The Justice Health Field received entity status in September, 2010.

The field is concerned with high risk populations who are:

• directly under the control of criminal and juvenile justice systems (or otherwise limited in freedom against their will because they are accussed, charged with or adjudicated for an offense that is considere illegal according to their country's statutes); or are
• indirectly affected by incarceration, arrest or other justice system contact, such as having parents in prison, or living in communities that are disproportioately under justice system supervision; or are
• provided health services, or have health services brokered, by justice system actors.

Background

Justice-involved populations are among the highest risk for health, mental health and substance abuse problems.  They are also medically and socially underserved prior to their contact with the justice system, while under its control, and after release from supervision. 

Because of the sheer size of the population (10 million persons are incarcerated on any given day around the world; roughly 6-8 times that figure are supervised in the community; and contact with justice systems through family incarceration, arrest, and community incarceration levels are exponentially higher) and their substantially increased relative risks of conditions that are contagious, preventable and socially and economically costly, this group is a critical one in terms of the public health of the larger community and the next generation.  The Justice Health Field takes a broad view of health and wellbeing, in line with that adopted by the World Health Organization.

Despite the fact that there is a clear need for a coherent agenda, research on effective practices in the area of health in justice-involved populations is woefully unsystematic.  In keeping with the conclusions in the recent publication, Knowing what Works in Health Care, the vast geographic and institutional variation in treatment approaches and standards, and the overreliance on home-grown instrumentation and practices is one clear symptom of the lack of organized knowledge in the area. 

Goal

We aim to organize and disseminate evidence surrounding health care and health issues for justice involved persons.  Within Cochrane, we seek to support, staff, edit and assist the completion of systematic and umbrella reviews across the groups.  We aim to work with review and methods groups to sensitise the collaboration about the nature and needs of this population, and the effects it has on the public health of their larger communities.

Justice Health Defined

We suggest that justice health is best thought of as concerning an especially high risk population (those under the supervision of the justice system, either in institutions or in the community) that is served in a unique setting (one that is offered often through the auspices of the justice system infrastructure in prisons, jails, detention centers) or under unique circumstances in the community (for those supervised by justice systems while they continue to live at home or in more open community-based settings).  Justice health includes both adults and adolescents.  Finally, populations under the control of justice systems around the world are disproportionately racial and ethnic minorities, from lower socio-economic classes, and on the whole, are under-resourced, undereducated, and suffer from constellations of social, physical and mental health problems.  Because the state assumes control of health care functions (among many others) for this population, and tends to do so very poorly, there is a common theme across the world of human rights concerns and issues of health care equity. 

Outcomes of Interest   Outcomes in the Justice Health may be conceptualized as standard medical/public health outcomes (e.g., disease reduction, prevention and effective management, overall wellness, quality of care measures, and improvements in efficiency and costs of care).  There are also socially relevant outcomes (e.g., increases in employment, reductions in offending, increased justice, and fewer human rights violations).  Thus, systematic reviews conducted, facilitated, or supported by the Justice Health Field are liekly to include multiple outcomes, and are likely to contain psycho-social secondardy outcomes.

Interventions    Interventions in the Justice Health Field tend to be complex, and often contain medical, delivery, psycho-social and support components.  As a Field, we are interested in assisting reviews of interventions covering a broad territory, from clinical decision interventions (e.g., does an immunization program based on a data-driven decision-making algorithm improve immunization and prevent unnecessary repeat immunizations?  Can increased screening for STIs at intake improve appropriate treatment responses?  Does tending to the health of incarcerated adolescents impact the community), more general practices that affect the quality of health care delivery (e.g., institutional/organizational education on the role of health, changes in prioritization of health over security), and psycho-social treatments and service brokerage assistance that are designed to empower individuals to access health care and to tend to their well being.