Correctional health care must be recognized as an integral part of the public health sector.

THERE HAS BEEN A TREMENDOUS increase in the correctional population over the last 25 years. Today, more than 2 million individuals are incarcerated in our nation’s jails and prisons, as compared to 500,000 in 1980.1 Much of this growth can be attributed to changes in sentencing law and policy, resulting in a dramatic increase in the number of inmates convicted of drug offenses and in lengthier sentences. In addition, as public health and social service programs are being reduced, more and more homeless individuals and those with mental health problems are ending up in correctional facilities.2 A disproportionate number of the incarcerated are poor3 and come from racial and ethnic minority groups.4 Their lifestyles often include drug and/or alcohol abuse,5 poverty,3 homelessness,5,6under education,7 unemployment,8 and unsafe sex.9 Given these factors, it is not surprising that the inmate population is 1 in which problems such as tuberculosis, HIV, hepatitis, STD’s, and the consequences of violence and trauma are much more prevalent than in the general population.10–16 Many of these illnesses can affect not only the individuals themselves, but also other inmates, staff, and the community at large. Overcrowding, the frequent movement of inmates both between and within correctional facilities, and the short length of time some of these individuals spend in a facility often make it difficult to identify, treat, and prevent the spread of these diseases. Despite the high prevalence of these problems in the prisoner population, the majority of prisoners have been medically underserved before their incarceration. This is due to a number of factors, including limited access to medical care in the community, lack of insurance, distrust of the medical establishment, competing priorities, and unpredictable lifestyles. Thus, for the majority of those who pass through correctional facilities each year, the jail medical staff functions as their primary provider, and is often the first contact with the health care system. For those inmates who suffer from chronic illnesses, drug or alcohol dependencies, communicable diseases, mental illnesses, or the various other ravages of poverty and violence, this contact with the public health care system is central to their health, the health of their families, and the health of the overall community. The opportunity to provide health care services in correctional facilities makes it possible to not only manage the treatment and prevent the spread of disease, but also to draw many inmates and their families into the public health care system. Many people think of jail or prison as a life time sentence. In reality, the overwhelming number of incarcerated individuals will be returning to their communities. The average length of stay in a jail is approximately 2 to 3 months,17 whereas for prison, it is approximately 3 years.18 This means that efforts of correctional health care staff aimed at identification, treatment, continuity of care, and prevention of health problems are critical not only in reducing the incidence and prevalence of disease in correctional facilities, but also in the community at large. In its landmark 2002 report to Congress on The Health Status of Soon-to-be-Released Inmates, the National Commission on Correctional Health Care19 found that the failure to treat these problems is likely to have significant adverse effects on society. The report noted that released inmates who are not treated for communicable diseases may transmit these diseases to members of the general community and that many inmates who are released with untreated communicable or chronic diseases, or with mental illness, are likely to become a much greater financial burden on their local health care system than if they had been treated while still incarcerated and in an earlier stage of their disease. The report concluded that: by providing comprehensive prevention, screening, and treatment services in prisons and jails, communities can take advantage of a tremendous opportunity to improve public health by reducing the problems associated with untreated inmates returning to the community. Many correctional systems do not have the necessary knowledge, skills, or resources to adequately address these problems. Collaborations between public health programs and correctional systems are an effective means of filling this gap. Public health departments have the staff, expertise, and other resources to assist correctional medical programs in developing and implementing necessary screening, surveillance, prevention, education, and transitional services. There are a variety of methods by which this can Correspondence: Joe Goldenson, MD, San Francisco Department of Public Health, Jail Health Services, San Francisco, CA. Email: jgoldenson@sfgh.org and sheriff@sfgov.org. Received for publication November 13, 2008, and accepted November 17, 2008. From the *Department of Public Health, Jail Health Services, San Francisco, California and †Sheriff’s Office, City and County of San Francisco, California Sexually Transmitted Diseases, February Supplement 2009, Vol. 36, No. 2, p.S3–S4 DOI: 10.1097/OLQ.0b013e318195ad6c Copyright © 2009, American Sexually Transmitted Diseases Association All rights reserved.