Prison overcrowding and the risks for public health: a global time-bomb?

Recent surges in prisoner numbers across much of the world have produced a global prison population of over 11 million along with severely overcrowded, under-resourced prisons. The consequences for health, justice and human rights are discussed in a new report by Catherine Heard, from the Institute for Criminal Policy Research (ICPR), based at the School of Law, Birkbeck in London. Here, Catherine discusses the report. As with all of our guest posts, the views represented are of the author and may not reflect the views of Fair Trials.  

“It was like a competition to survive, you know? The food, the sleeping space, everything.”

“My body feels so stiff. On average we probably get out of the cell for about an hour a week.”

“It was very dirty, our children regularly got sick with diarrhoea, skin diseases, cholera, they had colds all the time.”

“When I arrived I told them I was HIV positive. They never gave me my anti-retroviral treatment. My viral load has increased in detention.”

“People died when I was there. I had fevers, I had TB. I thought I would die.”

“Usually the doctor will assume you’re lying and ignore you.”

These are the words of people who have been held in overcrowded prisons in Thailand, Brazil, South Africa and Kenya; they are just a few of the first-hand descriptions featured in our latest report. They attest to the damage prison so often does to health – damage that in many cases lasts years beyond a person’s release.

Towards a health-informed approach to penal reform? Evidence from ten countries is one of a series of reports being published this year as part of our project, Understanding and reducing the use of imprisonment in ten countries. The countries we are researching are Kenya, South Africa, Brazil, the USA, India, Thailand, England & Wales, Hungary, the Netherlands and Australia. All but the Netherlands are currently running their prisons above official capacity – as, indeed, are the prison systems of most countries worldwide (see our World Prison Brief for more information).

The public health risks that this situation presents are serious. Overcrowded prison conditions lead to increased prevalence of communicable and chronic diseases, mental illness, substance misuse, violence, self-harm and suicide. The risks affect prisoners, staff, the families of prisoners and staff, and wider communities.

Prison populations bear a far greater burden of mental and physical health problems than general populations. People who enter custody usually come from the poorest and most marginalised sections of society communities that often have worse health due to socio-economic and health inequalities. And it’s all too easy for people with mental health problems, drug or alcohol dependency or other vulnerabilities to be propelled into the criminal justice system and custody because of those problems, when their needs would be better addressed through health-led interventions.

It’s also clear that prison environments tend to exacerbate existing health problems and often give rise to new ones. This results from poor conditions, lack of healthcare, availability of illicit drugs, social and psychological stresses, violence and mistreatment.

So, what would a health-informed approach to penal reform entail? For most countries, reducing prisoner numbers overall is an essential first step to ensuring better conditions and access to healthcare and treatment in custody. That means limiting the use of pre-trial detention; achieving fair and proportionate sentencing; and making smarter use of alternatives to custody.

It also means reducing the numbers of people in poor health who enter custody. To achieve that, most countries including the UK need to improve healthcare provision in the community, particularly for mental health conditions and drug and alcohol problems.

Then, for those reduced numbers for whom custody is inevitable, there must be proper access to healthcare, screening and treatment, harm reduction measures, and decent living conditions.

A sentence of imprisonment is a sentence of deprivation of liberty, not of damage to health. Prison systems that leave people in worse health than when they entered custody cannot achieve rehabilitation or make communities safer. They are more likely to perpetuate the revolving door of ill health, unemployment, poverty, homelessness and repeated arrests.

It will take political courage to call time on our over-reliance on prison and accept that other approaches, focused on tackling social injustice and health inequality, are more likely to reduce crime. The rewards will be safer societies and better public health.

Read the full report here.

Read more about ICPRs World Prison Research Programme and the ten-country project here.