Years of life lost to incarceration: inequities between Aboriginal and non-Aboriginal Canadians

Research Note: A Novel Sullivan Method Projection Framework With Application to Long COVID

Originally developed for estimating healthy life expectancy, the traditional Sullivan method continues to be a popular tool for obtaining point-in-time estimates of the population impacts of a wide range of health and social conditions. However, except in rare data-intensive cases, the method is subject to stringent stationarity assumptions, which often do not align with real-world conditions and restrict its resulting estimates and applications. In this research note, we present an expansion of the original method to apply within a population projection framework. The Sullivan method projection framework produces estimates that offer new insights about future trends in population health and social arrangements under various demographic and epidemiologic scenarios, such as the percentage of life years that population members can expect to spend with a condition of interest in a time interval under different assumptions. We demonstrate the utility of this framework using the case of long COVID, illustrating both its operation and potential to reveal insights about emergent population health challenges under various theoretically informed scenarios. The traditional Sullivan method provides a summary measure of the present, while its incorporation into a projection framework enables preparation for a variety of potential futures.

The Cedar Project: Racism and its impacts on health and wellbeing among young Indigenous people who use drugs in Prince George and Vancouver, BC

Racism continues to drive health disparities between Indigenous and non-Indigenous peoples in Canada. This study focuses on racism experienced by young Indigenous people who have used drugs in British Columbia (BC), and predictors of interpersonal racism. Cedar Project is a community-governed cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, BC. This cross-sectional study included data collected between August 2015-October 2016. The Measure of Indigenous Racism Experiences (MIRE) scale was used to assess experiences of interpersonal racism across 9 unique settings on a 5-point Likert scale, collapsing responses into three categories (none/low/high). Multinomial logistic regression models were used to examine associations between key variables and interpersonal racism. Among 321 participants, 79% (n = 255) experienced racism in at least one setting. Thirty two percent (n = 102) experienced high interpersonal racism from police, governmental agencies (child 'welfare', health personnel), and in public settings. Ever having a child apprehended (AOR:2.76, 95%CI:1.14-6.65), probable post-traumatic stress (AOR:2.64; 95%CI:1.08-6.46), trying to quit substances (AOR:3.69; 95%CI:1.04-13.06), leaving emergency room without receiving treatment (AOR:3.05; 95%CI:1.22-7.64), and having a traditional language spoken at home while growing up (AOR:2.86; 95%CI:1.90-6.90) were associated with high interpersonal racism. Among women, experiencing high interpersonal racism was more likely if they lived in Prince George (AOR:3.94; 95%CI:1.07-14.50), ever had a child apprehended (AOR:5.09; 95%CI:1.50-17.30), and had probable post-traumatic stress (AOR:5.21; 95%CI:1.43-18.95). Addressing racism experienced by Indigenous peoples requires immediate structural systemic, and interpersonal anti-racist reforms.

Feminist Abolitionist Nursing

The converging crises of COVID-19 and racist state violence in 2020 shifted public discourse about marginalization, public health, and racism in unprecedented ways. Nursing responded to the pandemic with heroic commitment and new politicization. But public engagement with systemic racism is forcing a reckoning in nursing. The profession has its own history of racism and of alliance with systems of state control with which to contend. In this article, we argue nursing must adopt an ethics of abolitionism to realize its goals for health and justice. Abolitionism theorizes that policing and prison systems, originating from systems of enslavement and colonial rule, continue to function as originally intended, causing racial oppression and violence. The harms of these systems will not be resolved through their reform but through creation of entirely new approaches to community support. Nursing as a collective can contribute to abolitionist projects through advocacy, practice, and research.

