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Indigenous people are incarcerated at a much higher rate in Canada than the general population.1 It is well known that incarceration is a negative determinant of health.2 For Indigenous Peoples, the legacy of colonialism and ongoing systemic racism, including in the Canadian justice system,3 has both immediate and far-reaching negative health impacts, and contributes to health inequities between Indigenous and nonIndigenous Peoples. The overincarceration of Indigenous people leads to an inequitable distribution of the health harms of incarceration, as well as an enormous burden of years of life lost attributable to incarceration for Indigenous Peoples.
Indigenous men lose 4-6 times more years of life to incarceration than non-Indigenous men, and Indigenous women lose 6-9 times more years of life than non-Indigenous women, across both the federal penitentiary and British Columbia provincial jail systems.1 However, Indigenous people in some provinces and territories likely have a much higher ratio of life lost to incarceration compared with non-Indigenous Canadians than those reported above. For example, in Manitoba, Indigenous adults are incarcerated 18 times more often than non-Indigenous adults, compared with a rate ratio of 4.5 in British Columbia, which suggests the ratio of years of life lost to incarceration in Manitoba is higher, perhaps much higher, than in British Columbia.1 This should not be viewed as fair punishment, as many rigorous reports over decades have shown that the inequitable incarceration rates are a result of the effects of colonialism and systemic racism.3,4
To illustrate the effect of this social determinant, it is helpful to compare years of life lost to incarceration with years of life lost to premature death from common diseases. Although being incarcerated is not the same as dying prematurely, liberty is of such fundamental importance that it is protected by section 7 of the Canadian Charter of Rights and Freedoms, in the same section as life and security of person. Indigenous men lose years of life to incarceration at a rate of 76 times years of life lost to cancer for First Nations men; 53 times years of life lost to heart disease and stroke; and 9 times years of life lost to injuries.5 Indigenous women spend less time incarcerated than Indigenous men, but they also lose many more years to incarceration than to common...