The examples and perspective in this deal primarily with the United States and do not represent a worldwide view of the subject.(September 2024) |
Mass incarceration is a major problem in the United States. People who have been incarcerated or are currently incarcerated face many challenges including challenges with their health. This wikipedia post studies the health problems that can come with incarceration by looking at the relationship between children being incarcerated and the health outcomes they have as adults, [1] the health effects of incarcerated people with HIV, [2] the effect of aging on people with a history of incarceration, [3] and the effect that the Affordable Care Act has on the health insurance status of people who have been incarcerated. [4]
The number of people being incarcerated in the U.S. has been rapidly increasing over the years. The United States has more children incarcerated than the rest of the world, and in 2015 had 920,000 people arrested under the age of 18. [1] Some people are even arrested when they are younger than 14 and do not get released until well into their adult years. High proportions of children and adolescents who have been incarcerated have their physical, mental, developmental, and social health needs not being met. [1]
The goal was to research the connection between children who have been incarcerated in the United States and the health outcomes they have when they become adults. [1] To do that they analyzed the National Longitudinal Study of Adolescent to Adult Health data from 1727 adults (Wave IV) who were first incarcerated at less than 25 years old. They chose four different health outcomes to compare: these were the general health of adults, mobility limitations, depressive symptoms, and suicidal thoughts. [1]
The researchers used chi-squared tests and multivariate logistic regression models and compared the health outcomes between the subjects whose age at first incarceration fell in the following ranges: less than 14 years old; 15 to 17; 18 to 20; 21 to 24. The sociodemographic data showed that those in the youngest age group included a higher proportion of black or Hispanic people compared to the other age groups. It was also found that there were fewer white participants who were incarcerated as children. [1]
The results for the health outcomes were that child incarceration predicted adult mobility limitations, adult depression, and adult suicidal thoughts compared to people incarcerated when they were 21 to 24. The negative health effects that incarceration can have, especially on children, is a social problem that more people need to focus on. Along with the negative health effects that incarceration can have on children, it also impacts those with HIV. [1]
Incarceration has negative effects on the overall health of people including people with HIV. Every year, around 15% of people with HIV go through a correctional facility in the United States, and 1 in 7 people with HIV are incarcerated every year. The article studied the relationship between incarceration and the health of people with HIV and the mediators present in this relationship. [2] The first mediator that the article studied was substance use. The leading cause of death for people who have been recently released from prison is substance use. The other mediators chosen included the overall health of the people taking part in this study, the decreased adherence to the antiretroviral therapy used to suppress HIV symptoms and the narrow engagement in medical care. [2]
The researchers used data from the Veterans Aging Cohort Study (VACS) and found 1,591 HIV-infected veterans and collected data about their overall health and unhealthy drug and alcohol use. They compared these participants with and without a history of incarceration and by their sociodemographic characteristics such as age, gender, education level, housing, and income and the four mediators discussed previously (substance use, overall health, adherence to antiretroviral therapy, and narrow engagement in medical care) using chi square tests and t tests. [2]
Out of the 1,591 people surveyed 47% of them had a history of incarceration and that having been incarcerated was independently associated with a 4.2-point higher VACS index score, equivalent to approximately 15% higher risk of mortality in 5 years. The researchers found that the people with a history of incarceration were more likely to be black, low income, recently homeless and less than a high school education compared to the people who have never been incarcerated. The people who have been incarcerated were also more likely to have used drugs recently and have unhealthy alcohol use. People who were previously incarcerated were less adherent to the antiretroviral therapy than people who have not been incarcerated. Incarcerated and non-incarcerated were equally likely to have received care and engage with their care. [2]
After adjusting their VACS score and taking out recent drug use, they found that drug use had the biggest mediating effect and does play a role in the poor HIV outcomes for previously incarcerated people. Individuals with a history of incarceration were more likely to be engaging in drug use and this accounted for 22% of the association between incarceration and the VACS score. Overall, people who were incarcerated were more likely to have worse HIV outcomes and it is important to bring awareness to the negative health effects that people with HIV who have been or are currently incarcerated can suffer from. [2]
Besides affecting people with chronic illnesses and children, incarceration can also affect the health of older adults. The article examined if having a history of incarceration was associated with worse mental and physical health in older adults. [3] The researchers also wanted to see if racism and sexism had an effect on these outcomes. The number of women in the prison system grew by 700% in the span of 30 years so that may be having a drastic effect on their health. Women are more likely to have multiple health conditions. People of color are more likely to be incarcerated than white people and get harsher sentences for the same crime. Black women have the highest incarceration rates among women and are at a higher risk of getting a disease. [3]
