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, 2013Vancouver, BCN. Sharifi, BSc, MD, CCFP, ABAM, CCHP

Chronic Disease in Prison

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

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