Prison Health is Community Health: Prisons, Health and Human Rights - PowerPoint PPT Presentation

Loading...

PPT – Prison Health is Community Health: Prisons, Health and Human Rights PowerPoint presentation | free to view - id: 584716-OTBjZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Prison Health is Community Health: Prisons, Health and Human Rights

Description:

Prison Health is Community Health: Prisons, Health and Human Rights Rick Lines MA, LLM Executive Director, Irish Penal Reform Trust Health Promotion Winter School – PowerPoint PPT presentation

Number of Views:823
Avg rating:5.0/5.0
Slides: 25
Provided by: RickL65
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Prison Health is Community Health: Prisons, Health and Human Rights


1
Prison Health is Community Health Prisons,
Health and Human Rights
Rick Lines MA, LLM Executive Director, Irish
Penal Reform Trust Health Promotion Winter
School Dundalk Co Louth 11 January 2007
2
Prison Populations
  • Worldwide
  • Over 9 million people incarcerated in prisons at
    any one moment
  • Republic of Ireland
  • Approximately 3,200 prisoners at any moment
  • Government proposes to expand this number to over
    4,000
  • Over 5,000 people committed each year
  • 85 of all committals in 2005 were for
    non-violent offences (90 for women)
  • 78 of all committals under sentence in 2005 were
    for 12 months or less (89 for women)
  • 39 of all committals under sentence in 2005 were
    for 3 months or less (55 for women)

3
Prisoners Right to Health
  • People do not surrender their rights when they
    enter prison
  • The right to the highest attainable standard of
    health is explicitly retained
  • States are under the obligation to respect the
    right to health by, inter alia, refraining from
    denying or limiting equal access for all persons,
    including prisoners or detaineesto preventive,
    curative and palliative health services - UN
    Committee on Economic, Social and Cultural Rights
  • States have a legal obligation under the European
    Convention on Human Rights to safeguard the
    health and well-being of people they hold in
    custody

4
The Principle of Equivalence
  • People in prison have a right to access a
    standard of health care equivalent to that
    available in the outside community
  • United Nations General Assembly
  • World Health Organization
  • United Nations Office on Drugs and Crime
  • UNAIDS
  • Council of Europe
  • European Prison Rules
  • Prison policy and/or legislation in most European
    States, including Ireland

5
Determinants of Health and Determinants of
Incarceration
  • A significant proportion of prisoners in most
    countries are members of groups that suffer
    social, economic or ethnic/racial discrimination
    in the broader society.
  • Poverty
  • Unemployment
  • Early school leaving/low-literacy
  • Members of groups racial or ethnic groups that
    experience systemic discrimination
  • Homeless/under-housed
  • People who use drugs
  • People with mental illness

6
Determinants of Health and Determinants of
Incarceration
  • Penitentiary populations contain an
    over-representation of members of the most
    marginalized groups in society, people with poor
    health and chronic untreated conditions. - WHO
  • Blood borne diseases (HIV/AIDS, Hep BC)
  • Mental illness
  • STIs
  • Tuberculosis
  • Drug related health issues
  • Multiple health issues in combination

7
Health Problems Concentrated in Prisons - TB
  • Tuberculosis as many as 100 times higher among
    prison populations
  • MDR-TB common in prisons due to inconsistent
    treatment access
  • Risk of spreading TB and MDR-TB heightened by
    poor and overcrowded prison conditions

8
Health Problems Concentrated in Prisons - Mental
Illness
  • WHO Europe estimates that up to 40 of people in
    prison suffer from some form of mental illness
  • UN Special Rapporteur on Health has expressed
    concerns that people with mental health problems
    are often misdirected towards prison rather than
    appropriate mental health care or support
    services
  • UN Special Rapporteur on Violence Against Women
    has noted that mentally ill women are at high
    risk of sexual abuse in custodial settings

9
Mental Illness in Irish Prisons
  • 60 of women and 35 of men have suffered from
    mental illness at some stage in their lives.
  • The rate of severe mental illness among remand
    prisoners is almost 40 times higher than in the
    general community 13 times higher among
    sentenced prisoners (Kennedy, 2006)
  • 35 of prisoners who were homeless on committal
    said they had been diagnosed with mental health
    issues, and of them two-thirds had been
    hospitalised in a psychiatric institution.
  • Two-thirds of female prisoners homeless on
    committal stated that they had previously been
    diagnosed with a mental health problem (Seymour
    Costello, 2005)

10
Health Problems Concentrated in Prisons - Drug
Use
Proportion of people who use drugs among prison
population in the EU
11
Health Problems Concentrated in Prisons - HIV
and HCV
  • Mass incarceration of people who use drugs means
    mass incarceration of people living with HIV
    and/or HCV
  • Zero tolerance approaches (supply reduction,
    mandatory drug testing) promotes injecting as a
    method of ingesting drugs
  • Denial of access to harm reduction measures (i.e.
    sterile injecting equipment) increases high risk
    injecting and potential transmission of disease

