New Study Explores Barriers and Facilitators to Quality Healthcare Among Incarcerated African Americans
New Study Explores Barriers and Facilitators to Quality Healthcare Among Incarcerated African Americans
With more than 1.9 million incarcerated individuals in the U.S., African Americans are 5.9 times more likely to be incarcerated. A new study titled "Barriers and Facilitators to Quality Healthcare for African Americans with Incarceration Histories," published in the Journal of General Internal Medicine, examines the impact of the lack of quality health care among these individuals during and after incarceration and the need to address barriers to access.
Incarcerated African Americans are disproportionately impacted by health conditions such as chronic diseases, mental illnesses, and substance use disorders, as well as reproductive health challenges. Preventive measures, such as cancer screenings, are often overlooked among these populations, increasing potential long-term risk. To address these inequities, investigators conducted four focus groups (participants were described as "co-researchers") of African American men and women aged 40 and older released from Illinois State Prisons or Cook County Jail during or after 2015. Co-researchers were asked to report retrospectively on their experience of accessing, understanding, and using health care during and after incarceration.
Vickii Coffey, Ph.D.
"Many persons released from incarceration return home to vulnerable communities that are ill-equipped to address their medical and social survival needs," shares primary study investigator Vickii Coffey, Ph.D., associate professor in the Department of Social Work at the College of Health and Human Services at Governors State University. The department is well-known for its distinct emphasis on social justice and inequality issues. "There is a critical need to address barriers to accessing health care during and after incarceration, particularly given racial disparities in health care treatment and outcomes and the long-term negative consequences in Black and Brown communities."
One of the major barriers identified by co-researchers are excessive and punitive co-pays. Incarcerated people in at least 35 U.S. states are charged a co-pay when seeing a nurse or a physician during incarceration.
Diane Morse, M.D."Many health care professionals are surprised by the number of incarcerated individuals who face excessive co-pays for medical care, despite often being impoverished and suffering from chronic illnesses while earning only pennies per hour if they work in prison or jail," shares Diane Morse, M.D., senior author on the study and internal medicine physician at the University of Rochester Medical Center (URMC). "Providing appropriate care is a federal mandate. Despite being the only ones in the U.S. who have a constitutional right to health care, the risk of death upon returning to the community for formerly incarcerated individuals has been shown to be almost 13 times that of the general population."
Other reported barriers to care included a lack of trustworthiness of health care systems, gaps in overall understanding and knowledge of health conditions and preventive measures, and hesitation to get help because of the negative attitudes and actions of correctional staff and/or health care providers. Many people are detained in jail for months or years awaiting trial and are later found not guilty.
"Generally, incarceration administrators and health care staff are not adequately meeting health care standards and guidelines, such as screening for and addressing cancer, diabetes, and other chronic conditions more commonly found among incarcerated people" states Morse, who is also an associate professor in the Department of Public Health Sciences and associate director of the Office of Health Equity Research at URMC’s Center for Community Health & Prevention.
Facilitators to accessing health care and cancer screening occurred after release and included positive interactions with providers, feeling respected, having greater access to quality health care, and being given the tools and information by physicians to better understand their health. Co-researchers expressed readiness to address health challenges after serving their time. They reported their interest in prioritizing their health, noting the change in "having the freedom to make decisions about and to control what happens to their bodies."
Morse sees this readiness firsthand through her clinical work with formerly incarcerated individuals at the Wellness Initiative Supporting Health (WISH) Transitions Clinic within the Jordan Health Center in Rochester, NY.
Study authors are interested in expanding research about individuals’ assimilation back into community health services post incarceration, as well as best practices on educating community health providers on health promotion and prevention among incarcerated and formerly incarcerated persons. Providers need enhanced training and resources to make an informed clinical decision on patients’ health care needs and next steps.
"Individual health and public health are critically linked," states Coffey. "Addressing barriers and facilitators to quality health care for African Americans with incarceration histories can positively contribute to decreasing inequities in the health and well-being of all communities."