Though the U.S. incarcerates more people than any other nation, a new study finds its medical professionals are not being effectively trained to care for the vulnerable population.

Published in December in Springer Nature, the study found training for medical residents and students on carceral health is insufficient and lacks a standardized curriculum. Many programs are offered as electives, meaning that students may forgo the option altogether and miss out on a crucial aspect of medical education.

About 2 million people are currently held in U.S. carceral facilities, such as prisons, jails and detention centers. As of 2001, more than 5.6 million adults living in the U.S. had ever served time in prison, according to the U.S. Bureau of Justice Statistics. The bureau estimated that nearly 12% of all men and about 2% of women born in the U.S. could be expected to serve time in state or federal prison in their lifetimes.

Nicole Mushero, MD, PhD, an assistant professor at Boston University and lead researcher of the study, said people who are incarcerated are at higher risk for a host of health issues, but not enough medical students are learning about those vulnerabilities.

“There’s a lot of chronic health conditions, like diabetes, asthma, hypertension, cancer, and a lot of mental health conditions," Mushero told The Nation’s Health. "That cannot be understated — the mental health needs of this population are really not taken care of in the way that they should be, as well as higher rates of substance use disorders.”

Just as in the wider population, the U.S. incarcerated population is aging, bringing new challenges.

“That carries with it a lot of health implications, because we know that as people age, they generally develop more health conditions," she said.

If health and behavioral needs are not adequately provided for while people are incarcerated, they will likely struggle after release, Mushero said. People who have been incarcerated often face systemic bias, high rates of homelessness, unemployment and uninsurance, the study said.

“By not targeting that population, we are in fact creating worse health more globally for the (U.S.) population,” Mushero told The Nation’s Health. "It is a real public health issue.”

Major racial and socioeconomic inequities also exist within the carceral population. Black and Hispanic people are disproportionately arrested, convicted and imprisoned compared to the white population. For example, while Black people made up 13% of the U.S. population, they accounted for 37% of people who were incarcerated as of 2023.

At Boston University, all third-year medical students receive mandatory training in incarcerated patients, and the school is now piloting a program to expand the education into a longitudinal track. Mushero hopes similar programs will be developed at other medical school and residency programs around the country.

“What I hope for the future is that this population becomes recognized as any other group in their need for a unique lens of health care and particular medical issues," Mushero said.

Photo by Andresr, courtesy iStockphoto