Sarah Saunders - Inmates Health: A look into infectious disease within prison

Inmates Health: A look into infectious disease within prison

Sarah Saunders

Athabasca university

Introduction

Disease, infection, poor health; these are all issues inmates within the federal correctional system face. Correctional facilities often provide poor living conditions, unsanitary quarters and lack of access to proper healthcare. The combination of these conditions creates the perfect environment for inmates to be at increased risk for diseases such as HIV, hepatitis C, tuberculosis, and sexually transmitted diseases. Correctional Service Canada reported in 2001, a total of 1.8% of the federal inmate tested positive for HIV and hepatitis C infections, which in total, accounted for 23.6% of the inmates (Corrections Service Canada 2013). Contributing factors such as environmental conditions, social expectations, socio-economic status, education, community influence and policy all come together to play an important role in the disease process within the Canadian correctional system. Social determinants of health have an important place in the healthcare system and indicate to us, which population or individuals have higher risks of poor health.

Model of Health

Multilevel healthcare models are a tool used to assess and implement necessary changes or interventions for healthcare issues. Many different models can be used for any given healthcare issues however, each model will allow for different interventions as they address different needs. Social models of health move beyond pathogens, physical, biological and anatomical influencing factors and draws on more social determinants of health such as race, gender, environment, and wealth. This model of health uses people’s social behaviours as a base for explaining how and why illness can affect people differently. Using the social determinants of health reviewed in my previous blog post (SDH) to understand that someone’s state of wellbeing may be influenced by the context they involve themselves in. Some of these factors include lifestyle factors, community networks, living and working conditions, socio-economic and environmental factors (Community Development and Health Network). An ecological model of health looks at environmental factors that influence someone’s behaviours causing negative or positive effects on one’s state of health. Ecological models of health influence people’s behaviours in many ways, ranging from an individual level to a policy level. The five levels of ecological influences include individual, interpersonal, organizational, community and policy factors (Rural Health Information Hub 2018). Using these two frameworks in conjunctions with each other, the social-ecological model of health is applied.

Social-ecological models of health have been used for many years to address health issues. Developed and introduced in the 1970’s, the social-ecological multilevel model of health was later finalized into a theory in the 1980’s (Kilanowski 2017). Using a multisphere ring, identifying influencing factors that contribute to health issues, we will apply this model of health for disease within prison. Identifying the individual at the center of the sphere, the closer the “microsystem” is to the individual within the sphere, the greater the influence on health-related issues (Kilanowski 2017). The multisystem sphere used to explain the social-ecological model of health include the individual, relationships, community, and society (Centre for Disease Prevention and Control 2021).

Greg Simmons, an ex prisoner who speaks out about his experience within the Canadian corrections system. He describes his relationships with peers and his community prior to being sentenced to serve time. He explains that he resorted to robbery, reflecting on cultural norms of his way of living. Given his way of living prior to prison, he was convicted and sentenced. Once inside prison he was no better off, facing still, low socioeconomic status, perceived feelings of worthlessness and lack of access to healthcare. He developed his own coping mechanisms that involved self medicating with heroin, resulting on addiction and increased risk taking behaviours.

Individual Level

Corrections Service Canada assessed the risk factors on an individual level. Age, education, history of substance use and risk-taking behaviours such as multiple sexual partners were all assessed to begin developing interventions to decrease infectious disease within prisons. Intake screening was developed and is available to all inmates entering into a Canadian Correctional facility (Corrections Service Canada 2013). Education sessions are performed by nursing staff to inmates regarding safe sex and disease transmission. Inmates now have access to education such as completing or obtaining a GED with the possibility of post secondary schooling. All of these interventions are in line with a social-ecological model of health on the microlevel of individual change. Mental health nurses are employed at all corrections facilities to address underlaying mental health disorders that lead to poor choices and self medication of illegal drugs. Substance use and addiction is widely researched and proven to increases risks that lead to contraction of infection diseases (Bick 2007). Vaccinations are also widely available within prison, provided by medical staff, hand hygiene promotion, access to clean water and soap to prevent infections?