To get information on the effects the researcher used the Health and Retirement Survey which is a representative survey of people who are over 50 in the United States and had a sample of 11,883 people. To measure the mental health effects, they asked about depressive symptoms and to measure the physical health effects they examined the physical limitations of the subjects. They wanted to measure three different independent variables and asked questions revolving around their incarceration history, their gender and sex and their race and ethnicity. They used General linear models to assess the effect of the three independent variables and how they interact. Most of the sample was female, White and the average age was 65. [3]
The results showed that incarcerated individuals had more physical limitations and depressive symptoms with men and women who were older than 52. They also found that women who were previously incarcerated had higher rates of health problems specifically women of color who had the highest rates of negative physical and mental health symptoms compared to any other group. This article brings attention to the negative health outcomes that people who have been incarcerated can face especially women of color. [3]
Incarceration often has a negative effect on health, and it has been shown that health can worsen during imprisonment and after being released. The health disruptions that incarceration can cause are concerning and one of them is the disturbances in health care. The article evaluated the association between a history of incarceration, whether people have health insurance, and if living in a state using the Affordable Care Act served as a mediator. [4] They used data from the National Longitudinal Study of Adolescent to Adult Health from Wave V from 2016-2018 using data from 8,965 people. The sample's age range (33-34 years) is focused on those in prime age in labor force participation. The authors then used multiple logistic regression to see how ACA Medicaid expansion and people who have been previously incarcerated interact to see if the affiliation between history of incarceration and the status of health insurance is different if the respondent lives in a state with ACA Medicaid expansion. [4]
The researchers found that 91.3% of people said they had insurance, a subset of 14.9% had public insurance, 13.7% had been previously incarcerated, and 69.9% of the respondents lived in a state with ACA Medicaid expansion. They found that people who have been incarcerated were less likely to have insurance, ACA Medicaid expansion was positively associated with being insured and they found that being previously incarcerated and Medicaid expansion on public health insurance were statistically significant. [4]
In states without ACA expansion, the probability of being on public health insurance is 8.8% for those without a history of incarceration and 7.3% for those with a history of incarceration. However, in states with ACA expansion, the predicted probability of being on public insurance is 16.3% for those without a history of incarceration and 23.7% for those with a history of incarceration. Consistent with prior literature, the findings suggest that formerly incarcerated persons are less likely to have insurance and that ACA Medicaid expansion is associated with a greater likelihood of being insured. The results also show that ACA Medicaid expansion disproportionately benefits previously incarcerated persons in terms of enrolling in public health insurance programs. The findings are a reminder that despite the potential benefits of the ACA for improving healthcare access among formerly incarcerated people, the states that have not yet adopted the ACA are primarily concentrated in the South and are also the states with the highest concentration of uninsured populations and rates of incarceration. [4]
The first three articles have shown that incarceration causes negative effects on the health of most people with a history of incarceration but especially people who were incarcerated as a child, [1] those with a chronic illness like HIV, [2] and women of color. [3] The final article showed that having a history of incarceration can make it harder for people to have access to health insurance. [4] Incarceration is a social problem because of all the health problems it can cause or worsen. It is important to bring the health problems that incarceration can cause to people's attention because the only way to make changes is to learn more about the issues.
Former prisoners have higher odds of hospitalization and death from cardiovascular disease, even after controlling for socioeconomic status and race. [5]
The incarceration of juveniles often results in adverse mental health consequences, especially in adult facilities. [6] Such incarceration is also related to worse health across the life course. [7]
Support for women experiencing menopause in incarceration is outlined in the 2009 Kyiv Declaration on Women’s Health in Prison.
The relationship between incarceration and health, compared to research on other social effects of incarceration, has been a topic of research for a relatively short period of time. [8] Most of the foundational research on this topic was conducted in the 25 years before 2015, and indicates that incarceration generally has negative effects on prisoners' mental health, but some positive effects on their physical health. [9] In the United States, the negative health effects of incarceration contribute to racial disparities in health between white and black women. [10]
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.
