As a doctor and medical student, we have witnessed much preventable suffering. A patient recently diagnosed with stage IV cervical cancer is an example. Widely considered a preventable cancer, this woman had had an abnormal Pap test 10 years prior. She was then incarcerated, where cancer screening and monitoring were neglected for a long time, until she became so ill that she had to be transferred to hospital.

The incarceration of women has increased astronomicallyincreasing by almost 600% in recent decades. As reproductive health faces a new wave of criminalization, we must include the criminal legal system in our analysis and discussion of women’s health disparities. Experience of incarcerated people higher rates of chronic diseases, infectious diseases and mental health problems. Especially, Black women are disproportionately criminalized and incarcerated, and similarly most affected by many diseases. Social determinants of health drive these disparities, as poverty, racism, lack of economic opportunity, and government neglect intersect to lead to lawsuits, preventable suffering, and premature deaths.

Cervical cancer remains a a particularly disturbing disparitytaking into account the preventive measures readily available.

Background

Cervical cancer is the fourth most common cancer among women worldwide. HPV, main cause of cervical cancercan transform normal cells into malignant cells over time. Despite HPV vaccination available since 2006 — which reduces the incidence of cancer by up to 90% — there is at least one left 11,500 new cases of cervical cancer and 4,000 deaths per year in the United States Screening for early changes remains critical and is recommended for anyone with a cervix between the ages of 21 and 65. Pap tests allow for close monitoring, early treatment and better patient outcomes.

Race, socio-economic statusEducation level and access to care are among the many factors that contribute to cervical cancer disparities. This is partly explained by differential vaccination rates, with rates decreasing as family income decreasesand those without insurance having lower vaccination rates. Ultimately, the mortality rate from cervical cancer is 65% higher among Black and Native American women.

With incarceration of a well-known driver of social and economic marginalization, it deserves special attention to explain and address racialized health disparities among women. Incarcerated women have a disproportionate burden of cervical cancer, with cervical cancer on site almost be diagnosed twice as often like the general population. The lack of screening before, during and after detention contributes to cervical cancer being the most common cancer among incarcerated women.

A history of exploitation

The medical field of gynecology has a long history of exploitation and abuse. The “father of modern gynecology” James Marion Simsregularly conducted experimental procedures on enslaved black women without anesthesia in the mid-1800s. He gained prestige and wealth by surgically repairing vesicovaginal fistulas, aiming not to improve health but to prolong fertility in order to maximize the supply of slave labor.

Cervical cancer specifically has a dark story medical operation. Henrietta is missing immortalized cell line was derived from her cervical cancer tissue sample in 1951 without the information of her family. consent or compensation. This and much more contributed too deep medical mistrustespecially when it comes to prison spaces. Recent history would show that this skepticism and fear are well-founded. In California prisons, sterilizations without consent continued into the 21st century with nearly 1,400 documented from 1997 to 2013. In Ocilla, Georgia, a 2020 survey found that many women Irwin County Detention Center underwent excessive and unnecessary procedures without informed consent, including hysterectomies.

Barriers to care

Prison spaces reproduce many of the worst aspects of American medicine, including racism, dehumanization, and indifference. Ultimately, meaningful healthcare interactions become almost impossible as autonomy, respect, information sharing and privacy are all compromised. Formerly incarcerated women highlighted negative interactions with health care providers, logistical barriers to appointments, and cost concerns as reasons for poor health care. Many patients have the impression that their conditions are not taken seriously and this treatment is poor and late.

Due to the lack of mandatory standards, there is little or no transparency. At times, unlicensed doctors practicing substandard care for years without hindrance. Public and private medical providers are constantly under financial pressure and at the mercy of guards to facilitate on-site and off-site medical visits. Many incarcerated women have experienced histories of sexual, physical, and emotional abuse that may diminish their propensity to seek care in an environment that is too often worsens the trauma. In summary, the conditions are ripe for negligence and abuse of power.

Towards health equity

There is a common refrain that carceral facilities provide opportunities to address health disparities. This couldn’t be more wrong. The sad reality that incarceration sometimes allows people to access care to which they would not otherwise have access constitutes a challenge to our public health and social services infrastructure.

It must be Understood that jails and prisons are the obstacles tonot facilitators of health equity. For example, the short time spent in a local prison is destabilizing on many frontsleading to loss of jobs, housing and parental rights. Any potential health screening benefits are clearly better realized elsewhere. In prison, the long-term environment endured is so stressful and neglectful that women in their 50s suffer from geriatric problems among people in their 60s in the community.

Investing more in prison spaces for supposed health benefits ignores far superior interventions to address health disparities. It ignores one of the fundamental principles of public health, which is to go “upstream” and focus on prevention. By developing a deeper analysis of prison systems, we find that this undermines both preventive public health And public safety goals.

Camara Jones, MD, MPH, PhD, globally recognized expert on health equity, declares that“Achieving health equity requires valuing all individuals and populations equally, recognizing and rectifying historical injustices, and providing resources based on need.” Most important in this vision of equity is to focus on prevention — both preventing cervical cancer through increased vaccination and appropriate screening, and preventing involvement in the criminal justice system in the first place place.

Realizing that there is significant overlap between the root causes of criminalization and health disparities provides us with a clear road map on what, where, and in whom to invest. In no just society would access to basic public health and healthcare measures be based on criminalization.

Targeted investments in the social determinants of health remain an urgent priority. Thanks to an expanded and new hyperlocal public health modelscommunities can add good-paying jobs, more resources, and accessible, reliable services. Within prison facilities themselves, mandatory monitoring and alignment with national standards for testing and monitoring should be required. Support for women returning home should be much stronger, as this transition period can be isolate and disorient.

Addressing health disparities, including cervical cancer, requires recognizing the connections between health, race, and the criminal legal system. By building a strong supporting infrastructure, eliminating the need for prison spaces, we can begin to mitigate the impact of incarceration on women’s health disparities.

Julia Shuford is a medical student at Emory University School of Medicine in Atlanta, Georgia. Mark Spencer, MD, is an assistant professor of medicine at Emory University.