​Devyn E. Hoopfer
Department of Health Sciences, Carleton University
HLTH 5402: Biological and Social Fundamentals of Health
Dr. Renate Ysseldyk
April 7, 2025 

​Artificial Intelligence Declaration
This paper was written by the author. ChatGPT 4o was used for the purposes of idea generation, outlining, and/or language refinement. All content, arguments, and references have been independently evaluated by the author. The use of AI complies with the academic integrity policies of Carleton University and the HLTH 5402 instructor’s policy for this assignment.

Position Statement
I was previously employed by Correctional Services Canada. The stories I heard were nothing short of atrocities. These experiences profoundly changed the way I see the world. While this paper presents facts, figures, and statistics to build its case, it’s crucial to remember that behind every number is a human being shaped by circumstances. Each data point is a son or daughter that deserves dignity and respect.

Perpetual Punishment: Incarceration As a Social Determinant of Health
In Canada, approximately 38,570 people are held in federal, provincial or territorial custody (Statistics Canada, 2024), yet only 53.3% of them have been tried and sentenced (Public Safety Canada, 2023). For many incarcerated Canadians, a prison sentence marks the beginning of a vicious cycle fueled by stigma and systematic neglect. Indeed, of those sentenced, the average two-year recidivism rate was 23.4%  (Stewart et al., 2019) with incarceration impacting nearly every facet of life, including accessibility to housing, income, and, as discussed in more detail in this blog, health.
Social determinants of health (SDoH) are systemic social factors that drive differences in health across groups and are closely tied to structural inequities (Raphael et al., 2020). Incarceration is a profound but often overlooked SDoH. It disproportionately affects marginalized communities, worsening existing health disparities, and creating new ones. Incarceration is not just a legal issue or a moral failing, it reflects deeper societal failures, including those related to health equity and public health.

Colonization & Incarceration
The Canadian criminal justice system is deeply intertwined with the legacy of colonialism. Indigenous inmates account for 28% of the prison population, despite representing just 5% of the national population (Department of Justice, 2023). The forced relocation of indigenous communities to reserves, the repressive measures of the Indian Act, and the denial of treaty rights have contributed to socio-economic marginalization, setting the conditions for crime and victimization (Department of Justice, 2023). Additionally, the intergenerational trauma caused by residential schools and the foster care system has further disrupted family and community structures. Consequently, Indigenous people are more likely to suffer from poorer mental health and substance use disorders compared to non-Indigenous people (Cameron et al., 2021). Similarly, Black Canadians are overrepresented in correctional institutions due to racial profiling, socio-economic disadvantages, and systematic inequalities within the criminal justice system (Department of Justice, 2022).

Intersecting Inequities
There is significant overlap between risk factors associated with criminal behaviour and SDoH such as poverty, housing instability, racism, level of education, unemployment, and mental illness (Department of Justice, 2024). Most of the prison population report some history of family violence, family separation, physical or sexual abuse (Ulzen & Hamilton, 1998). Additionally, substance-use is also highly prevalent in this population compared to the general public (Kouyoumdjian et al., 2016).  
The intersection of these social determinants is often clustered in communities that are marginalized and under-resourced, where chronic stress and limited access to opportunity create vulnerability (Department of Justice, 2024). In such settings, individuals may adopt coping or survival strategies, such as substance use, petty theft, or informal economic activities, that are more likely to be criminalized than treated with social or health-based interventions. Rather than addressing the root causes of these behaviors, the criminal justice system often responds with punishment, reinforcing cycles of disadvantage.
For instance, homelessness or mental illness may lead to minor legal infractions like loitering or public intoxication, resulting in arrest rather than connection with housing services or mental health care. These punitive responses reveal the structural inequities in how different populations are policed and punished. Recognizing the overlap between SDoH and incarceration is essential for shifting toward a public health approach that treats these behaviors as symptoms of systemic failure rather than individual moral weakness.
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Barriers to Services Behind Bars
Once incarcerated, these individuals face further harm within the correctional system, particularly when in need of medical and/or mental health services. ​ Adequate health care remains a persistent challenge in Canada’s correctional facilities, with health care issues being among the most frequently reported inmate complaint (Office of the Correctional Investigator, 2023). Incarcerated individuals often face barriers to receiving timely and adequate care in prison (Canada et al., 2022), leading to poorer health outcomes than the general population (Kouyoumdjian et al., 2016).
Mental health services are particularly inadequate. There is strict control of medications within prisons and jails, where institutional concerns over drug misuse or diversion often override medical necessity (Fazel et al., 2004). This is extremely problematic given the disproportionately high rates of mental illness among inmates (Fazel et al., 2016). Fazel et al (2004) found that a mere 18% of participants with diagnosed mental illness were prescribed appropriate medication. Shortages of mental health professionals have left many struggling with mental illness, who were already failed by outside community supports (Mental Health Commission of Canada, 2017).
Those with mental illness may be written-up for being disruptive or aggressive, which could be caused by untreated mental health problems. Unfortunately, penalties may extend their sentences leaving them vulnerable longer. In many cases, individuals feel they have no escape other than to self-harm to receive medical attention or commit suicide, with much higher rates of both compared to the public (Kouyoumdjian et al., 2016).
Chronic and communicable diseases are more common in prisons and are often poorly managed (Stewart et al., 2015). Delays in care from prolonged waiting times, inadequate staffing, and limited access to specialized services further burden an already strained and underfunded system (Kouyoumdjian et al., 2016). For those with pre-existing issues or emerging health conditions, poor nutrition, inadequate ventilation, and overcrowding can worsen their health and enable the spread of communicable diseases (National Research Council, 2013). Diseases such as tuberculosis thrive in such conditions, where it remains a persistent concern (Kouyoumdjian et al., 2016). COVID-19 further exposed these vulnerabilities, with incarcerated populations experiencing higher infection and hospitalization rates (Zygmunt et al., 2024). Additionally, the prevalence of HIV, Hepatitis C, and syphilis is significantly higher among incarcerated individuals (Kouyoumdjian et al., 2016).
Despite the high prevalence of substance use (Correctional Service Canada, 2024) and associated health risks among incarcerated individuals, there is a notable lack of harm reduction programs within the provincial correctional system (Sander et al., 2019). Most facilities do not offer supervised consumption services, needle exchange programs, or tailored educational materials (Sander et al., 2019). This gap increases the risk of disease transmission through the sharing of needles, unprotected sex, and reusing tattoo needles.
Taken together, these conditions reflect a broader failure to uphold the health and rights of incarcerated individuals who fall under the purview of the government. Addressing these systemic gaps is not only a matter of health care reform but also one of social justice and public accountability.

