Incarceration, inclusion, and health equity: evidence, perspectives, and future directions
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Justice Health Unit, School of Population Health, Curtin University, Australia
SEICHE Center for Health and Justice, Yale University, United States
Norwegian Centre for Addiction Research, University of Oslo, Norway
BC Centre for Disease Control, University of British Columbia, Canada
Unlocking the Gates, Canada
Department of Family Medicine, McMaster University, Canada
Department of Psychiatry, Oxford University, United Kingdom
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A857
Globally more than 11 million adults are imprisoned on any given day, and at least 410,000 children are held in criminal justice detention. Incarceration is a marker for extreme disadvantage, and exposure to incarceration may compound health inequalities. Complex health needs among people in custody are normative. Given the rapid movement of people between disadvantaged communities and carceral settings, improving the health of people exposed to incarceration is important to reducing health inequalities globally. Health outcomes after incarceration are especially poor, with high rates of preventable mortality, injury, infectious disease, and decompensation of chronic disease documented in a growing number of (mostly high-income) countries. In this workshop we will consider prisons from a public health perspective: as settings through which marginalised and typically unwell members of the community pass, and in which health needs are managed by carceral systems that are rarely fit for purpose. We will summarise the evidence on health outcomes after incarceration, emerging from large cohort studies of adults and children released from incarceration in Australia, Norway, Canada and USA, and from an international consortium examining mortality after incarceration in 13 countries. We will identify key gaps in the evidence base, critically including research in low- and middle-income countries, and mechanisms for routinely monitoring health outcomes in and after incarceration.   Informed by these brief presentations, we will facilitate a multi-disciplinary Discussion focussing on the following key questions: 1. Is incarceration a cause of poor health outcomes, a marker of pre-existing health inequalities, or both? Does it matter? 2. What opportunities exist to improve health outcomes before, during, and after incarceration, through: *3.Upstream prevention and diversion; 4. Prison healthcare quality, standards, and monitoring; 5. Transitional support and post-release care coordination. 6. What critical next steps are required to support advocacy and policy reform, specifically for public health agencies, policy makers, clinicians, researchers, advocates, and civil society? At the conclusions of the workshop we will draft a Consensus Statement on Incarceration and Health Inequalities, which will be submitted to key international agencies for potential ratification.   Specific workshop Aims: 1. Sensitise a global public health audience to the health-related needs of children and adults who experience incarceration, and the role of incarceration in compounding or mitigating health inequalities at the population level 2. Identify multi-sectoral opportunities to improve the health of people exposed to incarceration through prevention, improved care, and post-release support. 3. Identify critical next steps for advocacy and policy reform. 4. Draft a Consensus Statement on Incarceration and Health Inequalities, which will be submitted to international agencies for potential ratification and published in a leading international journal.
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