There are a lot of people in Canada's jails and prisons, and many are among the unhealthiest in society.
There are about 140,000 criminal offenders under supervision at any given time, including 25,000 incarcerated in provincial and territorial jails and another 15,000 in federal penitentiaries.
Consider that, among men sentenced to federal penitentiary (meaning sentences of two years or more):
- 80 per cent have a serious substance-abuse problem;
- 64 per cent are overweight or obese;
- 34 per cent have suffered a traumatic brain injury;
- 25 per cent have a diagnosed mental illness;
- 28 per cent have hepatitis C;
- 20 per cent have a cardiovascular condition;
- 16 per cent have latent tuberculosis;
- 15 per cent have a respiratory illness;
- 14 per cent have asthma;
- 6 per cent have diabetes;
- 1.2 per cent have HIV-AIDS (about 10 times the national average);
- Life expectancy of inmates is about 15 years less than the general population.
And so on and so forth.
Incarceration should not solely be about punishment, but rehabilitation.
A stint in the slammer is a prime opportunity to get people the help they need – not only for compassionate reasons, but because early intervention has the potential to save significant health-care dollars down the road.
Yet the reality is quite different: The health care we provide in correctional facilities is often non-existent and routinely abysmal.
Year after year, the federal Correctional Investigator reports serious shortcomings in the delivery of care. For example, last year, Howard Sapers highlighted the fact that, when incarcerated, many inmates see their drug treatments for severe conditions like schizophrenia and AIDS suspended for weeks or months.
Many of the problems in delivering care in federal facilities have to do with chronic staff shortages.
It's hard to get health professionals to work in prisons because it's tough, frustrating work.
Penitentiaries have become, in many ways, de facto asylums and the ways that inmates are treated – such as with the frequent use of solitary confinement – can greatly exacerbate their illness.
Incarcerating people is expensive – about $120,000 a year for a federal inmate – but that's not a reason to skimp on health care.
In fact, one of the most effective ways to keep costs down in the long term is to keep inmates healthy – everything from ensuring they get their meds to instituting harm-reduction measures like needle exchange to reduce infections like HIV and hepatitis C.
Most prisoners return to live in mainstream society and we shouldn't send them back sicker after their sentences.
But if care is mediocre in federal correctional institutions, it is often much worse in provincial facilities, where the numbers and the turnover are much greater.
Because of the churn, and the fact that the provincial and territorial systems are disparate, we don't have good data but, anecdotally, we know the health status of provincial prisoners is often as bad as their federal counterparts.
A new report from the John Howard Society, Fractured Care, provides a good overview of these issues.
It also pays particular attention to Ontario, where prisoners don't even get health care provided by the Ministry of Health but by the Ministry of Community Safety and Correctional Services.
Having a parallel system doesn't really make any sense, especially that prisons don't have specialized programs.
About 75 per cent of prisoners spend fewer than three consecutive months in custody. But that brief period should be seen as a rare chance to connect with members of hard-to-reach populations and bring them into the health system.
Instead, conditions in correctional facilities tend to exacerbate already poor health.
Double-bunking – where two people share a cell designed for one – is common practice. It leads to a lot of violence and injuries and also promotes the spread of everything from bedbugs to antibiotic-resistant superbugs.
There is no question that there are exceptional challenges in providing health-care services in correctional facilities. The numbers of inmates and prisoners with substance-abuse problems, mental-health issues and a history of sexual abuse are astronomical.
But there are few other places where we have such a golden opportunity to have an impact – to improve the health of individuals, and the community to which they will return.