Health concerns hounding prisons and other formal places of detention must also be regarded as a public health issue to be able to effectively address them, participants in a three-day regional conference last week concurred.
Amid high prevalence of communicable diseases like tuberculosis and HIV, non-communicable diseases like diabetes and hypertension, and even mental disorders affecting prisoners and other persons deprived of liberty globally, "health problems in places of detention...require a public health approach that benefits the entire society," Boris Michel, Manila chief of the International Committee of the Red Cross, said.
The ICRC organized the 3rd Asian and Pacific Conference on Prison Health, on the theme of "Health Despite Bars," on Nov. 13-15.
Some 150 individuals from 21 countries involved in prison health took part in the event, which was first held in 2017 in Thailand, and in 2018 in Cambodia.
According to the Red Cross, the Asia-Pacific region has over 4 million prisoners, citing latest available data from the World Prison Population List. Globally, there are more than 11 million people held in penal institutions as of September 2018, the same report states.
Without referring to a particular geographical grouping, Rabindra Abeyasinghe of the World Health Organization in the Philippines said the level of TB in prisons "has been reported to be up to 100 times higher than that of the civilian population," while "the estimated global HIV prevalence (among) prisoners is 3 percent."
"The prevalence of mental disorders among prisoners is considerably higher than in the community, and studies have shown that suicide rates in prisons are up to 10 times higher than those in the general population," Abeyasinghe added.
He said prison settings, including overcrowding, poor ventilation, weak nutrition, and inadequate or inaccessible medical care, contribute to the spread of diseases, while "mental health issues are exacerbated by violence, enforced solitude or conversely, lack of privacy, lack of meaningful activity, isolation from social networks, and insecurity about the future."
"To address these challenges, we need to look beyond the four walls of a detention facility. We need to look at prison health as public health," Michel said, recalling the Declaration on Prison Health as Part of Public Health" adopted in Moscow in 2003.
"There is a need to establish effective communication and coordination among all health care actors and detention stakeholders so that they work together and achieve long-term sustainable results for detainees," he said.
"The integration of 'health care in detention' into national health policies and the incorporation of detainees into national health programs are critical if prison health is to be addressed as a public health issue."
Michel said stakeholders "need to go beyond curative care" and must examine as well "the inmates' living conditions."
Anchoring on the basic principle of ensuring that "the dignity and human rights of every prisoner are respected," Abeyasinghe of the WHO said health services provided in the country as a whole must equally be extended to prisons.
Screenings and check-ups must be regularly done to curb the spread of TB and other communicable diseases, and HIV prevention and services, such as provision of condoms, must be made available, he said.
Appropriate mental health treatment and care, and access to medication must also be provided to address mental health issues in prisons.
"We can decongest prisons if we transfer people with mental disorders who did not commit any offense or only minor offenses from prisons to mental health treatment facilities," Abeyasinghe said.
Sharing the experience of the Philippines, Health Secretary Francisco Duque mentioned his agency's coordination with the Bureau of Jail Management and Penology and the country's different correctional facilities.
"This conference could not have come at a more opportune time, as the U.N. General Assembly recently adopted the global action toward universal health coverage, and the Philippines early this year passed its very own Universal Health Care Law," Duque said.
The Philippines currently has more than 215,000 detainees and inmates inside its 558 jails and prisons, and its detention congestion rate is among the highest in the world. A notable increase in the recent couple of years has been noted, and is being attributed to the current government's aggressive war on drugs.
"For us, the priority is to bring all concerned authorities to work together (and) coordinate in a functional way," said Mitsuyoshi Morita, an ICRC doctor in the Philippines who has been visiting detention centers in the country since mid-2017.
Committing to continue partnering with relevant agencies "in this challenging journey," Boris Michel of the ICRC said looking at prison health care from all angles and considering prison health as a public health issue will be key to breaking the cycle of poor health outcomes in prisons.