Christopher Wildeman (Yale University) suggested that correctional facilities may present “a unique opportunity” to provide these individuals with “at least some medical care that they haven’t gotten otherwise.” Indeed, as Bruce Western (Harvard University) observed in his introductory remarks, “Prisons are coming to function as a massive organ of delivery for public health for people who are involved in the criminal justice system.” Newton Kendig (Federal Bureau of Prisons) outlined the public health opportunities for both jails and prisons. He noted that jails provide a strategic public health opportunity to screen and diagnose infectious diseases among persons who often evade traditional healthcare systems and yet are at high risk for illnesses, such as HIV infection and viral hepatitis, and prisons provide an opportunity to diagnose and treat chronic diseases, such as diabetes, hypertension, addiction, and mental illness among persons who frequently have not sought or had access to treatment prior to incarceration. The structured life of prison provides an opportunity for better compliance with taking prescribed medications and eating a healthy diet as well as engagement in drug treatment services, frequent recreation, and increasingly a tobacco-free environment.

On the other hand, the prison environment may have adverse effects on health as discussed in the background paper (Rich, Dumont, Allen, 2012). The nutritional value of meals is far from ideal, because energy-dense (high-fat, high-calorie) foods are still common in prison meals. Smoking also remains a serious problem, despite the trend toward smoke-free correctional facilities. Poor ventilation, overcrowding, and stress may exacerbate chronic health conditions. More evidence is available regarding the effects of incarceration on mental health. Two conditions are especially associated with a serious degeneration of mental health: overcrowding and isolation units. The association between crowding and suicide or psychiatric commitment has been noted at least since the 1980s. Strains on staffing and facilities have particularly serious repercussions on wait times and holding conditions for the mentally ill. Case studies have also revealed widespread and serious reactions to segregation units, in which inmates are restricted to isolation cells for 23 hours a day. The restriction of movement and deprivation of human contact triggers psychological responses, ranging from anxiety and panic to hallucination. A review of health effects of incarceration also must consider sexual assault and intentional injury, either self-inflicted or resulting from assault.

Prison health conditions and impacts were further discussed at the workshop. Jamie Fellner (Human Rights Watch) described prisons as “toxic environments” with a negative impact on inmate health. She underscored the damage that can result from isolated confinement: “We know that [solitary confinement] is bad for people who are mentally ill and can cause adverse symptoms for those who didn’t have prior symp-



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