The health of prisoners

[Guest guest]

The health of prisoners

Seena Fazel and Jacques Baillargeon,1 in their important Review on the health of prisoners, emphasise the increased prevalence, susceptibility to, and transmission of, various infectious diseases in prisoners. They focus on HIV infection, hepatitis B and C, and tuberculosis. Prisoners are also more susceptible to acute respiratory infections, sexually transmitted diseases, skin infections, and diarrhoeal diseases.2

The appalling prison conditions described by Fazel and Baillargeon are not restricted to resource-poor countries. They are prevalent in prisons in the UK, Europe, and the USA. In the UK today, the prevalence of tuberculosis in prisoners is 208 per 100 000, which is almost 14 times greater than the prevalence in the general population.3 Prisons in the countries of the former Soviet Union have the highest prevalence of tuberculosis anywhere in the world.4

Although crowded and poorly ventilated prison cells facilitate microbial transmission, it is the stress, poor nutrition, smoking, drugs, and HIV that have a profound effect on the immune system, resulting in high prisoner morbidity and mortality. As Louis Pasteur acknowledged on his deathbed, in reference to Claude Bernard's belief that disease was not caused by microbes alone, but rather by an imbalance of the body's “terrainâ€, “Le terrain est tout, le microbe n'est rien†(the terrain is everything, the microbe is nothing).

Prisoners, by default, lose their dignity, liberty, autonomy, and privacy, and are commonly accorded inadequate accommodation and health care. Basic ethical practice requires observation of the UN charter on human rights5 for prisoners by all governments. Urgent measures must be taken to rectify the prison conditions that underlie the disturbance of prisoners' body “terrain†and homoeostatic mechanisms.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60857-X/fulltext?rss=yes