Health Care Reform in Canadian Corrections Facilities

Download: Click here to access the full paper

Authors:

• Andrew Lee (Queen's University) 
• Alison Ross (Queen's University)
• Megan Saad (Queen's University)

Background: ​

The way health care is administered in Canadian correctional institutions has led to a parallel, but unequal system of care for one of society’s most marginalized populations. With mounting evidence that inmates experience high morbidity and mortality, the inadequate delivery of health care within prisons only exacerbates the consequences of incarceration and the social determinants of health. Despite increasing health expenditures across provinces and territories and health care innovation occurring outside of the prison system, corrections services have often failed to protect the health of inmates. More troublingly, the current governance of health care in prisons under the CCRA is incongruent with the Minimum Standards of Care for Prisoners set out by the United Nations, of which Canada has been a committed member. The aforementioned guidelines describe that health care provision should be under the jurisdiction of health systems, rather than the justice system, to protect prisoners’ well-being. The poor health outcomes of inmates are directly related to administrative challenges, poor human resourcing, and lack of prioritization of preventative medicine and public health. As highlighted above, health care delivery in Ontario prisons is currently inequitable and of poor quality. Therefore, we believe that it is critical that the OMSA promote the issue of prison health care as both an advocacy and educational priority for Ontario medical students.

Recommendations: 

• That the OMSA publicly support the transfer of governance of health care provision from provincial and federal corrections services to the Ontario Ministry of Health by:
  • Publicly advertising and promoting this position paper.
  • Establishing a social media campaign to explain the realities of health care within prisons.
  • Identifying prison health as a priority issue of advocacy for future advocacy events in the next 5 years.
  • Consider this topic for a future Provincial Day of Action.
• That the OMSA support prison health as a topic of advocacy to fulfill the CanMEDs Health Advocate role requirement in medical education curricula in Ontario by: 
  • Collaborating with prison health experts to develop and publicize a handbook and/or online module for caring for those who are incarcerated. The educational materials will focus on social/structural determinants that put individuals at risk for incarceration (i.e. school-to-prison pipeline), and pertinent considerations and best practices when caring for incarcerated or formerly incarcerated patients.
  • Support clinicians who work with incarcerated or formerly incarcerated individuals and collaborate with them to create clinical experiences and opportunities for students.
  • Meeting with the AFMC to discuss opportunities to incorporate prison health into the medical curricula as part of the advocate role in CanMEDs.
  • Collaborate with the academic representatives across Ontario to advocate for increased exposure to prison health as a topic within the formal undergraduate medical curriculum.