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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
00;00;09;04 - 00;00;26;03
Chris Fleming
Hello and welcome to Health Affairs This Week, the podcast where the editors of Health Affairs talk about the health policy news of the week and where we're still really excited to be doing these despite the fact that after our 50th episode, Don Lemon declared us past our prime. I'm Chris Fleming.
00;00;26;03 - 00;00;49;28
Marianne Amoss
And I'm Marianne Amoss. Before we get to this week's discussion, a quick note. On Tuesday, February 28th, we're hosting our first virtual networking happy hour for the Health Affairs Insiders membership community. Insiders from across the country will have the opportunity to network with other Health Affairs Insiders and health policy professionals, including members of the Health Affairs senior leadership team.
00;00;50;25 - 00;01;06;02
Marianne Amoss
And as always, check out Health Affairs Forefront. This week's slate of articles includes a new piece we have from Laura Gottlieb and coauthors helping us make sense of the recent spate of social care quality measures, standards and regulations that have come out in recent months.
00;01;06;24 - 00;01;29;20
Chris Fleming
Thanks, Marianne. And this week, our main topic is about health in U.S. prisons and jails. New data has just come out on deaths within state and federal prisons during the first year of the COVID pandemic. We'll talk more about that in a bit. But first, we wanted to call some attention to important developments in the ongoing discussion about gun regulation and liability for gun manufacturers.
00;01;30;12 - 00;01;38;13
Marianne Amoss
Yes, a lot of attention has focused on the debate in Congress over gun regulation, but there have been some important developments in the states, right, Chris?
00;01;38;29 - 00;02;04;15
Chris Fleming
Yeah, that's true. Several Democratic led states, New York, New Jersey, California, Delaware, they've passed laws that allow people to sue gun makers for improper marketing and sales of their products. Several other states are considering similar legislation. And in fact, state legislators in Colorado are reportedly introducing legislation on Thursday, February 23rd, which is the day that we're recording this.
00;02;05;02 - 00;02;19;14
Marianne Amoss
Yeah, that would radically change the legal climate in Colorado, where current state law makes it extremely difficult to sue gun companies and unsuccessful plaintiffs even have to pay gunmakers attorneys fees. But these laws are being challenged in the courts, right?
00;02;20;09 - 00;02;43;22
Chris Fleming
Yeah, that's true. Again, the gun industry has already filed suit in court to block the liability laws in the states we just mentioned. What the industry argues is that these state laws are preempted and that's a fancy 25 cent legal word for blocked by a federal law that was passed in 2005, the Protection of Lawful Commerce in Arms Act.
00;02;44;06 - 00;02;52;20
Chris Fleming
Now, the question, as so many questions do these days, could ultimately end up in front of the Supreme Court, particularly if lower courts issue conflicting decisions.
00;02;53;07 - 00;03;18;06
Marianne Amoss
Thanks, Chris. We’ll undoubtedly have more news for listeners on these issues in future podcasts. But for now, let's get back to the challenges facing those in prisons and jails with regard to COVID and other health matters. So incarcerated populations face a range of health issues. Some of these are a function of their living situation. The close conditions that incarcerated people live in can facilitate the spread of infectious disease.
00;03;18;26 - 00;03;28;09
Marianne Amoss
Exacerbating this problem is that prisons and jails have become overcrowded. Also, ventilation is poor. There's not a lot of air exchange within these buildings.
00;03;29;13 - 00;03;34;14
Chris Fleming
Right. And the demographics of the incarcerated population that plays a role here, too, right?
00;03;34;24 - 00;03;57;19
Marianne Amoss
Yeah, that's right. And although the incarcerated population skews a bit younger, being incarcerated can kind of age a person faster and incarcerated people have more chronic health conditions that put them at risk. To add to all that, communities are also at risk of increased illness as guards staff, visitors and incarcerated people themselves move in and out of carceral facilities.
00;03;58;02 - 00;04;25;19
Chris Fleming
Exactly. So now what we saw during the COVID pandemic was that incarcerated people were in a really vulnerable position. Prisons and jails offered the perfect environment for COVID to spread. Incarcerated people couldn't follow all those public health guidelines we all became so familiar with during the pandemic: social distancing, wash your hands, isolate from sick people. Testing wasn't a priority early on, and the vaccine rollout was uneven and slow.
