Health Behind Bars
- Human Rights Research Center
- 1 day ago
- 8 min read
Author: Nandhini Devaraj, MS
September 11, 2025
View the interactive visual report here on Tableau.
Introduction
When someone is sentenced to prison, they shouldn’t lose access to healthcare. For millions of incarcerated people around the world, basic medical care is delayed, denied, or simply not available. In the U.S., where incarceration rates are the highest in the world, the gaps are wide. Chronic illnesses go untreated, mental health needs are ignored, and prison clinics are often overwhelmed and under-resourced.
Globally, incarcerated individuals are far more likely to live with serious health conditions and are less likely to get the care they need than other members of society. From HIV to mental illness, the burden is high and the access is low.
This dashboard tells prisoners’ stories through data. It visualizes prisoner demographics, the realities of healthcare on the inside, and demonstrates how countries compare in providing care to prisoners. This isn’t just a policy failure. It is a public health and human rights emergency.
Who's Behind Bars
The U.S. prison population is not a mirror of the general population. Men make up over 93% of inmates, but only 49.5% of the overall population. (United States Census Bureau Quick Facts, 2025) The prison population is nearly 60% Black and Hispanic (38.6% Black and 29.5% Hispanic), despite these groups making up only 13.6% and 18.9% of the general population, respectively. (U.S. Census Bureau, 2024) Additionally, fewer old people are incarcerated compared to the U.S. population overall. One in five (20%) incarcerated individuals is now over age 51, compared to just over 16% of the general adult U.S. population. (Bureau of Justice Statistics, 2024)
These groups often have greater healthcare needs due to long-standing health disparities. For example, Black and Hispanic communities experience higher rates of chronic conditions like hypertension, diabetes, and asthma, largely driven by unequal access to care, food insecurity, and environmental exposures prior to incarceration. (Centers for Disease Control and Prevention, 2023) Older adults in prison are also more likely to suffer from complex health issues such as arthritis, cognitive decline, and cardiovascular disease, but most correctional facilities aren’t equipped to provide geriatric care. (Human Rights Watch, 2021; Bureau of Justice Statistics, 2022)
USA Behind Bars
More than 1.2 million people are locked up in U.S. state and federal prisons, which is more than in any other country in the world. Prison numbers grew quickly after laws were passed in the 1980s and 1990s. The number of incarcerated individuals dropped slightly during COVID-19, as seen in the graph below.
According to the Bureau of Justice Statistics (2023), more than 1.2 million people were held in U.S. state and federal prisons as of 2022. The United States still incarcerates more people than any other country in the world, with about 565 individuals incarcerated per 100,000 residents.
Much of the growth in prison populations can be traced back to federal legislation passed in the 1980s and 1990s. The Sentencing Reform Act of 1984 and the 1994 Crime Bill expanded mandatory minimum sentences and restricted parole, leading to longer prison terms and more people behind bars. These policies hit hardest in low-income communities and among people of color, especially during the peak years of the War on Drugs.
The rise of private prison contracts during this period also played a role. With companies profiting from incarceration, there were built-in incentives to keep prison populations high. At the same time, public fear around crime, often stoked by racially charged political messaging, contributed to a widespread “tough-on-crime” stance that shaped local and national policy.
The slight dip shown in the graph during the 2010s reflects some important changes. A number of states began rolling back harsh sentencing laws, particularly for nonviolent offenses. Courts expanded eligibility for diversion programs and early release. Public pressure around mass incarceration also increased, especially as more attention was paid to racial disparities in the system.
During the COVID-19 pandemic, many correctional systems reduced inmate intake and released eligible prisoners early in an effort to reduce crowding and limit viral outbreaks. While temporary, this marked one of the sharpest declines in U.S. prison populations in recent history.
The numbers remain especially high in places like Louisiana, Mississippi, and Oklahoma, each exceeding 600 incarcerated individuals per 100,000 residents. While some states saw temporary decreases during the pandemic, these three maintained or rebounded to pre-COVID levels and continue to lead the nation in incarceration rates. (Prison Policy Initiative, 2024; Bureau of Justice Statistics, 2023)
Sicker on the Inside
Inside prison walls, access to healthcare is often delayed, inconsistent, or inadequate, even though incarcerated individuals tend to have greater health needs than the general population.
The chart compares the prevalence of six health conditions among incarcerated individuals as compared to the general U.S. population.
Across most conditions, the incarcerated group shows higher percentages. The widest differences appear to be with issues related to arthritis, hepatitis, and infectious diseases. These are the areas where the gap between the two populations is most visible.
This pattern reflects long-standing health disparities tied to poverty, poor pre-incarceration healthcare access, and higher exposure to risk factors such as substance use, chronic stress, and untreated mental illness. Many people entering prison have gone years without regular medical care, especially in communities with limited providers or affordable services. As a result, conditions like arthritis, hepatitis C, hypertension, and infectious diseases are more common and often more advanced when finally addressed in prison settings. (Bureau of Justice Statistics, 2022; Centers for Disease Control and Prevention, 2023)
The Staffing Crisis
Even basic healthcare is lacking. While 81% of incarcerated individuals reported receiving a medical exam, 25% said they needed care but did not receive it, and over half reported having at least one untreated medical issue. (Bureau of Justice Statistics, 2022)
One of the most pressing issues in prison healthcare is the severe shortage of medical staff.
In the U.S., there is approximately one healthcare worker for every 4.5 incarcerated individuals. In Brazil, that ratio drops drastically; just one healthcare worker serves over 14,000 incarcerated people. These staffing gaps contribute to widespread burnout, delays in treatment, higher mortality rates, and legal claims related to neglect. (World Prison Brief, 2023; Human Rights Watch, 2021)
Globally, countries like Norway and Germany offer better models with public, integrated healthcare systems, strong staffing, and preventive care.
