Dr Lars Moller Project Manager World Health Organization Prisons and Public Health Northern Dimension – Prison Health Expert Group Oslo, Norway 13-14 February 2007 Dr Lars Moller Project Manager World Health Organization Distinguished Delegates, Ladies and Gentlemen, First of all I would like to thank the organizers for inviting me here today and represent the WHO Health in Prisons Project.

Purpose of the WHO Health in Prisons Project The purpose of the Project is to support Member States in improving public health by addressing health and health care in prisons, and to facilitate the links between prison health and public health systems both at national and international levels The purpose of the Project is to support Member States in improving public health by addressing health and health care in prisons, and to facilitate the links between prison health and public health systems both at national and international levels

Strategic objectives To establish integrated working between public health and prison health systems To encourage prisons to operate within recognised codes of human rights and medical ethics To assist the reduction of re-offending by contributing to prisoner’s rehabilitation and resettlement These are here in a short version: To establish integrated working between public health and prison health systems To encourage prisons to operate within recognised codes of human rights and medical ethics To assist the reduction of re-offending by contributing to prisoner’s rehabilitation and resettlement

Strategic objectives To reduce the exposure of prisoners to communicable diseases, preventing prisons becoming focal points of disease To promote prison health services to reach standards equivalent to those in the wider community To reduce the exposure of prisoners to communicable diseases, preventing prisons becoming focal points of disease To promote prison health services to reach standards equivalent to those in the wider community

The main problem globally is the high number of prisoners and in many countries in Europe the prison population increases. This slide shows the top 20 countries worldwide – of these are the 6 from the WHO European Region.

In Europe we find the highest prison population in the eastern part of the region. In Spain the figure is 145 prisoners per 100.000 inhabitants and in western Europe this figure is high.

Prison overcrowding Russia Brazil Rwanda This is just to show that without solving overcrowding it is difficult to solve health problems.

TB control in prisons, WHO/CDS/TB/2000.281 Most diseases are more frequent in the prison setting – this has both something to do with diseases prior to imprisonment but for many communicable diseases this is due to overcrowding, nutrition, health care etc. Last month WHO organized a conference in Romania on Prisons and Tuberculosis as this is a huge prison problem in most countries in the world. The slide shows the enormous difference in TB prevalence among prisoners and among the general population. Here we find differences up to 100 times, but in most countries we find figures of 20 times difference. TB control in prisons, WHO/CDS/TB/2000.281

Rates of HIV and hepatitis C infection among prison inmates in most countries are much higher than those in the general population. Data on HIV infection in prisons (available for many European countries though sampling methodology varies). Estonia 12% France 13% Italy 17% Ireland 2% (10% in women prisoners) Netherlands 11% (Amsterdam) Russian Federation 4% (58% in IDU prisoners in St. Petersburg) Portugal 11% Spain 14% (all prisons) Spain 31% (some regions) Switzerland.11% (Canton Berne) Ukraine 7% Adult population prevalence rarely exceeds 1% even in those countries worst affected.

Proportion of Drug Users in EU prisons (EMCDDA, 2002)

First time drugs in prison 41.7% - n=328 Ever used illicit drugs Study on drug use in two prisons – 1000 random selected prisoners in Kyrgyzstan Ever injected 73.2% - n=573 First time drugs in prison 41.7% - n=328 Ever used illicit drugs 78.6% - n=786 Ever shared n/s 79.7% - n=456 Used heroin 82.5% - n=473 Used last 3 months 87.4% - n=685 First time injected drugs in prison 54.2% Used opium 54.6% - n=313 Injected last 3 months 82.4% - n=472 Got clean n/s 97.5% - n=460 Used marihuana 71.7% - n=411 Shared n/s last 3 months 17.6% - n=83 Next year I am travelling to Kyrgyzstan to present data on a survey we performed in two prisons but here you will see that the drugs problem is huge in some places of the world and especially if you are close to Afghanistan Got clean n/s 92.8% -n=77

The WHO Health in Prisons Project 34 Member States are actively involved: 14 from west Europe: Austria, Belgium, Finland, France, Greece, Iceland, Ireland, Malta, Netherlands, Norway, Portugal, Spain, Switzerland, United Kingdom (England, Wales and Scotland) 12 from centre Europe: Albania, Croatia, Czech Republic, Estonia, Hungary, Lithuania, Latvia, Moldova, Poland, Romania, Slovakia, Slovenia 8 from east Europe: Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Ukraine, Uzbekistan We have now 33 Member States involved in the network and during the last three years this number has grown from 16 to 33. In total we have 53 Member States in the WHO European Region.

Steering group Representatives: International organizations: Pompidou Group, Council of Europe AIDS Foundation East-West WHO Collaborating Centre for Promoting Prison Health, Department of Health, England and Wales International Centre for Prison Studies, Kings College, London International Committee of the Red Cross Cranstoun Drug Services European Monitoring Centre for Drugs and Drug Addiction United Nations Office on Drugs and Crime The Royal Netherlands Chemical Society KNCV Member States: National Agency of Correctional Services, Ministry of Justice, The Netherlands Prison Health Services, Poland Medical Services of the Russian Penitentiary System, Ministry of Justice, The Russian Federation The Task Force had a meeting at the premisis of ICRC in Geneva in May and here is the updated list of Members

The WHO Health in Prisons Project Actual activities Best Practice award Prison Health Database Guide on prison health Status Paper on Prisons and Tuberculosis Prisons and Mental Health Prisons and Women This year we are mainly focusing on 4 important issues Best practice awards – we have for some years discussed how we could disseminate examples of best practice for our network and other interested in this subject. Our Collaborating Centre has been very active in this process and last year we awarded 15 prisons in Europe and we will give out the next awards next year. We have established a database with the examples. Talking about databases – we have developed a prison health database – we do this work in collaboration with the European Monitoring Centre for Drugs and Drug Addiction and the European Network on Drugs and Infections Prevention in Prison and we have received funding from the European Commission to support the development. Still we are collecting data but we have developed a tool for data presentation and data are available through our website. Currently, we are performing the final editing of a prison health guide, covering the most important area of prison health. The guide will be a new tool for prison health personnel. We expect to have a printed version ready by February 2007. In October we organized a conference on prisons and TB and a draft status paper on tuberculosis was adopted. The paper will be published early in 2007 and will give eveidence based recommendations on TB in prisons.

Web site: http//:www.euro.who.int/prisons lmo@euro.who.int Contact Lars Moller: lmo@euro.who.int