The Lingering Impacts of Incarceration
The health challenges of incarcerated individuals persist long after they are released. While there is no available Canadian data on post-release outcomes, international research consistently shows elevated mortality rates among the formerly incarcerated (Kinner et al., 2013), most often from preventable causes such as drug overdoses or chronic illnesses (Kinner et al., 2013). Additionally, many individuals experience traumatic events during their internment that contribute to long-term mental health problems such as post-traumatic stress disorder (Hammock et al., 2024).
Furthermore, stigma and restrictions may prevent individuals from acquiring adequate social support. Released individuals are more likely to be underemployed, earn lower incomes, lack social support, and have difficulty securing stable housing (Babchishin et al., 2022). These factors all negatively impact health (Raphael et al., 2020) and increase recidivism (Augustine & Kushel, 2022) further perpetuating the cycle.

The Need for Systemic Reform
Health issues in the criminal justice system are deeply rooted in structural inequities. Incarceration undermines physical, mental, and social well-being, far past the initial sentence, impacting health long after their debt to society has been paid. Without systemic reform, the correctional system will continue to function as both a consequence and a driver of poor health, particularly for marginalized communities. True justice cannot be achieved until the health, well-being, and dignity of every Canadian is recognized, prioritized and addressed. Until then, vulnerable individuals will continue to bear the cost of our inaction.

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Babchishin, K., Mularczyk, K., & Keown, L.-A. (2022).
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Fazel, S., Hope, T., O'Donnell, I., & Jacoby, R. (2004).
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Alissa Vaziri
Department of Health Sciences
Carleton University
HLTH 5402: Biological and Social Fundamentals of Health
Presented to Dr. Renate Ysseldyk
March 31, 2025

​Introduction: The Disappearance of Public Health Data
Imagine waking up one day to see that thousands of public health datasets have simply disappeared. Vital information that advances scientific discoveries, tracks diseases, and develops treatments that are necessary to protect public health are all gone. This is the unfortunate reality that the United States is currently facing in the wake of President Donald Trump’s administration. “The shifting landscape in the United States has caused confusion, anger, uncertainty, and anxiety among members of our community,” stated the American Association for the Advancement of Science at its annual conference in Boston on Thursday, February 13, less than a month into the current Trump administration (Oza, 2025). In recent news, thousands of web pages have been removed on the US Centers for Disease and Control and Prevention (CDC) website. Dr. Angela Rasmussen, a virologist at the University of Saskatchewan recently reported her concerns to CBC News stating she never thought “that the CDC would actually start deleting some of these crucial public health data sets” and that public health data is “really important for everybody's health — not just in the U.S. but around the world” (Canadian Broadcasting Corporation [CBC], 2025). This means that the loss of American public health data does not just affect the United States healthcare, it also affects Canada’s healthcare advancements, since Canada heavily relies on American health research to inform policies, strengthen healthcare interventions, and gain a better understanding of current diseases and infections. The United States has been a global health leader for a long time with investments in global health initiatives to combat Malaria, Ebola, HIV/AIDS to name a few (Fuster et al., 2017). The “America First” initiative that President Trump proposes fails to understand that global health research is not a charity, it is an investment in improving the health and quality of life for people in the United States, as well as the entire world (Fuster et al., 2017).
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Health research and health data are essential in the containment of infectious, genetic, and lifestyle diseases, in which health research requires appropriate funding and allocated resources to make progress in diagnosis and treatment for patients (Shrivastava, Shrivastava, & Ramasamy, 2017). Additionally, it is important that health data from ethnic and racial minorities are routinely collected and become standard medical practice to avoid rendering these groups as “invisible” in health research (Heyrana et al., 2023). Limiting research on vulnerable groups leads to generalization, exacerbates health inequities, and hinders the development of targeted interventions (Heyrana et al., 2023).

