4.  Developing a health-informed approach to penal reform The proportion of older people in custody has also been rising steadily. Between 1990 and 2009 the total prison population of America doubled, but the number of prisoners aged 55 or older increased by over 300 per cent (Williams et al, 2012). There are several distinct reasons for this growth. Many countries have increased their use of life or other indeterminate sentences (Jacobson et al, 2017); and prisoners serving these sentences often spend many years in prison, well into their old age and, in some cases, until their death. Other reasons include longer custodial sentences, mandatory sentencing laws and a greater preponderance of older people being sentenced to custody for serious offences (notably, when ‘historic’ crimes are prosecuted). Figure 7: Percentage change in prison population totals since 1995* * Percentage change in prison population total since 1995 for all countries (Kenya 1996) to most recent date for which figures are available. Data are drawn from World Prison Brief database as of May 2019. To curb prison population growth, reform is needed at many levels, both in the realm of criminal law and policy and more broadly, reflecting the many interwoven factors driving this growth. A thorough description of the options for reform is beyond the scope of this report,26 but key measures include: • The use of pre-trial detention should be reduced so that it is a last resort and is used for the briefest possible period. Alternatives to pre-trial imprisonment should be properly funded and organised. Investment in court systems and judicial capacity should be made to reduce case backlogs and ensure regular detention reviews. • The use of custodial sentences for less serious and non-violent offending should be a last resort. Community alternatives (including rehabilitative and treatment orders) should be available to replace these. 26 The Council of Europe addressed the issue of overcrowding in a White Paper published in 2016 (Council of Europe, 2016). The White Paper points to the inadequacy of state responses based solely on increasing prison capacity and other short-term measures. It calls on governments to address instead the root causes of overcrowding, by promoting better use of alternatives to custody, decriminalising some offences, and providing for more rigorous prison monitoring. 21