Running Head: INCARCERATED YOUNG ADULTS

Global Health Perspectives: Incarcerated Young Adults

Leah Langenberg, Brian Maina, Pasi Meri, Alex Riggins, Miranda Thomas
Missouri State University, Satakunta University of Applied Sciences

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Introduction
From the perspective of healthcare workers, health is viewed as a holistic measure of
physical, mental, emotional, spiritual, and social well-being, and to achieve this complete state of
health, none of these aspects may be lacking. This definition of health is similar to the World
Health Organization's (WHO) definition which defines health as "a complete state of physical,
mental and social well-being, and not merely the absence of disease or infirmity." When
discussing incarcerated young adults, the definition of health becomes complicated. By law, the
health of incarcerated young adults should be held to the same standard as the rest of society.
However, many factors contribute to this vulnerability group's standard of health being less than
that of those who are not incarcerated.
Description of the Vulnerability Group and their Definition of Health
Incarcerated young adults, imprisoned individuals ranging from ages 18 to 35, face
unique challenges accessing health care. These young adults are more likely to have health
issues, less likely to be insured, and may require regular access to care and medication more
frequently than the general population. This is causing a growing desire among incarcerated
young adults to learn about their health care options, as they are recognizing the importance of
maintaining their health. Similar to the rest of the population, securing access to care is a major
concern for many incarcerated young adults. With 10 million people cycling in and out of
correctional facilities ever year, nearly 40 percent of these individuals are young adults below the
age of 35 (BOP, 2015). This large vulnerability group is more likely to have mental health
issues, communicable diseases, and chronic illnesses such as tuberculosis, Hepatitis B (HBV),
Hepatitis C (HCV), human immunodeficiency virus (HIV), diabetes, asthma, and hypertension
(Young Invincibles, 2014). Therefore, access to health care is especially important to this

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population. Similar to the general population, many environmental influences including air
pollution, toxic substances, water quality, and infrastructure can contribute to the development of
disease. Prison environments may provide threats to inmate safety as well as a loss of privacy, all
of which can negatively contribute to an incarcerated young adults sense of well-being.
Considering all of these factors, incarcerated young adults would most likely agree with the
definition of health as a state of holistic well-being. However, this vulnerability group may also
include in their definition of health the ability to make their own choice of medical insurer and/or
provider, having secure access to care, safety, and privacy to achieve a complete state of health
and well-being
Health Promotion and Disease Prevention of Incarcerated Young Adults in the United
States
Health promotion is the process of enabling people to increase control over, and to
improve, their health (WHO, 2015). To reach a state of complete physical, mental and social
well-being, an individual requires a secure foundation in basic conditions including peace,
shelter, education, food, income, a stable environment, social justice, and equity (WHO, 2015).
Health promotion aims to secure these basic conditions for the population and ensure equal
opportunities and resources, enabling all people to achieve their fullest health potential. People
cannot attain their fullest health potential unless they are able to take control of the conditions
that determine their health, which is difficult for incarcerated young adults since their rights are
limited (WHO, 2015). For example, incarcerated young adults cannot buy a private insurance
plan. This limits the ability of incarcerated young adults to take control of their health and may
limit their quality of care.

