GOOD PRISON HEALTH IS GOOD PUBLIC HEALTH

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GOOD PRISON HEALTH IS GOOD PUBLIC HEALTH

• DR ANDREW FRASER
• Co-Director, WHO HiPP Collaborating Centre
• April 2009

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PORTFOLIO OF WORK OVER 15 YEARS

• Declaration on Prison Health as Part of Public
  Health
• HIV in Prisons
• Mental Health and Prisons Fact Sheet
• Mental Health Promotion in Prisons
• Promoting the Health of Young People in Custody
• Prisons, Drugs and Society Consensus Statement
• Status Paper on Prisons, Drugs and Harm Reduction
• Tuberculosis Control in Prisons A Manual for
  Programme Managers
• Trencin Statement on Prisons and Mental Health
• Kyiv Declaration on Womens Health in Prison
  Correcting Gender Inequities in Prison Health

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HEALTH STATUS

• Very poor
• Commonly
• Intravenous Drug Users gt20
• Addiction - Drugs, Alcohol gt70
• Mental Health Problems - severe and enduring 3-9
• - depressive symptoms 90
• Communicable Diseases - TB, HIV, Hepatitis C,
  STIs
• Smoking Prevalence gt80

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THE PRISON POPULATION SCOTLAND
R Houchin, 2005
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THE MAGNIFYING EFFECT

• Most prison systems are dynamic.
• Remand periods and sentences vary many are
  short.
• RATIO gt3
• Average Daily Population Annual Populations

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PRISON AND SOCIETY CONCENTRATION OF MIGRANTS
Source ICPS, 2008 Census Data 2001
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PRISONERS ARE THE PUBLIC

• Scotland Population 5 million
• Prisons 8,000 every day
• 26,000 every year
• 112,000 over 15 years
• lt20 die in custody each year

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HEALTH SECURITY

• The incidence of - TB in Russian Prisons 6.4
• TB-HIV 3.3
• (KNCV and Russian Prison Service)
• HIV Prevalence 28 in 1989 8 in 2007, Spain
• 4.5-5 of Russian prisoners n43,800
• Hepatitis C - 3 inject 80 share equipment in
  Scottish prisons
• - 27 prevalence Spanish prisons

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MENTAL HEALTH

• Prevalence
• Severe and Enduring Mental Disorder 3-9
• Serious Illness Requiring Hospital Care 8-12
• Depressive Symptom 90
• (A WHO Guide - Blaauw and von Marle)

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PRISON HEALTH AS PART OF PUBLIC HEALTH MOSCOW
DECLARATION, WHO-HIPP, 2003

• Develop close working links - health and prisons
  Ministries
• Ensure high standards of treatment for detainees
• Protection for personnel
• Joint training of professionals - disease control
• High levels of professionalism
• Continuity of treatment
• Unification of statistics

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PRISON HEALTH IS AN INTENSIVE PUBLIC HEALTH
SETTING

• Health security
• Patient safety
• Health system development
• Social Determinants of Health
• Human Rights

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PRISON HEALTH IS AN OPPORTUNITY, AS WELL AS A
THREAT

• The Case of Hepatitis B
• Glasgow intravenous drug users
• Vaccine uptake 1993 16
• 1994 19
• 1999 15
• 2001-02 52
• .. the universal offer of vaccination to all
  prisoners, within 2 years of the initiative's
  implementation, has had a dramatic impact on
  uptake among IDUs.
• (Hutchison et all, Vaccine 2004)

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CONVERSIONS TO HIV AND HCV
Dr Garcia, Spain, 2008
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HEALTH IMPACT OF PRISONTHE OPPORTUNITY?

• Health care access
• Health promotion
• Health security
• Harm reduction
• Personal safety

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HEALTH IMPACT OF PRISONTHE THREAT?

• TB
• Blood borne viruses
• Mental health
• Care for long-term conditions, communicable
  diseases
• Physical, mental and social wellbeing ..
• Widening inequality

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gt10

• The proportion of registered HIVve Russians who
  are in prison
• of Hepatitis Cve Scots who come through prison
  each year (est.)
• of TB cases in Russia that are now MDR

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We will not narrow health inequalities
sustainably unless we encompass prison health

• Prisoners
• Families
• Communities

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DR ANDREW FRASERCo-Director, WHO HiPP
Collaborating CentreDirector of Health and
Care, Scottish Prison Service, Edinburgh, United
KingdomTel 0044-131-244-6998Fax
0044-131-244-6995E-Mail andrew.fraser_at_sps.pnn.g
ov.ukWeb http//www.sps.pnn.gov.uk