Protecting the Human Rights of Prisoners: Promoting the Health of Everyone

A shortened version of this article is to be published in the July-August edition of Around Europe.

At the end of June, I attended the second CONNECTIONS Conference focusing on drugs and alcohol in the criminal justice system. The Conference drew delegates and speakers from across the European Union and beyond, and a great diversity of experience, both the successes and the failures, was shared over the course of two jam-packed days in London. Despite differences between jurisdictions, two constant themes proved pervasive: that drug and (particularly) alcohol rehabilitation and harm reduction services can and should be delivered more effectively (both in and out of prison), helping more people turn around their lives; and that impending budget cuts offer both an opportunity to think again, but also pose a great risk.

The right to health care for everyone, including prisoners, is well established in international law. The provision in Article 12 of the 1966 United Nations International Covenant on Economic, Social and Cultural Rights firmly stated ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The UN (1990) Basic Principles for the Treatment of Prisoners outlines how the aforementioned right to health shall be delivered: ‘Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation’. The principle of equivalence may be firmly established, but considering the high health risks associated with prison – overcrowding, lack of sterile needles and poorly cleaned living space all dramatically increase the risk of contracting infectious diseases such as HIV/AIDS, hepatitis and tuberculosis – it can be argued that states have a heightened responsibility to those they take into their custody which is not limited to provision of health care, but extends to enabling and promoting healthy living.

Dame Anne Owers, who has just stepped down as head of the prison inspectorate in England & Wales, warned the Prison Reform Trust on Tuesday that it will be ‘challenging to maintain progress [in the prison system], never mind continue it’ in the years ahead. The examples I heard at the CONNECTIONS Conference – from Moldova, Portugal, Hungary, France, Hungary, Lithuania and others – showed some of the real progress being made in promoting health and harm reduction services in prisons across the continent, but also revealed the staggering health inequalities that remain and the significant risks faced people in prison. In Lithuania, for example, 76 per cent of HIV patients had been injecting drug users, and 71 per cent of all drug-dependent people have spent time in prison at some point in their lives. The nature of imprisonment seems to further increase this risk, as studies from across Europe suggest that between seven and 24 per cent of the prisoners who do inject, started doing so once they were committed to prison. Needle exchange programmes, although available in the community, are often not available in prison – security concerns are cited as trumping the right to equivalence of health provision. Moldova’s experience highlights the danger of not addressing the health implications of this approach. A local NGO – Innovative Projects in Prisons – found one-in-five inmates had been or were injecting, using needles (sometimes little more than ball point pens) that were being shared by up to ten or 12 prisoners. As a consequence of their research, the Moldovan government agreed to allow the organisation to pilot needle exchange and condom distribution in prison on a peer-to-peer basis, significantly cutting rates of HIV transmission. In the ten years since, similar projects have sprung up in 24 prisons across Moldova.

Prison presents an opportunity to reach some of the most vulnerable and disadvantaged members of the community, and even to readdress some of the health inequalities in society. A high proportion of people with multiple health problems are incarcerated in prisons: for example, in England & Wales, 72 per cent of male and 70 per cent of female sentenced prisoners suffer from two or more mental health problems. Problems that the reality of prison life, more often than not, simply exacerbates. In the case of communicable diseases, diagnosis and treatment alongside the implementation of effective harm reduction schemes has benefits not just for the individuals concerned, but the communities to which prisoners will return upon release. Moldova, for example, is one of the few Eastern European countries that has managed to halt the spread of HIV throughout the entire population. Furthermore, good health and physical well being are crucial to the successful resettlement and social reintegration of ex-offenders after release from prison.

Good prison health is good public health. It is important that people do not come out of the prison system in a worse state of health than when they entered, more dependent on the public health and social services, less able to rebuild their lives. Ultimately though, it is only through a reduction in our overreliance on the use of imprisonment – over half of Council of Europe member states have larger prison populations than they did five years ago – that will limit the damage to individuals, families and communities that prison creates and perpetuates. The current budgetary constraints being experienced in many European countries is no excuse to demure from our responsibilities, or the broader social aims of criminal justice systems: the rehabilitation and social (re)integration of former offenders.