The Health of Jail Inmates

• DOI: 10.1177/0734016811415100
• Author: Allison Maze,Hefang Lin,Roberto Hugh Potter,Donell Bjoring
• Published date: 01 December 2011
• Date: 01 December 2011
• Subject Matter: Research Notes

Research Notes
Criminal Justice Review
36(4) 470-486
The Health of Jail Inmates:
ª 2011 Georgia State University
Reprints and permission:
The Role of Jail Population
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0734016811415100
http://cjr.sagepub.com
‘‘Flow’’ in Community Health
Roberto Hugh Potter1, Hefang Lin2, Allison Maze1, and
Donell Bjoring2
Abstract
Jails are often referred to as ‘ reservoirs of disease’’ and presented as the origin of infectious diseases
or for the development of chronic diseases. The present article argues that the data behind this
metaphor are generally taken from nonrepresentative studies by analyzing non-TB-focused studies
of jail inmate health issues published in both health and criminal-justice-related journals. Issues such
as the use of extremely large jail systems, geographic location, diseases studied, and the lack of atten-
tion to jail processes are examined. The article explores the ‘‘length of stay’’ variable from booking to
release known as ‘‘flow’’ and how the flow of detainees through jails over time affects who is left for
data collection. Data on releases from a large Florida urban jail system for a 1-year period are
analyzed to determine the impact of factors associated with release decisions. These, in turn, are
related to the representativeness and generalizability of the observed data in previous research and
analyzed in terms of potential bias for our understanding of the relationship between jail populations
and community health. Issues of health-focused practice standards and recommendations issued
without reference to ‘‘flow’’ factors are discussed. Finally, suggestions how criminologists and
criminal justice researchers can inform the research on health among jail inmates are canvassed.
Keywords
jails, length of stay, time/flow, Orange County Corrections Department
Introduction
Jails are often referred to as ‘‘reservoirs of disease’’ and presented as the origin of infectious diseases
or for the development of chronic diseases (Hammett, Harmon, & Rhodes, 2000). The sources of the
data, and especially the point in jail tenure at which information was collected from/on the detainee,
however, are rarely explored. For our purposes here, we want to examine how the issue of time/flow
has been treated in previous studies that report on the health conditions of jail populations. This will
1Department of Criminal Justice, University of Central Florida, Orlando, FL, USA
2Professional Services Division, Orange County Corrections Department, Orlando, FL, USA
Corresponding Author:
Roberto Hugh Potter, Department of Criminal Justice, University of Central Florida, PO Box 161600, Orlando, FL 32816,
USA
Email: rhpotter@mail.ucf.edu

---

Potter et al.
471
be related to known factors that affect length of stay in jails. Data from one large jail system will be
used to illustrate how taking data from various postarrest time points affects who remains in jail and
the health status picture that emerges.
Time/flow is an important variable in terms of knowledge about the health of jail populations.
Our hypothesis here is that jail flow affects the information on which health researchers have based
their conclusions in ways not acknowledged by those researchers. That is, as one moves from
collecting data during a rapid flow period (i.e., closer to intake) toward the stock population period
(i.e., those confined for longer periods of time), the information about ‘‘jail populations’’ is affected
by a ‘‘period’’ effect. Data taken from stock populations, then, is potentially very different from data
taken from populations closer to the booking point. In turn, the variables that affect the speed of
population flow through the jail setting also affect the biases introduced, when data are taken from
stock populations.
What We Know About Jail Inmate Health and What it Means for
Community Health: General Attributes of Jail Inmate Health Studies
Table 1 provides a summary of the available studies of jail inmate health conditions reported in
peer-reviewed journals and federal government documents. The span of these studies ranges from
1962 to 2009, demonstrating that there has been curiosity about the relationship between health and
populations that interact with the criminal justice system since well before the 1979 Bell v. Wolfish
decision clarified that the Constitutional requirement of health care provision applied to pretrial
inmates as a part of due process protections (Bell v. Wolfish, 1979; Cohen, 2008). We will now
examine the contents of Table 1 more systematically.
The first thing to note in Table 1 is the geographic location of the jails, where inmate health issues
were studied. For the purposes of this article, the region of the country is based on regions defined by
the Bureau of Justice Statistics (BJS; Stephan, 2001). There is only one nationally representative
study of jail inmate health (Maruschak, 2006) and only two multicity studies (Kahn, Voigt, Swint,
& Weinstock, 2004; MacGowan et al., 2009). Seven of the studies utilized northeastern jails, four of
single jail systems from New York State, one from Massachusetts, and one from Baltimore.
New York City’s Riker’s Island jail system features in multiple studies and several upstate jails are
also featured in one study (MacGowan et al., 2009). Two mid-western jail systems are featured,
though some of the 30 jail systems in the Kahn et al. (2004) and the MacGowan et al. (2009) studies
were also in the mid-west area. There are three studies that focus on single southern jail systems.
Again, many of the jails in the Kahn et al. (2004) and the MacGowan et al. (2009) studies were
located in the southeastern part of the nation. Finally, five studies focused on west coast jails.
Los Angeles County, with the largest jail system in the world, accounted for two of the five,
concentrating on the unit housing self-identified gay and/or transgendered (biological male)
inmates. More than half of all jails are located in the southern region of the nation.
With the exception of the BJS (Maruschak, 2006) study, most jail inmate health surveys focus on
a single jail system (i.e., a county; Rhode Island is a combined jail/prison campus), or a tiny fraction
of the more than 3,000 jails across the nation. As pointed out elsewhere (Maruschak, Sabol, Potter,
Reid, & Cramer, 2009), nearly half of all jail systems in the United States are located in the southern
region of the nation. The smallest proportion of jails, though not necessarily inmates, is found in the
northeastern portion of the nation. As noted earlier, the Los Angeles County jail system is the largest
in the world, with an average daily population (ADP) that has ranged from 18,000 to nearly 21,000
over the past decade. In some instances, these jails are included because they are in a ‘‘high morbid-
ity area’’ for a disease such as syphilis (e.g., Kahn et al., 2004) and the purpose is to determine the
impact of a jail-based program on a specific disease detection and prevention. For more general
knowledge of the physical health problems associated with jail inmates, however, it is difficult to

