Health in Prisons Project Oslo, 24 November 2009 Lars Moller Regional Adviser a.i. World Health Organization Regional Office for Europe Health in Prisons Project Prison Health – a Challenge to Public Health

Health in Prisons Project Prison Health is Public Health Main health problems in prisons: Mental Health Drug abuse/dependence Communicable diseases Pre trial detention Post-release mortality

Health in Prisons Project

Prison population European Region Source: International Centre for Prison Studies 2006

Health in Prisons Project % female of total prison population Europe Source: International Centre for Prison Studies 2006

Health in Prisons Project Prevalence mental illness, Example UK UK Prisons Psychosis 6-13% Neurosis40-76% Personality Dis.50-78% Drug use/dep.34-52% Alcohol dep.19-30% UK Community (adults of working age) 0.4% 17.3% % 4.2% 8.1% Source: Singleton at al and 2000

Health in Prisons Project Drug situation in European prisons: key points Many of those who enter prison have a drug problem: estimation 20-40% Drug use and risk behaviour often continues inside prison  high risk of infectious diseases Drugs services in prisons are sometimes poorly developed

Health in Prisons Project Prisons are a breeding ground for HIV/AIDS and other infectious diseases, because of: Injection of drugs in the absence of sterile syringes Sharing other injection equipment (water, spoons, etc.) and razors, toothbrushes: hepatitis C & B Tattooing, piercing, scarifications Unprotected sexual relations: voluntary (circumstances), prostitution, rapes Accidental punctures with infected needles: searches in the cells Safety of medical equipment (dental, medical, gynecological)

Health in Prisons Project HIV prevalence (%) in selected countries

Health in Prisons Project Prevalence IDU and needle sharing in prisons

Health in Prisons Project Drug users in two prisons of Kyrgyzstan (2006) n=1004 n=977 been more than 3 months in survey prisons 79% used drugs during last 3 months 55% used Marihuana 72% used Heroin 64% used Opium 73% injected during last 3 months 18% shared needles/syringes during last 3 months 35% had their first drug experience in a prison

Health in Prisons Project Needle/Syringe Exchange Programmes in prisons As of March 2009, Needle/Syringe Exchange Programmes have been introduced in over 60 prisons in at least 10 countries: SwitzerlandGermany ArmeniaLuxembourg SpainMoldova Iran Romania PortugalKyrgyzstan

Health in Prisons Project Evidence Substitution Treatment in prisons Reduces sharing of needle and syringes Has a positive impact on the prison by reducing drug-seeking behavior Makes re-incarceration among prisoners receiving OST less likely Has a positive influence on the contacts between (health) staff and prisoner Reduces risk behaviors upon release Reduce overdose deaths after release.

Health in Prisons Project HIV prevalence in Spanish prisons

Health in Prisons Project New TB cases in prisons

Health in Prisons Project Pretrieal detention as % of all prisoners, 2006

Health in Prisons Project Pretrial detention International standards Pretrial detention to be used only if there is a demonstrable risk that an accused person will: –abscond; –interfere with the course of justice; or –commit a serious offence. The widest possible use to be made of alternatives to pretrial detention.

Health in Prisons Project Post-release mortality rates (males) Farrell & Marsden (2008; n = 36,515)

Health in Prisons Project Post-release mortality rates (females) Farrell & Marsden [2008] n = 12,256

Health in Prisons Project Post-release mortality 20- to 50-fold increase in drug-related deaths in the 1st week after release –drops by 50% / week –plateaus at 4 weeks Odds of drug-related death in 1st wk post-release –Among women > 10 x that observed at 52 wks (OR 10.6; 95 %CI ) 70 x that in age-matched population –Among men ~ 8 x that observed at 52 weeks (OR 8.3: 95 %CI ). 30 x that in age-matched population Seaman et al 1996; Bird et al 2003; Singleton, Farrell, Marsden et al 2003; Farrell, Marsden (50,000 releases). Addiction 2008; Stewart et al (2004) Western Aus; Graham (2004) Victoria; Singleton, Farrell et al

Health in Prisons Project

Numerous WHO EURO publications detail the generally accepted rules, guidelines, principles and standards related to prison conditions, prison health care, and/or prevention and treatment in prison settings.

Health in Prisons Project Best selling WHO EURO publications Heat-health action plans (2008) 2.Public health significance of urban pests (2008) 3.Inequalities in young people’s health. HBSC international report from the 2005/2006 survey (2008) 4.Ensuring value for money in health care (2008) 5.Policies and practices for mental health in Europe (2008) 6.Protecting health in Europe from climate change (2008) 7.Air quality guidelines. Global update 2005 (2006) 8.The challenge of obesity in the WHO European Region and the strategies for response (2007) 9.Health in prisons (2007) 10.Feeding and nutrition of infants and young children (2003)

Health in Prisons Project Most translated publications in recent years Physical activity and health in Europe: evidence for action (15 languages) Promoting physical activity and active living in urban environments. The role of local governments. The solid facts. (15 languages) Health in prisons (12 languages) Social determinants of health. The solid facts (10 languages).

Health in Prisons Project

Awards, prizes Dr Alex Gatherer received the American Public Health Association Presidential Citation Award 2009 HIPP was nominated among 6 projects for the European Public Health Award 2009.

Health in Prisons Project Website HIPP: Thank you!