The public health importance of imprisonment is insufficiently recognized. This is despite the high numbers held in prisons in many parts of the world, the characteristics of prison populations and the disproportionate numbers of prisoners with serious health problems. Worldwide, around 10 million people are held in penal institutions. (1) Almost half of the world prison population is imprisoned in three countries: China, the Russian Federation and the United States of America (USA), even though their total populations amount to only one quarter of the world population. If one looks at imprisonment rates, the number of prisoners per 100 000 population, considerable variation occurs between countries and regions. While nearly three fifths of countries have rates less than 150 prisoners per 100 000 and the median rate for the world as a whole is 145 per 100 000, the rate range is from 756 per 100000 in the USA to 35 per 100000 in the western part of Africa. (1)
In recent decades, there has been a marked rise in the numbers of prisoners in many countries. Prison populations have risen in 71% of the countries listed in the World Prison Population List.(1) In the USA, the total number has risen from 450 000 in 1978 to more than 2 million by 2005 and in the United Kingdom of Great Britain and Northern Ireland, the prison population has doubled since 1990. (2) The rise in prison populations has in many countries resulted in considerable overcrowding. The reasons for the increase in the number of prisoners in developed countries are only partly explained by variations in rates of crime. The main reasons are stricter sentencing policies; despite the introduction, at the same time, of new restorative justice approaches.
Prison health is an inevitable part of public health; there is an intensive interaction between prisons and society. (3) Addressing health in prisons is essential in any public health initiative that aims to improve overall public health. The World Health Organization (WHO) Regional Office for Europe has specifically acknowledged this by its Health in Prisons Project since 1995,4 supporting Member States in improving public health by addressing health care in prisons and facilitating links between prison health and public health.
Prisoners do not represent a homogeneous segment of society. Many have lived at the margins of society, are poorly educated and come from socioeconomically disadvantaged groups. They often have unhealthy lifestyles and addictions such as alcoholism, smoking and drug use, which contribute to poor general health and put them at risk of disease. The prevalence of mental health problems is very high: some prisoners are seriously mentally ill and should be in a psychiatric facility, not prison. Moreover, communicable diseases such as HIV, hepatitis and tuberculosis are more prevalent in prisons than in the community. (4) Many prisoners have had no contact, or very limited contact, with health services in the community before they were detained in prison. Access to, as well as quality of, health services in prison is of vital importance.
Most prisoners return to the community, sometimes after relatively short periods of time in prison. The high numbers imprisoned, their vulnerability and the prevalence of serious health conditions create a situation requiring attention. Moore & Elkavich state that public health is a discipline in a prime position to call attention to these issues, to design programmes to assist prisoners and their families and to influence the social environment so as to "change the political climate and social policy surrounding who's using and who's doing time" (5)
A close look at the needs of women in prison and related health aspects raised issues of gender inequity and insensitivity, of human rights neglect and showed a general lack of public health concern. A full report about the specific health problems and needs of women prisoners is available. …