More than 10.2 million people are held in penal institutions around the world, with the United States having the highest prison population rate, mostly as pre-trial detainees/remand prisoners or sentenced prisoners. In most countries, a sizable proportion of prisoners belong to groups that face social, economic, or ethnic/racial discrimination in society.
The enjoyment of the highest attainable level of physical and mental health is a fundamental human right of all people, without exception. However, prisoners bear a disproportionate burden of health problems because their health needs are frequently ignored.
In this context, increased efforts are required to ensure a health promoting prison, which is described as having the following elements:
- health services are equivalent to what is provided in the country as a whole;
- the risks to health are reduced to a minimum; and
- that the dignity and human rights of every prisoner are respected.
Several international standards establish the level of health care that should be provided to prisoners. First and foremost, Article 12 of the International Covenant on Economic, Social, and Cultural Rights (United Nations, 1966) establishes “everyone’s right to the highest attainable standard of physical and mental health.” This applies to prisoners just as much as it does to everyone else. Those who are imprisoned retain their fundamental right to good health, both physical and mental, as well as the right to health care that is at least the same as that provided in the wider community.
According to WHO, people from the poorest and most marginalized sections of the population make up the majority of those serving prison sentences in all countries, and many of them have diseases such as tuberculosis, sexually transmitted infections, HIV/AIDS, and mental disorders. Tuberculosis infection rates among imprisoned populations are up to a hundred times higher than those found outside of prisons, and it is one of the leading causes of death among prisoners in many countries.
WHO strongly recommends that prison and public health care be closely linked. The Moscow Declaration on Prison Health as a Part of Public Health (WHO Regional Office for Europe, 2003) elaborated on some of the reasons why close working relationships with public health authorities are so important.
- Penitentiary populations contain an overrepresentation of members of the most marginalized groups in society, people with poor health and chronic untreated conditions, drug users, vulnerable people and those who engage in risky activities such as injecting drugs and commercial sex work.
- The movement of people who are already infected with or at high risk of disease to penitentiary institutions and back into civil society without effective treatment and follow-up increases the risk of communicable disease transmission both within and outside the penitentiary system. Responses to prevention and treatment must be based on scientific evidence and sound public health principles, with participation from the private sector, nongovernmental organizations, and the affected population.
- Most prisons around the world have unhealthy living conditions. Overcrowding, violence, a lack of light, fresh air, and clean water, bad food, and infection-spreading activities like tattooing are all common. Infection rates with tuberculosis, HIV, and hepatitis are significantly higher than in the general population.
Prisoners have general health needs similar to those found in the general population. The health promotion needs of prisoners: examples of assessment. Assessment of health needs lies at the heart of successful interventions and useful outcomes. Health needs can be assessed by examining the epidemiological evidence and talking to stakeholders (including physicians and other health care staff but, importantly, all other staff who influence prisoners, such as education staff, and also prisoners themselves).
All prisoners are likely to need:
- advice on preventing communicable diseases, including advice on avoiding sexually transmitted diseases, HIV infection and hepatitis, and advice on hepatitis B immunization;
- advice on high-risk lifestyles, including advice on avoiding drug overdose on leaving prison (needed by everyone because staff cannot identify everyone at risk); and protection against harm caused by smoking (including passive smoking);
- support in adopting healthy behavior, including appropriate levels of physical activity and a balanced diet; and
- Measures to promote mental health, including adequate time for association; a meaningful occupation (work, education, artistic activity and physical education); and contact with the outside world and help in maintaining family ties.
Mental health of prisoners
Factors in prisons contributing to poor mental health among prisoners which are listed by WHO and ICRC to include:
- Over crowding
- Various forms of violence
- Enforced solitude
- Lack of privacy
- Lack of meaningful activity
- Isolation from social networks
- Insecurity about future and
- Inadequate health services, especially mental health services.