1. Dr Lars Moller Project Manager World Health Organization
Prisons and Public Health Northern Dimension – Prison Health Expert Group Oslo, Norway February 2007
Dr Lars Moller
Project Manager
World Health Organization
Distinguished Delegates, Ladies and Gentlemen,
First of all I would like to thank the organizers for inviting me here today and represent the WHO Health in Prisons Project.

2. Purpose of the WHO Health in Prisons Project
The purpose of the Project is to support Member States in improving public health by addressing health and health care in prisons, and to facilitate the links between prison health and public health systems both at national and international levels
The purpose of the Project is to support Member States in improving public health by addressing health and health care in prisons, and to facilitate the links between prison health and public health systems both at national and international levels

3. Strategic objectives
To establish integrated working between public health and prison health systems
To encourage prisons to operate within recognised codes of human rights and medical ethics
To assist the reduction of re-offending by contributing to prisoner’s rehabilitation and resettlement
These are here in a short version:
To establish integrated working between public health and prison health systems
To encourage prisons to operate within recognised codes of human rights and medical ethics
To assist the reduction of re-offending by contributing to prisoner’s rehabilitation and resettlement

4. Strategic objectives
To reduce the exposure of prisoners to communicable diseases, preventing prisons becoming focal points of disease
To promote prison health services to reach standards equivalent to those in the wider community
To reduce the exposure of prisoners to communicable diseases, preventing prisons becoming focal points of disease
To promote prison health services to reach standards equivalent to those in the wider community

5. The main problem globally is the high number of prisoners and in many countries in Europe the prison population increases. This slide shows the top 20 countries worldwide – of these are the 6 from the WHO European Region.

6. In Europe we find the highest prison population in the eastern part of the region. In Spain the figure is 145 prisoners per inhabitants and in western Europe this figure is high.

7. Prison overcrowding Russia Brazil Rwanda
This is just to show that without solving overcrowding it is difficult to solve health problems.

8. TB control in prisons, WHO/CDS/TB/2000.281
Most diseases are more frequent in the prison setting – this has both something to do with diseases prior to imprisonment but for many communicable diseases this is due to overcrowding, nutrition, health care etc. Last month WHO organized a conference in Romania on Prisons and Tuberculosis as this is a huge prison problem in most countries in the world. The slide shows the enormous difference in TB prevalence among prisoners and among the general population. Here we find differences up to 100 times, but in most countries we find figures of 20 times difference.
TB control in prisons, WHO/CDS/TB/

9. Rates of HIV and hepatitis C infection among prison inmates in most countries are much higher than those in the general population.
Data on HIV infection in prisons (available for many European countries though sampling methodology varies).
Estonia 12%
France 13%
Italy 17%
Ireland 2% (10% in women prisoners)
Netherlands 11% (Amsterdam)
Russian Federation 4% (58% in IDU prisoners in St. Petersburg)
Portugal 11%
Spain 14% (all prisons)
Spain 31% (some regions)
Switzerland.11% (Canton Berne)
Ukraine 7%
Adult population prevalence rarely exceeds 1% even in those countries worst affected.

10. Proportion of Drug Users in EU prisons (EMCDDA, 2002)

11. First time drugs in prison 41.7% - n=328 Ever used illicit drugs
Study on drug use in two prisons – 1000 random selected prisoners in Kyrgyzstan
Ever injected
73.2% - n=573
First time drugs in prison
41.7% - n=328
Ever used illicit drugs
78.6% - n=786
Ever shared n/s
79.7% - n=456
Used heroin
82.5% - n=473
Used last 3 months
87.4% - n=685
First time injected drugs in prison
54.2%
Used opium
54.6% - n=313
Injected last 3 months
82.4% - n=472
Got clean n/s
97.5% - n=460
Used marihuana
71.7% - n=411
Shared n/s last 3 months
17.6% - n=83
Next year I am travelling to Kyrgyzstan to present data on a survey we performed in two prisons but here you will see that the drugs problem is huge in some places of the world and especially if you are close to Afghanistan
Got clean n/s
92.8% -n=77

12. The WHO Health in Prisons Project
34 Member States are actively involved:
14 from west Europe:
Austria, Belgium, Finland, France, Greece, Iceland, Ireland, Malta, Netherlands, Norway, Portugal, Spain, Switzerland, United Kingdom (England, Wales and Scotland)
12 from centre Europe:
Albania, Croatia, Czech Republic, Estonia, Hungary, Lithuania, Latvia, Moldova, Poland, Romania, Slovakia, Slovenia
8 from east Europe:
Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Ukraine, Uzbekistan
We have now 33 Member States involved in the network and during the last three years this number has grown from 16 to 33. In total we have 53 Member States in the WHO European Region.

13. Steering group Representatives: International organizations:
Pompidou Group, Council of Europe
AIDS Foundation East-West
WHO Collaborating Centre for Promoting Prison Health, Department of Health, England and Wales
International Centre for Prison Studies, Kings College, London
International Committee of the Red Cross
Cranstoun Drug Services
European Monitoring Centre for Drugs and Drug Addiction
United Nations Office on Drugs and Crime
The Royal Netherlands Chemical Society KNCV
Member States:
National Agency of Correctional Services, Ministry of Justice, The Netherlands
Prison Health Services, Poland
Medical Services of the Russian Penitentiary System, Ministry of Justice, The Russian Federation
The Task Force had a meeting at the premisis of ICRC in Geneva in May and here is the updated list of Members

14. The WHO Health in Prisons Project Actual activities
Best Practice award
Prison Health Database
Guide on prison health
Status Paper on Prisons and Tuberculosis
Prisons and Mental Health
Prisons and Women
This year we are mainly focusing on 4 important issues
Best practice awards – we have for some years discussed how we could disseminate examples of best practice for our network and other interested in this subject. Our Collaborating Centre has been very active in this process and last year we awarded 15 prisons in Europe and we will give out the next awards next year.
We have established a database with the examples.
Talking about databases – we have developed a prison health database – we do this work in collaboration with the European Monitoring Centre for Drugs and Drug Addiction and the European Network on Drugs and Infections Prevention in Prison and we have received funding from the European Commission to support the development. Still we are collecting data but we have developed a tool for data presentation and data are available through our website.
Currently, we are performing the final editing of a prison health guide, covering the most important area of prison health. The guide will be a new tool for prison health personnel. We expect to have a printed version ready by February 2007.
In October we organized a conference on prisons and TB and a draft status paper on tuberculosis was adopted. The paper will be published early in 2007 and will give eveidence based recommendations on TB in prisons.

15. Web site: http//:www.euro.who.int/prisons lmo@euro.who.int
Contact Lars Moller: