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Abstract
BackgroundThe increase in problematic substance use is a major problem in Canada and elsewhere, placing a heavy burden on health and justice system resources given a spike in drug-related offences. Thus, achievement of Sustainable Development Goal (SDG) Target 3.5 to ‘Strengthen the prevention and treatment of substance abuse’ is important for Canada’s overall realization of the SDGs, including SDG 3 (Good Health and Wellbeing). Since 2008, Vancouver’s Downtown Community Court (DCC) has pioneered an innovative partnership among the justice, health and social service systems to address individuals’ needs and circumstances leading to criminal behaviour. While researchers have examined the DCC’s impact on reducing recidivism, with Canada’s SDG health commitments in mind, we set out to examine the ways health and the social determinants of health (SDH) are engaged and framed externally with regard to DCC functioning, as well as internally by DCC actors. We employed a multi-pronged approach analyzing (1) publicly available DCC documents, (2) print media coverage, and (3) health-related discourse and references in DCC hearings.ResultsThe documentary analysis showed that health and the SDH are framed by the DCC as instrumental for reducing drug-related offences and improving public safety. The observation data indicate that judges use health and SDH in providing context, understanding triggers for offences and offering rationale for sentencing and management plans that connect individuals to healthcare, social and cultural services.ConclusionsOur study contributes new insights on the effectiveness of the DCC as a means to integrate justice, health and social services for improved health and community safety. The development of such community court interventions, and their impact on health and the SDH, should be reported on by Canada and other countries as a key contribution to SDG 3 achievement, as well as the fulfillment of other targets under the SDG framework that contain the SDH. Consideration should be given by Canada as to how to capture and integrate the important data generated by the DCC and other problem-solving courts into SDG reporting metrics. Certainly, the DCC advances the SDGs’ underlying Leave No One Behind principle in a high-income country context.
Highlights
This paper examines how the Downtown Community Court (DCC) in Vancouver addresses the health needs and realizes the full human potential of individuals, as proscribed under the Sustainable Development Goals (SDGs) agenda, of a local and marginalized segment of the Canadian population [1]
We submit that the development of such community court interventions, and their substantive impact, should be reported on by Canada and other countries as an important contribution to national achievement of Sustainable Development Goal (SDG) 3 (Good Health and Well-Being), SDG targets 3.4 and 3.5, as well as other cross-cutting targets under the broader SDG framework that coalesce with the social determinants of health (SDH) and systems strengthening (Table 1)
Using the DCC as a case study, the objective of our analysis is to examine the ways in which health and the SDH are addressed by a purpose-built court that implicitly aims to tackle the underlying SDH that lead to or are consequences of criminal offences fueled by addiction, poverty, mental illness, poor health, insecure housing, discrimination and rights abuses, as well as fractured social and familial networks
Summary
This paper examines how the Downtown Community Court (DCC) in Vancouver addresses the health needs and realizes the full human potential of individuals, as proscribed under the Sustainable Development Goals (SDGs) agenda, of a local and marginalized segment of the Canadian population [1]. We designed a study that consists of three inter-related research components: 1) documentary analysis of all publicly-available DCC reports and newsletters; 2) observational analysis of the court and how health and the SDH are addressed in practice; and a 3) print media analysis with a focus on how media addresses the DCC’s impact on client health and the SDH Together, these methods allow us to gain deeper insight into how the DCC’s design and daily operation intersect with and could inform Canada’s SDG agenda and, SDG 3 achievement. In the early to mid-2000s, Vancouver was hit hard by overdose fatalities [22], with a particular growth in overdoses from opioids such as methadone, morphine, codeine and oxycodone The effects of this problematic substance use increase were experienced most strongly in Vancouver’s Downtown Eastside where overdoses were concentrated, and where drug use was linked to communicable disease transmission and criminal activity, both placing heavy burdens on communities and government resources [23]. Vancouver’s criminal justice system struggled to manage a co-occurring increase in drugrelated crime [25]
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