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Students and Faculty Member Spotlight Prison Health Crisis in Prestigious Journal

News March 27, 2024

Two students and their professor at the Lewis Katz School of Medicine at Temple University are bringing attention to a largely unseen public-health crisis: the severe lack of healthcare for people in prison.

A record 11.5 million people are incarcerated worldwide, including 2 million in the United States. These individuals are often denied access to medical care, resulting in poor health outcomes. Yet most people are unaware of this hidden tragedy and few medical schools teach about it.

At the Katz School of Medicine, two fourth-year students and a faculty member recently published an article in The BMJ, a wide-reaching medical journal, shedding light on the crisis and how medical schools can help.

“It’s very uncommon to learn anything about this in medical school. Yet hundreds of thousands of people are affected each year, physically and mentally. Their family members, communities, and networks are also affected,” said Brian Tuohy, PhD, a sociologist and assistant professor at the Katz School’s Center for Urban Bioethics. He co-authored the paper with Hannah Calvelli and Olivia Duffield, both dual-degree medical students in the Master’s in Urban Bioethics program.

“Healthcare in carceral settings is very limited and very low-quality,” explained Dr. Tuohy, who researches and teaches about the social determinants of health, including incarceration. “People’s medical complaints are not taken seriously, and problems are often caught very late.”

As a result, people who are incarcerated tend to suffer serious harms – including higher rates of infectious and chronic diseases, substance use disorders, and mental illnesses, the authors noted.

These injustices hit especially hard in disadvantaged communities – such as the area surrounding Temple – where mass incarceration is common.

“High rates of imprisonment are associated with [neighborhoods’] poorer overall health,” the authors reported. Additionally, higher levels of incarceration among racial minorities worsen existing health inequities, they found.

Teaching medical students about these issues is a vital way to bring attention and start addressing the crisis, said Calvelli, the article’s lead author.

“It’s important to learn about these things, but it’s also important to advocate for change,” added Duffield.

Assisting People in Prison

Calvelli and Duffield were inspired to take action after learning about the prison health crisis in Dr. Tuohy’s inaugural “Community Engagement” course in 2021. There, they collaborated with Prison Health News (PHN), a local nonprofit that responds to health questions from people in prison across the country. Expanding on this work the next year, the students and Dr. Tuohy established a community service initiative with PHN, as part of the Katz School’s voluntary service learning program. The idea for the research paper grew out of these efforts.  

A key challenge, the students learned, is that people in prison lack access to health information and opportunities to advocate for themselves. They also face huge power imbalances and deep stigmatization. So Calvelli and Duffield set out to help.

Through their service-learning initiative, to date about 60 Katz School students have responded to letters from people in prison with health- or advocacy-related questions. The students also attend trainings, workshops and presentations in carceral settings through the PHN partnership.

“The letters are really powerful and painful,” said Duffield, who co-leads the initiative with Calvelli.

The students have discovered, for instance, that people diagnosed with cancer and other illnesses while in prison receive little to no guidance.

“There’s no counseling, and they don’t know where to go from there, in terms of accessing healthcare,” Calvelli lamented.

Added Duffield: “People will write us and say, ‘I’m on these eight medications and I don’t even know what they’re for’ or ‘I was diagnosed with this condition and I don’t even know what that is.’”  

These experiences are “very impactful for the students,” explained Dr. Tuohy. “They get into the person’s world, and the letters allow them to humanize the person.”

Calvelli and Duffield are impressed by their classmates’ replies, which they review to ensure students’ responses adhere to best practices.

“Our role as students has been to be a resource for people in prison and a liaison between them and medical information,” Calvelli said. “They don’t have access to the internet or their social networks or basically anything else.”

Students have even researched which foods are available in the prison commissary, so they can recommend items people can buy to help manage their diabetes, Duffield noted.

“This is helping us become adaptable and thoughtful providers,” she said. “It’s important to think about what’s realistic for a patient, and tailor a plan to their situation.”

Due to Temple’s North Philadelphia location, third- and fourth-year students frequently care for patients who’ve spent time in prison or who are in police custody, during their rotations at Temple Health.

“Working with patients who are incarcerated has been eye-opening,” said Calvelli, who is pursuing a career in surgery.  

‘Building a Movement’

The article is already sparking interest and activity, the authors reported.

“The BMJ has a big readership and a very high impact factor [a measure of a journal’s influence],” said Dr. Tuohy. “Medical education programs around the world will see this article and think about these issues. It opens up the conversation.”

For example, the paper led medical students at The George Washington University to invite the authors to a carceral health seminar, which Dr. Tuohy recently attended. Additionally, the authors have already presented their work at major medical-education conferences of the American Medical Association and the Association of American Medical Colleges.

These experiences have had a profound effect on Calvelli and Duffield. In addition to learning about the dire health impacts of imprisonment, they’ve developed leadership, research and communication skills.

“Hannah and Olivia were the leaders on this project, and we went back and forth on the paper as a team, commenting and editing,” said Dr. Tuohy. “They are both superstars. They’re empathetic, intellectually curious, passionate, and extremely smart.”

When Calvelli and Duffield graduate this spring, they will each receive an MD degree and a Master of Arts in Urban Bioethics (MAUB). The first degree of its kind in the country, MAUB focuses on issues related to health disparities, including such factors as race, gender, socioeconomic status, and incarceration.

Dr. Tuohy’s classes and mentoring have been a pivotal part of their education, they said.

“Dr. Tuohy has been a wonderful mentor, and I know I’ll keep in touch with him after medical school,” stated Calvelli. “He helped us look at the big picture of prison health, which has so many angles and voices at play. He also encouraged us to aim at the bigger outlets like The BMJ, and see what our impact can be.”

“We want to make the world a better place,” said Duffield, who plans to specialize in infectious diseases. “I feel like we’re building a movement of practitioners and others who are poised to make a change.”