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Years of life lost to incarceration: inequities between Aboriginal and non-Aboriginal Canadians Owusu-Bempah, Akwasi; Kanters, Steve; Druyts, Eric; Toor, Kabirraaj; Muldoon, Katherine A; Farquhar, John W; Mills, Edward J Jun 11, 2014

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RESEARCH ARTICLE Open AccessYears of life lost to incarcenirctforment (OECD) countries with an incarceration rate of search identifies substantial racial differences in “years ofOwusu-Bempah et al. BMC Public Health 2014, 14:585http://www.biomedcentral.com/1471-2458/14/585Stanford, California 94305-5101, USAFull list of author information is available at the end of the article117 prisoners per 100,000 population [1]. The size ofCanada’s federal prison population has increased modestlyin the past decade. This increase, however, has not beenuniform across racial groups. The Canadian Aboriginalprison population has risen by almost 40%, while thenon-Aboriginal prison population has risen by just over2% [2]. For Aboriginal women the increase over this timelife lost to incarceration” in the United States. The ob-jective of the present analysis is to use similar methodsin a Canadian context by focusing on differences in yearsof life lost to incarceration for Aboriginal and non-Aboriginal peoples, where “years of life lost to incarcer-ation” is defined as the years spent incarcerated. Thisline of inquiry is more challenging in Canada with lim-ited access to correctional and demographic data that isdisaggregated by race.* Correspondence: edward.mills@uottawa.ca3Faculty of Health Sciences, University of Ottawa, 25 University Private,Ottawa, Ontario K1N 6 N5, Canada4Stanford Prevention Research Center, Stanford University, 291 Campus Drive,Organization for Economic Cooperation and Develop-Methods: Incarceration data from provincial databases were used conjointly with demographic data to estimaterates of incarceration and years of life lost to provincial incarceration in (BC) and federal incarceration, by Aboriginalstatus. We used the Sullivan method to estimate the years of life lost to incarceration.Results: Aboriginal males can expect to spend approximately 3.6 months in federal prison and within BC spend anaverage of 3.2 months in custody in the provincial penal system. Aboriginal Canadians on average spend moretime in custody than their non-Aboriginal counterparts. The ratio of the Aboriginal incarceration rate to thenon-Aboriginal incarceration rate ranged from a low of 4.28 in Newfoundland and Labrador to a high of 25.93 inSaskatchewan. Rates of incarceration at the provincial level were highest among Aboriginals in Manitoba with anestimated rate of 1377.6 individuals in prison per 100,000 population (95% confidence interval [CI]: 1311.8 – 1443.4).Conclusions: The results indicate substantial differences in life years lost to incarceration for Aboriginal versusnon-Aboriginal Canadians. In light of on-going prison expansion in Canada, future research and policy attentionshould be paid to the public health consequences of incarceration, particularly among Aboriginal Canadians.Keywords: Prison, Incarceration, Aboriginal, Public healthBackgroundCanada has a relatively low rate of incarceration comparedto its American neighbours. It ranks in the middle of theperiod was 85%, while the Aboriginal male prison popula-tion increased by 26% [2].Previous American research has examined the impact ofincarceration by race on life years [3]. Importantly, this re-between Aboriginal andCanadiansAkwasi Owusu-Bempah1, Steve Kanters2, Eric Druyts3, KabJohn W Farquhar4 and Edward J Mills3,4*AbstractBackground: Aboriginal representation in Canadian corredecade. We calculated “years of life lost to incarceration”© 2014 Owusu-Bempah et al.; licensee BioMedCreative Commons Attribution License (http:/distribution, and reproduction in any mediumration: inequitieson-Aboriginalraaj Toor2, Katherine A Muldoon2,ional institutions has increased rapidly over the pastAboriginal and non-Aboriginal Canadians.Central Ltd. This is an Open Access article distributed under the terms of the/creativecommons.org/licenses/by/2.0), which permits unrestricted use,, provided the original