Health Without Barriers
European Federation for Prison Health
For decades, the world’s prison population has experienced a constant increase, with an average growth of 25-30% during the last fifteen years. At present, about 2 million people are detained in European prisons. But if we consider the high turnover of inmates, about 6 millions of them get imprisoned every year in European penitentiaries.
In many Countries, the number of inmates has largely overtaken the capacity system of their prisons, creating overcrowding and several collateral effects (spread and increase of infectious diseases and STD, number of inmates in each prison cell exceeding the official capacity, lack of psycho-physical welfare and minimum standards hygienic conditions, etc.)
The impossibility of guarantying the respect of human rights is a fundamental issue affecting European prisons. It is determined by several, interconnected reasons:
Overuse of arrest and imprisonment (in some cases house arrest could be an alternative to reduce overcrowding);
Poor structural conditions: overcrowding, malnutrition, lack of ventilation and hygiene;
Poor prison management: violence and abuses, gathering of gangs, corruption;
Low access to health care: absence of prevention, lack of treatment, weak or nonexistent linkages with public health services and NGOs, lack of the necessary medical equipment/structures;
Low access to screening test for transmittable diseases;
Stigma and general discrimination of inmates, and particular categories(homosexuals, drug addicted etc.);
Denial and general lack of interest for the current situation affecting prisons.
The persistency of high-risk behaviors inside prisons results generally at high level:
Unprotected sexual relations
Injection of drug in the absence of sterile needles and syringes
Tattoing, piercing, scarification, brother blood sharing rituals
Sharing other items of injection and common use (razors, toothbrushes, spoons, water etc.)
In this context, prison can often become a container of a variety of diseases, like:
Mental health issues
Sexually transmitted diseases
HBV, HCV, HIV
Some high-risk behaviors are also bound to addictions (smoke, alcohol, drugs) ,and are widespread among inmates, causing often themselves the raising of the disease.
Suicide is the last way to escape from a reality of deep discomfort, in which prisoners are forced. The suicide rate in Europe varies from 0 to 30 each 10.000 inmates, with an average of 6/10.000.
Prisons take people from diverse settings who would not otherwise meet, creating the opportunity to spread bloodborne viruses among them, and then sending them back to their original social networks as potential sources of infection.
The infection risk results higher during imprisonment: HIV, HBV, HCV and TB rates are significantly higher among inmates, in comparison with the general population. Mental issues are also more relevant in prisons, and there is a high risk connected with cardiovascular illnesses.
Entry in prison can be seen under any perspective as a deprivation of personal freedom. Nevertheless, for many marginalized individuals (alcoholics, drug addicted, illegal immigrants etc.), this critical moment in life could represent also a unique opportunity to diagnose and treat silent diseases associated with their condition.
Epidemiological data are very difficult to collect therefore, areas of intervention are not easy to be planned and identified. In many Countries there is a lack of human and economical resources: a qualified prison health staff is scarce or barely existing, and the standard quality of prison health services is often inferior than the public health system.
These issues, together with the need to organize epidemiological monitoring units at national/international level, are the main reasons leading to the idea of creating an European network of scientific societies actively involved in prison health.
At present, in most European Countries, the Ministries of Justice or Interior are responsible for health in prison. Recently, in some of these Countries reforms have been implemented, which transfer this responsibility to the Ministry of Health, namely: France, Italy, Norway, Sweden and UK (some Cantons in Switzerland and two regions in Spain have adopted similar reforms). The increasing attention towards prison health issues observed in the last years and this gradual shift of responsibility, created the ideal conditions in which HWBs, the European Federation for Prison Health, could be established and move forward.