Reflections on Health Access in Prisons

May 4, 2023


My name is Randolph Riley, I am a prison activist and writer from Lake Loon, Nova Scotia. I am the co-founder of the Black Power Hour radio show collective on CKDU 88.1fm and am a community researcher with Dr. OmiSoore Dryden, James R Johnston Chair of Black Canadian Studies, Faculty of Medicine at Dalhousie University.

In addition to the work I do with Dr. Dryden, I am a support worker on the Visiting Committee at the East Coast Prison Justice Society. In this role, I take phone calls from prisoners, who are in provincial jails, and aid and support with issues they are having within the institution, including barriers or challenges regarding healthcare, habeas corpus, and/or living conditions. I am also currently spearheading four new projects: two with the East Coast Prison Justice Society – one researching and reporting on systemic discrimination in the carceral system, the other project is updating the Family Court resource book titled “Where to Go for Help”, a resource for families interested in supports to assist them in different family matters. 

The other two projects are: “Mobilizing Partnerships Project” which aims to increase mental health supports for those formally incarcerated and engaging with community to bridge some gaps in finding resources for those reintegrating back into society; and last “Black Men’s Sexual Health Project” which highlights and identifies key concerns for the health of Black men as it pertains to sexual health and safer sex practices.

Over the course of the 2022 - 2023 academic year, I have been reviewing literature on prison health in Canada to highlight the incompetent care Black prisoners receive while incarcerated. In developing my article summaries, I have noticed across Canada, healthcare within provincial and federal prisons is being held to less of a standard than the level of care Canadians receive here in society.

I was curious to learn on my literature search, that Alberta (2010), Nova Scotia (2001), and now as of late, British Columbia (2018), are the only provinces in Canada that have transferred their healthcare services from the Ministry of Corrections, over to the Ministry of Health, which is responsible for delivering care to the general population. All other provinces have the Department of Justice responsible for care, which in turn means that the provincial government cannot be held accountable for how the services are delivered. 

The articles I have reviewed focus on the conditions and obstacles that Black people experience while incarcerated. Black prisoners in the United States and Canada face higher rates of chronic diseases, infectious diseases, and mental health issues compared to the general population. They also experience barriers to accessing healthcare, including lack of access to medications and delays in receiving treatment. Additionally, Black prisoners face discrimination and racism within the correctional system, which may further exacerbate their health conditions and hinder their reintegration into society upon release. The research suggests that healthcare reform is needed in correctional facilities to address the healthcare needs of Black incarcerated individuals.

Research in some of the areas I have mentioned is limited mostly due to lack of transparency within institutions; however, there is progress to address these barriers. Social justice movements, activists, along with physicians and lawyers are calling for better health care and data-sharing - an important lever to shed light on pervasive issues.

Since 2009, the Canadian government along with its provincial counterparts have been making amendments in support of trans rights – some provinces and territories are a bit more diligent than others. In learning about Bill C-16 (An enactment that amended the Canadian Human Rights Act and the Criminal Code to add gender identity to the list of discrimination) and Toby’s Act (Ontario’s enactment giving trans folks the right to be free from harassment and discrimination), I see from the research there is a push for equality for all genders, which I was happy to learn about. However, it is important to make sure that this work remains intersectional, and that Black trans people also can access these services free from anti-Black transphobia.

As strong as these Federal and Provincial Acts are in writing, to protect the health and wellbeing of all, prisoners are still not guaranteed an acceptable standard of care. In short, there is still much work to be done, especially when it comes to transparency between government, correctional institutions, and the public.

In my research, it was difficult to find any articles specifically regarding issues for Black men while in prison. However, I was able to identify some of the challenges faced by Black people while inside, which are:

  • Difficulty accessing proper skin care (and we know Black people are already disadvantaged when it comes to dermological care and knowledge in the general public).

  • A lot of our prisons and jails go years without cleaning vents and air ducts, which produces poor air quality in these institutions. Given the overrepresentation of Black men in prisions and the high number of Black people who have asthma and other pre-existing breathing conditions, this is particularly harmful for Black men.

  • Systemic discrimination perpetuated by healthcare physicians, whereby  stereotypes, racism, and stigma about Black men can lead to inadequate health care attention. For example, Black men share that their side effects and symptoms are not taken seriously.

Throughout my research I am still left wondering why in some provinces it is deemed appropriate to place healthcare services in the hands of the Department of Justice, an entity with no healthcare expertise and expect it to be an adequate mode of care? If I were given the opportunity to initiate a research project on prison health, I would investigate the drug inventory of prison healthcare, review, and document all diagnoses and prescriptions given to prisoners, to find out which drugs are over-prescribed and the resulting negative impacts effecting prisoner health.

I recently learned that Dalhousie med students will be learning about prison health for the first time this year. This is important because the more research and the more awareness on this important topic, the more knowledgeable future doctors will become. Again, it is important to make sure this education focuses on systemic anti-Black racism and its impact on the health of Black prisoners.

Prison health must be taught to all healthcare practitioners. This learning journey of the inner workings of the prison system and its ability to provide care (or not provide care) outlines where interventions must be made, and proactive health care is required.

Check out the article summaries!