Emtricitabine/tenofovir, sold under the brand name Truvada among others, is a fixed-dose combination antiretroviral medication used to treat and prevent HIV/AIDS. It contains the antiretroviral medications emtricitabine and tenofovir disoproxil. For treatment, it must be used in combination with other antiretroviral medications. For prevention before exposure, in those who are at high risk, it is recommended along with safer sex practices. It does not cure HIV/AIDS. Emtricitabine/tenofovir is taken by mouth.
Healthcare reform in the United States has had a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
In the United States, health insurance coverage is provided by several public and private sources. During 2019, the U.S. population was approximately 330 million, with 59 million people 65 years of age and over covered by the federal Medicare program. The 273 million non-institutionalized persons under age 65 either obtained their coverage from employer-based or non-employer based sources, or were uninsured. During the year 2019, 89% of the non-institutionalized population had health insurance coverage. Separately, approximately 12 million military personnel received coverage through the Veteran's Administration and Military Health System.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
As of 2012, approximately 1,100,000 people in Malawi are HIV-positive, which represents 10.8% of the country's population. Because the Malawian government was initially slow to respond to the epidemic under the leadership of Hastings Banda (1966–1994), the prevalence of HIV/AIDS increased drastically between 1985, when the disease was first identified in Malawi, and 1993, when HIV prevalence rates were estimated to be as high as 30% among pregnant women. The Malawian food crisis in 2002 resulted, at least in part, from a loss of agricultural productivity due to the prevalence of HIV/AIDS. Various degrees of government involvement under the leadership of Bakili Muluzi (1994–2004) and Bingu wa Mutharika (2004–2012) resulted in a gradual decline in HIV prevalence, and, in 2003, many people living in Malawi gained access to antiretroviral therapy. Condoms have become more widely available to the public through non-governmental organizations, and more Malawians are taking advantage of HIV testing services.
Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.
Various issues in medicine relate to lesbian, gay, bisexual, transgender and queer (LGBTQ) people. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBTQ health include breast and cervical cancer, hepatitis, mental health, substance use disorders, alcohol use, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Medicaid estate recovery is a required process under United States federal law in which state governments adjust (settle) or recover the cost of care and services from the estates of those who received Medicaid benefits after they die. By law, states may not settle any payments until after the beneficiary's death. States are required to adjust or recover all costs under certain circumstances, all involving long-term care arrangements. Federal law also gives states the option to adjust or recover the costs of all payments to health care providers except Medicare cost-sharing for anyone on Medicaid over the age of 55.
Members of the United States population between the ages of 18 and 29 who decide that it is in their financial best interest to forgo health insurance are sometimes referred to as young invincibles by the insurance industry, a term coined to express the idea that the young demographic perceives themselves as immune to sickness and injury. The argument is that these individuals are young and in good health, so they have a low risk of experiencing substantial health issues that would lead to large amounts of spending on health care. Further, this group tends to have a mentality of “it won’t happen to me” with regards to most causes of injury. Together, these beliefs lead to the young invincibles not purchasing insurance.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act's provisions are still in effect.
Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.
Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.
The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.
The Oregon health insurance experiment was a research study looking at the effects of the 2008 Medicaid expansion in the U.S. state of Oregon, which occurred based on lottery drawings from a waiting list and thus offered an opportunity to conduct a randomized experiment by comparing a control group of lottery losers to a treatment group of winners, who were eligible to apply for enrollment in the Medicaid expansion program after previously being uninsured.
HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.
Under the public healthcare policy of the United States, some people have incomes too high to qualify in their state of residence for Medicaid, the public health insurance plan for those with limited resources, but too low to qualify for the premium tax credits that would subsidize the purchase of private health insurance. These people are described as falling into the Medicaid coverage gap.
Anna Aizer is a labor and health economist, who currently serves as the Maurice R. Greenberg Professor of Economics at Brown University where she is also a Faculty Associate at the Population Studies and Training Center. Her research focuses on child health and well-being, in particular the effect of societal factors and social issues on children's health.
Black maternal mortality in the United States refers to the disproportionately high rate of maternal death among those who identify as Black or African American women. Maternal death is often linked to both direct obstetric complications and indirect obstetric deaths that exacerbate pre-existing health conditions. In general, the Centers for Disease Control and Prevention defines maternal mortality as a death occurring within 42 days of the end of pregnancy from any cause related to or aggravated by the pregnancy or its management. In the United States, around 700 women die from pregnancy-related complications per year, with Black women facing a mortality rate nearly three times more than the rate for white women.
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