning beds. A recent article explains that the function of the tanning beds is to address vitamin D deficiencies in inmates, but officials are also hoping to improve the facility’s reputation.    Why is the prison suddenly considering the health of its inmates? The tanning beds are a response to public outcry regarding an incident in 2009 when a young lawyer died of gallstones while in custody because he was denied health care.  While it is important to address vitamin D deficiency, I am confounded by the fact that Butyrka Prison is ignoring the root of this issue. Thus, the most interesting aspect of this article is its reflection of the larger problem plaguing prisoners around the globe: lack of access to adequate health care.

Should funds, manpower, and resources be allocated to prisoners when there are law- abiding citizens who don’t even have access to health care? My answer is an unequivocal ‘yes’ for two reasons, one based on ethics and one based on public health considerations. Ethically, inmates in any country deserve the same quality of health care that is available to rest of the population. Two documents detail the underlying principles of this argument. First, in 1976, the US Supreme Court concluded in Estelle v. Gamble, that “deliberate indifference to the serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’ ” in violation of the Eighth Amendment of the Constitution.  Furthermore, in 2003, staff from prisons around Europe wrote the Declaration on Prison Health as a Part of Public Health. The document states that the health status and legal situation of an individual are separate entities and should not influence each other.  Therefore, denying health care to inmates is punishment in addition to legal sentencing and should not be allowed to continue.

If you find yourself completely at odds with my ethical reasons for allowing inmates access to adequate health care, consider the public health implications. Penitentiary systems cultivate diseases because they are crowded, are not conducive to the proper maintenance of hygiene, and provide opportunities for risky sexual contact and needle sharing to occur. Many penitentiary systems display higher rates of certain diseases than the general population, including HIV/AIDS, hepatitis, tuberculosis, and mental disorders. For instance, up to 5% of those imprisoned in Argentina are HIV-positive, while only 0.5% of the general population are infected.  Furthermore, prisoners return to society – if they don’t die first. Previously healthy inmates face a greater likelihood of contracting certain diseases or deadlier forms of certain diseases. If they do become infected while incarcerated, they bring those diseases back to the community, making the burden even worse. For instance, drug-resistant tuberculosis (MDR-TB) in Russian prisons has been particularly onerous. MDR-TB is a treatable, curable disease with obtainable resources that should be higher on the agenda than tanning beds.

Incarcerated individuals should be targeted to the same degree as other high-risk groups, such as sex workers and drug users. In addition, treating prisoners is a way to increase access to a percent of the population, which could improve the overall health of the applicable nation. Instead of allowing inadequate health care in prisons to spread disease, we should embrace the opportunities inherent in the structure of the penitentiary system to combat infections. In prisons, inmates don’t have to travel long distances to a clinic to see a health professional and receive treatment. They can be tested and diagnosed, educated about safe sexual practices and sharing needles, and provided with medications.  Furthermore, prisons can implement directly observed therapy, which can help prevent the creation of drug resistant strains because the patients are monitored to ensure that they are taking the medication at the correct time and for the full course.  Ultimately, the health of inmates around the world appears to be mostly on the back burner, but is an obvious target for intervention by policy makers.

References

“Notorious Russian Prison to get Tanning Beds.” WHDH 7News NBC Boston 16 Jan. 2011. <http://www1.whdh.com/news/articles/bizarre/12003291235163/notorious-russian-prison-to-get- tanning-beds/>

Parfitt, Tom. “Crime and Unjust Punishment in Russia.” The Lancet 376.9755 (2010): 1815- 1816. <http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62152-6/fulltext&gt;.

Thorburn, Kim Marie. “Health Care in Correctional Facilities.” West J Med 1995; 163: 560 – 564. 26 Nov. 2010 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303263 /pdf/westjmed00363-0052.pdf>

World Health Organization. “Prison Health as Part of Public Health.” 24 Oct. 2003. <http://www.euro.who.int/__data/assets/pdf_file/0007/98971/E94242.pdf&gt;.

Caplan, Arthur, Ph.D. “Lousy Care in Prison Threatens to Undermine Recent Wins Against AIDS.” msnbc News 1 Dec. 2010. <http://www.msnbc.msn.com/id/40437376/ns/health- health_care/>

Partners in Health. “PIH Russia” and “Tuberculosis and MDR-TB.” <http://www.pih.org/pages/russia/&gt;