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The United States continues to have one of the highest incarceration rates in the world,
encompassing 5 percent of the world population, and nearly 25 percent of the worlds prisoners
(Project HOPE, 2014). Although incarceration rates have risen sharply since the 1970s, and
remain elevated, the health effects of imprisonment have been neglected (Schnittker & John,
2007). Mental health, substance abuse problems, and communicable diseases are the main
healthcare issues in jails and prisons as compared to the community.
Communicable diseases, or an infectious disease transmitted by direct or indirect contact
with an affected individual, pose interesting challenges in terms of disease control among
incarcerated young adults. Factors that may increase risks of communicable diseases include
overcrowding, nutritional deficits, ineffective sanitation, and unprotected sexual activity
(Damari, 2014). Given this information alone, one might suspect that the prison environment
would have a higher incidence of infectious disease, and the data supports this conclusion. In the
United States, diseases that have particularly high incidences within the incarcerated population
include HIV, HBV, HCV, tuberculosis, syphilis, gonorrhea, and chlamydia. For example,
compared to a non-incarcerated person, an incarcerated person is 2.5 times more likely to have
HIV, 5 times more likely to have HBV, 9-10 times more likely to have HCV, and 6-10 times
more likely to have active tuberculosis (Damari, 2014). These rates need to be controlled for the
health of the incarcerated population as well as for the health of the community. As the health of
a community depends on the health of all of its parts, the prison population is no exception.
Determining ways to address the issue of a high incidence of communicable diseases in
correctional facilities remains a challenge. Possible solutions include improving the available
healthcare structure and disease surveillance, voluntary disease testing for those incarcerated
including young adults, and providing vaccinations. Another common measure to prevent

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communicable diseases is encouragement of frequent hand-washing and improved personal

hygiene. However, this simple solution can prove to be problematic in the prison setting because
soap can be a rare commodity, shower access can be restricted, and alcohol-based hand sanitizers
are unpopular due to flammability (Damari, 2014). Another controversial measure that is
commonly recommended to prevent sexually transmitted diseases such as HIV, hepatitis,
syphilis, gonorrhea, and chlamydia is the availability of condoms. Consensual and
nonconsensual sexual activity within prisons is a well-documented risk factor for acquiring these
diseases and the Center for Disease Control (CDC) has recommended that condoms be made
available to correctional facility residents (Damari, 2014). However, some argue that providing
condoms promotes sexual activity within the prison environment, an activity that is prohibited.
This has led very few prisons to follow the CDCs recommendation. Addressing the high rates of
communicable disease among the incarcerated population, including incarcerated young adults,
poses a variety of challenges, but is an important public health concern that needs to be given
more attention.
Other than the high incidence of communicable diseases among the young adult
incarcerated population, another area of concern is the mental health of those imprisoned. Mental
illness afflicts nearly one-quarter of the United States correctional population, most of which are
severe, including psychotic disorders and major mood disorders (NAMI, 2015). Across the
United States, individuals with severe mental illness are three times more likely to be imprisoned
than to be in a mental health facility. Furthermore, 40 percent of individuals with a severe mental
illness will spend time in jail, prison, or community corrections (NAMI, 2015). Sadly, jails and
prisons have become the United States major mental health facilities, a purpose for which they
were never intended. However, the Supreme Court clearly determined that the Eighth

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Amendment requires prison officials to provide access to adequate medical care, including
mental health care. New statutory changes and programs are implemented every year for
offenders diagnosed with mental health issues to be provided with improved access to services
(Project HOPE, 2014). Public health and safety officials can collaborate in developing more
effective and efficient strategies for managing incarcerated, mentally ill, young adults both
before and after release into their communities.
Health Promotion and Disease Prevention of Incarcerated Young Adults in England
Health promotion and the prevention of disease among young incarcerated adults is an
important aspect of nursing that must be taken into account, especially as a large amount of the
adults incarcerated in England are young adults. According to Home Office records, 65% of all
incarcerated adults are under 30 years of age. The range and frequency of physical health
problems experienced by prisoners appears to be similar to that of young adults in the
community, but there appears to be a very high incidence of mental health problems among
prisoners in England compared to the general population (Marshall, Simpson, and Stevens,
2001). Furthermore, other health care needs such as chronic diseases like diabetes may be made
more complicated by imprisonment.
Health promotion has been identified by the Ottawa Charter as the process of enabling
individuals and communities to exert control over the determinants of health and thereby
improve their health, (World Health Organization, 1986). However, there are several challenges
that are faced when providing health care in a custodial setting and in particular. Custody effects
care in that it removes the opportunity for self-care and independent actions. So, when an inmate
has a chronic condition such as diabetes or is asthmatic, they are not able to self-administer
medication such as insulin when required. Because the nature of such conditions is very

