The importance of the principle of equivalence – that prisoners are entitled to the same standard of healthcare as the general public without discrimination– is widely recognised including in the revised Standard Minimum Rules. Healthcare for prisoners should be delivered by the country’s national health service rather than by prison authorities or judicial institutions.
Overcrowding is an obvious cause of and contributing factor in many of the health issues in prisons, most notably infectious diseases and mental health issues. The latest data shows that 22 national prison systems hold more than double their capacity, with a further 27 countries operating at 150% – 200%.
Due to overcrowding and poor nutrition, tuberculosis rates– and rates of multi drug-resistant TB – in many prisons are 10 to 100 times higher than in the community. TB in prisons is also commonly associated with HIV co-infection.
Rates of HIV/AIDS are much higher in prisons than in the general population. Infection spreads through needle-sharing among injecting drug users, tattooing and piercing, unprotected sex (whether consensual or rape), and poor standards of medical hygiene.
At least 10-15% of people in prison in Europe have a significant mental illness, according to the World Health Organisation, and many more have common mental health problems such as depression or anxiety. As well as poor prison conditions, bullying, marginalisation, stigma and discrimination all harm mental health.
Women prisoners have particular health needs, which go far beyond their need for reproductive healthcare and pre- and post-natal healthcare. Women in prison are disproportionately likely to be victims of domestic or sexual abuse, to experience poor mental health, and to have alcohol and drug dependency problems. The World Health Organisation estimates that at least 75% of women entering European prisons are estimated to have problems with drug and alcohol use, for example. Women are also more likely to develop mental health problems while in prison and are more likely to self-harm or attempt suicide than male prisoners. Women prisoners surveyed by PRI in Central Asia and the South Caucasus (2014) said that what they needed most to help them build a new life on release was health treatment.
Research shows that children and young people are far more likely to have poor mental health and to attempt suicide than their peers outside prison. Children in prison in particular may struggle to follow staff instructions and suffer disciplinary measures as a result.