first 7 years since it was instituted (King and Mauer, 2001). The authors projected that, in 2026, 30,000 three-strikes prisoners will be serving sentences of 25 years to life. In California, new felony admissions of prisoners older than 40 increased from 15.3 percent in 1994 to 23.1 percent in 1999.

A survey by the New York Times (Liptak, 2005) found that 132,000 of the nation’s prisoners are serving life sentences. The number of “lifers” has almost doubled in the last decade, far outpacing the overall growth of the prison population. About one-third of the lifers sentenced between 1988 and 2001 are serving time for crimes other than murder, including burglary and drug crimes. Fewer lifers have a chance of parole. In 1993, the New York Times survey found that about 20 percent of lifers had no chance of parole. In 2004, that number rose to 28 percent. As a result, the United States has a large and permanent population of prisoners who will die of old age behind bars. According to the Sentencing Project (Mauer et al., 2004), the increase in life sentences reflects changes in state policies, not continuous increases in violent crimes.

These figures on the graying of the prison population indicate that a small, but growing segment of today’s prisoners face chronic diseases, such as diabetes and heart disease.

Health Status of Inmates

A highly disproportionate number of inmates suffer from infectious diseases, chronic diseases, and mental illness compared with the rest of the nation’s population. According to a 3-year study requested by Congress and delivered in May 2002 by the National Commission on Correctional Health Care (The Health Status of Soon-to-Be-Released Inmates), tens of thousands of inmates are being released into the community every year with undiagnosed or untreated communicable disease, chronic disease, addiction, and mental illness (NCCHC, 2002). The report paints a picture of a large and concentrated population at high risk for communicable and chronic diseases.

Communicable diseases During 1996, about 3 percent of the U.S. population spent time in a prison or jail; however, between 12 and 35 percent of the total number of people with certain communicable diseases in the nation passed through a correctional facility during that same year (NCCHC, 2002). There were an estimated 107,000 to 137,000 cases of sexually transmitted diseases (STDs) among inmates in 1997 and at least 465,000 STD cases among releasees.

Hepatitis Hepatitis B and C are viral diseases that attack the liver. Both can cause lifelong infection, cirrhosis of the liver, cancer, liver failure, and

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