I chose female inmates as an exemplary group who faces with health inequality and I will present “Health status and access to health services of female prisoners in Greece: a cross-sectional study” from Geitona and Milloni to support my point.1
I will set the focus of my essay on female inmates, but before doing so, I want to state general hardships of both male and female inmates confront. In general, inmates are vulnerable about their health because of three reasons: low life quality prior to and during imprisonment and challenges in healthcare access during incarceration. Prisons mostly receive people from economically disadvantaged, marginalized communities which already have a high rate of infections and drug abuse. So, when people get in prison they already have poorer health than common population. That’s why inmates need even more healthcare than the rest. Due to a crowded lifestyle they have a higher risk of contagious air-borne and blood-borne infections (especially tuberculosis, HIV and Hepatitis B and C).2 Also, since “prisoners automatically lose the social component of health, including the loss of control of a patient’s circumstances, the loss of family and familiar social support and a lack of information and familiarity with their surroundings”, they tend to have mental illnesses. 3 Lastly, imprisoned people may have some limitations on reaching to health personnel and making the staff believe in them despite the stigmatization. People who are not imprisoned can decide which doctor and hospital they want to go, yet prisoners usually have less scope of opportunities before them. Also, their physicians are usually assigned by the authorities working in prison. This may end up with a problem in the objectivity of the physician. As Coyle stated “full-time prison physicians … will form close relationships with prison management”, and thus it may be hard for these physicians to isolate themselves from their social interactions with management and be completely objective against imprisoned patients.4 Lastly, since incarcerated patient needs to contact with the prison staff first to reach to healthcare personnel, even if there is a wide variety of healthcare options, staff may limit the access since they may not believe to the trueness of the prisoner’s illness.
I wanted to focus on female prisoners because some additional reasons make their healthcare even more essential than incarcerated men. The first matter is that the incarcerated female population increased by 16% worldwide between 2006 and 2012.5 Also, it has been shown by various research that female prisoners have more frequent and severe mental illnesses than the general population and imprisoned men.6,7 Lastly, women often visit prisons for non-violent crimes; thus they usually have shorter sentences in prison.7 This may mean the increase in sexually transmitted, air-borne and blood-borne infections in the community. That’s why taking care of female prisoners is also an important public health matter and concerns everyone in general community.
The research I chose to present is done between January-December 2014, in one of two female detention centers of Greece called Korydallos. The researchers performed a questionnaire that focuses on 3 points respectively: socio-economics and detention characteristics, self-reported health, access and utilization of the health services. In the first section, the questionnaire investigated age, ethnicity, marital status, education, etc.; the reason, frequency, and duration of imprisonment. In the second section, mental, dental and physical health status is investigated both prior to and during incarceration. Also, sexual behaviors and addictions are questioned. In the last section, the frequency of healthcare service visits, availability of healthcare services and women’s satisfaction from these services is analyzed.1 With all three parts of this questionnaire; this research provides evidence for all three points I did in my second paragraph. That’s why I selected this article as a comprehensive one. Also, it examines mental, dental and physical health together, which makes it complete. According to results, 3 out of 10 women reported their general health status as poor/ very poor, 63.4% of the prisoners stated that their health got worsened during incarceration. 55% avowed their mental health poor/very poor and 82.2% said that they experience much/very much sadness and anxiety related to imprisonment. While almost 4 out of 5 women feel anxiety, only 52.5% of all prisoners applied to a psychologist or a psychiatrist.1 This may show that there is inadequate access to health services. Statements of prisoners support these results. Almost half of the prisoners described the quality of health services as poor and access as insufficient. Only 16% of prisoners found services good/very good.1 To sum up, this research shows health and healthcare service access in Greece between female inmates from poor to moderate.
In short, while prisons receive people with poorer health than the general community, incarceration itself may worsen the health status. Female prisoners are especially vulnerable about their health under prison conditions. Also, it is particularly important to provide a proper primary and secondary healthcare to imprisoned women since they usually visit prisons due to milder crimes and for shorter periods and they usually return to the community after a short while. The research done by Geitona and Milloni shows that prison affects women’s health in a bad manner and healthcare access is poor. Thus, measures need to be taken to promote healthcare services in prisons, especially in female detention centers.