work is properly credited.Owusu-Bempah et al. BMC Public Health 2014, 14:585 Page 2 of 6http://www.biomedcentral.com/1471-2458/14/585MethodsWe first compared rates of incarceration betweenAboriginal and non-Aboriginal Canadians for both theprovincial and federal correctional systems in Canada.Second, we calculated the years of life lost to incarcerationfor these two population groups for the provincial prisonsystem in British Columbia (BC), and the Canada-widefederal correctional system. Years of life lost to incarcer-ation represents the number of years spent incarceratedand therefore lost to incarceration.Data sourcesCanada has a two-tiered correctional system. Offenderssentenced to two or more years are sent to the federalsystem, and offenders sentenced to less than two yearsor who are detained before trial are sent to the provincialsystem. Disaggregated incarceration data by Aboriginalstatus are not readily available (except for the BC provin-cial system), and so, we requested these data for the fed-eral system and all other provincial systems through thefederal Access to Information Act and provincial Free-dom of Information Acts [4]. These data make use ofthe Employment Equity Act (1995) definition of Aboriginalstatus, which is inclusive of Métis [5].Table 1 provides a summary of all data elements usedin the analyses, their sources, dates of retrieval, and theiranalytical use. Incarceration data were provided to us asadmissions (the total number of persons admitted tocustody in a given year) and/or one-day counts (the totalnumber of persons in custody on an exact date). The typeof data we received was at the discretion of the data pro-vider. One-day counts were available for Newfoundlandand Labrador, Ontario, Manitoba, Saskatchewan, Alberta,the Yukon and Nunavut. (Note that data provided byPrince Edward Island, Nova Scotia, New Brunswick,Quebec, and Northwest Territories did not includeone-day counts, and were therefore excluded from thepresent analyses.) One-day count data for BC were ob-tained directly from the BC Justice publicly availabledatabase [6].Although one-day count data for the federal systemwere obtained from the Correctional Service of Canada(CSC) through the Access to Information Act, these datawere not disaggregated by sex and age. We thereforemade use of additional data from the Public SafetyCanada’s 2012 annual report [7] to construct age- andsex-specific distributions by Aboriginal status.Additional demographic data needed to performour analysis were acquired through Statistics Canada.Aboriginal and non-Aboriginal population sizes for eachprovince were obtained from the 2011 National House-hold Survey and used as the population denominator[8]. Probability of survival to various ages according torace and sex were obtained from the 2007–2009 lifetables and CANSIM (Canadian socio-economic infor-mation management system) table 109–5402 [9,10].Data analysesThe available one-day count data were used conjointlywith the population estimates to calculate rates of incar-ceration by Aboriginal status for the provincial and fed-eral systems. These rates of incarceration werecalculated for the entire adult population aged 18 yearsand older. Rates of incarceration were calculated by div-iding the one-day counts by the adult population, andthen multiplying by 100,000. The corresponding 95%confidence intervals (CI) were constructed using z-intervals for proportions.The one-day counts, population estimates, and prob-ability of survival data were used to calculate the yearsof life lost to incarceration using the Sullivan method[11]. The Sullivan method lends itself well to situationssuch as this one, where mortality and a specific condi-tion (in our case, incarceration) are collected separately.The years of life lost to incarceration calculations wereonly completed for the BC system and the federal systembecause age- and sex-specific distributions of incarcer-ation were obtainable for these datasets.An abridged Sullivan’s life table was used with 5-yearage categories. The only exception was a 2-year categoryfor ages 18–19 years. For each age category, the age-specific incarceration prevalence was used to adjust theperson-years of the age category – obtained using