This report presents an analysis of data collected on the health status of people in prison and prison health systems for 39 countries in the WHO European Region. The Health in Prisons European Database (HIPED) survey collected data from Member States between 2016 and 2017 to enable monitoring and surveillance of health in prisons. The aim of this report is to provide an indication of the current status of prison health in the European Region and highlight areas of prison health policy that should better be aligned to WHO guidance. The report presents data and recommendations under the following headings: prison population statistics, prison health-care systems, prison environment, risk factors for ill health, disease screening on admission, prevention of infection, treatment and mortality. These data, alongside WHO guidance on health in prison, will help to inform and influence policy-makers to improve the health outcomes of people in prison.

On any given day, more than 1.5 million people in the WHO European Region are incarcerated. The health profile of people in prison is one of complex, co-occurring physical and mental health conditions, and the poor health status of this population is typically set against a backdrop of entrenched and intergenerational social disadvantage. Risk factors for poor health overlap with risk factors for incarceration, such as substance use, unstable housing and low educational attainment. Incarceration and the process of transitioning back into the community following release also impact on health, and continuity of care between health services in prisons and the community is often lacking.

The field of prison health covers both the health status of individuals in prison and the organization of prison health systems and services. Prison health must be recognized as a broader public health issue, as most people who are incarcerated will return to the community, usually after a relatively short prison sentence. Many people return to prison due to reoffending, and this cycle between prison and community can lead to disjointed and ineffective health care. The benefits of health services delivered (and the consequences of inadequate health-service delivery) in prison are often only realized after individuals return to their communities. Lack of adequate health care in prisons and detention centres frequently requires community health services and hospitals to intervene, at considerable cost, when an individual’s physical or mental health problems become acute following release from prison. In the initial period following release from custody, individuals have an increased risk of suicide, self-harm and drug overdose, meaning continuity of care during this transition is essential. This has significant public health implications and can constrain a country’s capacity to address health inequalities systematically.

In line with what is generally known about the health of people in prison, data from the Health in Prisons European Database (HIPED) paint a picture of an extremely vulnerable population that suffers from poor health and engages in risky health behaviours, leading to noncommunicable and communicable diseases and mental health conditions. Prevalence of indicators such as tobacco-smoking, injection drug use and bloodborne viruses is shown to be much higher than generally is seen in the community. Furthermore, a large proportion of deaths in custody were found to be from suicide, which emphasizes the urgent need for Member States to safeguard the lives of individuals in their care by ensuring that prison health systems have appropriate screening and treatment for mental health disorders and suicide risk both on reception to prison and throughout an individual’s stay in custody.