Countries with public, integrated prison health systems see fewer lawsuits, better outcomes, and faster care. The U.S., by contrast, separates prison healthcare from its public systems and contracts much of it to private firms. (World Health Organization, 2022; Human Rights Watch, 2021)
Integrating prison healthcare into the public system could improve continuity of care, reduce long-term medical costs, and better support individuals reentering society with chronic or mental health conditions. It would also align prison health policy with broader public health goals, especially during crises like pandemics, where gaps in care can affect both prison and community populations.
What Happens When Healthcare Fails?
The consequences of understaffing and neglect in prison healthcare aren’t just administrative, but they are deeply human. Incarcerated people often wait weeks for basic treatment, and preventable conditions such as untreated infections or unmanaged chronic illnesses can escalate into medical emergencies. These delays have contributed to in-custody deaths and rising numbers of legal claims. Between 2015 and 2022, states paid out hundreds of millions of dollars in lawsuits related to medical neglect. (Prison Legal News, 2022)
Chronic understaffing also drives high turnover among correctional healthcare staff. Many professionals leave due to low pay, emotional strain, and unsafe working conditions. These challenges have been worsened by nationwide shortages in nursing and other frontline care roles. Additionally, most prison healthcare workers receive little or no specialized training in trauma-informed care, mental illness management, or the correctional environment itself. These gaps limit both the quality and timeliness of care, compounding health risks for incarcerated patients. (National Commission on Correctional Health Care, 2021)
Conclusion
The lack of medical care in U.S. prisons is not just a gap in service. It’s a systemic failure. Incarcerated individuals often face worse health outcomes not because their needs are greater, but because the structures in place are ill-equipped, understaffed, and often indifferent to their suffering.
Fixing this isn’t only about improving prison clinics. It’s about rethinking how we define justice, health, and dignity. The people behind bars are still people, and access to care should not end at the prison gate.
Glossary
Arthritis – A condition that causes pain and swelling in the joints, like knees or fingers.
Asthma – A condition that makes it hard to breathe because the airways in the lungs become tight and swollen.
Burnout – When someone feels very tired and stressed from working too much without enough rest.
Cardiovascular disease – A sickness that affects the heart and blood vessels.
Chronic illness – A sickness that lasts a long time and needs regular care, like asthma or diabetes.
Cognitive decline – Trouble with memory, thinking, or solving problems, often happening as people get older.
Correctional facility – A place, like a prison or jail, where people stay after breaking the law.
Data – Facts or numbers used to study or explain something.
Decarceration – Reducing the number of people held in jail or prison.
Diabetes – A health condition where the body has trouble using sugar for energy.
Diversion programs – Programs that help people avoid jail by offering treatment or education instead of punishment.
Early release – Letting someone out of prison before their full sentence is over, often with rules to follow.
Geriatric care – Healthcare for older adults.
Healthcare access – The ability to get medical help when it’s needed.
Healthcare worker – Someone like a doctor, nurse, or helper who treats people who are sick or injured.
Hepatitis C – A virus that can hurt the liver and make someone very sick.
HIV (Human Immunodeficiency Virus) – A virus that weakens the body’s immune system, making it harder to fight off illness.
Incarcerated – Being kept in a prison or jail.
Infectious disease – A sickness that spreads from person to person, like the flu.
Inmate – A person who is staying in a prison or jail.
Justice system – The group of laws, courts, and police that deal with crime and punishment.
Lawsuit – When someone asks a court for help because they were hurt or treated unfairly.
Mandatory minimum sentence – A law that says someone must stay in prison for a certain amount of time, no matter what.
Medicaid – A government program that helps people with low income get medical care.
Mental health – A person’s emotional well-being and how they deal with stress, feelings, and thoughts.
Mortality – The number of people who die in a certain group or place.
Neglect – When someone doesn’t get the care or help they need.
Oversight – Watching over something to make sure it is being done the right way.
Pandemic – A disease outbreak that spreads across the world, like COVID-19.
Parole – When someone is let out of prison early but must follow special rules.
Policy – A rule or plan made by a group or government.
Prevalence – How common something is in a group of people.
Preventable – Something that could have been stopped from happening with the right actions.
Prison clinic – A small medical center inside a prison where inmates can get healthcare.
Private healthcare – Medical care run by companies that try to make money.
Profit-driven – Focused mostly on making money, sometimes more than helping people.
Public health – Services that help protect and improve the health of whole communities.
Public system – A service run and paid for by the government using tax money.
Recidivism – When a person goes back to prison after being released.
Reentry – When someone leaves prison and returns to live in the community.
Sentencing – A judge’s decision about how long someone must stay in prison.
Staff burnout – When healthcare workers feel too tired or stressed to keep working well.
Staffing shortage – When there aren’t enough workers to do a job, like doctors or nurses
Systemic – A problem that is built into a whole system, not just one person or place.
Trauma-informed care – Medical care that understands some people have been through scary or painful experiences and treats them with care and respect.
Data Sources
Additional Sources
Centers for Disease Control and Prevention. (2023) Health disparities by race and ethnicity. U.S. Department of Health and Human Services.
Human Rights Watch. (2021). Old behind bars: The aging prison population in the United States.
National Commission on Correctional Health Care. (2021) The correctional healthcare workforce crisis.
Prison Legal News. (2022). Medical neglect and inmate lawsuits by state.
World Health Organization. (2022). Prison health is public health: Policy brief.
The Sentencing Project. (2023). Trends in U.S. corrections.