On Nelson Mandela International Day, WHO highlights the major obstacles people face in prisons while trying to stay healthy. WHO’s new report “Cancer and health inequities in prison settings” explores ways of protecting the well-being of every one of them.
Prisons can bring health to vulnerable people
“According to the latest studies, many people living in prisons are strongly willing to be screened for cancer and to learn more about protecting their health in general. Some of them hadn’t even had access to health services before they got to detention. So, prisons can provide a unique opportunity to bring health to the vulnerable,” said Dr Carina Ferreira-Borges, Senior Adviser for Noncommunicable Diseases (NCDs) and Programme Manager of Prison Health at WHO/Europe.
More than 1.5 million people are being held in detention across the WHO European Region, and they are more likely to suffer from NCDs such as cancer and cardiovascular diseases than the general population.
“Although in most Member States prisons screen for 3 types of cancer – breast, cervical and colorectal – as recommended by WHO, there are still many prisons that are only now taking steps in this direction,” added Dr Ferreira-Borges.
The new WHO report flagged the major factors that make the health of detained people even more fragile, including:
- poor record-keeping in prisons
- low prioritization of addressing health issues
- inconsistent quality of the health care provided.
Cancer and cardiovascular screening: what makes them effective in prisons?
The main findings of the WHO report suggest that prison health screening programmes and vaccination can benefit people living in detention and reduce costs for health systems. For instance, breast, cervical and colorectal cancer screenings lead to better health outcomes for women and men in prisons.
Yet programmes to screen for cardiovascular diseases have shown poorer outcomes, even though they are much more available for people living in detention today.
“It is very important that screening programmes are followed up by consistent referrals for diagnosis and access to treatment. Without the follow-up, screening will surely not be cost-effective or even ethical, and health inequities are likely to remain at the same level,” said Dr Filipa Alves da Costa, a public health specialist working in the health in prisons programme at the WHO European Office for the Prevention and Control of NCDs.
“Another success factor is health education programmes. In prisons, they can improve screening rates and health literacy among people with low socioeconomic status,” she added.
Prison has an ageing effect: time to act now!
There is plenty of evidence that detention has an ageing effect on people, even those with short prison sentences. Therefore, screening could be started at a younger age in the prison population than in the general population.
To understand what kind of health-care programmes and practices are more effective in prison settings, more research and data are needed. For example, most recent studies on prison health are focused on cervical cancer, while women comprise only 5% of prison populations in the WHO European Region.
At the same time, Member States can take WHO-recommended action now to reduce health inequities in prisons, including the following.
- Upon arrival at prison, all individuals should be screened for immediate health risks (including signs of poor mental health) as soon as practicable.
- Within the first week of custody, all individuals should undergo a major health assessment.
- Member States should implement validated screening tools that capture information on NCDs.
- Data from health screening in prison should be captured and reported at the national level.
- Longitudinal data should be captured, as these are essential to understanding continuity of care and how moments of transition may impact access to care and treatment.
According to the principles of the WHO European Programme of Work 2020–2025, all Member States are mandated to provide health services in prisons of an equivalent standard to those in the wider community.