Prisons are not isolated institutions; social and economic change in the wider society affects their internal dynamics. Health conditions within lower socioeconomic segments of the population influence the health characteristics of prisoners at admission, and health conditions in the wider society have major implications of inmate health care. The analysis demonstrates that continued declines in the health status of the general population and the poor in particular, coupled with punitive sentencing policies, will strain correctional health care delivery systems. Findings indicate the need for research that links street behavior to actions in the prison and even back to the streets. In addition, Federal policies to improve the health conditions of the poor must include inmates, because improvements in inmate health will have an impact on urban society at large. Figures and 101 references (Author abstract modified)