Yale-WHO partnership develops educational programs to improve prison healthcare

Tim Tai

The SEICHE Center for Health and Justice at Yale announced two new educational programs for health practitioners who care for incarcerated populations around the world on Sept. 25. 

The two courses will guide workers on dealing with non-communicable diseases, such as diabetes, and infectious diseases like tuberculosis. Both programs, which are available online through Yale Coursera, were developed in collaboration with the World Health Organization. The infectious diseases course was also created with help from the United Kingdom Health Security Agency.

“[This] recent project with WHO provided a really unique opportunity to enhance education for practitioners who practice internationally behind bars,” said Lisa Puglisi, an associate professor of medicine and director of Transitions Clinic-New Haven under SEICHE. 

According to Filipa Alves da Costa, a public health consultant at the WHO, the organization contacted Yale faculty members at the end of 2021, hoping to create educational initiatives for healthcare practitioners who work in prisons.

In 2022, the team first developed an online training course on non-communicable diseases, spearheaded by Emily Wang, the director of SEICHE and a professor of medicine and public health at Yale. 

The course was first launched as a system of virtual interaction between instructors and practitioners, including several modules, workshops and participant activities. It ran for a set period of time from May to June 2022.

According to da Costa, more than thirty ministries of health around the world nominated public health experts to participate in the program. Those experts took lessons from the course to prison health care providers in their respective countries.  

Even though the course was initially designed for European countries, the team has also reached out to the Pan American Health Organization and has received requests from Asian and African prison systems to join the program as well, Puglisi said. 

Building on the first course’s success, the team developed another program on infectious diseases, which was launched on Coursera in September. 

“Since incarcerated individuals face unique health challenges, we applaud the SEICHE Center for Health and Justice and the WHO-HIPP for helping to fill a needed gap in health education to prevent disease for New Haven residents and beyond,” Brooke Logan, Deputy Director of the New Haven Health Department, wrote to the News.

The non-communicable diseases course is also in the last stages of an adaptation to an asynchronous format on Coursera, da Costa said, which would allow participants to join the course at any time and progress through the course at their own pace.

Puglisi highlighted the importance of having a centralized and flexible platform through which health care providers could access course materials. 

“Practicing healthcare providers are busy, they are not given a lot of time for learning activities as often on their own time,” she said. “Yale Coursera provides a really unique, accessible platform that can be used internationally.”

Historically, Puglisi said, the international health community has focused on preventing infectious diseases in prison settings, such as tuberculosis outbreaks. Experts have only recently recognized the importance of the widespread health effects of non-communicable diseases, according to Puglisi. 

Since the COVID-19 pandemic, she added, experts have been trying to balance the amount of attention and resources devoted to both types of diseases. 

“For a time, we were dropping everything and only focusing on COVID, because that’s what the times called for,” Puglisi said. “But it’s not the only risk incarcerated people face, it’s not even necessarily the most deadly thing incarcerated people face. The leading cause of death of people in prisons is actually cancer and heart disease.”

SEICHE’s recent program is one of the first curricula for healthcare providers in prisons to center non-communicable diseases.

Puglisi also highlighted the urgency of improving healthcare within prisons, where incarcerated people endure a disproportionate burden of illness. 

“We incarcerate people who are minoritized and are often kept out of or have poor access to community health systems to begin with,” she said. “Prisons have relatively poor resources to address the health needs of a population with an abundant burden of illness, not to mention the way that [conditions during incarceration] affect physical and psychiatric states. Exposure to the place can worsen things or create new illness.”

The new courses are designed to adapt “community standards of care” to prison settings, Puglisi added, where legal, bureaucratic or physical constraints may make it difficult to use conventional healthcare practices.

Da Costa said that all the experts who helped develop the programs have had experience with incarcerated populations, which allowed them to include examples of real interventions that worked in prison environments. Still, she said that problems still persist. 

“There are things which healthcare practitioners cannot change immediately,” she said “[P]erhaps it’s more related to their legislation in their countries.”

The case of hypertension, Puglisi said, illustrates the challenges of providing health care in prisons. 

According to Puglisi, doctors usually recommend lifestyle modification as a first step to patients with hypertension, such as a better diet and more exercise. In prisons, though, she said, that is easier said than done.  

“If they’re in a high security, solitary confinement setting, [movement] is going to be challenging; even in a very overly crowded, low security setting, that remains challenging,” she said.

Puglisi said she believes that by including more previously incarcerated people in the development and distribution of health education programs, they could more effectively benefit incarcerated populations.

Shelby Henderson-Griffiths, a law student at City University of New York who was formerly incarcerated, was a fellow at Yale Prison Education Initiative at Dwight Hall for two years. During her fellowship, she worked with SEICHE on social justice and advocacy efforts. 

Because of factors like the understaffing of prison medical systems and the difficulties of managing power dynamics behind bars, Henderson-Griffiths said she views improving healthcare for incarcerated people as an uphill battle. 

“As an incarcerated person, sometimes you can put in a medical ticket and maybe people are not taking you seriously,” she said. “Maybe you don’t know what to say in the medical ticket.” 

She also emphasized the role of SEICHE’s programs in providing knowledge about prison healthcare to medical professionals.

She said that this is especially important since information about caring for incarcerated people is rarely taught in medical schools.

“Taking more time to educate their patients, changing their terminology, and any efforts to humanize the practice of medicine in a prison facility is ultimately going to be beneficial for the people who are incarcerated,” Henderson-Griffiths said.

SEICHE was founded in 2020 as a collaboration between the Yale School of Medicine and the Yale Law School.