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Canadian literature on federal correctional institutions and prison living indicate a shortage inadequate and available healthcare services to meet the needs of the prison population, despite prisoners higher rates of health challenges (e.g. mental health, addictions, HIV/AIDS) in comparison to the general population. With fewer resources, concerns arise about the delivery, quantity, and quality of penal healthcare provision. Thus, the authors examines former prisoners’ experiences of, in comparison to government reports on, wait-times, and request processes for healthcare services, as well as issues of access, quality of interactions with healthcare professionals and the regulations and policies governing healthcare provision. The paper aims to discuss these issues.

The authors compare data gathered from interviews with 56 former-federal prisoners with publicly available Correctional Services Canada reports on healthcare delivery, staff-prisoner interactions, programmes and services, and overall physical and mental health to identify consistencies and inconsistencies between the government’s and former prisoners’ understandings of penal healthcare.

Discrepancies exist between prisoners reported experiences of healthcare provision and government reports. Prisoners are dissatisfied with healthcare provision in more secure facilities or when they feel their healthcare needs are not met yet become more satisfied in less secure institutions or when their needs are eventually met.

Theories of administrative control frame the analyses, including discrepancies between parolee experiences and Correctional Service Canada reports. Policy recommendations to improve healthcare provision are highlighted.

Aging and mental illness both represent significant public health challenges for incarcerated people in the USA. The COVID-19 pandemic has further highlighted the vulnerabilities of incarcerated people because of the risks of infectious disease transmission in correctional facilities. Focusing on older adults with mental illness, this paper aims to examine efforts to decarcerate US correctional facilities during the COVID-19 pandemic and whether these approaches may lead to sustainable reforms beyond the pandemic.

A narrative literature review was conducted using numerous online resources, including PubMed, Google Scholar and LexisNexis. Search terms used included “decarceration pandemic,” “COVID-19 decarceration,” “aging mental illness decarceration,” “jails prisons decarceration,” “early release COVID-19” and “correctional decarceration pandemic,” among others. Given the rapidly changing nature of the COVID-19 pandemic, this narrative literature review included content from not only scholarly articles and federal and state government publications but also relevant media articles and policy-related reports. The authors reviewed these sources collaboratively to synthesize a review of existing evidence and opinions on these topics and generate conclusions and policy recommendations moving forward.

To mitigate the risks of COVID-19, policymakers have pursued various decarceration strategies across the USA. Some efforts have focused on reducing inflow into correctional systems, including advising police to reduce numbers of arrests and limiting use of pretrial detention. Other policies have sought to increase outflow from correctional systems, such as facilitating early release of people convicted of nonviolent offenses or those nearing the end of their sentences. Given the well-known risks of COVID-19 among older individuals, age was commonly cited as a reason for diverting or expediting release of people from incarceration. In contrast, despite their vulnerability to complications from COVID-19, people with serious mental illness (SMI), particularly those with acute treatment needs, may have been less likely in some instances to be diverted or released early from incarceration.

Although much has been written about decarceration during the COVID-19 pandemic, little attention has been paid to the relevance of these efforts for older adults with mental illness. This paper synthesizes existing proposals and evidence while drawing attention to the public health implications of aging and SMI in US correctional settings and explores opportunities for decarceration of older adults with SMI beyond the COVID-19 pandemic.

With a rapidly growing population of older adults with chronic illness in US prisons, the number of people who die while incarcerated is increasing. Support for patients’ medical decision-making is a cornerstone of quality care for people at the end of life (EOL). This study aims to identify, describe, and analyze existing policies regarding EOL decision-making in U.S. Departments of Corrections.

This study performed an iterative content analysis on all available EOL decision-making policies in US state departments of corrections and the Federal Bureau of Prisons.

This study collected and reviewed available policies from 37 of 51 prison systems (73%). Some areas of commonality included the importance of establishing health-care proxies and how to transfer EOL decision documents, although policies differed in terms of which patients can complete advance care planning documents, and who can serve as their surrogate decision-makers.

