Minimal Standards of Adequacy: A History of Health Care in US Prisons

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PROJECT SUMMARY The disproportionate impact of covid-19 in U.S. jails and prisons offers stark evidence of a reality rooted in history: the incarceration of more than two million people constitutes a public health catastrophe. Mass incarceration threatens the well-being of communities and exacerbates health disparities. Inside of prisons, incarcerated people face a variety of health challenges. They are more likely to have HIV/AIDS, Hepatitis C, tuberculosis, and an array of common sexually transmitted diseases than their non- incarcerated counterparts; over 40 percent of people in prisons have a chronic condition. Peer-reviewed literature, news reports, and legal claims provide evidence of egregious shortfalls in prison medical services. As increasing evidence emerges demonstrating that prison health care is inadequate, there remains no comprehensive study of how this overwhelming contemporary health policy and humanitarian crisis arose. Minimal Standards of Adequacy: A History of Health Care in U.S. Prisons explores how incarcerated people, medical and corrections professionals, reformers, policy makers, and the courts defined and perceived prison medical services during the past century. Building upon path-breaking work about the health consequences of incarceration, about the history of prisons, and about how incarcerated people endured and resisted being abused and exploited as medical research subjects, the book explores questions related to so-called routine medical care. It begins in the 1920s and 1930s, when state-level court cases and federal legislation related to prison hospitals highlighted confounding questions about health-related rights and governmental obligations in carceral institutions. It explores the amorphous standards that influenced prison-based care in the post-World War II years, and how incarcerated men and women experienced medical services. Minimal Standards also assesses prison health activism, paying special attention to its connection with the civil rights movement, and the 1976 Supreme Court case, Estelle v. Gamble, which, building on state-level lawsuits, helped establish that people in prisons have a constitutional right to health care. It shows that, in the wake of Estelle, professional organizations like the American Medical Association and American Public Health Association articulated standards for service provision even as prisons became more prevalent, more bureaucratized, more privatized, and more openly punitive. The book ends with the recognition that more than forty years after Supreme Court Justice John Paul Stevens maintained that the government must “provide the persons in its custody with a health care system which meets minimal standards of adequacy,” major legal and ethical questions regarding the medical rights of incarcerated people – and reports of abuses of those rights – abound. Based on rigorous research in national, state, and local archives, Minimal Standards offers insights about legal, medical, policy, and prison history, and perspective on the roots of a modern public health calamity.