It is said that no one truly knows a nation until one has been inside its jails.
A nation should not be judged by how it treats its highest citizens, but its
lowest ones.
Nelson Mandela
Chronic Disease in Prison
Family Medicine Forum, 2013
Vancouver, BC
N. Sharifi, BSc, MD, CCFP, ABAM, CCHP
Chronic Disease in Prison
• Definition
– “[A] chronic disease [is] an illness or condition
that affects an individual’s well-being for an
extended interval, usually at least six months, and
generally is not curable but can be managed to
provide optimum functioning within any limits the
condition imposes on the individual.”
• CorrectCare, 2012
Chronic Disease in Prison
•
•
•
•
•
•
•
•
Arthritis
Asthma
Hepatitis
HIV
Hypertension
Mental Illness
Obesity
Substance Use Disorders
Chronic Disease in Prison
•
•
•
•
•
•
•
•
•
Substance Use Disorder
Mental Illness
Hypertension
Obesity
Arthritis
Asthma
Hepatitis
Cancer
HIV
*Wilper et al, 2009
Chronic Disease in Prison
• Prevalence of chronic medical conditions
among jail and prison inmates in the USA
compared to the general population.
• Binswanger et al, 2009
Higher odds ratio
•
•
•
•
•
•
•
•
Substance Use Disorder
Mental Illness
Hypertension
Arthritis
Asthma
Hepatitis
Cancer
HIV
Same odds ratio
• Diabetes
• Angina
• Myocardial infarction
Lower odds ratio
• Obesity
Chronic Disease in Prison
• Challenges/Opportunities
– Data collection
– Allocation of resources
– Disease management
– Empowering patients
– Continuous quality improvement
Chronic Disease in Prison
• National Commission on Correctional
Healthcare Recommendations
– Total disease management
• Clinical practice guidelines
– Regular visits
• Flow sheets
– Degree of control
Crime and bad lives are the measure of a State’s failure.
All crime in the end is the crime of the community.
H.G. Wells