04/01/2013 06:13 pm ET Updated Jun 01, 2013

Let's Talk About Prison Health Care

On April 4 in Chicago, Rep. Greg Harris will hold a public hearing on HR57, a proposal that would provide independent oversight of Illinois Department of Correction's (IDOC) health care services.

This hearing marks the first major public discussion of prison health care in Illinois.

This is important because IDOC is not just an agency of 26 prisons that costs taxpayers about $1.3 billion a year. It is also a health care system for nearly 50,000 inmates, which Illinois recently gave a 10-year, $1.4 billion contract to Wexford Health Sources, a private prison health care company, to run.

These facts have profound and under-examined implications for state and local budgets, public safety, and civic health.

The United States Constitution's prohibition against cruel and unusual punishment requires prison officials to provide adequate health care for inmates.

Over the past 40 years, as Illinois' inmate population has increased by more than 700 percent, IDOC's constitutional health care obligations have become increasingly difficult to fulfill.

In its January 2013 Quarterly Report, IDOC reported that it housed almost 50 percent more inmates than it was designed to hold. Many minimum- and medium-security facilities housed more than 100 percent beyond their design capacity. These numbers place a nearly impossible demand not only on IDOC's ability to house inmates, but also on its ability to deliver health care services. Compared to the general public, inmates have significantly greater health care problems, with higher rates of chronic and infectious disease, addiction, and mental illness. The more inmates that IDOC incarcerates, the more sicknesses it must treat.

Apart from overseeing the care of its general population, IDOC also struggles to treat the growing number of inmates with special needs. For instance, over the past decade, Illinois' elderly prison population grew by more than 300 percent, far outstripping increases in other age groups. While exact estimates vary and there is no Illinois-specific data, it is widely accepted that U.S. prisons and jails house more mentally ill people than psychiatric hospitals. Additionally, a 2010 study by the National Center on Addiction and Substance Abuse at Columbia University found that 65 percent of the U.S. prison population meets the DSM IV medical criteria for substance abuse or addiction, though only 11 percent receive treatment.

These special populations and the costs associated with their care stem from decades of choices made by elected officials with the support of the public. Decisions to lengthen sentences, mandate harsher punishments for drug-based offenses, and close public mental health institutions have filled IDOC with inmates who are drug addicted, mentally ill, and growing older. As a consequence, state prisons have become de facto hospitals, asylums, drug treatments facilities, and retirement homes.

Faced with unprecedented prison overcrowding, IDOC's health care responsibilities put an enormous burden on correctional staff and administrators. In this way, the state of prison health care system directly affects IDOC's ability to promote public safety. With Illinois' fiscal crisis, IDOC has limited resources. The more resources IDOC must devote to health care, the less it has to provide inmates with programming that is proven to reduce criminal behavior. For instance, in Fiscal Year 2013, IDOC officials have reported that the agency must devote approximately 98 percent of its funding to basic operations, with less than 2 percent to spend on rehabilitative programming.

IDOC's health care system is not just an issue for the state's prisons. Every year, about 30,000 inmates leave IDOC to return to their communities. If the prison system is not able to meet its health care obligations, cities, counties, and the general public will inevitably pay a higher price when inmates are released, with increased transmissions of infectious diseases, emergency room visits, and higher recidivism rates.

This is not meant as criticism of IDOC's staff and administration. It is a testament to the men and women who staff Illinois' prisons that the system is able to function as well as it does.

The greatest problem facing IDOC's health care is that its system was created and is still defined by unasked questions and unintended consequences. When elected officials mandate harsher sentences or shutter community-based mental health programs, their intent is to be tough on crime or save taxpayer money, not to fill prisons with elderly inmates or inmates with special and expensive health care needs. As a result, IDOC's health care needs are never meaningfully taken into account when elected officials determine the laws, policies, and funding that govern the state's prison system.

Through decades of passing laws and supporting policies that have filled our prisons with an unprecedented number of inmates, we have built a prison health care system without asking difficult and yet fundamental questions about what we have created. Where will we find the resources to ensure our prison system can provide constitutionally adequate health care? Given Illinois' fiscal crisis, is prison the most cost-effective way to treat people with special health care needs? Do we want our prisons to double as hospitals for the mentally ill or the elderly?

Of course, failing to ask these questions is also a way of answering them: we just keep our current system, which will exhaust our resources, strain our prison system, and result in diminishing levels of care of inmates, most of whom will eventually leave IDOC and return to our communities.

As the executive director of the John Howard Association (JHA), Illinois' only non-partisan prison watchdog, I ask concerned citizens and community-based organizations and advocacy groups to attend Representative Harris' hearing, to learn more about this issue, to present relevant testimony, and to help demonstrate the importance of prison health care: that prison health is public health. Please go to JHA's website to learn more.

To find out more about prison health care, see JHA's 2012 report, "Unasked Questions, Unintended Consequences: Fifteen Findings and Recommendations on Illinois' Prison Healthcare System."