How the Microscopic Influences the Macroscopic: A Look into Infectious Disease in Prisons
By Vida Lugo and Alexus Shaw
Microbes are everywhere, but what makes certain populations more susceptible than others? With crowded conditions and inadequate access to healthcare, it is no surprise that the infectious disease burden is significantly higher in the prison population compared to the general public. Though they are often viewed as separate issues, the relationship between community and carceral health is bidirectional and further exacerbated by the cyclical nature of incarceration.
In many ways, jails and prisons provide the perfect breeding ground for infectious diseases. Sanitation is at the forefront of the problem. The subpar standard of living in many facilities exists in the context of wider societal discrimination. It is not uncommon to hear of incarcerated individuals experiencing extreme dehydration, being forced to use contaminated water sources, or lacking water altogether. Anne Nigra, an environmental health scientist, highlights that chemical and bacterial toxins found within US prisons are evidence of a “devaluing of the lives of people who are incarcerated in these facilities.” From an infectious disease lens, the inability of incarcerated people to adequately sanitize their hands and bodies directly contributes to increased rates of disease transmission. Overcrowding not only exacerbates this problem but also puts an additional burden on accessibility. We have seen how the exploding incarcerated population has led to more money being funneled into the prison-industrial complex with few changes that positively improve the lives of those incarcerated within them.
When considering precipitating conditions, it is important to consider the common transmission routes for infectious diseases. For bloodborne pathogens, like HIV and hepatitis C virus, the lack of harm reduction strategies such as condoms and safe needle exchange makes this population increasingly vulnerable. In addition, pathogens spread via respiratory droplets, like COVID-19, thrive in prison conditions where individuals are in close quarters with constant contact. The coronavirus pandemic reaffirmed the need to consider the public health implications of prisons and jails. As case numbers inside grew, some facilities in Georgia and Florida stopped or underreported COVID-19 cases.
Others saw an increased propensity for people to hide symptoms “for fear of being placed in solitary confinement, in which they are locked alone in a cell at least 23 hours each day with virtually no human contact” The increasing strain on facilities through simultaneous overcrowding and understaffing leaves many people with delayed access to care. It is disheartening to think about how “a few years served can translate into a life sentence of poor health.”
A general distrust incarcerated individuals have in the health system further exacerbates conditions. Individuals may be both less likely to pursue care or follow medical advice of providers. This medical mistrust is well founded. African Americans and Latinos are disproportionately represented in the incarcerated population compared to their share of the general population. These are also the demographics that have been on the receiving end of the deep-rooted implications of systemic racism, including discrimination in the medical system . Laws have been in place for years that have created obstacles to not only accessing healthcare but improving the overall well-being of minority populations. Additionally, both the medical and carceral system have been complicit in egregious experimentation on minority populations. Considering the long history of systemic targeting of these populations in this country and the inhumane conditions of many prisons, it is unsurprising that incarcerated individuals often harbor distrust toward the medical system. Multiple studies emphasize that African Americans express more distrust in the health-care system at baseline. Putting these individuals in an environment where they are further dehumanized only increases this sentiment. Additionally, the goals of the prison system directly conflict with the goals of a physician and patient relationship. The ideal physician-patient relationship is based on trust and mutual respect, but in the carceral system, where the focus is on punishment and abandonment, these values often clash. As a result, trust is often compromised.
On a local level, it is clear how overcrowding remains a pressing concern. As a result of covid shutting down courts, many cases lingered unresolved and county leaders did not embrace decarceration for public health at scale. Hundreds of individuals in Fulton County jail were sleeping on the floor and in 2022, during the height of the pandemic, over 3,400 people were incarcerated there despite a capacity of 2,254. The failure of elected officials to pursue alternatives to arrest and incarceration continue to create the conditions for disease to thrive inside jail facilities. Elected officials are faced with sinking a never-ending amount of money into jail facilities to keep them minimally operational or pursuing alternative investments that might enhance safety and health simultaneously. As of July 2024, commissioners voted on a $300 million dollar plan to renovate Fulton County jail.
While rejecting robust investments in alternatives, this influx of cash to the jail comes on the heels of many reports of the inhumane living conditions of the jail, leading to a Department of Justice Investigation . The investigation noted that the conditions of the jail violate the 8th and 14th amendments of the United States Constitution. The county and DOJ are now under a new consent decree to bring the jail to minimum standards. Beyond that, there is a long way to go. As Assistant Attorney General Kristen Clarke said, “People do not abandon their civil and constitutional rights at the jailhouse door.”
