Social construction and policy implementation: Inmate health as a public health issue

Objectives. This article develops and tests a concise multi-stage approach for assessing the impact of social construction on the implementation of public programs designed to benefit negatively constructed groups. The framework suggests that negative constructions lead to policy choices that create problems in the implementation process. These problems prevent the accomplishment of key subobjectives necessary for ultimate program success. Methods. We test the utility of the framework in an analysis of a key public health issue-the spread of HIV/AIDS and tuberculosis in prisons. Despite great strides in the treatment and prevention of these diseases outside prison walls, the incidence and severity of both in the incarcerated population has increased dramatically over the last five years. We hypothesize that the problem of inadequate funding, arising from the negative social construction of this unique target population, is to blame. Results. In an analysis of 50 state correctional systems, we find that states with the most negative constructions of criminals and potential criminals spend dramatically less on inmate health, relative to other states. Conclusions. Our analysis suggests that inadequate funding levels in states with negative constructions of criminals and potential criminals jeopardizes the implementation of prison programs targeted at the prevention and treatment of HIV/AIDS and tuberculosis.