SPECIAL FOCUS Healthcare in prisons This Special Focus explores the potential that prisons have to be settings for the prevention of disease, the promotion of health, and for identifying and treating physical and mental health needs for the benefit of individual prisoners, staff and communities as a whole. It draws on international standards, such as the UN Sustainable Development Goals (the SDGs). It also draws on the Guidance Document on the Nelson Mandela Rules, produced by the OSCE Office for Democratic Institutions and Human Rights and Penal Reform International (PRI), as well as PRI’s Mental health in prison: A short guide for prison staff. Introduction Rates of disease, substance dependency and mental illness among prisoners are much higher than in the community. People in prison often come from impoverished and marginalised backgrounds where they may have been exposed to transmissible diseases and inadequate nutrition, and their access to good quality health services will have been limited. Some prisoners may have neglected their health and may never have been treated by a qualified doctor before their imprisonment, particularly if they come from rural or remote areas. Additionally, people in prison may have a history of abuse. 2 | They may also have substance dependence and be suffering from withdrawal symptoms. Once in prison, the conditions in which prisoners live in can create serious risks to their physical and mental health. Prison populations have a disproportionately high rate of people suffering from mental health or behavioural problems, many pre-dating prison and others developing, or worsening, when in prison due to poor conditions and a lack of mental healthcare. A lack of access to sufficient nutritious food and safe drinking water and inadequate opportunities for physical exercise – all of which are common in prison settings – can also contribute to the deterioration of health. Poor sanitary conditions increase the chances of skin or parasitic diseases, and the lack of sunlight, fresh air, heating or ventilation can also seriously affect prisoners’ health. The transmission of diseases is rife in overcrowded facilities, placing the lives of both prisoners and staff at risk. Communicable diseases are a particular concern, with infection rates for tuberculosis between 10 and 100 times higher than in the community.1 Prisoners are five times more likely to be living with HIV than adults in the general population, and they have been identified by UNAIDS as a key population that has been left behind in responses to the AIDS epidemic.2 Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019