00;04;25;28 - 00;04;46;20
Chris Fleming
So as a result, as one might expect, prisons and jails became hotspots of COVID transmission. Research showed that the case rates of COVID 19 among incarcerated people were nearly five times higher than in the general population. And the COVID related death rate in the prison population was three times higher than in the overall U.S. population.
00;04;47;19 - 00;05;00;29
Marianne Amoss
Right. Now, there were calls for decarceration to reduce the prison population and therefore the transmission of COVID. And this did temporarily reduce the prison population by a bit. But that reduction hasn't been permanent.
00;05;01;17 - 00;05;41;18
Chris Fleming
And as we all know, that ran into some political headwinds, and that's become another element of controversy in the ongoing debate about prison populations and legal policy in the country. And that all brings us back to this new data that was released last week by the UCLA Law Behind Bars Data Project. As a quick note that this data project is financed by Arnold Ventures, and Arnold Ventures also generously supports several Forefront series for Health Affairs, including series on dual eligibles for Medicare and Medicaid, provider prices in the commercial market, and ACOs (Accountable Care Organizations) and accountable care.
00;05;42;15 - 00;06;11;20
Chris Fleming
This is a dataset that showed that mortality in U.S., state and federal prisons jumped nearly 50% in 2020. To put that into actual numbers, that means at least 6100 people died in prisons in 2020, compared with about 4200 the previous year. Now we have some data for 2021. It's incomplete, but reports from 28 states. And just to put that in perspective, that represents about half of the prison population.
00;06;12;07 - 00;06;18;08
Chris Fleming
That preliminary data shows that mortality rates were above pre-pandemic levels as well in 2021.
00;06;19;00 - 00;06;40;18
Marianne Amoss
Yeah, that's right. And this is particularly interesting because this is the first comprehensive data we have on prison deaths during COVID. The Justice Department used to collect and analyze data on mortality within the carceral system, but that stopped in 2019 when stewardship of the data was transferred to a different government body. And since then, data has been imprecise and incomplete.
00;06;41;03 - 00;06;48;27
Marianne Amoss
And actually, last year, a bipartisan committee found that the Department of Justice had failed to implement a law governing reporting of deaths in custody.
00;06;50;00 - 00;07;13;07
Chris Fleming
Well, you know, we always want bipartisan agreement, but that's probably not the way they hope to get it. So this problem of incomplete or missing data is on carceral health is, it's not new. We've covered this in the Journal and on Forefront several times in the recent past. Just a couple of examples, November 2022 Journal article by Neal Marquez and coauthors.
00;07;13;22 - 00;07;41;25
Chris Fleming
They looked at racial, racial and ethnic inequalities and COVID mortality among incarcerated populations in Texas. Their paper that they were trying to fill a knowledge gap on the issue. And they wrote that this gap was caused in part by a lack of reporting of COVID-19 outcomes by race and ethnicity by most prison systems. Now we have another example in a January 2023 Forefront article Michael Forrest Behne and coauthors.
00;07;42;10 - 00;07;55;18
Chris Fleming
They noted that prison hospital data is omitted from federal datasets, causing researchers and advocates to really have to put in a ton of legwork to try to obtain carceral health records and statistical reports.
00;07;55;29 - 00;08;13;06
Marianne Amoss
Yeah, and this is a problem because as the old adage says, what gets measured gets managed. Lack of data means less transparency about what's happening in terms of health in prisons and jails, as well as a reduced ability to improve conditions in carceral facilities.
00;08;13;26 - 00;08;32;15
Chris Fleming
Well, this is definitely an issue to keep an eye on. But we'll have to leave it there for today. Thanks for listening to another episode of Health Affairs This Week. If you like the episode, tell a friend, leave a review and subscribe wherever you listen to podcasts, and if you didn't like it, lie. Thanks for talking with me, Marianne.
00;08;33;05 - 00;08;41;25
Marianne Amoss
Thanks, Chris.