CRIMINAL JUSTICE AND PUBLIC HEALTH:

IMPROVING THE WHOLE COMMUNITY AND PERSON

Roberto Hugh Potter, Ph.D.Health Scientist

Coordinating Center for Infectious DiseasesCenters for Disease Control and Prevention

DIFFERENT ENTITIES

• CRIMINAL JUSTICE SYSTEM:– POLICING– JAILS/DETENTION– PROSECUTORS/ PUBLIC

DEFENDERS (PRIVATE ATTORNEYS)

– COURTS– COMMUNITY

CORRECTIONS– PRISONS

• HEALTH SYSTEM:

– PUBLIC HEALTH– PRIVATE MEDICAL

PROVIDERS– PUBLIC HOSPITALS– PRIVATE HOSPITALS– NURSING HOMES &

LONG-TERM CARE FACILITIES

DIFFERENT MISSIONS?

• INDIANA DEPARTMENT OF CORRECTIONS:– The mission of the Indiana Department of Correction

is to maintain public safety and provide offenders with self improvement programs, job skills and family values in an efficient and cost effective manner for a successful return to the community as law-abiding citizens.

• Vision– Your Indiana Department of Correction is a

community dedicated to improving and protecting lives in all communities.

DIFFERENT MISSIONS?• MISSION STATEMENT

– The Indiana State Department of Health supports Indiana's economic prosperity and quality of life by promoting, protecting and providing for the health of Hoosiers in their communities.

• VISION STATEMENT– To achieve a healthier Indiana, the ISDH will:– Focus on data-driven policy to determine appropriate evidence-based activities. – Evaluate activities to ensure measurable results. – Engage its partners and include appropriate intra-agency programs in policy-

making and programming. – View its essential partners to include local health departments, physicians,

hospitals and other health care providers, other state agencies and officials as well as local and federal agencies and officials, community leaders, businesses, health insurance companies, Medicaid, health and economic interest groups, and other groups outside the traditional public health model.

– Actively facilitate the integration of public health and health care activities to improve Hoosiers’ health.

SAME ISSUES?

• Minority over-representation

• Health disparities

• Many health risk factors are also criminogenic factors

• High recidivism rates

• Lack of program resources

• Short-staffed

Hart’s Inverse Care Law (1971)

• Those with the greatest levels of illness (burden of disease) have the most limited access to health care services;

• Poorer populations have the least access to health care and most often the greatest burden of infectious and chronic diseases

DIFFERENT BEHAVIORS, OVERLAPPING ROLES?

• PUBLIC HEALTH FOCUSES ON

– PRIMARY AND – SECONDARY

PREVENTION

• OF HEALTH RISK BEHAVIORS;

• PROSECUTION/• JUDICIARY/• CORRECTIONS/• COMMUNITY

CORRECTIONS FOCUS ON:

– SECONDARY AND – TERTIARY PREVENTION

• OF BEHAVIORS ASSOCIATED WITH CRIMINALITY

CY 2006 INDIANA CJ “FLOW”• 229,883 total arrests (2005)

• 115,000 jailed > 48 hours; (50% assumption)

• 98,681 new probation cases (adult) 2005; (43% of arrests)• 99,342 exited probation (adult) 2005; (0.5% decline over prior year)

• 121,014 probation population (adult) 2005

• 24,455 prison census on 12/31/05; (1.9% growth over prior year)• 14,089 total admissions to DOC CY06; (6% of total arrests)

• 25,237 census on 1/1/07 (<10% of arrests)

• 6446 paroled (2005)

HEALTH PROBLEMS OF CORRECTIONAL POPULATIONS

• Jail Inmates, 2002:• 37% some current medical condition and/or impairment

– 22% reported 1 condition, 14% two or more– 63% reported no current medical condition;

• OVERALL DISEASE PREVALENCE:• ARTHRITIS 12.9%• HYPERTENSION11.2%• ASTHMA 9.9%• HEART 5.9%• TB (LIFETIME) 4.3%• RENAL 3.7%• HEPATITIS 2.6%• HIV 1.3%

CAUSES OF DEATH IN STATE PRISONERS 2001-2004

• More than half of all prisoner deaths involved:– Heart diseases (27.3%) and– Cancers (23.3%)

• Other major causes were :– Liver diseases (10.1%)– AIDS-related (7.2%)– Suicides (6.1%)

PRISONS SAFER THAN THE COMMUNITY?

• Data reveal that:– 19% lower overall death rate for prisoners than in the

general public;– For African Americans, a 57% lower comparative

mortality rate

• Washington state data reveal that within 3 years of release, prisoners:– 3.5 times more likely to die than state population; first

two weeks most dangerous, even on parole (67%);– Overdose, heart disease, homicide and suicide

leading causes of death once released

IMPACT OF POOR HEALTH ON THOSE YOU SUPERVISE?

• Chronic pain

• Poor work performance

• Absenteeism

• Missing supervision meetings

• Lowered wages

• Family discord

• High-cost health seeking behaviors

Essential Public Health Services

• Monitor health status to identify community health problems • Diagnose and investigate health problems and health hazards in the

community • Inform, educate, and empower people about health issues • Mobilize community partnerships to identify and solve health

problems • Develop policies and plans that support individual and community

health efforts • Enforce laws and regulations that protect health and ensure safety • Link people to needed personal health services and assure the

provision of health care when otherwise unavailable • Assure a competent public health and personal health care workforce • Evaluate effectiveness, accessibility, and quality of personal and population-

based health services • Research for new insights and innovative solutions to health problems

PARTNERSHIPS!

• Build partnerships between your health department and criminal justice agencies:– pandemic flu is a great starting point– http://www.pandemicflu.gov/plan/workplaceplanning/l

awenforcement.pdf– http://www.pandemicflu.gov/plan/workplaceplanning/c

orrectionchecklist.pdf

• Cross-train for general knowledge and comfort• Develop formalized linkage services• Co-locate services

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