There are two compelling reasons for providing health care in prisons. First is the importance of prison health to public health in general. Prison populations contain a high prevalence of people with serious and often life-threatening conditions.
Sooner or later most prisoners will return to the community, carrying back with them new diseases and untreated conditions that may pose a threat to community health and add to the burden of disease in the community. Thus there is a compelling interest on the part of society that this vulnerable group receive health protection and treatment for any ill health.
The second reason is society’s commitment to social justice. Healthy societies have a strong sense of fair play: those involved in the provision of health care are committed to reducing health inequalities as a significant contribution to health for all.
It is a fact that the majority of prisoners come from the poorest parts of society, with deficiencies in education and employment experience. Their admission to prison can be the first time they have had a settled life with adequate nutrition and a chance to reduce their vulnerability to ill health and social failure.
Prison health care can play an important role in reducing health inequalities.
All this underlines the need for governments to give a degree of priority to health in prisons. First, they should meet their duty of care for those deprived of their liberty.
Second, they should respect prisoners’ human rights, aid the protection of their health and contribute to public health as a whole, thus making a major contribution towards reducing health inequalities in a vulnerable part of the population while society awaits the effects of action on the broader social determinants of health.
It is not, however, easy to provide health care in prisons which by their nature are designed for safe custody and provided with regimes that have necessarily developed around questions of security.
Difficulties with isolation of services
One of the early and important lessons learned is that prison health services cannot be adequately provided in isolation from other health and social services. In 2003, WHO published, the Moscow Declaration, which called attention to the need for prison health services to be integrated or work closely with public health services.
Since then, the need to avoid professional isolation has been further developed as part of WHO’s work with health systems. It is now realized that prison health has important implications for health governance as a whole.
A modern prison health service takes as its working method the “health in all policies” approach, in which effective and systematic action for the improvement of health genuinely uses all available measures in all policy fields.