At least half of Canada's 40,000 prison inmates report enduring abuse as children – just one of a catalogue of maladies affecting inmates detailed in a new study that assembles the country's first comprehensive portrait of prisoner health.
The paper draws on dozens of research projects to depict a population of Canadians that is grappling with mental-health issues, substance abuse and communicable diseases at rates far higher than the general population.
The author, Fiona Kouyoumdjian, a postdoctoral fellow with the Centre for Research on Inner City Health of St. Michael's Hospital, views the document as a wide-ranging diagnosis that points to several prescriptive measures governments could undertake to improve inmate health and, by extension, public health and public safety.
"I'm always trying to reframe incarceration as an opportunity to improve health," said Dr. Kouyoumdjian, who works part-time as a prison doctor between her research duties.
Health and prison officials have long known that inmate populations are disproportionately unhealthy compared to the rest of the population. Many previous studies have focused on single diseases or addictions. Dr. Kouyoumdjian's review gathers that narrow data in a single place to create a broad spectrum of prison disorders.
She starts off considering the social backgrounds of the thousands of people in custody. Half of the inmate population report a history of sexual, physical or emotional abuse in childhood. An unspecified majority grew up dealing with "major adverse events," such as family violence, parental absence or child-welfare interventions. Between 15 per cent and 20 per cent of aboriginal inmates – who make up one-quarter of the inmates in the federal system – attended residential schools.
"I think this challenges our tidy perceptions we might have about victims versus offender," Dr. Kouyoumdjian said.
This imperfect background makes for a population rife with mental-health issues. Research from Edmonton summarized in the review showed that among provincial inmates in the city, 91.7 per cent of inmates had a diagnosable mental illness, 87.2 per cent had a substance-abuse issue and 56.7 per cent had an antisocial personality disorder.
Around one in three women and one in five men in federal custody take some kind of psychiatric medication, the review found.
To all this, incarceration adds an elevated prevalence of many communicable diseases. Tuberculosis is five times more common in custody than out. Thirty per cent of female inmates and 15 per cent of male inmates in federal custody have hepatitis C. Rates of sexually transmitted infections are also high.
There is a higher purpose in compiling this roster of disorder and disease. Dr. Kouyoumdjian says the study suggests three major areas governments could focus on to improve inmates health.
The first is good access to a primary-care physician, both in custody and after release. "There is no single disease that we could target in order to improve health for everyone," she said. "It really needs to be focused on more than one change. Making sure that people have good access to primary care when they're in custody, but especially when they leave custody, is really valuable.
Second, prisons could be doing far more to manage addictions. Inmates in many provincial institutions, for example, can't initiate methadone treatment. And those leaving custody could greatly improve their health prospects if prisons provided harm-reduction education and naloxone, an overdose antidote.
The ultimate goal is far more ambitious than merely improving health outcomes for the tens of thousands of people who cycle through prisons every year. There are important knock-on effects for the rest of society, according to Dr. Kouyoumdjian, "such as decreasing health-care costs, improving health in the general population, improving public safety and decreasing reincarceration."