Status Report On Prison Health in The WHO European Region 2022

Status report on
prison health in the

WHO European Region
2022
Status report on
prison health in the
WHO European Region
2022
Abstract
This report provides an overview of the performance of prison health systems in the WHO European Region. It contains
2020 data obtained through a survey collected from 36 countries, where a total of 613 497 people were deprived of their
liberty. In most of these countries, responsibility for delivering prison health care was shared between the Ministry of Health
and the Ministry of Justice/the Interior. Preventive services, such as vaccines, were universally offered for COVID-19 in all
Member States, even though deficiencies still persisted in access to vaccination for other diseases such as hepatitis B. The
response implemented for COVID-19 was good, except when people were transitioning into the community. Continuity
of care was an area needing investment, with only around half of Member States ensuring access to community health
services. The most prevalent condition was mental health disorders, but the ratio of psychiatrists to people in prison did
not ensure equity of care and access to treatment was suboptimal. Harm minimization focused mostly on access to drug
use treatment and less on safe injecting or tattooing practices. Access to hepatitis C (HCV) treatment was not on track to
achieve HCV elimination and needs urgent attention. The most common cause of death in prisons was suicide, followed
by COVID-19 and drug overdose. Overcrowding was reported in 20% of Member States. Even though Member States are
improving their capacity to provide disaggregated data, further investment is needed to increase capacity to provide
morbidity and health behaviour data.
KEYWORDS
PRISONS
DELIVERY OF HEALTH CARE
HEALTH INFORMATION SYSTEMS
HEALTH STATUS
HEALTH WORKFORCE
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Corrigendum
Status report on prison health in the WHO European Region 2022.
Copenhagen: WHO Regional Office for Europe; 2023
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Page 6
Paragraph 9, line 1, “This publication was made possible by
funding from the Finnish Ministry of Social Affairs and Health
and from the United Kingdom Health Security Agency” should
be replaced by “This publication was made possible by funding
from the Finnish Ministry of Social Affairs and Health, from the
Federal Office of Public Health of Switzerland and from the
United Kingdom Health Security Agency”.
This correction was incorporated into the electronic file on 9

