The epidemic of mass incarceration is both a cause of and a contributor to racial disparities in the United States. State departments of correction collectively spent $8.1 billion on health care services in 2015, an estimated one fifth of overall prison expenditures. For many people—particularly people of color without health insurance and inequitable access to health services in the community—incarceration may be a period during which they are more likely to receive health services. However, corrections-based health care is not subject to the same regulations, oversight, and accountability as community-based health care. Information on health care needs and quality also is not readily reported by these systems. Expanding access to high-quality health care for incarcerated people represents a public health opportunity to screen, prevent, diagnose, and treat illnesses. The provision of HIV testing, counseling, prevention, treatment, and care, as well as the delivery of effective treatments for substance use disorders, HCV, and mental health disorders, is especially important given the high rates of these illnesses among justice-involved populations.
Despite the aforementioned opportunities, health-related research focused on justice-involved populations remains limited to a relatively small number of investigators. According to a study that examined National Institutes of Health (NIH)–funded research projects from 2008 to 2012, fewer than 0.1% of NIH grants focused on justice health research. The authors had several recommendations to increase NIH support of justice health research, including establishing justice-focused training and career development programs for researchers. We performed a 10-year retrospective review of the NIH Research Portfolio Online Reporting Tools Expenditures and Results Tool (RePORTER) in September 2019 and identified only two NIH-funded training programs that have a specific focus on justice-involved populations. These T32- and R25-grant-supported programs are funded by the National Institute on Drug Abuse. Thus, an urgent need exists to expand training in this field of research and to increase the number and capacity of investigators working with justice-involved populations. Directed efforts to expand training opportunities are needed, particularly for underrepresented minority investigators, to increase the number of early career scientists appropriately trained to conduct clinical, behavioral and social science research with these disadvantaged populations. Herein, we summarize important goals and objectives for justice-focused health researchers and provide examples of applied and practical training experiences.
Kathryn M. Nowotny PhD, Melissa J. Zielinski PhD, Kristi L. Stringer PhD, Tracy Pugh MHS, Elwin Wu PhD, Lisa R. Metsch PhD, Nabila El-Bassel PhD, DSW, Amy S. Nunn MS, ScD, and Curt G. Beckwith MD
American Journal of Public Health, January 2020