Among inmates who died in the custody of the Shelby County Jail from 2016 to the present, the leading cause of death — 21 out of at least 52 — involved cardiovascular disease as either the main cause or a contributing cause.
That mirrors the overall health of the county, where heart disease is also the leading cause of death, but also shows significantly higher rates in jail compared to the 21.8% of all deaths caused by heart disease countywide, a figure from the Shelby County Health Department.
“If there’s already disparities (in the community), they’re just going to be magnified in a setting for incarceration,” said Dr. Nicole Redmond, who works at the National Heart, Lung, and Blood Institute and is interested in cardiovascular health and health equity.
Like many jails across the country, the detainees at the Shelby County Jail, known commonly as 201 Poplar, are disproportionately Black and low-income, both higher risk populations for heart disease.
People with multiple arrests are also less likely to have access to health care, and people with three or more arrests are more likely to have been diagnosed with chronic health conditions including heart issues, according to the Prison Policy Initiative.
Individuals recently released also have a higher risk of being hospitalized and dying of cardiovascular disease compared with the general population, even after accounting for differences in racial identity and socioeconomic status, according to a 2017 paper published in the American Journal of Cardiology.
Researchers also found that correctional health care varies in terms of quality and oversight and that both prisons and jails “often include unhealthy diets and limited exercise and offer a lack of autonomy to self-manage medications and lifestyle.”
Heart-related problems more likely for those incarcerated
Jail inmates are significantly more likely to have heart-related problems than the general U.S. population, according to data from the National Inmate Survey and the National Survey on Drug Use and Health (10.4% of the jail population compared to 2.9% of the general population).
The Shelby County Health Department, which oversees the county’s contract with medical provider Wellpath in the jail, declined an interview request for this story.
In order to maintain good heart health, detainees — like any individual — need good nutrition as well as access to exercise and physical activity, Redmond said.
And it’s important to note that jails are not the same as prisons, Redmond said. Someone might be held in jail for just one day or for a year or more while awaiting trial, while prisons generally hold people after conviction.
The Shelby County Sheriff’s Office told The Commercial Appeal that Aramark, its contracted food provider, follows U.S. Food and Drug Administration-approved standards and guidelines in crafting meals for detainees.
“It is important for us to know about pre-existing medical conditions so any issues can be addressed at the beginning of the intake process,” the sheriff’s office said. “It is imperative that detainees be forward and upfront about any health problems. We also encourage healthy eating, including the daily consumption of a fruit or vegetable.”
COVID-19, staffing shortages may impact health
In a 2021 court-ordered report, independent consultant Mike Brady wrote about the risks of COVID-19 to medically vulnerable detainees.
Negative impacts to health included staffing shortages resulting in detainees being “locked in their cells oftentimes for days if not weeks at a time” with no outdoor large muscle group exercise.
The sheriff’s office said in a written statement to The CA that they dispute Brady’s report about inmates being locked in their cells for days or weeks at a time. Currently, detainees have access to both an indoor and outdoor gym, the department said, including a rooftop recreation area.
While Brady said the jail’s private healthcare provider Wellpath was “dedicated to delivering patient-centered, competent medical care to all the inmates,” he also wrote that their ability to deliver consistent care was limited by the aged physical facility and the limited number of appointments available with community providers.
In an April 2023 follow-up inspection by consultant Rick Wells, Wells detailed minutes of town hall meetings where detainees on multiple pods said medical did not respond to sick call requests in a timely manner or at all.
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Staff told Wells they average about 70-80 sick call requests per day, many of which are duplicates, and that they see non-emergent sick calls no later than 72 hours after the request.
“The Main Jail has demonstrated inconsistencies or missing information relative to the sick calls and sick call request process,” Wells wrote.
In their statement to The CA, the sheriff’s office said sick calls are conducted daily, with detainees seen by nurses, physicians and mental health providers “depending on the nature of the issue.” The jail, they said, has eliminated many duplications of sick calls.
The combination of already vulnerable populations with correctional settings that are not designed as health care providers makes a “perfect storm,” Redmond said.
“If it’s already suboptimal in the community, then if someone was maybe not diagnosed or not adequately treated or provided the resources to address their cardiovascular health in the community, I’m not sure how we would further resource a jail to do that,” Redmond said.
Katherine Burgess covers government and religion. She can be reached at katherine.burgess@commercialappeal.com or followed on Twitter @kathsburgess.
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