Relationship Level

Relationships are extremely influential for human behaviour, often causing those close to one and other to partake in similar activities. Relationships within one’s life begins to shape socioeconomic status from a young age and also ones perceived socioeconomic status. Perceived socioeconomic status needs to be considered when implementing health models to create change because people behave in a manner they feel they have to behave within their social circles. At a microsystem level, peers, family, school and social circles are important determining factors for positive development and to influent life choices. Those that grow up in low socioeconomic status are often exposed to low-income families, peer circles of similar backgrounds resulting in missing an important developmental part of childhood. Guidance from parents and role models shapes they way we make decisions and choices. Positive guidance and role models have the ability to result in decreases risk taking behaviours that lead to criminal activity, imprisonment and higher risk of contracting infectious diseases. Using the social-ecological model of health, individuals are removed from their community and peers, provided with structure within a correctional facility with access to healthcare providers and medical treatment they may otherwise not have in their community living situations (Nowotny 2017).

Community Level (school, work, neighbourhood)

Infectious disease at the community level is important to understand because socioeconomic status influences behaviours that increases the risk of incarceration. Individuals living in poor and marginalized communities represent a large portion of the incarcerated population (Sander 2015). At the community level of addressing infection disease, one of the most effective ways to decrease transmission is through harm reduction policies such as clean needle exchange programs and opioid substitution therapy (Sander 2015). In the community, people living in poor and marginalised locations often are faced with unsanitary conditions. By providing incarcerated people with sanitary living conditions, access to clean needle exchange programs and an inner community that must live in the same manner, we are keeping the public safe after rehabilitation of the inmates back to outside living.

Societal Level

Given that most prisoners return to the community setting, most prison health is connected to greater public health policy (Sander 2015). Assessing social and cultural norms of those within prison provides a picture of at-risk individuals for infectious disease. Alcohol and street drug use is strong risk factor to infectious disease such as HIV and hepatitis C infections (Moaxen et. al., 2019). Within this population being assessed, social and cultural norms in low socioeconomic communities includes self managing mental health disorders with drug use leading to decreased access to clean needle exchange programs. This results in cultural norms of needle sharing and risk-taking behaviours such as unprotected sex (Moaxen et. al., 2019). The expert advisory committee on healthcare transformation in corrections discusses these norms at a societal level within prison includes through policy development ensuring equal healthcare access to inmates (Howard 2019).

Conclusion

Infectious disease within prison is a greater public health concern than once thought. Prisons were developed for the purpose of maximizing public safety and had very little thought put into minimizing disease transmission. As knowledge and concerns evolve, public safety becomes an issue when inmates are rehabilitated back to the community, bringing infectious diseases contracted in prison with them. Using a multilevel model of health addressing social and economical factors infectious disease rates can be addressed and potentially corrected. The social-economic model of health allows for interventions to be implemented at microlevels including individual, relationship, community, and societal interventions. Corrections Service Canada has worked closely with Public Health to improve prison conditions to address infectious diseases. Although there is more work to be done, we are headed in the right direction to address health concerns within the Canadian correctional system.

References

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Centre for Disease Control and Prevention (2021) The Social-Ecological Model: A Framework for Prevention, The Social Ecological Model, Retrieved from: https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html

Correction Service Canada (2013) Forum on Corrections Research, Vol. 14 No. 2, Retrieved Feb 27, 2021 from [archived]: https://www.csc-scc.gc.ca/publications/forum/e142/e142f-eng.shtml

Community Development and Health Network (No Date) Models of Health, Fact Sheet 1, Retrieved Mar 1, 2021 from: https://www.cdhn.org/sites/default/files/downloads/FACTSHEETS%201_Screen%20View%281%29.pdf

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Nowotny. K., (2017) Health Care Needs and Service Use Among Male Prison Inmates in the United States: A Multilevel Behavioral Model of Prison Heath Service Utilization, Health and Justice 5, Article 9, Retreived Mar 7, 2021 from : https://doi.org/10.1186/s40352-017-0052-3

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Moaxen. B., Assari. S., Neuhann. F., Stover. H., (2019) The Guidelines on Infection Control in Prison, The Lancet, Retrieved Mar 7, 2021 from: DOI:https://doi.org/10.1016/S0140-6736(19)30279-X

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