It is time for us all to embrace person-centred language for people in prison and people who were formerly in prison

The use of person-centred language is well accepted regarding substance use and infectious disease healthcare and research, and appropriate acronyms have become commonplace, e.g., "people who inject drugs (PWID)" has mostly replaced phrases like "injecting drugs users". However, the use of the term's 'prisoner' or 'prisoners' remains common. Although less common, terms such as 'offenders' and 'inmates' are also still used on occasion. This persists despite calls from people with lived experience of incarceration, and fellow academics, to stop using these terms. Given the considerable overlap between substance use, infectious diseases, and incarceration, in this commentary we discuss how they interact, including the stigma that is common to each. We propose that using person-centred language (i.e., people in prison or people formerly in prison) needs to become the default language used when presenting research related to people in prison or people formerly in prison. This is a much-needed step in efforts to overcome the continued stigma that people in prison face while incarcerated from prison officers and other employees, including healthcare providers. Likewise, overcoming stigma, including legalised discrimination, that follows people who were formerly in prison upon gaining their freedom is critical, as this impacts their health and related social determinants, including employment and housing.

Racial Profiling, Surveillance and Over-Policing: The Over-Incarceration of Young First Nations Males in Australia

Historically, countries such as Australia, Canada and New Zealand have witnessed an increased over-representation of minority groups who are exposed to the criminal justice system. For many years in Australia, young First Nations males have been over-represented in the juvenile justice system in all states and territories. Many of these young males have disengaged from their schooling early, some through deliberate exclusion from the education system and others by choice. However, the choices for many young First Nations males may not be as clear cut as first might seem. This paper shows that over-representation in the juvenile justice system may be as a direct result of racial profiling, surveillance and over-policing of First Nations peoples within Australia. The literature addresses the ways in which young First Nations males experience these phenomena from an early age, and the long-term effects and consequences that can arise from these occurrences. An analysis of the current research both internationally and within Australia is thus conducted.

Applying an Indigenous and gender-based lens to the exploration of public health and human rights implications of COVID-19 in Canadian correctional facilities

Due to overcrowding and subsequent unavoidable close contact, poor ventilation, and decreased hygiene standards and healthcare services as compared with in the community setting, the prison environment is highly conducive to the transmission of infections, including COVID-19. Physical distancing measures may be difficult to implement without introducing interventions that may violate human rights. Given that Indigenous women represent over 41% of federally incarcerated women, this is a cause for concern. Indigenous women are also more likely to have higher rates of numerous chronic conditions, including respiratory illnesses, substantially increasing vulnerability to COVID-19 complications. This can be exacerbated in prisons as access to healthcare may be limited. Outbreaks within the prison setting can not only overwhelm an already over-stretched healthcare system but also spread to the community and disproportionately impact marginalized communities and populations. In this commentary, we explore the public health and human rights implications of COVID-19 in prisons while calling particular attention to the unique needs and circumstances of incarcerated Indigenous women based on international best practice-based guidance to preventive and responsive measures to COVID-19.

Race, cannabis and the Canadian war on drugs: An examination of cannabis arrest data by race in five cities

BACKGROUND

The enforcement of drug laws in the United States has been heavily racialized. A substantial proportion of individuals arrested and prosecuted for drug possession in America are Black and Latino, despite similar rates of drug use across racial groups. Due to a lack of access to racially disaggregated criminal justice data, little is known about how race influences drug law enforcement in Canada.

METHODS

We conducted an analysis of cannabis arrest data obtained from police services in five Canadian cities (Vancouver, Calgary, Regina, Ottawa, Halifax) to determine whether racial differences exist in rates of arrest for minor cannabis possession in Canada.

RESULTS

With just one exception, we find that both Black and Indigenous people are over-represented amongst those arrested for cannabis possession across the five cities examined.

CONCLUSIONS

Canadian cannabis legalization lacks measures to redress the racialized harms caused by the war on drugs because the full extent of these harms remains largely unknown. Broader collection and dissemination of disaggregated criminal justice data is needed in the Canadian context in order to inform criminal justice and social policy.