Many prison systems have an opportunity to enhance their patient medical decision-making policies to bring them in line with community standard quality of care. In addition, this study was unable to locate policies regarding patient decision-making at the EOL in one quarter of US prison systems, suggesting there may be quality-of-care challenges around formalized approaches to documenting patient medical wishes in some of those prison systems.

To the best of the authors’ knowledge, this is the first content analysis of EOL decision-making policies in US prison systems.

The physical environment of correctional facilities promote infectious disease transmission and outbreaks. The purpose of this study is to compare the COVID-19 burden between the correctional facility (incarcerated individuals and staff members) and non-correctional facility population in Ontario during the COVID-19 pandemic.

All individuals in Ontario with a laboratory confirmation of SARS-CoV-2 between 15 January 2020 and 31 December 2022 and entered into the provincial COVID-19 data were included. Cases were classified as a correctional facility case (living or working in a correctional facility) or a non-correctional facility case. COVID-19 vaccination status was obtained from the provincial COVID-19 vaccine registry. Statistics Canada census data were used to calculate COVID-19 incidence and hospitalization rates for incarcerated cases and the non-correctional facility population.

Between 15 January 2020 and 31 December 2022, there were 1,550,045 COVID-19 cases in Ontario of which 8,292 (0.53%) cases were reported in correctional (63.8% amongst incarcerated individuals, 18.6% amongst staff and 17.7% amongst an unknown classification) and 1,541,753 (99.47%) were non-correctional facility cases. Most cases in correctional facilities were men (83.8%) and aged 20–59 years (93.1%). COVID-19 incidence and hospitalization rates were generally higher among incarcerated individuals compared to the non-correctional facility population throughout the study period. COVID-19 incidence peaked in January 2022 for both the correctional facility population (21,543.8 per 100,000 population) and the non-correctional facility population (1915.1 per 100,000 population). The rate of COVID-19 hospitalizations peaked for the correctional facility population aged 20–59 in March 2021 (70.7 per 100,000 population) and in April 2021 for the non-correctional facility population aged 20–59 (19.8 per 100,000 population). A greater percentage of incarcerated individuals (73.0%) were unvaccinated at time of their COVID-19 diagnosis compared to the non-correctional facility population (49.3%). Deaths amongst correctional facility cases were rare (0.1%, 6 / 8,292) compared to 1.0% of non-correctional facility cases (n = 15,787 / 1,541,753).

During the COVID-19 pandemic, individuals incarcerated in correctional facilities in Ontario had higher COVID-19 incidence and hospitalization rates compared to the non-correctional facility population. These results support prioritizing incarcerated individuals for public health interventions to mitigate COVID-19 impacts in correctional facilities.

This study aims to ask how HIV/AIDS is arranged as a public threat in and through Canadian law, particularly in relation to transmission, and how strategies of capture extend the affective force of criminalization leading to poor health outcomes for persons living with HIV/AIDS.

This is a conceptual paper with a focus on applying affect theorist Jasbir Puar’s work on assemblage and debility. The authors use Puar’s work to frame the conditions that persons with HIV/AIDS experience in the Canadian criminal justice context as debilitating.

The authors found that while HIV transmission is not itself a criminal act in the Canadian criminal justice context, activities where transmission is prevalent or possible have been criminalized, particularly in relation to nondisclosure of health status, sex work and substance use. Further, the authors found that when the activities associated with HIV transmission are criminalized, strategies of capture extend the affective force of criminalization first in the inadequate provision of health-care and pharma-care services, second in state resistance to implement harm reduction measure and third in punitive population management strategies.

Persons living with HIV/AIDS have historically experienced stigmatization, especially intersecting with neoliberal, white supremacist and heteropatriarchal axes of power. This paper uses assemblage theory to shore up how these relations operate in ways that close off possibilities, by constituting the HIV/AIDS assemblage as a criminal – rather than a health phenomenon. This paper, thus, holds Canada to account for debilitating a historically disadvantaged and multiplying marginalized population.

