Social Determinants of Physical Health Conditions among Incoming Canadian Federal Inmates

Why we did this study

International health studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical health conditions relative to the general population. Although higher levels of engagement in risky health behaviours (e.g., drug and alcohol use) probably play a role, social determinants of health are also more common among offender populations. The purpose of the present study was to examine how social determinants and the physical health status were related in men offenders admitted to CSC.

What we did

Data collected over a six-month period on all incoming men offenders (N =2,273) were used to determine the prevalence of chronic physical health conditions upon admission to CSC.  This information was then related to a selection of social determinants factors identified from the literature as being important in explaining the presence of health conditions among Canadians. To determine which of the social determinant factors best predicted each of the health conditions, logistic regression models where developed. These models controlled for age and Aboriginal ancestry while examining the impact of each of the social determinants on health. If a social determinant was not found to be significant with the inclusion of the other covariates, it was excluded from the final model for each health condition. 

What we found

Results indicated that many men reported having at least one chronic physical health condition on admission to federal custody. Many, especially men of First Nations ancestry, had also experienced social determinants associated with poorer health outcomes over the course of their life such as poverty, low educational attainment, substandard housing, and underemployment. While the presence of many of the social determinants was associated with the reporting of physical health conditions among the men, results revealed that two social determinants factors in particular were consistently related to poorer health: history of childhood abuse and the use of social assistance.

The presence of social determinants, however, did not completely mediate the relationship between, Aboriginal ancestry and having a physical health condition, suggesting that other factors have a role in explaining this relationship. For example, even when considering the impact of the social determinants, differences between Aboriginal and non-Aboriginal men remained with regard to health conditions of the central nervous system. Further research could examine whether these conditions may be linked to lifestyle factors not represented among the social determinants.

What it means

The findings of this study confirms the literature that social determinants factors such as poverty and early childhood abuse have a negative impact on the health of individuals, including the health of federal offenders in the Correctional Service of Canada (CSC). A better understanding of the how these factors affect offenders will help inform strategies to address correctional health issues, and potentially, reduce the progression and impact of chronic health conditions through targeted correctional education and intervention programs.

For more information

Stewart, L., Nolan, A., Thompson, J. & Sapers, J. (2015). Social determinants of physical health conditions among incoming Canadian federal inmates. (Research Brief B-59).Ottawa,Ontario:Correctional Service Canada.

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