Recognizing carceral health as a public health discipline

Carceral populations in the United States have a disproportionately high prevalence of mental illness, substance use disorder, and communicable and non-communicable chronic disease in comparison to the general population. A historical prohibition of federal fund usage for incarcerated populations has led to both significant resource constraints for carceral healthcare entities and a lack of formalized and consistently enforced healthcare benchmarks for incarcerated people. This has resulted in subpar healthcare standards and delivery and poor health outcomes, ultimately driving up costs for both carceral health systems and the communities to which people return to upon release. Public health agencies are well suited to help improve carceral health given their mission of health promotion and integral role in public safety, but their historical tendency towards disease and crisis-specific interventions in carceral settings has contributed to a fragmented presence and a longstanding disconnect with carceral entities that has affected the quality of interagency collaboration. The COVID-19 pandemic demonstrated the indispensability of infrastructure for communication and shared information and decision-making, with implications for the need to maintain broad, continuous communication and planning efforts between public health and carceral agencies extending beyond the pandemic and other crisis situations. Accordingly, we argue that the complexity and uniqueness of carceral health warrants its recognition as a public health discipline and that the creation of a public health unit focused on carceral health that regularly interfaces and collaborates with carceral entities utilizing a population medicine perspective is essential to improving carceral healthcare.