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Focus on global health outcomes shouldn’t exclude jails and prisons

Minneapolis, Minn. – The state of healthcare access and quality in jails and prisons should not be excluded from international efforts to understand and improve healthcare coverage for vulnerable populations, according to a recent publication in The Lancet Public Health authored by Tyler Winkelman, MD, MSc, Division Chief of General Internal Medicine at Hennepin Healthcare and Co-Director of the Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute. Currently, metrics used by the World Health Organization (WHO) to monitor health coverage across the world exclude information from jails and prisons – inappropriately influencing the overall picture of a country’s health – and ignoring the critical health needs in these settings.

People in jails and prisons have higher rates of physical health, mental health, and substance use conditions. These care needs are often not adequately addressed during incarceration, and poor access to needed health services in jails and prisons are not accounted for by international systems designed to monitor progress toward universal health coverage. To ensure the equitable response and progression of these worldwide efforts, the author(s) recommend considering them in future estimates.

“Health care in prisons is a crucial public health issue that is conspicuously absent from international efforts to achieve universal health coverage across the globe,” explains Dr. Winkelman, who is also a primary care physician at Hennepin Healthcare.

“And worldwide, people who are incarcerated typically don’t receive the same type of care as those in the community, even though it’s mandated by the Mandela Rules, which clearly outline standards of care in jails and prisons. Although the WHO has led important progress in expanding healthcare coverage across the world, the care incarcerated populations receive is not included in their current monitoring efforts. Without intentional focus on these populations, they will continue to have poor health outcomes and inequities will persist.”

The WHO tracks progress toward universal health coverage in each country using an index-based measure that was developed to monitor health coverage in the general population and the most disadvantaged populations. Dr. Winkelman and his co-authors write that incorporating jail and prison healthcare coverage into this index is a crucial first step to improving the health of individuals who spend time in jails and prisons and ensuring equitable progress toward WHO goals.

“Countries with high incarceration rates will likely have results that show an overestimation in their progress toward universal coverage, masking important health inequalities,” said Dr. Winkelman.

The paper also discusses how health care in jails and prisons often remains unaccountable due to oversight from departments of corrections instead of healthcare agencies. This, along with often antiquated systems for healthcare records, has led to low quality care and disruptions in care upon release.

“This discontinuity in care at release is a critical issue for people with multiple and complex healthcare needs,” said Dr. Winkelman. “Upon release from jail or prison, there’s often a disconnect in care – even in high-income countries. The health needs of those released from jail or prison go unmet, which leads to higher incidence of emergency department visits, illness, and death.”

The manuscript “Universal health coverage and incarceration” is published in The Lancet Public Health, June 2022. To view the journal article, go to




About the Hennepin Healthcare Research Institute Hennepin Healthcare Research Institute (HHRI) is the research arm and a nonprofit subsidiary of Hennepin Healthcare System, Inc., an integrated healthcare system that includes HCMC, a nationally recognized Level 1 Trauma Center and acute care and teaching hospital. HHRI is one of the largest nonprofit medical research organizations in Minnesota and consistently ranks in the top 10 percent of all institutions receiving research funding from the National Institutes of Health. For more information about research at HHRI, visit

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Hennepin Healthcare


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Hennepin Healthcare Research Institute

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