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individualized and difficult to manage, many issues may be faced. For example, if nurses or
other members of staff propose a form of action that may aid a prisoner, their actions may clash
with security conditions and they may not be able to carry out the medical care that they deem to
be necessary. Moreover, nurses and other medical staff may find themselves in very difficult
situations when they try to aid such prisoners as they face the risk of being manipulated. Some
prisoners may attempt to obtain medication that they do not require for many reasons. In turn,
this can create a sense of suspicion amongst health care staff of all of the prisoners (Marshall,
Simpson, and Stevens, 2001).
Nurses are in an ideal position to influence the people they interact with, empowering
them to achieve positive outcomes. Whether this is by engaging in a primary intervention, taking
action to reduce the incidence of disease; or through secondary prevention, by systematically
detecting the early stages of disease and intervening before full symptoms develop (Royal
College Of Nursing, 2012), interns of the mental health problems among young incarcerated
adults in England, this is an area in which nurses and their interventions may prove to be vital.
This is particularly an important aspect of the prison health care service in England as there is
widespread concern that the prison environment, with its rules and regimes, may have a
detrimental impact on the mental health of prisoners, and those with mental illnesses in particular
(Birmingham, 2003).
Research from The Offender Health Research Network (2010) has shown that only twothirds of prisoners with a mental illness were documented to have seen a prison general
practitioner at reception and only 12% saw a mental health professional such as a mental health
nurse in the reception. This indicates that there is a lack of skilled health professionals who are
able to adequately assess, and therefore prevent, patient deterioration from the onset. Therefore,

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it would appear to be necessary to have health professionals, such as mental health nurses, to
screen patients at the reception so that those prisoners who need extra support during early
custody, including women, those with a history of a mental illness, and prisoners likely to be on
remand for extended periods of time can be identified and their mental health can be taken care
of accordingly.
Rehabilitation of Incarcerated Young Adults in the United States
According to the National Institute of Justice, of any of the free nations in the world, the
United States has the highest incarceration rate (Petersilia, 2011). The Economist even declared
that No other rich country is as punitive as the Land of the Free (Petersilia, 2011). Between the
years of 1960-1990, the crime rate became more than 5 times its previous rate, violent crime
quadrupled, and the murder rate doubled (Petersilia, 2011). This was largely attributed to the
leniency of punishment in the United States, especially for repeat violent offenders (Petersilia,
2011). Since then, many measures have been passed to get tough on criminals (Petersilia,
2011). Some of these include altered sentencing guidelines that enforced prison sentences for
crimes that may have only earned probation in the past, three-strikes-youre-out laws which
commanded prison sentences for repeat offenders, mandatory minimum sentences that force
judges to carry out fixed prison sentences regardless of extenuating circumstances, and truth-in
sentencing measures which require the incarcerated individuals to serve more of their original
sentence before becoming eligible for parole (Petersilia, 2011). These legislative measures not
only increased the length of prison sentences, but increased the probability of going to prison if
convicted (Petersilia, 2011). When looking at the effect of these measures, it is becoming quite
evident that the $50 billion the United States spends on the correctional system is much too high
of a cost for the benefit it provides (Petersilia, 2011).

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It is true that there has been a decline in the crime rate since these get tough measures
have passed, however only about a quarter of this decline in the crime rate can be attributed to
repeat offenders being behind bars (Petersilia, 2011). Even with this decline due to prospective
repeat offenders being off of the streets and unable to commit new crimes for a period of time,
this drop in crime rates will not last indefinitely (Petersilia, 2011). The majority of these
offenders will be given the opportunity to commit crimes again, as evidenced by the 93% of
incarcerated adults that will be released from prison, excluding only the 7% of inmates who die
in prison, have life sentences, or are on death row (Petersilia, 2011). With such a large proportion
of the incarcerated population eventually returning to life outside of prison, it seems that it would
be beneficial to reprogram and educate this population to become functional, contributing
members of society. However, due to the lack of rehabilitation offered to incarcerated young
adults, these men and women are leaving prison with lengthy criminal records more than likely
including gang and drug charges, extensive histories of drug and alcohol abuse, noteworthy
periods of homelessness and unemployment, and a physical and/or mental disability (Petersilia,
2011). It seems this population of incarcerated young adults is being set up for failure, and
therefore primed to recommit a crime, once they do reemerge into society (Petersilia, 2011).
It has become evident that the United States correctional system does not correct the
behaviors of inmates (Petersilia, 2011). Two-thirds of inmates released from prison are rearrested
for at least one new serious crime, and more than half are arrested again within 3 years of their
release date, accounting for approximately 15-20% of all adult arrests (Petersilia, 2011). Because
of the lack of correction in the United States correctional system, United States citizens are being
victimized by repeat criminals who have served their time, but experienced no modification to
their behaviors (Petersilia, 2011). Not only does this directly affect the crime rate in the United

