Prison Health is Public Health
As the entire world grapples with the effects of COVID-19, prisons, jails, and other detention facilities may not be the first among the concerns that the public considers. Yet, these institutions allow us to consider the management of the outbreak from a micro-societal viewpoint that could offer important mitigation strategies for other settings.
Why are prisons epicenters of concern when it comes to COVID-19? We know that prisoners often reflect the disparities in social health affecting groups that are disproportionately likely to be incarcerated. Racial minorities, persons with substance abuse and/or mental health disorders, persons living in poverty are also more likely to have comorbid health concerns (e.g., diabetes, hypertension, heart diseases). Other illnesses such as tuberculosis and Hepatitis-C, which are more common amongst prisoners, exacerbate complications due to COVID-19 infections and are also significant comorbid factors. Some researchers have argued that “multimorbidity” is common among the prison population, which may cause earlier onset and greater severity than illnesses in the general population.
In prison settings, communicable diseases have the potential to be transmitted between prisoners, by staff and visitors, between prisons through transfers, and staff cross-deployment to and from the community. COVID-19 outbreaks in custodial settings are especially important for public health because an outbreak could quickly overwhelm prison health-care services. Furthermore, prisons are a vector for community transmission that will disproportionately impact marginalized communities. In other words, released prisoners and inmate visitors could impact the most vulnerable communities by carrying the infections back home. Controlling communicable infections and other public health concerns such as COVID-19, HIV and Hepatitis C, in correctional settings can have positive effects both in these settings and on surrounding communities.
Good news from Belize
RTI has had a special opportunity to observe the response to the COVID-19 pandemic in Belize, including in the prison system. In 2017, the U.S. Embassy in Belmopan engaged us to help with a governance project based on access to reliable, open-source data. The project, a partnership with the Belize Association of Planners, aims to strengthen civil society, improve government service delivery, and support democracy and security.
We contacted the Kolbe Foundation, a nonprofit, non-governmental organization that has managed the Belize Central Prison in Hattiesville since 2002. With their permission, we developed a short summary to underscore the importance of prison health to the Belizean community and to highlight the successful planning and intervention strategies implemented to protect these populations.
Located about 20 miles outside of Belize City, the Belize Central Prison is the only secure detention facility in the country. The sprawling complex includes the multiple adult housing units, the Addiction Rehabilitation Center (ARC), and Wagner's Youth Facility. In early July 2020, the Belize prison had a population of 1,222 individuals which included 34 females and 29 juveniles. Because the facility took important steps to prepare for the crisis, the prison has not had any COVID-19 cases.
While the first Covid-19 diagnosis in the U.S. involving a detained person was announced on March 16, 2020, the rest of the world had already been busy addressing issues regarding populations in detention. Iran, for example, temporarily released 70,000 prisoners serving sentences of less than five years to reduce in-custody transmission. During Italy’s well documented crisis, failure to calm incarcerated populations led to widespread rioting. Similarly, countries worldwide rushed to implement mitigating strategies.
The Kolbe Foundation released a plan to help prevent the introduction of the virus to the facility on March 13. Developed and approved by the Prison Director, Medical Officer, and the Chief of Security, the plan established clear guidelines regarding access restrictions, isolation protocols, and daily sanitation recommendations. Ten days later, after the first Belizean case of COVID-19 was confirmed, the prison issued an updated plan with additional screening practices, including checking temperatures of all persons entering the facility. The plan also documented changes in prison programming and recreational activities to reflect social distancing guidelines. Importantly, the prison administration also reiterated and demonstrated a strong commitment to promoting hygiene and health orientation information and public health awareness among prisoners and the outside community through the posting of fliers and broadcasts from the Jeremiah Radio Station, an independent radio station operated by the facility.