"When you first walk out the gates…where do [you] go?": Barriers and opportunities to achieving continuity of health care at the time of release from a provincial jail in Ontario

We aimed to explore continuity of health care and health barriers, facilitators, and opportunities for people at the time of release from a provincial correctional facility in Ontario, Canada. We conducted focus groups in community-based organizations in a city in Ontario, Canada: a men’s homeless shelter, a mental health service organization, and a social service agency with programs for people with substance use disorders. We included adults who spoke English well enough to participate in the discussion and who had been released from the provincial correctional facility in the previous year. We conducted three focus groups with 18 total participants. Participants had complex health needs on release, including ongoing physical and psychological impacts of time in custody. They identified lack of access to high quality health care; lack of housing, employment, social services, and social supports; and discrimination on the basis of incarceration history as barriers to health on release. Access to health care, housing, social services, and social supports all facilitated health on release. To address health needs on release, participants suggested providing health information in jail, improving discharge planning, and developing accessible clinics in the community. This pilot study identified opportunities to support health at the time of release from jail, including delivery of programs in jail, linkage with and development of programs in the community, and efforts to support structural changes to prevent and address discrimination. These data will inform ongoing work to support health and continuity of care on release from a provincial correctional facility.

History of Childhood Abuse in Populations Incarcerated in Canada: A Systematic Review and Meta-Analysis

BACKGROUND

A history of childhood abuse may affect people's health and criminal justice system involvement. Understanding the prevalence of childhood abuse among individuals in prison is important to inform effective and appropriate correctional services.

OBJECTIVES

To review and summarize data on the prevalence of childhood abuse among people experiencing imprisonment in Canada.

SEARCH METHODS

We searched for studies in bibliographic indexes, reference lists, and gray literature, and we consulted experts.

SELECTION CRITERIA

We included studies published since 1987 that reported data on prevalence of a history of abuse before the age of 18 years among people in Canadian prisons, including any abuse, physical abuse, sexual abuse, emotional abuse, and neglect.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed titles and abstracts for eligibility and reviewed full texts for eligibility. Analyses included summary estimates and meta-regression with random effects.

MAIN RESULTS

The search identified 1429 records. We included 34 unique studies in our review and 29 nonoverlapping studies in our meta-analysis. The summary prevalence for any type of childhood abuse was 65.7% (95% confidence interval [CI] = 52.6, 77.7; range = 56.2% to 75.0%) among women; only one study reported the prevalence among men (35.5%). The summary prevalence of sexual abuse was 50.4% (95% CI = 33.5, 67.2; range = 9.9% to 77.3%) among women and 21.9% (95% CI = 15.7, 28.8; range = 8.3% to 55.6%) among men. The prevalence of neglect was 51.5% (95% CI = 43.1, 59.7; range = 45.5% to 65.1%) among women and 42.0% (95% CI = 12.7, 74.6; range = 6.8% to 99.0%) among men. The prevalence of physical abuse was 47.7% (95% CI = 41.3, 54.0; range = 16.3% to 83.0%), and the prevalence of emotional abuse was 51.5% (95% CI = 34.8, 67.9; range = 8.7% to 96.0%); we did not find differences according to gender. Prevalence estimates for all types of abuse showed high and unexplained variability across studies.

CONCLUSIONS

Half of people in prisons in Canada experienced abuse in childhood. Public Health Implications. Prisons should incorporate trauma-informed approaches. Research is required to understand the association between a history of childhood abuse and criminal justice system involvement and to prevent childhood abuse and mitigate its adverse effects. Systematic Review Registration. PROSPERO CRD42017056192.

Addressing Women's Unmet Health Care Needs in a Canadian Remand Center: Catalyst for Improved Health?

Incarcerated women have a disproportionate burden of infectious and chronic disease, substance disorders, and mental illness. This study explored incarcerated women's health and whether a Women's Health Clinic improved care within this vulnerable population. Retrospective chart reviews and focus groups were conducted. Poor access to care in the community due to competing social needs was described. Barriers to care during incarceration included lack of comprehensive gender-specific services, mistrust of providers, and fragmentation. Of 109 women, high rates of mental illness, partner violence, substance use, sexually transmitted infection (STI), and irregular Pap testing were observed. Pap (15% to 54%, p < .001) and STI (17% to 89%, p < .001) testing rates increased. Fragmentation of care remained at transition points, and further work is needed to improve continuity within corrections and the community.