May 2023.
iii
iv
Contents
Acknowledgements vi
Abbreviations vii
Foreword viii
Preface ix
Executive summary x
Introduction 1
1. Methods 5
1.1 The WHO Prison Health Framework 5
1.2 HIPEDS 5
1.3 Data collection procedure 9
1.4 Data analysis 9
1.5 Data validation 11
2. Findings 13
2.1 Penal statistics 13
2.2 Inputs: prison health system 18
2.3 Outputs: health service delivery 25
2.4 Impacts: health outcomes 44
2.5 Influencing factors 47
2.6 Cross-cutting principles 52
3. Exploring the effects of governance arrangements for the delivery of health care in prisons 59
3.1 Health information systems 59
3.2 Delivery of health-care services 60
3.3 Environmental factors 62
3.4 Adherence to the principle of equivalence and other international standards 62
4. Limitations 65
5. Discussion and conclusions 67
6. Key messages 73
References 75
Annex 1. Country profiles 81
Annex 2. Health in Prisons European Database Survey (HIPEDS) 447
Annex 3. Raw data describing the process of death data transfer to the national
registration system 483
v
Acknowledgements
The WHO Regional Office for Europe would like to thank Further contributions were received by members of the
Filipa Alves da Costa, WHO European Office for the Health in Prisons Programme (HIPP)’s Steering Group:
Prevention and Control of Noncommunicable Diseases, Ruth Gray, South Eastern Health and Social Care Trust,
Denmark, for developing this publication; and Daniela Northern Ireland, United Kingdom (oral health indicators);
Correia, Institute of Public Health of University of Porto Ehab Salah, Prisons and HIV adviser, UNODC, Austria
(ISPUP), Portugal, as part of the work conducted by the (pregnancy indicators); Olivia Rope, Chief Executive Officer,
WHO Collaborating Centre on Behavioral and Social Penal Reform International, United Kingdom (gender-related
Determinants of Noncommunicable Diseases, for analysing indicators); Linda Montanari, Principal Scientific Analyst,
the data. The WHO Regional Office for Europe is also thankful European Monitoring Centre for Drugs and Drug Addiction,
to Sumudu Kasturiarachchi, WHO European Office for the Portugal (drug use indicators); Éamonn O’ Moore, National
Prevention and Control of Noncommunicable Diseases, Health and Justice Team, United Kingdom Health Security
Denmark, for support in the selection and interpretation Agency, United Kingdom (COVID-19-related indicators);
of external data for meaningful comparisons; and Elizaveta Merja Mikkola and Jussi Korkeamäki, Finnish National
Lebedeva, Tobacco Control Programme, WHO European Institute for Health and Welfare, Finland (health systems
Office for the Prevention and Control of Noncommunicable organization and financing indicators); Lara Tavoschi, Public
Diseases, Denmark, for input on tobacco control policies; Health Unit, University of Pisa, Italy (vaccine indicators); and
Sergei Bychkov, NCD Surveillance, WHO European Office Erika Duffel, European Centre for Disease Prevention and
for the Prevention and Control of Noncommunicable Control, Sweden (infectious disease indicators).
Diseases, Denmark, for support in survey development
The WHO Regional Office for Europe would also like to
for data collection and management; and Sofia Ribeiro,
acknowledge the focal points and WHO representatives
WHO European Office for the Prevention and Control of
who participated in the focus groups held both in Russian
Noncommunicable Diseases, Denmark, for critical revision
and in English to discuss aspects of data quality and
of the report.
strategies to improve the validity of responses. Particularly
The work was conducted under the technical guidance noteworthy, in this respect, were the contributions made by
of Carina Ferreira-Borges, Regional Advisor, Alcohol, Illicit Germany, Kazakhstan, Spain, Switzerland, Ukraine and the
Drugs and Prison Health, WHO Regional Office for Europe, United Kingdom. Thanks, too, to Maria Neufeld, Technical
Denmark. Officer, and Yanina Andersen, Public Health Specialist,
Alcohol, Illicit Drugs and Prison Health Programme, WHO
The structure used in this report follows the WHO Prison
Regional Office for Europe, Denmark, for facilitating these
Health Framework, a framework for assessment of
focus groups.
prison health system performance. This framework was
conceptualized with important contributions from Marieke The external reviewers of this report were Sunita
Verschuuren, WHO European Office for the Prevention Stürup-Toft, United Kingdom Health Security Agency,
and Control of Noncommunicable Diseases, Denmark; United Kingdom, and Lara Tavoschi, Public Health Unit,
Yanina Andersen, WHO European Office for the Prevention University of Pisa, Italy, for whose thoughtful comments
and Control of Noncommunicable Diseases, Denmark; we are extremely grateful.
Sunita Stürup-Toft, United Kingdom Health Security Agency,
Finally, this report would not be possible without the
United Kingdom; and Daniel Lopez-Acuña, WHO European
contribution of the focal points of the Member States of
Office for the Prevention and Control of Noncommunicable
the WHO European Region. Their time and expertise put
Diseases, Denmark.
into answering the Health In Prisons European Database
The indicators used in the survey resulted from refinements survey (HIPEDS) and providing additional responses and
made to those used in the previous (2019) iteration of this clarifications whenever requested during the validation
document, which were further refined by a Technical Expert process were crucial.
Group composed of Stuart Kinner and Louise Southalan,
This publication was made possible by funding from the
Justice Health Unit, Centre for Health Equity, Melbourne
Finnish Ministry of Social Affairs and Health, from the
School of Population and Global Health, University of
Federal Office of Public Health of Switzerland and from the
Melbourne, Australia; Emily Wang and Tyler Harvey, SEICHE
United Kingdom Health Security Agency.
Center for Health and Justice, Yale School of Medicine and
Yale Law School, United States of America.
vi
Abbreviations
BMI body mass index

