Towards a health-informed approach to penal reform? Evidence from ten countries the State of California must end its decades-long mass incarceration policies. In Brown v Plata, the majority held that a court-enforced population limit was essential to secure prisoners’ rights against cruel and unusual punishment. ‘Prisoners retain the essence of human dignity inherent in all persons’, the court said; and judges have a responsibility to remedy violations of the constitutional prohibition against cruel and unusual punishment. This extends to the provision of healthcare. The decision ended a long tradition of federal courts simply deferring to correctional authorities. The Supreme Court emphatically affirmed the judiciary’s role in protecting prisoners’ rights in the face of ongoing and persistent constitutional violations by prison authorities in relation to healthcare. This report examines the effects of failed penal policies through the lens of health. The evidence it dispassionately presents is powerful and at times moving and distressing. The report makes a compelling case for re-shaping our justice and health policies to ensure that society’s most vulnerable citizens are better protected. I am confident that ICPR’s wider project examining the use of imprisonment in ten countries – of which this report forms part – will contribute to our understanding of the causes and consequences of the misconceived over-use of imprisonment. More importantly, it will help us to achieve lasting change. Edwin Cameron Justice of the Constitutional Court of South Africa iv