People who get locked up are more likely to be dealing with chronic health issues and less likely to receive care than the general population. Being incarcerated also creates additional health issues due to the poor conditions of jails and prisons.

Often not the worst but the most vulnerable people end up in prison. The same factors that lead to run-ins with law enforcement often mean these people are not able to access regular health care before they get locked up.

People inside face many barriers to care whether they deal with substance use disorders, mental health needs, disabilities and even pregnancy.

According to a new report released by the Prison Policy Initiative, state prisons do not meet their requirement to provide for the essential needs of people they incarcerate.

“As a result, people in state prison are kept in a constant state of illness and despair,” Lee Wang, the author, wrote.

The survey found that 80% of people in state prisons diagnosed with hepatitis C still have it despite it being highly treatable. “Reflecting the unwillingness of state prison systems to provide appropriate treatment, even at the expense of public health,” Wang wrote.

Half of people in state prisons didn’t have insurance when they were arrested compared to a mere 8%of the general population that does not have insurance. Over a quarter of people coming to prison also have a chronic health condition. These conditions like diabetes, which a higher number of inmates have than the general population, are exacerbated by poor care and food inside prisons.

Women and native people face the highest rates of mental illness. More than half of people in state prisons have some sign of mental health issues, according to the report. The report points to policy failures: the government “[…] chipped away at the social safety net and accessible community-based treatment for years, while spending on the carceral system has increased.”

The lack of community based solutions to substance use disorder also funnels people into prisons where they lack access to treatment. Half of people in state prisons who have a history of drug use also have one or more mental health issues. A large number of people inside also have a disability, 40% nation wide and 50% of women in state prisons.

The report suggests that stakeholders should improve the actual conditions of incarceration that make people sick  or sicker, create better oversight and move older people out of prison permanently.

“Finally, while this should be obvious, addressing bad policy and creating better prison policies must not come at the expense of non-carceral, community-based solutions,” the Wang wrote. “States must curtail their reliance on police, jails, courts, and prisons as solutions to social and public health problems.”