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States, it indirectly affects future crime rates (Petersilia, 2011). When a young adult becomes
incarcerated, they leave behind family and loved ones who are adversely affected (Petersilia,
2011). This is related to the fact that sons and brothers of men who have been to prison are more
likely to end up in prison themselves (Petersilia, 2011).
Research from 1990 and beyond has shown that inmates who have earned a high-school
equivalency diploma, vocational training, and drug and alcohol rehabilitation while in prison
have a greater likelihood of attaining jobs and avoiding relapse once they reentered society
(Petersilia, 2011). Implementing such programs reduced the reoffending rate by 15-20%, and this
rate could have shown greater improvement if programs for released inmates bridged over into
life outside of prison to continue rehabilitation (Petersilia, 2011). These programs would pay for
themselves in the long run by cutting down rearrest rates in young adults (Petersilia, 2011). Some
of these programs have been implemented in the past, and while some have failed due to the
incorrect use of funds for enhanced social services and rehabilitation of inmates post-release,
those that were implemented according to the original design were actually effective (Petersilia,
2011). Ex-inmates who participated in community service, employment programs, and alcohol
and drug treatment programs had 10-20% lower rearrest rates than those who did not participate
in such programs (Petersilia, 2011).
Efforts for rehabilitation of incarcerated young adults are currently in progress. While the
offenders are in prison, community partnerships between law enforcement, social service
agencies, and religious institutions provide resources and support for their rehabilitation
(Petersilia, 2011). These partnerships are focused on offenders who are motivated to turn their
life around, especially those who are at the highest risk for becoming a reoffender once released
from prison (Petersilia, 2011). These individuals are paired with a mentor, and social service

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agencies begin working with these inmates to move toward a better life (Petersilia, 2011). Once
the inmates are released, they are offered work and treatment opportunities (Petersilia, 2011).
However, if the offender falls back into crime and fails to stay on their new path, the partnership
acts quickly to rearrest the offender and may fast-track the prosecution (Petersilia, 2011). For
many involved in these partnerships, the results have been promising (Petersilia, 2011). The
rearrest rate for these individuals is 30% lower than those not involved in such a program
(Petersilia, 2011).
Rehabilitation for incarcerated adults is important even after they are released from
prison. A collection of risk assessment tools, called the risk-need-responsivity model (RNR), is
used to match the individual with the correct program (Petersilia, 2011). These treatment
programs have a great emphasis on cognitive behavioral and social learning techniques
(Petersilia, 2011). These techniques include anger management classes and focus on weaning
offenders from their negative and antisocial approach in life (Petersilia, 2011). They implement
rewards and punishments for behavior, and utilize peers and family members to reinforce their
messages (Petersilia, 2011). Many research studies have shown that these efforts work
(Petersilia, 2011). High-risk offenders that participated in these programs cut their rearrest rate
by as much as 20%, and because of this success, states such as Maine, Illinois, and Oregon have
implemented the risk-need-responsibility model (Petersilia, 2011).
Rehabilitation programs for incarcerated young adults have the potential to improve their
lives, but rehabilitation will not work for everyone (Petersilia, 2011). Because of this, it is
important to recognize the difference between an offender who is motivated and willing to
change and an offender who will not change even if assistance is offered to them. (Petersilia,
2011). When implementing such rehabilitation programs, it is necessary to be selective about