---

and
’
for
for
vast
less
30%’
(continued)
‘the
are
for
within
Respondents
month,
than
of
1
reported
reported
hr
respondents;
system,
majority
detained
than
more
released
72
ALOS
Not
1
Not
that
males
observed
1980)
850
in
of
of
of
of
10-day
in
a
(out
(consecutive
admitted
year)
conditions
screening
over
period
December,
Number
Respondents
500
Distribution
987
1
1
Jail
Number
of
Systems
Studied
of
dental;
of
observed
observed
surgical,
of
disease;
Hx
stays
health
Measures
infectious
of
utilization;
psych);
conditions
chronic
acute
diseases;
hospital
(medical,
and
mental
conditions
Type
Reported
Distribution
Drug
Distribution
’;
injury
...
arrival
physical
abuse;
(including
prior
‘visual
blood
Measured
acute
diseases;
recording;
physicals;
health
after
Hx
and
injuries;
chronic
health;
placement’
testing
admission,
Hx;
diseases;
infectious
substance
mental
shortly
health
injury
surgeries);
inspection;
pressure
selected
PPD
STD
Conditions
Acute
On
Mental
NY
Data
of
admission
York,
admission
Point
Collection
Upon
New
Upon
and
for
for
days;
days
IL
Characteristics
Study
9
49
of
¼
NY
¼
County,
Studies
reported
Remmlinger,
Loewenstein
(1977)
respondents;
system,
mean
median
Location
Albany,
Not
Cook
Health
studies
Jail
in
and
Obis
Della
1.
health
1975)
(2-week
and
Lyons
(1962)
Penna,
Schwartz,
period
June,
(1983)
Table
Author
General
Whalen
Novick,
1,420
Raba
472

---

2.5
one
days,
’—
stay
weeks,
direct
one
to
in
to
months
average
6
and
remain
less,
(continued)
of
for
presented
the
4–90
third
Respondents
due
distribution;
or
days
of
for
of
total;
males,
one
91
reported
months
days
years
incarceration’
measured
logged
skewed
5
for
for
months
females—no
measure
third
prisoners
3
third
and
for
2
ALOS
Not
‘‘Duration
Approximately
¼
3
to
as
10%
(n
and
a
as
103)
118
Day
6,
those
charts
and
¼
of
inmates
male
and
Facility
July
with
(n
intake
responded;
not
reported
of
of
females
20%
594
on
medical
inmates
attrition
males
3;
1,800
of
held
1983—only
with
sample
95)
many
possible
females
30%
between
Day
inmates
included.
capacity
be
Number
Respondents
397
Interviews
1,082
1
1
1
Jail
Number
of
Systems
Studied
social
risk
and
quality
of
observed
to
reporting
regressed
variables
medical
various
provided
while
and
accessed
histories
Measures
against
use,
illnesses,
of
health
inmates
predict
care
conditions
compared
services
of
symptom;
(OLS)
and
to
care
detained
of
reporting
prior
behaviors,
demog...