Abstract
According to the latest data, in 2018 about 590,000 people were held in prison on any given day in the EU, and more than double in the entire region. People in prison face multiple and complex health care issues, including a higher prevalence of communicable diseases than the general population. These are likely to be the result of a combination of overlapping, and sometimes interlinked, risk factors for infection, ill-health, and incarceration, such as problem drug use. Incarceration may facilitate the offer of quality health care services to people who are otherwise hard to reach and provide an occasion to target socially deprived groups who often have low level of healthcare access when in the community. Delivering health protection and harm reduction programmes in prisons not only benefits the prison population but also has the potential to reduce the risk of transmission of some infectious diseases in the community, intervening earlier in the natural history of disease. They are also likely also to have a knock-on effect in supporting individuals’ reintegration into community life and future health - providing a ‘community dividend’ to health interventions in prisons. Yet, such health gains may be diminished by suboptimal integration with community services. Continuity of care, or throughcare, between prison and community services is a mainstay of any health care interventions delivered in detention, especially when tackling chronic conditions (e.g. HIV, mental illnesses) or problem drug use.
The World Health Organization (WHO) has long supported the concept of prison health as an inseparable component of public health. This view is enshrined by the principle of Equivalence of Care between prison and community, endorsed by the United Nations in the Nelson Mandela Rules. During the 2019 WHO Prison Health Conference in Helsinki, it was acknowledged that prisons contribute to achieving the UN’s Sustainable Development Goals through improving health, reducing health inequalities and provide a fairer and safer society for all. However, a number of challenges hampers the successful implementation of such a concept, including the need for evidence-based decision making, inter-sectoral partnerships and adequate monitoring systems.
This workshop will provide attendees with a comprehensive overview of prison health and the relevance of a multi-sectorial public health approach to frame and address it. The workshop will be structured around three main topics: governance of prison health and current models in Europe; health issues and disease burden in the prison population; current and future perspectives for evidence-based approaches to prison health. The discussion of two case studies, problem drug use and HCV micro-elimination, will create the context for an in-depth analysis of key challenges for prison health implementation, reflecting on aspects such as health needs, equity, multidisciplinarity, continuity of care, monitoring and community dividend.
Key messages
Provide a comprehensive picture of the main challenges of prison health in Europe, the public health issues affecting the prison population and how these relate to community public health systems. Reflect on how public health systems need to incorporate prison health into their strategies for reducing inequalities and improving health outcomes of vulnerable and socially deprived populations.
Problem drug use the public health imperative: what some of the literature says