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​How Research and Data Address Social and Biological Factors
So how does health research and health data shape biological factors and address the social determinants of health? Research has shown that collecting social determinants of health data such as socioeconomic status can help predict health outcomes and create evidence-based interventions to target issues like malnutrition, neurocognitive development problems, and infant mortality (Kachmar et al., 2019). Not only does collection of health data impact biological health but researching variables like socioeconomic status can also help inform policy decisions to tackle systemic barriers in healthcare (Kachmar et al., 2019). Another example is that social determinants of health data can help implement new support programs for patients such as housing assistance, which research has shown to reduce depression and anxiety (Bambra et al., 2010; Feldman, Davlyatov, & Hall, 2020).
So what happens when life-saving public health data is suddenly erased, as is rapidly happening in the United States? Efforts made to address the social determinants of health and health disparities will be severely hindered, which can have devastating health and social consequences for vulnerable populations, especially since marginalized populations tend to have the most missing health data (Rose et al., 2023; Weiss & Waller, 2022).  
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Funding Cuts to Health Research
Unfortunately, the current cuts to American research are not new. Back in 2017, the Trump administration proposed a $5.8 billion cut to the National Institutes of Health (NIH), which Congress ultimately rejected (Cancer Discovery 2017; Katz & Wright, 2017). Experts warned that such cuts could have severely hindered efforts to develop immunotherapies and other life-saving treatments, potentially impacting patient outcomes (Cancer Discovery, 2017; Katz & Wright, 2017). Additionally, cuts made to lower drug prices in 2017 did not take drug research and patient access into account, with access to care being a social determinant of health (Dabbous et al., 2019). 

​What Can be Done About Missing Health Research and Data for Canada?
Fortunately, in Canada, we have one of the highest life expectancies in the world according to the Canadian Institutes of Health Research (CIHR), in which advancements to improve quality of life were achieved through strong investments in health research (Canadian Institutes of Health Research, 2023). However, this success is not guaranteed, and with recent challenges in the United States, Canada could also be at risk. Given that there is potential for disruptions to health research and loss of data due to the cuts, scientists and researchers must be innovative by creating frameworks and investing in Canadian research to advance public health efforts here in Canada. To put the idea of frameworks into perspective, a case study in India was done to help locals implement preventative health strategies to combat cervical cancer but were met with missing epidemiological data like HPV, sexual behaviour, and cervical cancer incidence which hindered the research progress (Man et al., 2023). So this prompted the researchers to develop a framework called “Footprinting” which uses the epidemiological data from other similar geographical zones in India and make educated evidence-based estimates for the missing local data (Man et al., 2023). Frameworks like this can help researchers in Canada overcome missing data by using data from similar populations, ensuring that evidence-based public health research can still be conducted despite data losses. Additionally, Canada must increase health research funding and avoid the cuts to public health workforce, especially in light of the current challenges in the United States (Hoffman et al., 2019; Weil, 2016). As of July 2025, The Canadian Medical Association Journal (CMAJ) proposes that “we can improve our own systems” by implementing better wastewater surveillance and electronic medical records for increased infectious disease monitoring and strengthening overall public health of the population (CBC, 2025; Charlebois & Pawa, 2025). The work that is done in health research extends beyond any political election cycle and is useful for tackling systematic health injustices (Hoffman et al., 2019). Investing in evidence-based clinical practices, hiring more staff per capita, and addressing current systematic inefficiencies will help strengthen Canada’s healthcare during this time of limited data and research (Guyon & Perreault, 2016; Weil, 2016). It is time for Canada to innovate, invest, and commit to evidence-based public health research because when the data disappears, lives are put at risk. 

Declaration: The outline for creating this blog used the ChatGPT AI tool with permission for the HLTH 5402 course. The actual blog was written fully by the author without AI use.

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Kachmar, A. G., Connolly, C. A., Wolf, S., & Curley, M. A. Q. (2019).
Socioeconomic status in pediatric health research: A scoping review. The Journal of Pediatrics, 213, 163–170. https://doi.org/10.1016/j.jpeds.2019.06.005

Katz, I. T., & Wright, A. A. (2017).
Scientific drought, golden eggs, and global leadership – Why Trump's NIH funding cuts would be a disaster. The New England Journal of Medicine, 376(18), 1701–1704.
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Man, I., Georges, D., Bonjour, M., & Baussano, I. (2023).
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Rose, C., Barber, R., Preiksaitis, C., Kim, I., Mishra, N., Kayser, K., Brown, I., & Gisondi, M. (2023).
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Weil, T. P. (2016).
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Weiss, P. S., & Waller, L. A. (2022).
The impact of nonrandom missingness in surveillance data for population-level summaries: Simulation study. JMIR Public Health and Surveillance, 8(9), e37887.
​https://doi.org/10.2196/37887