thelength of each age category, the number of people in theage group, and the probability of survival prior to theage category of interest. In this fashion, the total numberof years spent in custody and the total number of yearslived out of custody were separated within the totalnumber of life years. Summing these across age groupsfor each sex and each race provided prison-free life ex-pectancies, imprisoned life expectancies and overall lifeexpectancies. Our calculations were restricted to thoseaged 18–55 years in BC and 18–65 years in Canada.This difference in age spans between the BC provincialanalysis and the Canada-wide federal analysis is duedata availability. Rate ratios (RR) were used to compareAboriginal to non-Aboriginal Canadians.ResultsTable 2 presents rates of incarceration for those aged18 years and older in 2011 by Aboriginal status for provin-cial prison systems in Newfoundland/Labrador, Ontario,Manitoba, Saskatchewan, Alberta, BC, Yukon and Nunavut,and for the Canadian federal correctional system. The pro-vincial incarceration RR comparing Aboriginal to non-Aboriginal Canadians varied from 4.28 per 100,000 popula-tion in Newfoundland and Labrador to 25.93 per 100,000population in Saskatchewan. Rates of incarceration in theeratovOwusu-Bempah et al. BMC Public Health 2014, 14:585 Page 3 of 6http://www.biomedcentral.com/1471-2458/14/585Table 1 Components and data sources for incarceration ratComponent Analytical useInstitutional DataNewfoundland one-day counts Estimate rates of incarcePrince Edward Island No data availableNova Scotia annual admission counts Data provided by this prprovincial systems were highest among Aboriginals inManitoba, with an estimated rate of 1,377.6 individualsin custody per 100,000 population (95% CI: 1,311.8 –1,443.4). Non-Aboriginals in the Newfoundland provincialsystem had the lowest overall rate (47.3 [95% CI: 41.9 –52.6] persons per 100,000 population). The provincialprison system in the territory of Nunavut had a lowerestimated rate than Newfoundland, but is based on asample size of 1. Rates of incarceration among Aborigi-nals in the Manitoba, Saskatchewan, Alberta and Yukoncompatible with analytic mNew Brunswick annual admission counts Data provided by this provcompatible with analytic mQuebec annual admission counts Data provided by this provcompatible with analytic mOntario one-day counts Estimate rates of incarceratManitoba one-day counts Estimate rates of incarceratSaskatchewan one-day counts Estimate rates of incarceratAlberta one-day counts Estimate rates of incarceratBritish Columbia one-day counts Estimate YLLP (NxPix) and rincarcerationYukon one-day counts Estimate rates of incarceratNunavut one-day counts Estimate rates of incarceratNorthwest Territories annual admission counts Data provided by this provcompatible with analytic mCanada one-day counts Estimate YLLP (NxPix) and rincarcerationSex distribution among federally imprisonedAboriginals and non-AboriginalsEstimate YLLP (NxPix)Age distribution among federally imprisonedAboriginals and non-AboriginalsEstimate YLLP (NxPix)Demographic Data2007-2009 Life tables for total Canadianpopulation disaggregated by provinceand sexTo obtain lx in using the Sumethod to estimate YLLPProbability of survival by age and sexfor aboriginalsTo obtain lx in using the Sumethod to estimate YLLPDemographics by age, sex andAboriginal statusTo obtain Nx in using the Smethod to estimate YLLP aestimate ratesNote: 1) YLLP, years of life lost to prison; 2) NxPix, number of individuals with disabisurviving to the age at beginning of the age category; 5) No data was provided byQuebec, and Northwest Territories did not include one-day counts, and were therefand years of life lost to incarceration analysesSourceion Newfoundland and Labrador Department of Justice;Received September 26, 2011Prince Edward Island Department of Justice andPublic Safety; Received September 12, 2011ince was not Nova Scotia Department of Justice;provincial systems were all above 800 persons in custodyper 100,000 population.Table 3 shows life years lost to incarceration by Aboriginalstatus and sex for the provincial system in BC andwithin the federal correctional system throughout Canada.Non-Aboriginal females spent