More than 2 million people are incarcerated in the United States.¹

And the incarcerated population is increasing.

I know that corrections is a tough job.

Your work is important to the health and safety of all Americans in numerous ways.

And the inmates in your custody and care are often the most "down and out," or "at-risk" individuals in our society.

My bosses, President Bush, Department of Health and Human Services Secretary Mike Leavitt, and Assistant Secretary for Health Admiral John Agwunobi, and I truly appreciate your service and dedication to our nation.

Correctional Health = Community Health

As Acting Surgeon General, I am charged with protecting the health and safety of this great Nation, including incarcerated men and women.

It is our duty to provide health services while people are serving their debt to society.

And improving the health of incarcerated men and women helps to secure the health, security, and prosperity of our great nation.

Many of us here in this room understand the link between correctional health and community health.

Unfortunately, there are some who do not fully understand how correctional and community health impact each other.

The reality is that every year, over half a million individuals are released from state and federal prisons into communities across our nation.²

Let's think about what would happen without correctional health services.

The man in prison now with tuberculosis will one day return to his family.

He will in be close quarters with his family and in crowded places outside the home, especially if he lives in an urban area.

He passes T-B onto his family and others within his community. His family goes to work and passes T-B to co-workers and friends.

As you can see, the number of infected individuals goes up….fast. All from one person released from prison with an infectious disease. And T-B is just one example.

To protect our nation, it is absolutely imperative to provide good medical care to incarcerated individuals.

And even more than medical care, we must help the men and women in our custody to take better care of themselves and practice healthy behaviors so that they are as healthy as possible when they return to their communities.

American Correctional Association

Because of my connections to our profession, I am well aware that there are still some within our own corrections field who don't fully embrace that our "custody" and health "care" missions are intertwined.

I want to thank the American Correctional Association for your leadership in promoting correctional health.

The efforts you have launched in preparation for this conference will help us to take a giant leap in bridging correctional "custody" and correctional health "care."

On behalf of the U.S. Department of Health and Human Services, I applaud:

• First, the creation of your first-ever Professional Interest Section for health care.
• Second, the development of the new peer-reviewed journal Correctional Health Today.
• Third, the dedicated track of health care workshops at this very conference that offers cross-training opportunities for health care practitioners and corrections personnel.

  I noticed that there are more than 35 workshops throughout the conference that focus on health. That is commendable.

• And last but not least, I congratulate you on the two new Certified Corrections Nurse and Certified Corrections Nurse Manager designations that will help prepare health professionals entering the corrections field.

Let's all take a moment to give the A-C-A a round of applause.

<<Pause for applause>>

USPHS Commissioned Corps

I also want to acknowledge the health officers who represent my team ? the uniformed United States Public Health Service Commissioned Corps.

These 6,000 health officers work throughout the U.S. Department of Health and Human Services and other important agencies, such as the Bureau of Prisons.

I am very proud of the work that they do to improve health and the health care system in our prisons.

Priorities

Pubic Health Service officers also play a central role in supporting the priorities of the Office of the Surgeon General.

Many of the health issues that are being addressed over the course of this conference intersect with the priorities of the Office of the Surgeon General.

I want to take a few moments to tell you about two of our priorities, why we feel they are so important, and how they relate to our continued work with prison populations.

• Our first priority is Prevention. - What each of us can do in our own lives and communities to make ourselves and our families healthier.
• The other priority we're focusing on relentlessly is Eliminating Health Disparities.

Prevention

Let's start with prevention, because it is the cornerstone of everything that we do at H-H-S.

Prevention is a priority for us because every year millions of Americans get sick and die from preventable causes.

We want to change that. But, right now our nation has it backwards.

We live in a treatment-oriented society, where too little time, money, and effort are invested in preventing diseases.

We wait years and years, doing nothing about unhealthy eating habits and lack of physical activity, until people get sick.

Then we spend lots of money on costly treatments to try to make people well, often when it is already too late.

We need to refocus our efforts on preventing illness and injury.

The good news is that there are six key steps that can help prevent disease:

1. Good nutrition,
2. Physical activity,
3. Maintenance of a healthy weight,
4. Regular health screenings,
5. Vaccinations,

and

6. Preventing exposure to tobacco and secondhand smoke.

Prevention and Correctional Health

For those of you in correctional health care, prevention takes on an even more urgent imperative, in the treatment and control of infectious disease, mental illness, and substance abuse.

As we know, incarcerated men and women have a higher prevalence of health problems than the general population.

For example, the rate of confirmed AIDS cases in state and federal prisons is more than three times higher than in the overall U.S. population.³

Many of the men and women in our correctional facilities were unable to sustain healthy lives on the outside.

And when they enter our facilities, they bring with them a host of physical and mental health problems.

This makes our jobs especially challenging… But wherever there is challenge, there is opportunity.

As correctional leaders, we help keep society safe, and we care for the men and women serving their debts to society.

For these inmates, incarceration is an opportunity to access the support they need for their long-standing health conditions - including substance abuse problems and infectious diseases.

This is important work for protecting society because individuals move from the community, through jails and prisons, and back into the community in a relatively short time frame.

Providing effective health care interventions helps to ensure that diseases are limited or eliminated before they reach back to homes and communities.

Disease prevention saves lives. It can also save money.

