Excess Burden or Excessive Burden: Prisons and Infectious Disease Control

Abstract: Prison systems can play numerous roles in a society's security in terms of the separation of criminals from the general population, rehabilitation of criminals prior to reentry in society, and deterrent effects on criminal behaviors. Yet, prison systems also create a set of obligations for the state towards prisoners including responsibility for their health and healthcare and a set of related challenges in terms of infectious disease control. Densely populated with high volumes of entry, movement, exit and reentry, prison systems have historically provided breeding grounds for infectious diseases and acted as epidemic lenses with important consequences for society at large. This talk considers two health policy case studies involving infectious diseases in prisons: 1) Tuberculosis and Multidrug Resistance in the former Soviet Union; 2) Chronic Hepatitis C Virus in the United States. In both, new more expensive and efficacious technologies are evaluated in terms of their effectiveness, costs, cost-effectiveness with consideration given to affordability and the specific ethics of making such decisions for incarcerated individuals.

About the Speaker: Jeremy Goldhaber-Fiebert, PhD, is an Assistant Professor of Medicine, a Core Faculty Member at the Centers for Health Policy/Primary Care and Outcomes Research, and a Faculty Affiliate of the Stanford Center on Longevity and Stanford Center for International Development. His research focuses on complex policy decisions surrounding the prevention and management of increasingly common, chronic diseases and the life course impact of exposure to their risk factors. In the context of both developing and developed countries including the US, India, China, and South Africa, he has examined chronic conditions including type 2 diabetes and cardiovascular diseases, human papillomavirus and cervical cancer, tuberculosis, and hepatitis C and on risk factors including smoking, physical activity, obesity, malnutrition, and other diseases themselves. He combines simulation modeling methods and cost-effectiveness analyses with econometric approaches and behavioral economic studies to address these issues. Dr. Goldhaber-Fiebert graduated magna cum laude from Harvard College in 1997, with an A.B. in the History and Literature of America. After working as a software engineer and consultant, he conducted a year-long public health research program in Costa Rica with his wife in 2001. Winner of the Lee B. Lusted Prize for Outstanding Student Research from the Society for Medical Decision Making in 2006 and in 2008, he completed his PhD in Health Policy concentrating in Decision Science at Harvard University in 2008. He was elected as a Trustee of the Society for Medical Decision Making in 2011.