Jail Conditions And Mortality: Death Rates Associated With Turnover, Jail Size, And Population Characteristics.

In 2019, there were approximately ten million admissions to more than 3,000 US jails-facilities that had become increasingly deadly in the prior decades. Between 2000 and 2019, jail mortality rose by approximately 11 percent. Although incarceration is widely viewed as a health hazard, relationships between jail conditions and jail deaths are understudied. Using data from the Bureau of Justice Statistics and Reuters journalists, we assessed mortality rates and conditions in approximately 450 US jails in the period 2008-19. During those years, certain facility characteristics were related to mortality. For example, high turnover rates and high populations were associated with higher death rates. Greater proportions of non-Hispanic Black people in jail populations were associated with more deaths due to illness, and the presence of larger shares of non-US citizens was associated with lower overall mortality rates. Our findings suggest that heavy reliance on incarceration and the prevalence of broad health disparities escalate jail mortality.

Transitions in "Privatized" Prison Health Systems: Emergency Department Visits and Hospitalizations Among Incarcerated People in Florida, 2011-2018.

Objectives. To examine rates of emergency department (ED) visits and hospitalizations among incarcerated people in Florida during a period when health care management in the state's prisons underwent transitions.Methods. We used Florida ED visit and hospital discharge data (2011-2018) to depict the trend in ED visit and hospital discharge rates among incarcerated people. We proxied incarcerated people using individuals admitted from and discharged or transferred to a court or law enforcement agency. We fitted a regression with year indicators to examine the significance of yearly changes.Results. Among incarcerated people in Florida, ED visit rates quadrupled, and hospitalization rates doubled, between 2015 and 2018, a period when no similar trends were evident in the nonincarcerated population.Public Health Implications. Increasing the amount and flexibility of payments to contractors overseeing prison health services may foster higher rates of hospital utilization among incarcerated people and higher costs, without addressing major quality of care problems. Hospitals and government agencies should transparently report on health care utilization and outcomes among incarcerated people to ensure better oversight of services for a highly vulnerable population.

Help Without Hassles: Instituting Community-Based Care for U.S. Veterans after the War in Vietnam.

In 1979, the U.S. Congress approved funding for an outpatient, community-based "readjustment counseling" program to be overseen by the Veterans Administration (VA) and accessible to those who had served in the military during the era of the war in Vietnam. Today, three hundred Vet Centers are located throughout the country and their doors are open to veterans of a variety of conflicts; they outnumber VA hospitals two to one. This article explores conditions undergirding the establishment of the first Vet Centers and the program's broader implications, as well as the general issue of why public health systems change over time. Highlighting dynamics of how the VA gradually "deinstitutionalized" in the mid-twentieth century, it focuses on trends related to war and health, notions of federal responsibility, health activism and rights of people from marginalized groups, and connections between political ideology and medical diagnoses and treatment.

"The Service I Rendered Was Just as True": African American Soldiers and Veterans as Activist Patients.

In this article, I examine how African American soldiers and veterans experienced and shaped federally sponsored health care during and after World War I. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of advocates to mobilize for health care rights in the mid-20th century, I focus primarily on the experiences and activism of patients in the interwar years. Private and government correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as "policy actors" who viewed health and medical care as "politics by other means." In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow, and helped shape a veterans' health system that emerged in the 1920s and remained in place for the following century. They also laid the groundwork for the system's precedent-setting desegregation, referred to by advocates of the time as "a shining example to the rest of the country."

The founding of Walter Reed General Hospital and the beginning of modern institutional army medical care in the United States.

When Walter Reed United States Army General Hospital opened its doors in 1909, the Spanish-American War had been over for a decade, World War I was in the unforeseeable future, and army hospital admission rates were steadily decreasing. The story of the founding of Walter Reed, which remained one of the flagship military health institutions in the United States until its 2011 closure, is a story about the complexities of the turn of the twentieth century. Broad historical factors-heightened imperial ambitions, a drive to modernize the army and its medical services, and a growing acceptance of hospitals as ideal places for treatment-explain why the institution was so urgently fought for and ultimately won funding at the particular moment it did. The justifications put forth for the establishment of Walter Reed indicate that the provision of publicly funded medical care for soldiers has been predicated not only on a sense of humanitarian commitment to those who serve, but on principles of military efficiency, thrift, pragmatism, and international competition. On a more general level, the story of Walter Reed's founding demonstrates a Progressive Era shift in health services for U.S. soldiers-from temporary, makeshift hospitals to permanent institutions with expansive goals.