Behind Bars and Beyond Care: The Flaws of the Prison Healthcare System
“No one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens but its lowest ones.” -Nelson Mandela
By PETER PARK
America is a country that is no stranger to incarceration. In fact, America has the highest number of incarcerated individuals in the world, with almost two million people currently serving time in either jail or prison. The health and well-being of these people is something that is, in theory, protected by the Constitution. Estelle v. Gamble (1976) was a Supreme Court case that decided based upon the Eighth Amendment that, “[a]n inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death[.] … In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose.” In other words, not addressing a prisoner’s health is equivalent to cruel and unusual punishment.
However, even with this decision upholding that it is the right of the incarcerated to have their medical needs met, countless flaws continue even today, fifty years later. Men, women, and children behind bars all across America still do not receive appropriate medical treatment for their ailments, both physical and mental, for a plethora of preventable reasons.
What Ails Prisoners?
The incarcerated population in the United States experiences extremely high rates of chronic illnesses or conditions, infectious diseases, mental health disorders, and traumatic injuries when compared to the general population. According to a JAMA Internal Medicine study from 2016 using the Bureau of Justice Statistics (BJS), 61.7% of prison residents reported one or more chronic physical conditions. Chronic physical conditions are enduring health issues that typically persist for a year or longer, require constant medical care, and limit one’s capacity to participate in everyday activities. This figure is considerably higher than in 2004, when it was around 56%.
The spread of infectious diseases is also rampant in prisons. Foundational flaws with the American prison system, such as unsanitary conditions, poor ventilation, overcrowding, and constant movement and turnover, result in extremely high infection rates and constant outbreaks of diseases like COVID-19, MRSA, and influenza. Sexually transmitted diseases like Hepatitis C and HIV are frequently passed around due to a high rate of those entering the prison system already carrying the disease, a large amount of both consensual and non-consensual unprotected sex, and sharing of needles both for tattoos as well as illicit drug use.
Equally important to physical health is mental health, which is also a serious issue in the carceral system. The aforementioned JAMA study from 2016 found that 40.1% of prisoners report ever having a mental health condition. This figure has risen from 24.5% in 2004. Of all prisoners in the study, 13.3% meet the clinical criteria for current severe psychological distress. Many who enter the prison system are predisposed to mental health conditions, and the cocktail of severe environmental stressors in the system, as well as the lack of attention given to those suffering from mental health issues, results in these conditions manifesting. Additionally, research done by the CDC shows that 46% of individuals in all correctional or detention facilities have a history of traumatic brain injury, and this correlates strongly with mental health conditions.
Why Medical Care in Prisons Falls Short
Despite the previously mentioned Supreme Court ruling that established healthcare for those who are incarcerated as a Constitutional right, care inside prisons remains notoriously inadequate due to several core flaws:
Prison’s Self-Interest Trumps Patient Care: Prison healthcare systems operate largely as extensions of correctional departments rather than separate public health entities. The morally dubious result of this is that the primary objective of these systems is to minimize the financial and legal liability of the prisons themselves, rather than putting emphasis on patient health.
Financial Barriers (Medical Co-Pays): Most prison systems employ financial walls that end up preventing people from receiving care. Studies show that 90.4% of state prison residents are housed in facilities that require medical co-payments. This means prisoners must cover part of the cost of their medical treatments. This is extremely difficult due to the low wages of an inmate (the average hourly wage being $0.14 to $0.63 across states), as well as the fact that the majority of inmates live below the poverty line (57% of men and 72% of women, according to the American Action Forum).
Privatization and Cost-Cuts: 36 states contract out correctional healthcare to private, for-profit companies. These corporations have an incentive to provide the bare minimum of care to maximize profit margins, which inevitably leads to understaffed facilities, treatment delays, and restricted access to more expensive, premium medications.
The Gap Between Corrections and Public Health: Correctional facilities do not operate in tandem with the broader public health environment. What this means is that modern best-practice disease prevention tactics such as harm reduction supplies, syringe services, or up-to-date antiviral treatments are frequently restricted, which greatly hinders the system’s capacity to maintain and contain outbreaks.
Alarming Statistics:
13.8% of incarcerated individuals with chronic physical conditions receive no medical visits whatsoever while imprisoned.
33.0% of prisoners who report a mental health condition receive no mental health treatment.
41.7% of those meeting the clinical criteria for severe psychological distress receive no mental health treatment in prison.
2.17 (Adjusted Odds Ratio): High co-payments (exceeding one week's prison wage) more than double the likelihood that a sick prisoner will go without a needed healthcare visit compared to lower or no co-pay facilities. Even low co-pays increase this risk by 43%.
HIV is 3 times higher, and Hepatitis C is roughly 10 times higher behind bars than in free society.
Rectifying the System
There are many potential solutions and reforms that, if implemented, could greatly reduce the impact of these flaws. The first is transferring oversight to public health agencies. If the responsibility of prison healthcare is shifted from Departments of Corrections and is instead placed under public health departments, medical care would be severed from monetary goals and would be overseen by the wider medical community. Additionally, eliminating medical co-payments could open the door for thousands of prisoners who were previously unable or unwilling to pay for medical treatment they require.
A risk-prevention possibility is to expand regular universal screening and treatment. If routine screenings and access to treatment for chronic and infectious conditions are made more widely available, outbreaks can be nipped in the bud before they spread and infect the wider prison population.
Finally, when an incarcerated person has completed their sentence, providing them with Medicaid coverage and directing them to local health clinics and mental health providers (as well as housing support) can ensure that they continue to live healthy lives and do not become reliant on the prison system in order to stay healthy.
With Liberty and Justice for All
America is a country that is built upon freedoms. Whether or not someone has broken the law, there are certain inalienable rights that must not be compromised. The Eighth Amendment guarantees that no one will be punished in a manner that is cruel and unusual. When a person needs medical care and said care is not taken seriously, or when it is withheld altogether, it is an admission that America does not truly believe that all men are created equal; it is a confession that it is okay to pick and choose who does or does not truly have rights. Nelson Mandela is correct in his assessment that only by viewing how a nation treats its lowest can it be judged. If America were held up to that standard, its moral standing would crumble. We should be better than this. We are the Land of the Free and Home of the Brave, and by fixing this internal injustice we better our nation as a whole in a vital way.
Sources & Further Reading
American Civil Liberties Union (ACLU). “Medical and Mental Health Care.” ACLU Issues.
Centers for Disease Control and Prevention (CDC). “Public Health Considerations for Correctional Health.” CDC Correctional Health, July 3, 2024.
Library of Congress. “Eighth Amendment: Overview.” Constitution Annotated, Congress.gov. Accessed October 11, 2026.
Lupez, Emily Lupton, et al. “Health, Access to Care, and Financial Barriers to Care Among People Incarcerated in US Prisons.” JAMA Internal Medicine, 2024.
Nam-Sonenstein, Brian. “New Prison Policy Initiative Report Explains Notoriously Bad Correctional Healthcare.” Prison Policy Initiative, February 19, 2025.
Reynolds, Andrew. “Prison Health Is Public Health.” Positively Aware, September–October 2018.
Sawyer, Wendy. “How Much Do Incarcerated People Earn in Each State?” Prison Policy Initiative, April 10, 2017.
Sawyer, Wendy, Brian Nam-Sonenstein, and Peter Wagner. “Mass Incarceration: The Whole Pie 2026.” Prison Policy Initiative, March 11, 2026.
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