Drugs and drug-related harms continue to challenge prison systems in Europe and interventions in this setting must be driven by evidence gathered through monitoring, data-collection and research. The remarks come in conclusions published by the World Health Organization Regional Office for Europe (WHO–Europe), in collaboration with Public Health England and the EMCDDA.
The conclusions were adopted unanimously at the annual international conference on prisons and health, convened under WHO-Europe’s Health in Prison Programme (HIPP)(11–12 December 2017). Organised by WHO-Europe, with the support of Public Health England and the EMCDDA, the event addressed the needs of prisoners with drug-related problems (1). The conclusions represent a step forward in the prison health policy at European and international level.
Experts attending the meeting, hosted by the EMCDDA, underlined the public health and social relevance of improving knowledge in this area and called for awareness-raising among policymakers, health and justice professionals and prison administrations on the need for effective interventions in this setting.
Prisoners have higher rates of drug use and injecting than the general population and those with drug-related problems make up a significant proportion of the prison population. Among high-risk drug users in the community, over half report having been imprisoned more than once. Taking note of these facts and figures, and of the high rate of post-release mortality, the meeting recognised prisoners as a disadvantaged group in terms of health and wellbeing and acknowledged prisons as important settings to address health inequality and contribute to public health protection.
In the conclusions, the experts acknowledge standards set out in the ‘United Nations Standard Minimum Rules for the Treatment of Prisoners’ (‘Nelson Mandela Rules’, 2015), which represented an important advancement in human rights and access to healthcare for people living in prison. Rule 24 calls for the same standards of healthcare in the prison setting as in the wider community and continuity of care between the two.
The conclusions call on policymakers, health and justice professionals and prison administrations to:
- implement a ‘whole-of-government approach’ to prison healthcare;
- operate within a framework of equivalence of healthcare between prison and community;
- treat the person as a whole, including physical and psychosocial support;
- recognise that drug treatment should take account of wider health and social care issues;
- ensure that service design is informed by research evidence;
- develop and agree minimum staffing levels;
- adopt the UN comprehensive package of services to address HIV, TB, and viral hepatitis B;
- undertake prison reform measures to improve the living and working conditions; and
- adopt and implement alternatives to conviction or punishment.
Through this initiative, the participating organisations shared good practice, explored public health and health service delivery challenges in the prison setting and considered current scientific evidence to support policy and intervention.