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how funds are allocated for rehabilitation. These life-changing opportunities should be offered to
those who can and will make a change for the better (Petersilia, 2011). Doing so will not only
benefit each of the rehabilitated offenders, but will also benefit each and every US citizen who
will subsequently be subjected to less repeat crime (Petersilia, 2011).
Rehabilitation of Incarcerated Young Adults in Finland
According to the Finlex databank, the national constitutional law states that No one
shall, without an acceptable reason, be treated differently regardless of gender, age, ethnic origin,
language, religion, belief, opinion, health, disability, or other personal characteristics (Finlex,
2015). This law forms the fundamental core upon which all other laws are based and worded.
Several laws contribute to description of rehabilitation for incarcerated young adults.
Finlands national prison law states that all prisons are to maintain the health and performance
activity of those who are incarcerated. The Criminal Sanctions Agency is the organization which
executes all prison punishments, and they are responsible for the maintenance of public health
care services in all prisons. Any incarcerated person has the same rights to medical services as
any other citizen within the country. All patients have the right to quality medical treatment
services so that humanity, conviction of personality, and privacy are all maintained (Finlex,
2015).
In Finland, all people who are 18 years of age and older are considered to be adults.
When a person is 15 years old, Finland National Criminal Sanctions Agency will define the
person as an adult, with punishment according to the offense (Criminal Sanctions Agency, 2015).
The Statistical Yearbook created by the Criminal Sanctions Agency contains a wide range
of information about prison statistics including number of prisoners, structures, and activities.
According to the most recent statistics in 2005, most young adults under 18 years of age are

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given supervised sentences, guidance, and societal support. These are the primary interventions
for keeping young adults away from a life of crime. In Finland, prisoners can follow a
rehabilitative sentence by attempting to earn an education or by acquiring work. Work activities
are separated into production work and rehabilitative work. The purpose of rehabilitative work is
to offer basic employment skills and on-the-job training. Following the education route, once one
has achieved a basic education, they may apply for continuing college studies. Some prisons are
taking part in activities to reduce recidivism and offer other social rehabilitation programs as
well (Criminal Sanctions Agency, 2015)
Government and Non-government Organizations in the United States
The Department of Health and Human Services (HHS) is a government entity that
regulates various government-based health programs (U.S. Department of Health and Human
Services, 2015). To understand government health programs in the United States, this
fundamental base of health care structure is pertinent to grasp how the entirety of the system
comes together (U.S. Department of Health and Human Services, 2015). The HHS is part of the
federal government, and is the department responsible for administrating programs that deal with
health and welfare (U.S. Department of Health and Human Services, 2015). This department
alone has access to almost one fourth of all federal government expenditures and administers
more grant dollars than all other federal agencies combined (U.S. Department of Health and
Human Services, 2015). The Department's programs are administered by eleven operating
divisions composed of eight agencies in the U.S. Public Health Service and three human services
agencies (U.S. Department of Health and Human Services, 2015).
With an understanding of this department, a basis for its sub-branches can be formulated.
Each sub-branch of the HHS constitutes a focused division of health based care to a population

