Understanding Health Care Utilization in Custody: Situation of Canadian Penitentiaries

Abstract

Studies reveal that people under correctional supervision suffer from health problems in proportionally greater numbers than the general population and that their use of health services is extensive. However, very few studies shed light on this phenomenon. The poor health status of inmates is neither the only nor the most important factor in the understanding of health services utilization in custody. Organization of services, health professional practices, and users' perceptions are all important variables in understanding health care consumption. This review of the literature, mostly Canadian studies, aims at documenting some factors that could help us understand the practices of health care utilization behind the walls.

Chronic health conditions reported by male inmates newly admitted to Canadian federal penitentiaries

“…Inmates engage in more high-risk health behaviours (e.g., intravenous drug use, tattooing, smoking, physical aggression, sexual activity with multiple partners and alcohol abuse) than members of the general population. 1,5 Inmates' higher rates of brain injury also suggest an increased likelihood of being involved in activities that can result in physical injury. 7 Socio economic factors known to be associated with poorer health (e.g., poverty, low education, substandard housing and unemployment or underemployment) are also more common among inmate populations.…”

“…[1][2][3][4][5][6] Several factors could explain this difference. Inmates engage in more high-risk health behaviours (e.g., intravenous drug use, tattooing, smoking, physical aggression, sexual activity with multiple partners and alcohol abuse) than members of the general population.…”

“…8,9 In some cases, incarceration itself, with the increased exposure to individuals with higher rates of infection and continued risky behaviours while in correctional facilities, may contribute to the generally poorer health status of inmates. 1,5,10 Correctional Service Canada (CSC) is responsible for all adult offenders receiving sentences longer than 2 years. There is reason to be concerned that rates of chronic health conditions of federal inmates may be increasing because of demographic shifts in the incarcerated population.…”

Chronic Health Conditions Among Incoming Canadian Federally Sentenced Women

“…International studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical and psychiatric disorders relative to the general population (Fazel & Baillargeon, 2011; Harris, Hek, & Condon, 2007; Robert, 2004; Stewart et al, 2015; Wilper et al, 2009). This is not surprising, given that many well-established social determinants of health, such as poverty, low educational attainment, and early childhood abuse (Commission on Social Determinants of Health, 2008; Raphael, 2009), are more prevalent among offender populations (De Viggiani, 2006; Fazel & Baillargeon, 2011).…”