12
Health Problems Concentrated in Prisons - HIV
and HCV
  • HIV - Rates of infection are typically more than
    10 times higher than outside prisons
  • Spain estimated at 16.6, with figures as high
    as 38 among some prison populations
  • Italy 17
  • France 13
  • Switzerland 11
  • Netherlands 11
  • Hepatitis C - The vast majority of peer-reviewed
    published studies have found that between 20 and
    40
  • Injecting - 0.3 - 34 of prisoners in the
    pre-expansion EU and Norway inject while
    incarcerated
  • 0.4 - 21 first injected in prison

13
HIV and HCV in Irish Prisons
  • Allwright, et al (1999) Study of 1,200
    prisoners
  • HIV infection rate of 2
  • HCV infection rate of 37
  • Nearly half of women tested HCV-positive
  • Long, et al (2000) Study of 600 committal
    prisoners
  • HIV infection rate of 2
  • HCV infection rate of 22.
  • Among women the HIV seroprevalence rate was
    nearly 10 and HCV infection rate was 56.

14
Injecting Drug Use in Irish Prisons
  • 1997 1 in 3 prisoners injected while
    incarcerated, 84 of them sharing syringes. 1 in
    4 of this group was HIV positive. (OMahony)
  • 1999 1 in 5 prisoners who injected drugs first
    injected while in prison. Nearly half injected
    while incarcerated, 3 in 5 of them sharing
    injecting equipment. 87 of those who had shared
    tested positive for HCV. (Allwright, et al)
  • 2000 1 in 5 prisoners who injected drugs first
    injected in prison. 2 in 5 shared injecting
    equipment while incarcerated. 90 of those who
    had shared tested positive for HCV. (Long, et al)
  • 2000 51 of clients accessing MQIs needle
    exchange had been incarcerated. 2 in 5 reported
    injecting while in prison, 70 of them sharing
    equipment. (Merchants Quay Ireland)

15
Environmental Health in Prisons
  • Overcrowding/lack of space
  • Poor sanitary conditions
  • Inadequate lighting and ventilation
  • Extremes of temperature
  • Insect and rodent infestation
  • Insufficient/non-existent personal hygiene
    supplies
  • Poor or underdeveloped medical infrastructure

16
In Summary
  • The people committed to prison are those whose
    social and economic marginalisation place them at
    increased risk of physical and mental health
    problems.
  • They are incarcerated in overcrowded, unsanitary
    and stressful conditions, alongside others who
    share the same increased health vulnerabilities.
  • As a result, the prison environment is one marked
    by disease transmission, environmentally
    exacerbated health decline and death

17
Prison Health Case Study Lithuania
  • 2002 - HIV outbreak among prisoners who inject
    drugs was identified at the Alythus Prison
  • 263 prisoners tested positive for HIV within the
    space of a few months
  • Prior to the outbreak, testing had identified
    only 18 HIV infections in Lithuanias entire
    prison system, and only 300 persons were known to
    be living with HIV in the country as a whole.

18
Prison Health Case Study South Africa
  • High rates of both HIV and TB
  • 1995 to 2000 - 584 increase in natural deaths
    of prisoners
  • 1999 - Department of Correctional Services
    examined post-mortem reports and concluded that
    90 were HIV-related
  • Based upon these figures and the continuing
    growth of the South African prison population,
    the study predicted that by 2010, 45,000 people
    would die in SA prisons

19
Challenges for Health Providers
  • High needs population, often with multiple and
    complex health problems
  • Housed in an environment that is not conducive to
    promoting health
  • Prison authorities/structures not always
    welcoming of outsiders
  • Access
  • Time
  • Confidentiality
  • Community health authorities not welcoming of
    prisoners
  • Seen as the responsibility of Justice/Prison
    Service not Health
  • Health workers not trained or comfortable in
    working in prison environment or with prisoners

20
Opportunities for Health Providers
  • Prisoners are often very motivated about health
    issues
  • Prisoners will have greater trust with external
    health workers than with prison health workers
  • Prison health staff are often overburdened and
    under-staffed, and welcome support from external
    health professionals if approached correctly
  • Engagement with prisons by outside professionals
    can contribute to improved conditions and wider
    prison reform

21
Responsibilities of Health Providers
  • To respect and promote the right to health of
    people in prison just as we do people outside of
    prison
  • Respect the individual autonomy of people and
    prison and their right to make their own
    decisions about their health
  • Respect the expertise of prisoners and
    ex-prisoners and work with them in developing
    effective interventions

22
Responsibilities of Health Providers
  • To integrate prisons within our broader concept
    of community when developing overall
    regional/national health strategies
  • To understand and conceptualise prisons as a
    source of harm to health (both individual and
    community)
  • To take or initiate opportunities to build our
    skills in working with people in prison and in
    the prison environment
  • To be an advocate for prisoners health rights
    and prison reform

23
Prison Health is Community Health
Health is a fundamental human right
indispensable from the exercise of other human
rights. UN Committee on Economic, Social and
Cultural Rights
Kamiti Prison Nairobi, Kenya
24
  • Rick Lines, Executive Director
  • rlines_at_iprt.ie
  • Irish Penal Reform Trust
  • www.iprt.ie
About PowerShow.com