Implicit Bias and Health Disparities in the Incarcerated Population: A Review With a Focus on Neurological Care and the Canadian Perspective

Abstract

Implicit bias held by health care providers can adversely affect the care provided to vulnerable populations and contribute to existing healthcare inequities. Few reports exist on the health of incarcerated individuals. We herein aimed to report how implicit bias affects the care of incarcerated and detained individuals, especially for those experiencing neurological diseases. We frame our review by providing an overview of the organization of the Canadian correctional system and of its population. We highlight the flagrant overrepresentation of Indigenous people and racialized groups in Canadian prisons, which is germane to the healthcare in this population, particularly when viewed through the lens of intersectionality. We also discuss health disparities between incarcerated individuals and the general population, whether it be in terms of neurological, psychiatric, or infectious diseases. Factors other than implicit bias found to affect medical care for these individuals include the perception of safety issues for both healthcare providers and patients in hospital and clinic settings, as well as resource limitations, confounding psychiatric comorbidities and non-organic disorders, and systemic barriers to adequate followup in this population. Using illustrative cases from our institution's experience, paired with findings from our review of the literature, we demonstrate that incarcerated or detained individuals represent a vulnerable group disadvantaged through a series of inequitable policies and actions, which put this group at higher risk of poor general and neurological health. Data specific to neurological diseases in this population are lacking, especially pertaining to long-term healthcare experiences and outcomes. In addition to highlighting literature gaps in this population, we propose ways in which barriers to care can be addressed, such as the development of multidisciplinary care teams to facilitate care and follow-up in these populations. Healthcare providers should make use of opportunities presented to diagnose and treat diseases in this population. Follow-up by specializing nursing and physician teams, as well as care during incarceration by medical and rehabilitation team members including occupational and physiotherapists may help build bridges between healthcare and carceral institutions. Education to raise awareness of implicit bias and mitigation strategies amongst health care providers is another way in which care provided to incarcerated individuals can be improved.

Establishing Orthopaedic Standards of Care for Incarcerated Patients

“…Justice in the medical context is defined as fair, equitable, and appropriate treatment of persons, in this case regardless of their legal status 14 . This principle requires that health-care providers do not let biases or preconceptions about incarcerated patients, who are often stereotyped as unreliable, dangerous, or manipulative, impact their decision-making or care 16,17 . Justice demands that the care provided to patients is not influenced by their legal standing, whether they have been charged with, convicted of, or are innocent of a crime 18 .…”

Health Equity in Neurosciences

“…The article by Veilleux and colleagues is a review focused on neurological care of people while they are incarcerated [4]. This highlights an area where there are likely to be many opportunities to improve health care, and on which there is a paucity of awareness and available literature.…”