Sustainability – Page 203

Lisbon, Portugal, 15 February 2023New report on prison health in Europe highlights a good COVID-19 response, but raises issues of overcrowding, suicide rates and deficient mental health servicesWHO/Europe today launched its second “Status report on prison health in the WHO European Region” at an event hosted by the Portuguese Government. The report provides an overview of the performance of prison health systems in the Region based on survey data from 36 countries. The data shows that the response of countries to COVID-19 in prisons was generally good, however, it also highlights areas of concern, including overcrowding and a lack of services for mental health, which represents the greatest health need among people in prison across the Region. The survey, conducted in 2021, takes a retrospective look on the previous year. Below are key findings from the report.In 2020, a total of 613 497 people (*number includes both unsentenced and sentenced individuals who are held in prison) were incarcerated in the 36 countries surveyed. This shows a decrease of around 6.6% compared to 2019, mainly due to COVID-19 measures. The share of unsentenced people in prison increased in 2020, also likely as a result of the COVID-19 pandemic.The most prevalent condition among people in prison was mental health disorders, which affected 32.8% of the prison population. This figure likely represents a significant underreporting as most noncommunicable diseases were poorly recorded and estimates were lower than expected. Fewer than half of the countries surveyed provided data. The most common cause of death in prisons was suicide, with a much higher rate than in the wider community.Continuity of care requires greater investment, with only half of Member States ensuring access to community health services to people on release from prison.The overall response to COVID-19 in prisons across the Region has been good, with vaccines offered universally in all Member States and the isolation of COVID-19 cases in most prisons.1 in 5 Member States reported overcrowding, which has various negative consequences for health. Alternative non-custodial measures should be considered for offences that do not present a high risk to society and where more effective measures exist, such as diversion to treatment for drug use disorders.Deficiencies persisted in preventive services, including access to vaccination. 16.7% of Member States did not offer vaccination against hepatitis B or diphtheria–tetanus–pertussis (DTP) in any prisons, both of which are recommended for all people on admission to prison.“Prisons are embedded in communities and investments made in the health of people in prison becomes a community dividend. Incarceration should never become a sentence to poorer health. All citizens are entitled to good quality health care regardless of their legal status,” said Dr Hans Henri P Kluge, Regional Director of WHO/Europe. “Crucially, the WHO Health in Prisons European Database monitors the health of people in prison so we can assess prison health systems, which are part of overall health systems, and identify areas that need strengthening. When prisons are excluded from the general health system, local communities can be the hardest hit.” Ministers from the Portuguese Government also welcomed the publication of the report and highlighted the importance of prison health in Portugal and across the Region. “It’s a great honour and responsibility to host the meeting of the WHO/Europe Health in Prisons Programme (HIPP) in Portugal. Health in all policies is a priority of the Portuguese Government, leaving no one behind,” said the Portuguese Minister of Health, Manuel Pizarro. “The Minister of Justice pays special attention to the living conditions of the prison population, and in conjunction with the Ministry of Health, is determined to ensure that the right to health and human dignity – central values of this Government – are a reality in Portuguese prisons,” added the Minister of Justice, Catarina Sarmento e Castro. “Providing health care to people in prison is to ensure respect for human life, which should guide all countries. This study and today’s meeting show that Portugal is working to improve health care to inmates, based on the scientific research and data collected,” stated the Minister of Science, Technology and Higher Education, Elvira Fortunato.The report contains detailed profiles of each surveyed country. Selected findings from Portugal show the following.Prison occupancy decreased significantly from 114% to 91% since the previous report in 2019, largely due to COVID-19 response measures. The incarceration rate decreased by 28%.WHO advocates for greater involvement of ministries of health in the delivery of health care in prisons across the Region. In Portugal, an inter-ministerial agreement was established in 2009 that allowed for all people in prison to be covered by the Portuguese national health service (P-NHS) by law. Portugal is one of the countries where health care in prisons is fully covered by the P-NHS, with arrangements and protocols established for transferring people in prison to specialized institutions to treat severe mental health disorders and cancer.The rate of psychiatrists working in prisons is higher than the average in the Region, however, suicide rates in prison are relatively high compared to the general population.In 2020, in the Region, Portugal had the fourth lowest number of people newly admitted to prison, largely as a result of response measures to prevent or control COVID-19.In most prisons, clinical records are still paper-based, making health planning possible only at the local level and data extraction for national health policy planning extremely difficult. It also affects continuity of care when people are admitted or released.“I thank Portugal for hosting this report launch and congratulate the Government for its progressive and forward-looking approach to health, justice and social responsibility,” said Dr Kluge. “Portugal is 1 of the 5 countries that do not legally permit life sentences, striving for people to be given a second chance whilst investing in their rehabilitation. Multisector reforms, including decriminalizing drug use in 2001, which diverts drug users to treatment and rehabilitation rather than incarceration, are also seen as a factor in reducing the prison population while addressing the root causes of substance abuse.”Commenting on the findings, Dr Carina Ferreira-Borges, Regional Advisor for Alcohol, Illicit Drugs and Prison Health, said, “The issue of overcrowding in prisons evident in this report is an important reminder of our over-reliance on incarceration and the need for alternatives.” Emphasizing how supporting people released from prison to reintegrate in the community and access the health services can reduce the likelihood of reoffending, she added, “Ministries of health play a critical role in protecting the basic human right to health. This report highlights the value of a health- and human rights-focused approach in dealing with offenders, providing important insights into the specific steps that can be taken to improve our systems, for people in prison and for all of society.”