“Beyond the Statute” is a series created by Sierra Benayon-Abraham, an assistant Opinion editor and third-year public health student. In these columns, she will be exploring various public health policies, laws and experiences that different marginalized communities encounter, along with the truths behind them. It is her goal to share the importance of understanding health care on a universal level while highlighting both the disparities and inequities that exist for distinct marginalized groups. With UCLA’s campus abound in students interested in health care, law and public policy, Bruins who have either an interest in or experience with the topic are welcome to submit op-eds or letters to the editor to be published as part of this series to represent the many facets of health care policy.

The World Health Organization proclaims that every human being has the right to attain the highest level of physical and mental health care. Yet the reality is that this is far from the truth for vast swaths of the global population, especially many marginalized communities.

However, there is one community in particular that has repeatedly had its health needs thrown behind bars, effectively suppressing these needs or leading them to be forgotten.

Individuals who are incarcerated — that is, imprisoned in a correctional institution — are commonly sentenced to a life of inadequate access to health care.

“It is both the case that incarcerated people have special constitutional protection for their access to health care, and that they have challenges that no one else in our society faces,” said Aaron Littman, an assistant professor at the UCLA School of Law.

Incarcerated individuals are often at the mercy of their prison and jail officials when it comes to accessing care, choosing a physician and receiving adequate treatment, said Littman, who is also faculty director of the law school’s Prisoners’ Rights Clinic and deputy director of UCLA Law’s Behind Bars Data Project.

People who are incarcerated are disproportionately more likely to have chronic health conditions including diabetes, high blood pressure, HIV, tuberculosis, substance misuse and mental health disorders as a direct result of the inadequate care often received in correctional facilities.

Treating these conditions is often a low priority in correctional institutions, despite a 1976 Supreme Court ruling that found that purposeful disregard for medical exigencies amounts to cruel and unusual punishment.

Further, medicines that might treat or cure illnesses commonly experienced among those incarcerated can frequently remain inaccessible in correctional facilities, often deemed too expensive.

Los Angeles nonprofit A New Way of Life works closely with previously incarcerated women to support successful rehabilitation and reunification with the community and family members, as well as individual growth.

“Many formerly incarcerated people come out of jails and prisons with various untreated or undertreated health conditions as a result of the poor care they received while incarcerated,” said Stanley Thermidor, A New Way of Life’s policy and advocacy strategist, in an emailed statement.

It is pivotal that mass incarceration is understood as a public health concern.

“The way in which they (those who are incarcerated) are able to access health care is another reminder of the way in which they are devalued,” said Shirin Bakhshay, an assistant professor at the School of Law who teaches criminal law and procedure alongside psychology and law.

Poor health outcomes, limited access to primary care, reduced nutrition and adverse childhood experiences due to a family member’s incarceration are distinct challenges faced by incarcerated individuals and their loved ones. These challenges are unfortunately only continuing down a negative trajectory, especially after the COVID-19 pandemic.

A confluence of events leading to these inequitable practices, including new sentencing guidelines and changes to criminal laws, have helped to establish the mass incarceration crisis.

“In some states, doctors who have lost their licenses to practice medicine are given what are called limited practice licenses to perform medical services only in the context of an institution like a prison,” Littman said. “These are people who would not be permitted to practice elsewhere.”

Diseases and infections do not distinguish between prison walls or national boundaries. To pardon a sick prisoner and release them for rehabilitation while simultaneously disregarding the state of their health after their release is a favor to no one.

“Regardless of its impact on broader society, it’s unacceptable to leave people in the wealthiest modern democracy on earth at the mercy of a state that won’t treat their cancer, that won’t prevent their blindness, that won’t address infection so they lose limbs,” Littman said. “That’s not okay.”

To withhold certain antibiotics from inmates on the rationale that the expensive cost would not be worth the minimal reward is to disregard the human right to health care entirely, and that hardly includes just prisoners.

To decrease health expenditures for a medical system that is inherently lackluster is akin to conserving water during a raging forest fire.

Would it be so problematic to put resources and funds in areas where they are needed most?

If funds are invested to treat people in prisons, transmission rates will be reduced in the general community, the cost of treating people with advanced diseases will decrease, and people will live productive lives that reap the economic benefits of having a healthy workforce.

This was most recently evident in the COVID-19 pandemic, as the consequences for public health from outbreaks in correctional facilities were dire.

Few incarcerated individuals receive vital treatment or have health insurance coverage after they are released from custody. Release can subsequently represent one step forward, but two steps back, because of the failure to invest in the healthcare necessary for rehabilitation.

Other than just denying these individuals their right to health care, there are broader aspects at play that have a greater impact on worldwide health care, including the spread of antimicrobial resistance.

“If we don’t care about or if we don’t provide resources to the most vulnerable of our population, soon we’ll find that we are susceptible to the same oppression,” Thermidor said in the statement. “The issues formerly incarcerated people face are the same ones everyone face; it is only exacerbated.”

Justice and equity in health care for all, including those incarcerated, should not be an impossible pursuit.

Simply put, the public health laws surrounding those incarcerated are far too little, far too late.