This review integrates and builds linkages among existing theoretical and empirical literature from across disciplines to further broaden our understanding of the relationship between inequality, imprisonment, and health for black men. The review examines the health impact of prisons through an ecological theoretical perspective to understand how factors at multiple levels of the social ecology interact with prisons to potentially contribute to deleterious health effects and the exacerbation of race/ethnic health disparities.

This review finds that there are documented health disparities between inmates and non-inmates, but the casual mechanisms explaining this relationship are not well-understood. Prisons may interact with other societal systems – such as the family (microsystem), education, and healthcare systems (meso/exosystems), and systems of racial oppression (macrosystem) – to influence individual and population health.

The review also finds that research needs to move the discussion of the race effects in health and crime/justice disparities beyond the mere documentation of such differences toward a better understanding of their causes and effects at the level of individuals, communities, and other social ecologies.

The purpose of this paper is to examine relationships of self-care behavior, illness representation and diabetes knowledge with A1C (level of glycemic control) in 124 incarcerated persons.

Using a cross-sectional design, summary scores and items from the self-care inventory revised, brief illness perception questionnaire and the spoken knowledge for low literacy in diabetes were evaluated using linear regression to assess their relationship to A1C.

Metabolic control was suboptimal for the majority of inmates with diabetes. The final regression model was statistically significant (F (3, 120)=9.51, p=0.001, R²=19.2 percent). Higher log10 HbA1C (A1C) was associated with lower personal control beliefs (B=−0.007, t (122)=−2.42, p=<0.02), higher self-report of diabetes understanding (B=0.009, t (122)=3.12, p=0.00) and using insulin (B=0.062, t (122)=2.45, p=0.02).

Similar to findings with community dwelling participants, enhancing diabetes personal control beliefs among inmates may lead to lower A1C.

Highly structured environments with limited options for self-care, personal choices and readily available health care may give some incarcerated persons with diabetes no motivation to improve diabetes control even if they have an understanding of what to do.

While there is abundant research in the community describing how these factors influence A1C levels, research of this nature with incarcerated persons with diabetes is limited. Findings will inform diabetes programming during incarceration to better prepare inmates for reentry.

Using the example of women incarcerated in Canada, this paper aims at showing the necessity of studying prisoners’ health and healthcare through a perspective informed both by a criminology of the body and prison/penal sociology. Health is too often constructed as a set of discrete variables that can be isolated from the whole person and her environment. In this paper, we want to show the complexities and richness of situating carceral health and healthcare within the experience of the body and prison. After describing the situation of women in prison in Canada and their health status before incarceration and while in prison, the intricacies of health, healthcare and punishment will be described and we will conclude by showing how health and the body act as a site of control and a site of resistance for incarcerated women.

Mental health care in prisons involves many stakeholders. As a consequence, the goals involved are divergent but there is no sound theoretical framework that accounts for the complexity of care in prison. This paper considers a broad theory and its conceptual framework that differentiates between prisoners with emotional suffering and those without, the need for care from an objective point of view as opposed to a subjective one, and the need for care related to mental health problems versus care related to limiting recidivism.

According to the principle of equivalence of care, health care in prison has to be of the same standard and quality as in the general population. This study aims to determine the geographic accessibility of dialysis services for older prisoners and the older general population in Switzerland and whether accessibility and availability of dialysis care are equivalent.

Spatial accessibility analysis incorporated four different data types: population data, administrative data, street network data and addresses of prisons and hemodialysis services.

Analysis revealed that the average travel time to the nearest dialysis service was better for prisoners (11.5 min) than for the general population (14.8 min). However, dialysis service for prisoners is hampered by the necessary lead-time in correctional settings, which, ultimately, leads to longer overall access times (36.5 min). Accordingly, the equivalence of dialysis care for older Swiss prisoners is not entirely respected for availability and accessibility.

The strength of the study lies in the combination of ethical principles and the highly tangible results of a spatial accessibility analysis. The ethics-driven empirical analysis provides arguments for policy-makers to review the current practices.