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(U.S. Department of Health and Human Services, 2015). Understanding each sub-branch, its
population, and its actions is another key element necessary to comprehend the mass construct of
the U.S. organizations and community health concerns.
The three Human Services Agencies of the HHS include the National Institute of Health,
the Food and Drug Administration, and the Center for Disease Control and Prevention (U.S.
Department of Health and Human Services, 2015). The National Institutes of Health (NIH) is a
medical research organization supporting over 38,000 research projects nationwide in diseases
including cancer, Alzheimer's, diabetes, arthritis, heart ailments and AIDS. It includes 27
separate health institutes and centers (U.S. Department of Health and Human Services, 2015).
The Food and Drug Administration (FDA) assures the safety of food and cosmetics, and the
safety and efficacy of pharmaceuticals, biological products, and medical devices (U.S.
Department of Health and Human Services, 2015). These products represent almost 25 cents out
of every dollar in United States consumer spending (U.S. Department of Health and Human
Services, 2015). The Centers for Disease Control and Prevention (CDC) administrates a system
of health surveillance to monitor and prevent disease outbreaks (including bioterrorism),
implements disease prevention strategies, and maintains national health statistics (U.S.
Department of Health and Human Services, 2015). It also provides for immunization services,
workplace safety, and environmental disease prevention (U.S. Department of Health and Human
Services, 2015).
The U.S. Public Health Service is constituted of eight agencies, each propagating and
devising plans of action for different at-risk populations (U.S. Department of Health and Human
Services, 2015). The Indian Health Service (IHS) provides health services to 1.8 million
American Indians and Alaska Natives of more than 560 federally recognized tribes (U.S.

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Department of Health and Human Services, 2015). The Indian health system includes 46
hospitals, 324 health centers, 309 health stations and Alaska Native village clinics, and 34 urban
Indian health programs (U.S. Department of Health and Human Services, 2015). The Health
Resources and Services Administration (HRSA) provides access to essential health care services
for individuals who have low-incomes, are uninsured or who live in rural areas or urban
neighborhoods where health care is scarce (U.S. Department of Health and Human Services,
2015). The HRSA also oversees the nation's organ transplantation system (U.S. Department of
Health and Human Services, 2015). The Substance Abuse and Mental Health Services
Administration (SAMHSA) provides funding through block grants to states to support substance
abuse and mental health services, including treatment for Americans with serious substance
abuse problems or mental health problems (U.S. Department of Health and Human Services,
2015). The Agency for Healthcare Research and Quality (AHRQ) supports research on health
care systems, health care quality and cost issues, access to health care, and effectiveness of
medical treatments (U.S. Department of Health and Human Services, 2015). It also provides
evidence-based information on health care outcomes and quality of care (U.S. Department of
Health and Human Services, 2015). The Centers for Medicare & Medicaid Services (CMS)
administers the Medicare and Medicaid programs (U.S. Department of Health and Human
Services, 2015). Medicare provides health insurance for more than 44.6 million elderly and
disabled Americans (U.S. Department of Health and Human Services, 2015). Medicaid, a joint
federal-state program, provides health coverage for some 50 million low-income persons,
including 24 million children, and nursing home coverage for low-income elderly (U.S.
Department of Health and Human Services, 2015). CMS also administers the State Children's
Health Insurance Program that covers more than 4.4 million children (U.S. Department of Health

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and Human Services, 2015). The Administration for Children and Families (ACF) administers
the state-federal welfare program, Temporary Assistance for Needy Families, providing
assistance to an estimated 4 million persons, including 3 million children (U.S. Department of
Health and Human Services, 2015). It administers the national child support enforcement system
and the Head Start program for pre-school children (U.S. Department of Health and Human
Services, 2015). It also provides funds to assist low-income families in paying for child care, and
supports state programs to support foster care, adoption assistance and programs to prevent child
abuse and domestic violence (U.S. Department of Health and Human Services, 2015). The
Administration on Aging (AOA) provides services to the elderly, especially to enable them to
remain independent (U.S. Department of Health and Human Services, 2015). Helps provide athome services, meals on wheels and transportation (U.S. Department of Health and Human
Services, 2015). The Public Health Service Commissioned Corps (USPHS) is a uniformed
service of more than 6,000 health professionals who serve in many HHS and other federal
agencies (U.S. Department of Health and Human Services, 2015). The Surgeon General is head
of the Commissioned Corps (U.S. Department of Health and Human Services, 2015).
Non-governmental agencies (NGOs) that support and aid public health initiatives can
also be found throughout the United States (Paul, 2000). NGOs are not for profit organizations
that are not incorporated via governmental action (Paul, 2000). A NGO is a voluntary citizens'
group which is organized on a local, national or international level (Paul, 2000). NGOs are taskoriented and driven by people with a common interest, and they perform a variety of service and
humanitarian functions such as bringing citizen concerns to the government, advocating and
monitoring policies, and encouraging political participation through provision of information
(Paul, 2000). Human rights, the environment, and health are three of the major issues that NGOs