the least amount of time incustody with an average of 0.005 years (1.8 days) in BCprisons and 0.002 years (0.7 days) in federal penitentiaries.On average, Aboriginal males spent 3.75 times longer inprovincial custody than non-Aboriginal males in BC andethods September 15, 2011ince was notethodsNew Brunswick Department of Public SafetyCommunity and Correctional services;Received September 13, 2011ince was notethodsMinistre de la Securite Publique Quebec;September 8, 2011ion Ministry of Community Safety and Correctional Services;Received December 14, 2011ion Manitoba Justice; Received September 19, 2011ion Ministry of Corrections, Public Safety and Policing;Received on August 24, 2011ion Alberta Solicitor General and Public Security;Received on September 13, 2011ates of JusticeBC Dashboards – Corrections Adults Custody.Retrieved for April 1, 2011ion Department of Justice; Received on September 8, 2011ion Department of Justice; Received on September 19, 2011ince was notethodsNorthwest Territories Justice; Received September 16,2011ates of Correctional Service Canada; Received on October 25,2011Public Safety Canada. 2012 Annual Report: Corrections andConditional Release, Statistical Overview. 2011 results used.Public Safety Canada. 2012 Annual Report: Corrections andConditional Release, Statistical Overview. 2011 results used.llivan Statistics Canada. Annual Demographic Estimates: Canada,Provinces and Territories. Catalogue no. 91-215-Xllivan Statistic Canada: Table 109–5402 Probability of survival atvarious ages, by population group and sex, Canadaullivannd toStatistics Canada. 2011 National Household Survey.Catalogue Number: 99-011-X2011027lity (incarceration); 3) Nx, number of persons in population; 4) lx, probability ofPrince Edward Island 6) Data provided by Nova Scotia, New Brunswick,ore excluded from the present analyses.Table 2 Rates of incarceration (per 100,000 population) for adAboriginalRate of incarceration (95% CI) Total adultpopulationProvincial penal systemsNewfoundland/Labrador 202.2 (147.3-257.1) 25713Prince Edward Island NA 1,484Nova Scotia NA 23,735New Brunswick NA 15,588Quebec NA 101,096Ontario 468.1 (438.9-497.3) 210,426Manitoba 1377.6 (1311.8-1443.4) 120,645Saskatchewan 1260.1 (1188.7-1331.6) 93,643Alberta 800.3 (753.7-846.9) 140,320British Columbia 305.1 (277.9-332.3) 157,669Yukon 1285.6 (984.4-1587.3) 5,366Nunavut 639.5 (514.5-764.4) 15,638Northwest Territories NA 13,831Canada federal penal systemOwusu-Bempah et al. BMC Public Health 2014, 14:585 Page 4 of 6http://www.biomedcentral.com/1471-2458/14/5856.18 times longer in federal custody. Aboriginal malesspend an average of 3.6 months incarcerated in the federalCanada 330.4 (318.7 342.1) 925,146Note: CI, confidence interval; NA: not applicable due to unavailable data.*Only one incarceration reported.system and within BC spend an average of 3.2 months in-carcerated in the provincial prison system. Aboriginal fe-males spend on average 6.4 times longer incarcerated inTable 3 Years of life lost to incarcerationLifeexpectancy(in years)Non-prisoncomponent(in years)Prisoncomponent(in years)British Columbia provincial penal systemMaleAboriginal 72.03 71.76 0.270Non-Aboriginal 79.80 79.73 0.072FemaleAboriginal 76.30 76.27 0.032Non-Aboriginal 84.03 84.03 0.005Canada federal penal systemMaleAboriginal 72.03 71.72 0.303Non-Aboriginal 79.80 79.75 0.049MaleAboriginal 76.30 76.28 0.018Non-Aboriginal 83.42 83.42 0.002Note: 1) All standard errors below 0.013; 2) Calculations were restricted tothose aged 18–55 years in BC and 18–65 years in Canada. This difference inage spans between the BC provincial analysis and the Canada-wide federalanalysis is due data availability.the provincial prison system within BC and 9 times longerin the federal system across Canada than non-Aboriginalults aged 18 years or olderNon-Aboriginal Rate ratio(95% CI)Rate of incarceration (95% CI) Total adultpopulation47.3 (41.9-52.6) 637,064 4.28 (4.09-4.48)NA 106,952 N/ANA 710,122 NANA 579,480 NANA 6,080,120 NA75.4 (73.7-77.2) 9,749,071 6.23 (6.22-6.25)75.1 (69.0-81.2) 775,341 18.59 (18.50-18.67)49.2 (43.9-54.5) 676,566 25.93 (25.73-26.13)67.7 (64.5-70.9) 2,607,172 11.91 (11.87-11.94)67.3 (64.5-70.0) 3,325,281 4.54 (4.52-4.57)67.3(32.1-102.6) 