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