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may focus on (Paul, 2000). They provide analysis and expertise, serve as early warning
mechanisms, and help monitor and implement international agreements (Paul, 2000). There are
several non-governmental organizations, such as the Acumen Fund, Partners in Health, and
World Vision (Briner, 2015). The Acumen Fund works nationally and internationally to support
the goal of ending poverty (Briner, 2015). Partners in Health focuses on two major goals which
include bringing the benefits of modern medical science to those most in need of them and
serving as an antidote to despair (Briner, 2015). This NGO works both nationally and
internationally (Briner, 2015). World Vision functions nationally and internationally and
advocates for and takes action to implement and attain a wide variety of reduced health risks
(Briner, 2015). This NGO focuses on children, water, disaster relief, economics, education,
gender, health, and U.S. work (Briner, 2015). There are many more NGOs in the United States,
however, as of 2015, the Global Journal ranked these three American NGOs within the top 10
NGOs in the world (Briner, 2015). Further, 38 of the top 100 NGOs are based in America
(Briner, 2015).
Government and Non-government Organizations in England
In England, local councils formally assume the role of addressing community health
concerns. Councils and government run organizations, such as Healthwatch, provide a powerful
voice for patients and local communities (Department of Health, 2013). Ultimately in England,
the responsibility for addressing the health concerns of communities falls upon the department of
health, whose purpose is to help people live better for longer. The Department of Health in
England ensures that people have the support, care, and treatment that they need with the
compassion, respect, and dignity that they deserve. The Department of Health works with health

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care organizations such as the National Health Service (NHS) and other parts of government to
address the health concerns of communities.
Furthermore, in order for concerns of local communities to be specifically addressed,
Clinical Commissioning Groups (CCGs) have been created. CCGs are made up of doctors,
nurses, and other professionals who use their knowledge of local health needs to plan and buy
services for their community from any service provider that meets the NHSs standards. This
means there is better care suited specifically for local communities, and that a professional,
multidisciplinary team is able to use their knowledge to address health concerns of communities.
To further support communities and ensure that their needs are addressed, health and
well-being boards are established in every area to ensure that services work together to respond
to communities needs and priorities. The participants on the boards can range from community
organization to elected representatives. They act as the voice of the community, decide what the
community needs, and informs the CCGs and local authorities when they commission services.
As previously mentioned, local health watch organizations provide communities a voice in the
decisions that affect them, and in doing so ensure that their health concerns are addressed. The
local health watch organization will report their view and concern to Healthwatch England in
order for their concerns to be raised to a national level.
In conclusion, the health care system in England is one in which a collection of
organizations are involved, but with the majority of the organizations being government based.
Together, the groups are able to actively and effectively address the health concerns of local
communities, and in doing so, ensure that people live longer, with better quality of life.
Compare and Contrast Governmental and Nongovernmental Organizations in the United
States and England

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There is a major difference between governmental and non-governmental organizations

in the United States and England. The English formulation of a fundamental part of their
healthcare is obtained and implemented through the Clinical Commissioning Groups (Brennan
Ramirez, Baker, &Metzler, 2008). These groups consist of doctors, nurses and other
professionals who use their knowledge of local health needs to plan and buy services for their
local community from any service provider that meets The NHSs standards (Brennan Ramirez,
Baker, &Metzler, 2008). These groups have been formed to advocate for specific localized care
that can better meet the needs of a community (Brennan Ramirez, Baker, &Metzler, 2008).
The United States and England, however, also have much in common when it comes to
the government based system of health care administration (Brennan Ramirez, Baker, &Metzler,
2008). Each has setup a system that articulates health care regulation and delegates health care
action through a descending aggregate of interdependent organizations (Brennan Ramirez, Baker,
&Metzler, 2008). In reference to the NGOs, while names may differ, the structure and goals are
the same. Regardless of national borders, NGOs worldwide are organizations that are
independent from the government and are brought into existence by the dedication of volunteers
and donations (Brennan Ramirez, Baker, &Metzler, 2008). They work towards a variety of goals
that are aimed at furthering the advancement and aiding care to those in need worldwide
(Brennan Ramirez, Baker, &Metzler, 2008).
Nursing Theory related to Incarcerated Young Adults
Dorothy Johnsons Behavioral System Model is the nursing theory that best applies to the
incarcerated young adult population. This theory states that humans have two major systems
including biological and behavioral systems (Johnson, 2011). The behavioral system of a person
consists of the individual striving to make continual adjustments to achieve, maintain, and adapt