The Health Status of Soon to be Released Inmates report shows that prevention and screening of S-T-Ds and T-B, can save health care dollars in the long run.⁴

Screening and appropriate interventions decrease the transmission of infectious diseases during incarceration and after the individual is released back into the community.

Each time you treat an incarcerated person for an infectious disease, you are preventing the spread of a serious contagious disease into the community at large.

As health professionals and administrators, each of you has the opportunity to spread the prevention message each and every time you see a patient.

Correctional health care helps us to prevent disease among our inmates, and it helps to prevent disease in our communities.

Eliminating Health Disparities

In addition to taking part in a shift toward prevention, correctional health providers also lead in another area: eliminating health disparities.

More than 60% of state and federal inmates are African American or Latino.⁵

And some are the result of the disparities within our nation: Socio-economic disparities, educational disparities… and health disparities.

Many individuals who are incarcerated today are from our nation's poorest neighborhoods.

They generally have low educational achievement and few job opportunities. In addition, they lack access to quality health care services.

Unfortunately, some of these individuals chose a life of crime for what they thought was a quick fix, or because of substance abuse and mental health problems.

Reform is possible for many of the prisoners in our custody and care.

It is also possible to make progress on eliminating disparities through corrections-based interventions.

For many inmates, the corrections system may be the only contact they have with a health care professional for years.

When an individual is released from a prison or jail setting, the corrections system no longer has responsibility, or authority, for his or her care.

Many times the person is released without much money or support, right back into the old neighborhood - without linkages back to the health care community.

Many of us have seen it time and time again:

• A prisoner is released back into community where his social network is involved in drugs.
• He does well for a while and then succumbs to substance abuse and the negative forces in his environment.
• He is arrested for his crimes and brought back to prison.
• He suffers, and his children, wife, and extended family suffer.

You can insert a lot of other health and mental health problems into that scenario and come up with the same result.

To close the gap, we can help maintain the good treatment and care started in the correctional facility by helping to link released prisoners to health services on the outside.

HHS and Correctional Health

The U.S. Department of Health and Human Services supports numerous health and substance abuse programs to offer care for individuals after they are released from our correctional system.

The Substance Abuse and Mental Health Services Administration, or SAMHSA, which is also part of H-H-S, is funding important grant programs in this area.

SAMHSA programs enable communities to provide effective substance abuse prevention and mental health services to prisoners returning to their families and communities after incarceration.

Last year, SAMHSA announced $7.2 million in new grants for a Jail Diversion Grant Program.

This program helps to divert individuals with mental illness away from the criminal justice system and into community-based mental health and substance abuse treatment services.

In addition, SAMHSA grantees are helping ensure that life skills training, housing placement, vocational training, job placement, and health care are available.⁶

To help provide more access to affordable health care, President Bush has also substantially increased support for Community Health Centers.

These Centers are a critical component of our health care safety net and many inmates will return to communities served by community health centers.

Since 2001, President Bush's Health Center Initiative has established nearly 900 new or expanded health center sites and increased the number of grantees by 32%.

These centers are helping to eliminate health disparities.

And they provide care regardless of ability to pay or criminal history.

Community health centers are important re-entry linkages.

Such linkages are very difficult to create and maintain.

And yet, many of you are positioned to be that type of linkage yourselves.

As corrections officers and health professionals, you take many important steps to eliminate health disparities.

• You identify those who are infected with disease, through early testing and screening in prison or jail,
• You begin or continue treatment,
• You conduct appropriate discharge planning,

and

• You make connections for the continuity of care.

Through each of these steps, you are improving the health of the inmate, the correctional institution, the community, and the nation as a whole.

Closing

In closing, let me make one final point:

I know that you have some of the hardest jobs in America… but you also have some of the most important jobs in our nation.

• You keep us safe,
• You stand watch over inmates, but you also protect their health.

and

• You transform minds, bodies, and souls so that down-and-out individuals can become healthy, productive members of society when they return to their communities.

The charge is great, the resources can sometimes be scarce, but never forget that you make a positive difference - for those who are in your custody, for our communities, and for our nation.

Over the past few days, I have had the opportunity to meet with some of you individually.

I am encouraged by the ideas and experiences you have shared with me.

Please continue to create partnerships, share experiences, and strengthen the bridge between the corrections community and the correctional health community.

Our ability to collaborate and build on our strengths through partnerships will make a tremendous difference.

I look forward to working with all of you as we move ahead in improving correctional health.

Thank you.

¹ Harrison and Beck. Prisoners in 2005. November 2006. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf
² Harrison and Beck. Prison and Jail Inmates at Midyear 2005. May 2006. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf
³ Maruschak, L. Bureau of Justice Statistics Bulletin: HIV in Prisons 2004. U.S. Department of Justice. November 2006. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/hivp04.pdf
⁴ National Commission on Correctional Health Care. The Health Status of Soon-to-be-Released Inmates: A Report to Congress. Available at: http://www.ncchc.org/pubs/pubs_stbr.vol1.html
⁵ Harrison and Beck. Prisoners in 2005. November 2006. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf
⁶ SAMHSA Jail Diversion Grant Program. More information is available at: http://www.samhsa.gov/news/newsreleases/060420_jails.htm.

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Last revised: March 20, 2007