“Prisoners are disproportionately affected by chronic health problems”

More than 10 million people are held in penal institutions throughout the world, with the United States having the highest incarceration rate in the world. There are reports of neglect, abuse, exploitation, and human rights violations in prisons, documented globally.

Human rights, including the right to health, are often ignored. Substandard living conditions, neglect and poor medical care are common. Health services in prisons are often of low quality or hard to access. Primary care, disease screening and immunizations are frequently lacking, even in the context of a higher risk for illness and death for detainees. Acute care services have also been reported in many countries as substandard, with many challenges linked to appropriate and timely follow-up and referrals to experts or to external health services.

People in prisons and jails tend to be sick more often than the general population. They are disproportionately likely to have chronic health problems (high blood pressure, diabetes, HIV, tuberculosis, substance use, mental health problems).

While imprisonment is challenging, it should also be an opportunity to provide health education, medical care, preventive health services and substance use treatment to marginalized groups who are generally hard to reach in the community.

What are some of the obstacles to proper healthcare in prisons?

Health services in prisons are often inadequate and fall short of society’s standards. There are staffing challenges, supply shortages, sub-standard primary care and acute care services. These serious shortcomings have multiple causes, including funding issues, policy gaps, lack of explicit protocols, and the marginalization of the prison population.

Healthcare staffing challenges and the lack of appropriate policies and protocols often mean that medical decisions are made by prison staff who are not equipped or trained to make health-related judgments.

There is understandable distrust in the healthcare system on the part of those in detention

For many health workers in carceral settings, there is a risk of ‘Dual Loyalty’ – when there’s a conflict between the health workers’ professional duties to their patients and their obligations to their employer (i.e. prison authorities). It can lead health workers to turn a blind eye to or even engage in torture, forced feedings, shackling, prescribing psychiatric medications inappropriately, solitary confinement, disclosure of health data to third parties without consent, body searches, and capital punishment, among others. Healthcare staff must be aware of this risk and ensure that they have the same professional independence as their professional colleagues who work in the community.

How is the health of detainees related to the prison population?

It is easier for infectious diseases (such as Covid-19 and tuberculosis) to spread in prisons because of overcrowding and the nature of places of detention as ‘congregate settings’. This can impact both those behind bars and staff. The health needs of staff and prisoners must be considered together, especially given the risk of communicable diseases.

Ranit Mishori is a Professor of Family Medicine at Georgetown University and Senior Medical Advisor at Physicians for Human Rights, United States.