Towards a health-informed approach to penal reform? Evidence from ten countries Figure 1: Prison population rate (number of prisoners per 100,000 of the national population) and total prison population for countries featured in the ten country project* *Most recent figures available on World Prison Brief database as of May 2019. Figures vary by jurisdiction as to the specific dates to which they refer. Our research for the ten country project entails legal and policy reviews and empirical work, with input from a range of partners including legal and other practitioners, NGOs and in-country researchers. The aims of the project are to advance understanding of the factors driving high imprisonment levels and to devise strategies to curb the unnecessary resort to custody. The research to date has revealed the range and severity of the healthrelated impacts of imprisonment. We have set out, through this report, to highlight many of these impacts and to consider the scope for effective health-led interventions in the penal context. This report does not seek to provide an exhaustive account of health-related vulnerabilities and interventions.3 Rather, it highlights a number of key issues by drawing on recent academic research and policy reports from across the ten countries and on sources produced by expert bodies such as the World Health Organization. Several of the problems and interventions discussed in this report were the subject of papers presented at an international conference we held in November 2018 at Birkbeck, University of London, Mapping inequalities in prisoner healthcare worldwide.4 The report also features illustrative material about the lived custodial experience as it relates to health, much of it taken from interviews with prisoners and former prisoners which we and our partners have conducted. The latest available statistics on prison populations and overcrowding are drawn from our World Prison Brief database.5 It should be understood that we do not approach the topic of prisoner health and healthcare as health experts. At ICPR we conduct policy-oriented research on all aspects of the criminal justice system. Much of this work 3 Readers wanting to explore prisoner health and healthcare in more depth should review the sources listed under Further Reading (p. 34). 4 The event was funded by the Wellcome Trust/Birkbeck Institutional Strategic Support Fund. Researchers and practitioners with expertise on prison health in several of the ten countries presented their work across a range of health-related topics. More information can be accessed here: http://www.prisonstudies.org/news/icpr-holds-international-prisoner-health-conference 5 The World Prison Brief (Director, Roy Walmsley), at http://www.prisonstudies.org/, is hosted and maintained by the Institute for Criminal Policy Research. The data held on the Brief (which is updated on a monthly basis) are largely derived from governmental or other official sources. Prisons data used in this report were accessed from the database between March and May 2019. 2