To Advance Well-Being In Indian Country, Limit The Health Harms of Incarceration

By Rachel Simon Leila Borowsky Siobhan Wescott Matthew L. Tobey: For More Info, Go Here…

In South Dakota, where several of us work as physicians in correctional settings on and off tribal lands, American Indians and Alaska Natives account for 6 percent of the state population. In large part due to jurisdictional complexities, however, they represent more than 60 percent of the federal court caseload. Nationwide, American Indians and Alaska Natives comprise more than 2 percent of the US population and, like other racial/ethnic minorities, are overrepresented in the criminal justice system.

At The Intersection Of Health And Jails

Driving these disparities is the fact that rural American Indian and Alaska Native tribes experience post-colonial injustices, historical trauma, rural poverty, and racial discrimination, among other challenges. The counties where we work face the worst health outcomes in the United States. An American Indian child born in Todd County, South Dakota, has a life expectancy at birth of younger than 70 years old, a decade less than a white US counterpart in South Dakota. American Indian individuals who end up involved in the criminal justice system are yet further marginalized. As past studies have shown, strengthening the health care of incarcerated individuals would improve their health as well as that of the larger community.

Indian Country jails have unique jurisdictional complexity, with ties to tribal, federal, and state legal systems. There are approximately 3,000 inmates in the 80 tribal jails, according to the Bureau of Justice Statistics. The capacity of Indian Country jails ranges from fewer than 25 individuals to more than 300. The Bureau of Indian Affairs (BIA) funds the facilities, but three-quarters of tribes have negotiated federal contracts with the BIA that allow self-management of the facilities overall. Yet, when it comes to health care, even those self-managed jails often rely on a federal agency, the Indian Health Service (IHS) to serve as the primary source of health care for the jails. Other jails arrange health care through third-party providers. (Also of note, Alaska is unique in that only one of the many tribally run correctional facilities is under federal supervision due to the Alaska Native Claims Settlement Act.)

Limited information is available regarding the health care provided to individuals incarcerated in tribal jails. The Bureau of Justice Statistics published a report in 2011 indicating that only 20 tribal jails had clinical health care services provided on site, whether medical care or other services. Most jails relied on offsite facilities—often the IHS—to provide health care. Offsite care engenders personnel and financial costs due to transportation and officer supervision. In practice, these costs also have the consequence of diminishing patients’ access to non-urgent care. At the Rosebud Adult Correctional Facility in Rosebud, South Dakota, a tribally operated jail, our IHS-affiliated internal medicine team offers a weekly half-day primary care clinic. Patients with acute or complex issues that would be treated in-house at many of the nation’s jails—such as wound care or alcohol withdrawal—often require transport offsite to the local IHS facility for emergency or inpatient care.


To our knowledge, little to no funding is specifically designated for tribal jail health services in either BIA or IHS appropriations. Moreover, the IHS is funded at 47 percent of need, and with the high clinical needs of its population, its capacity is limited to engage in care programs at offsite facilities. Short of a major change in federal appropriations, improving health care access for American Indian and Alaska Native individuals who are incarcerated in tribal jails will likely require targeted efforts, starting with these:

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