20,789 19.34 (15.80-23.67)NA* 3,793 24.37 (N/A)NA 15,945 NA44.6 (43.8 45.4) 25,038,216 7.43 (7.42-7.44)females. Aboriginal males can expect to spend 3.8 and 6.2times longer in custody than non-Aboriginal males withinthe provincial and federal systems, respectively.Discussion and conclusionsThis analysis indicates that an Aboriginal Canadian canexpect to lose considerably more life-years to incarcer-ation than a non-Aboriginal Canadian. Our analysis fur-ther indicates that Aboriginals are over-represented asinmates in federal and provincial correctional institu-tions. At the federal level, Aboriginals lose six times asmany life years to incarceration than non-Aboriginals.Within the province of BC, Aboriginal Canadians loseapproximately four times as many life years to incarcer-ation as non-Aboriginal-Canadians. These relative differ-ences are more pronounced in women than men, butthe absolute differences remain larger among men.There is a growing body of evidence establishing theserious negative health consequences associated with in-carceration [12-14]. The health risks associated with in-carceration include physical and sexual violence, sexwithout condoms, and the sharing of needles, contribut-ing to the transmission of communicable diseases[15-17]. Signaled clearly by the recent assent of the SafeStreets and Communities Act (Bill C-10), which amongother provisions, increases mandatory minimum sen-tences for marijuana offences, the Canadian GovernmentOwusu-Bempah et al. BMC Public Health 2014, 14:585 Page 5 of 6http://www.biomedcentral.com/1471-2458/14/585is introducing harsher laws and increasing the use of in-carceration in Canada. We believe that it is critical to con-sider the serious health consequences associated with theuse of incarceration as a means of punishment. This isparticularly true for Aboriginal Canadians, a group alreadyprovided special consideration in criminal justice mattersas a result of their historical disadvantage. Population esti-mates predict that the Aboriginal population aged 20-29in Canada will grow by 40% by 2017 [18]. This is troublingbecause this age group contains the greatest proportion ofAboriginal offenders; Aboriginals therefore stand to bedisproportionately impacted by Bill C-10 [19].Aside from the quantifiable losses associated with incar-ceration there are a variety of societal impacts. These in-clude, but are not limited to, increased aggression andbehavioral problems in the children of those incarcerated,effects on the family structure, limits on future economicopportunities, and reduced community safety [20-24].From this we can infer that the disproportionate levelsof Aboriginal incarceration do not only have adversehealth consequences, but many negative social conse-quences as well.Aboriginal over-representation in the correctional popu-lation is highest in provincial institutions in Manitoba andSaskatchewan at rates of 1,377.6 and 1,260.1 per 100,000population, respectively. However, due to limited data, ouranalysis could only focus on the province of BC, whereAboriginals are incarcerated at a rate of 305.1 per 100,000population. Therefore, this provides a conservative esti-mate of life-years lost to provincial incarceration amongstAboriginal Canadians. The Sullivan method was usedbecause it is the most applicable method when usingprevalence data. However, if more extensive data wereavailable, better methods, that reflect transitions in andout of prison, could be used to estimate life years lost toincarceration with more precision and less bias. Thefederal data, contrary to the BC provincial data, did notdifferentiate the age distribution between sexes withineach racial group. This may introduce minimal bias asmales make up 96% of federal inmates. Finally, the preva-lence was estimated using one-day counts that may differthroughout the year. This extra source of variability is cap-tured in the construction of the confidence intervals, butshould be interpreted with some degree of caution.This study presents a unique approach to examiningAboriginal people’s experiences with incarceration inCanada. Previous research has focused on Aboriginal rep-resentation within Canadian prison systems as well asrates of incarceration