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20

by regaining the balance of a steady state in their lives (Johnson, 2011). A major focus of
Johnsons theory is to advocate for the fostering of effective and efficient behavioral function of
the individual to avoid illness (Johnson, 2011). There are seven behavioral subsystems in this
model including the attachment/affiliative, dependency, ingestive, eliminative, sexual,
aggressive, and achievement subsystems (Johnson, 2011). Any imbalance of these subsystems
results in disequilibrium in the behavioral health of the individual (Johnson, 2011).
The attachment/affiliative subsystem is concerned with the social inclusion intimacy and
the formation and attachment of a strong social bond (Johnson, 2011). There is an imbalance in
this subsystem when applied to the population of incarcerated young adults because the prisoners
are socially isolated from the rest of society, preventing them from being able to maintain strong
social bonds with friends and family while they are incarcerated. The dependency subsystem is
described by the approval, attention, or recognition and physical assistance of the individual
(Johnson, 2011). Incarcerated adults are unable to fit into this description because their behavior
is not approved of, and while they may receive attention or recognition for their actions, it is not
the positive feedback a person longs for. The ingestive subsystem emphasizes the meaning and
structures of the social events surrounding the occasion when the food is eaten (Johnson, 2011).
This is altered in the incarcerated young adult because while they are provided three meals per
day, mealtime in prison is not a time for bonding between family or friends, it is merely another
part of their daily schedule, and the food is made to meet the basic needs of the prisoner, not for
the comfort normally associated with food. The eliminative subsystem is concerned with human
cultures that have defined different socially acceptable behaviors for excretion of waste
(Johnson, 2011). An imbalance exists in this subsystem for incarcerated young adults because
they must use a toilet in the same stall where they sleep, without doors, and often in front of a

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21

cellmate. The sexual subsystem is described as both a biological and a social factor affecting the
behavior in the sexual life of an individual (Johnson, 2011). This is often altered in the
incarcerated adult because guards are not always around to monitor the inmates behavior,
resulting in the unfortunately high occurrence of sexual assault among prisoners. The aggressive
subsystem relates to the behaviors concerned with protection and self-preservation, including the
defensive response elicited when the individuals life or territory is being threatened (Johnson,
2011). Again, the guards are unable to constantly monitor the prisoners, so inmates are subject to
physical aggression and assault by other inmates. The achievement subsystem provokes behavior
that attempts to control the environment and the achievements of the individual in areas such as
intellectual, physical, creative, mechanical and social skills (Johnson, 2011). This subsystem is
imbalanced in the incarcerated young adults because being imprisoned puts any achievements an
individual may be working towards on hold until they are released. Those achievements are more
difficult to attain with a criminal record working against them.
Conclusion
In conclusion, incarcerated young adults should legally be receiving the same level of
health care as the total population. However, a number of factors contribute to the imprisoned not
obtaining the same level of holistic health as the rest of the developed world. There are deficits in
the environment, treatment, and attitudes toward incarcerated individuals, and this negatively
affects their physical, mental, emotional, spiritual, and social well-being in a multitude of ways.
An improvement in the health care and overall health of incarcerated young adults needs to be
addressed in order for the total population, which partially consists of past inmates, to be
healthier as a whole. If the holistic health of the incarcerated population improves, the rest of
society will find an increase in their overall well-being as well.

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22

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