WITNESS
Robert B. Greifinger, M.D., is a health care policy and quality management consultant. His work focuses on the design, management, quality improvement, and utilization management in correctional health care systems. He has extensive experience in the development and management of complex community and institutional health care programs and strengths in the bridging of clinical and public policy interests. His current clients include the courts, state and local correctional systems, and the Civil Rights Division of the United States Department of Justice. He has had a variety of assignments as a court appointed expert to investigate and design remedies for ailing correctional health care systems, and has worked on assignments for the Centers for Disease Control, the Urban Institute, the Council on State Governments, and John Jay College of Criminal Justice.
Dr. Greifinger has published extensively in the area of correctional health care. He is a frequent speaker on public policy, communicable disease control, and quality management in corrections. Dr. Greifinger was the principal investigator for the recently published Report to Congress on Seizing Public Health Opportunities through Correctional Health Care.
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STATEMENT
The conditions in some correctional facilities are redolent of conditions in prisons in the United States a century ago. In 1894, Dr. Julius Ransom, a prison physician, reported that 25 percent of the 1,000 inmates at the prison in Dannemora, N.Y., had active tuberculosis. In his report to Congress in 1907, the rates were unchanged, with high mortality, more than half of which was attributed to tuberculosis.
One hundred years later, despite the widespread availability of modern diagnostics, knowledge about containment, and multidrug regimens for communicable disease, some American prisons are currently incubators of this same scourge. Too little attention is being paid to inmates as public health sentinels. Too little attention is paid to preventing, diagnosing, and treating conditions that can poison life for families and members of the free-world society.
A view of the health status of inmates is a view through a window to our society at large. Because of whom we incarcerate, especially drug users and the mentally ill, inmate morbidity is highly concentrated with people who have mental illness, communicable disease, and the consequences of alcohol and substance abuse.… Not only are rates of diabetes, asthma, hypertension, and heart disease disproportionate to age-adjusted cohorts in the free world, rates of alcohol and drug use, communicable disease, and mental illness are even higher in comparison.
There are clear opportunities to improve the health status of inmates through focused attention to primary prevention, early detection, and evidence-based clinical interventions. Seizing these opportunities will not only accrue to the benefit of the inmates themselves, but also to the benefit of the public health. Of course, acting on these clear opportunities takes political will and resources.
Excerpted from a written statement submitted to the Commission
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