compared to other racial groups[25,26]. To the best of our knowledge, this is the firststudy to estimate the impact of over-incarceration amongAboriginal Canadians throughout an individual’s lifetime.Furthermore, by framing Aboriginal over-incarceration asa public health issue this analysis aims to bring newempirical evidence and renewed attention to a persistingCanadian problem.The Canadian Federal Correctional Investigator recentlycriticized the Correctional Service of Canada for making lit-tle progress in closing the gaps in adverse prison outcomesbetween Aboriginal and non-Aboriginal offenders [27].There is a clear need to examine the over-representationof Aboriginals at all stages of criminal justice processing,from the police, through the courts to the correctionalsystems. However, as this analysis clearly illustrated, thereis a critical need for better, more extensive data on thematter to inform evidence-based policy.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsAll authors took part in the study design, the analysis, and the interpretationof the data. Data were acquired by AO-B. The first draft of the manuscriptwas written by AO-B, and was critically revised for important intellectualcontent by all authors. The study guarantor is EM. All authors approved thefinal manuscript for publication.AcknowledgementsThis work was supported by a catalyst grant from the Canadian Institutes ofHealth Research (FRN 116392). We would like to acknowledge the expertiseand insights provided to us by Robert Hogg and Larry Nicholson.Author details1Centre of Criminology and Sociolegal Studies, University of Toronto, 14Queen’s Park Crescent West, Toronto M5S 3 K9 Ontario, Canada. 2School ofPopulation and Public Health, The University of British Columbia, 2206 EastMall, Vancouver, British Columbia V6T 1Z3, Canada. 3Faculty of HealthSciences, University of Ottawa, 25 University Private, Ottawa, Ontario K1N6 N5, Canada. 4Stanford Prevention Research Center, Stanford University, 291Campus Drive, Stanford, California 94305-5101, USA.Received: 30 September 2013 Accepted: 5 June 2014Published: 11 June 2014References1. Dauvergne M: Adult Correctional Statistics in Canada, 2010/2011. InStatistics Canada Catalogue no 85-002-X. Ontario, Ottawa; 2012. http://www.statcan.gc.ca/pub/85-002-x/2012001/article/11715-eng.pdf.2. 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AIDS Educ Prev 2002,14(5 Suppl B):53–64.16. Macalino GE, Vlahov D, Sanford-Colby S, Patel S, Sabin K, Salas C, Rich JD:Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virusinfections among males in Rhode Island prisons. Am J Public Health 2004,94(7):1218–1223.17. Wohl DA, Rosen D, Kaplan AH: HIV and incarceration: dual epidemics.AIDS Read 2006, 16(5):247–250. 257–260.18. Statistics Canada: Projections of the Aboriginal Populations, Canada,Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionOwusu-Bempah et al. BMC Public Health 2014, 14:585 Page 6 of 6http://www.biomedcentral.com/1471-2458/14/585Provinces and Territories 2001 to 2017. In Edited by Canada S. 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Psychol Bull 2012,138(2):175–210.24. Clear T: The Problem with ’Addition by Subtraction’: The Prison-CrimeRelationship in Low-Income Communities. In Invisible Punishment: TheCollateral Consequences of Mass Imprisonment. New York, NY: The New YorkPress; 2002:181–194.25. Wortley S, Owusu-Bempah A: Race, Ethnicity, Crime and Criminal Justicein Canada. In Race, Ethnicity, Crime and Criminal Justice in the Americas.New York: Palgrave Macmillan; 2012.26. Perrault S: The incarceration of Aboriginal people in adult correctionalservices. Juristat 2009, 29(3):9.27. Canadian Broadcasting Corporation (CBC): Aboriginal Corrections ReportFinds ’Systemic Discrimination. In Canada: Canadian BroadcastingCorporation (CBC); 2013. http://www.cbc.ca/news/politics/aboriginal-corrections-report-finds-systemic-discrimination-1.1338498.doi:10.1186/1471-2458-14-585Cite this article as: Owusu-Bempah et al.: Years of life lost toincarceration: inequities between Aboriginal and non-AboriginalCanadians. BMC Public Health 2014 14:585.Submit your manuscript at www.biomedcentral.com/submit


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