COPD chronic obstructive pulmonary disease
CPT European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or
Punishment
CVD cardiovascular disease
DTP diphtheria–tetanus–pertussis
EU European Union
FTE full-time equivalent
HBV hepatitis B virus
HCV hepatitis C virus
HIPED Health in Prisons European Database
HIPEDS Health in Prisons European Database Survey
HIPP Health in Prisons Programme
HPV human papillomavirus
MDR-TB multidrug-resistant tuberculosis
MMR measles, mumps and rubella
NCD noncommunicable disease
PEP post-exposure prophylaxis
PrEP pre-exposure prophylaxis
SD standard deviation
STI sexually transmitted infection
TB tuberculosis
UNAIDS United Nations Programme on HIV and AIDS
vii
Foreword
“Prison health is public health” – and I know first-hand that This is particularly important for noncommunicable
this is not merely a memorable headline. In my early career, diseases (NCDs), as these are not yet prioritized to the same
my work as a medical doctor in a Siberian prison shaped extent as infectious diseases. The results in the current
my vision of prison health and my conviction that no one report show that only 17% of Member States could extract
should be left behind. But allow me to go one step further data on the rate of overweight or obesity in the prison
and highlight that not only is prison health a human right, population. Although this is a considerable improvement
but also that every individual is entitled to access health on the previous report, it is still suboptimal. For this reason,
care in the same conditions as any other person living in the WHO believes that it is a priority for prison health systems
community, throughout their life course. This is of utmost to invest in their health records, so that evidence-based
importance as prisons are not silos: they are embedded policies can be adopted.
in communities and the investment made in the health
of people in prison can become a community dividend. This report also shows that, upon release, less than 50%
Incarceration should never become either a synonym for of Member States provide a support service to help people
or a sentence to poorer health. Health is a human right as leaving prison to register with community health services,
dictated by United Nations conventions, and all citizens while less than 40% provide people with medication for
are entitled to good-quality health care regardless of their all health conditions. There is abundant evidence that a
legal status. significant proportion of people in contact with the justice
system have limited access to health care, before and after
The WHO Health in Prisons Programme (HIPP) aims to incarceration. All these facts call for greater investment in
improve the health of people living in detention and leave continuity of care.
no one behind in the ambitious goal of achieving universal
health coverage for all citizens. To achieve this aim, it was Nelson Mandela once said that “no one truly knows a
considered that the starting point should be an in-depth nation until one has been inside its jails. A nation should
analysis of the prison health-care system. The Health in not be judged by how it treats its highest citizens, but its
Prisons European Database (HIPED), open to the public and lowest ones.” WHO’s European Programme of Work clearly
containing data collected through a periodic survey sent states that we need concerted actions and partnerships
to Member States, facilitates monitoring and surveillance across intergovernmental and nongovernmental agencies,
of health in prisons. The data provide an indication of the without forgetting people with lived experience, to achieve
status of prison health in the WHO European Region and higher gains. Prisons are often neglected, and the area of
highlight areas of prison health policy that should be better prison health has for too long been the invisible part of
aligned with WHO guidance. This is a unique resource and, WHO’s work. It is time to change this narrative, contribute
as such, HIPP has been recognized since 2021 as the United to reducing inequalities and invest in the health of people
Nations hub for health information in prison. living in prisons.
One of the key elements in improving health in prison

settings is, undoubtedly, to have high-quality data.
Dr Hans Henri P. Kluge
Director
WHO Regional Office for Europe
viii
Preface
Improving prison health is improving public health. that serve the needs of Member States. So, it was a game
Incarceration should no longer be a sentence to poorer changer when, in 2019, the results of the first HIPED survey
health outcomes. Instead, it should be an opportunity to (HIPEDS) were published – the first ever comprehensive
access timely and quality-based health care, and to address report on prison health, providing a comprehensive
risk factors for both communicable and noncommunicable overview of the status of prison health in the WHO European
diseases, which will ultimately translate into health gains Region. The current publication covers not only health
throughout the life course. These gains are important not services and outcomes, but also other areas that have a
only for individuals but also for the population in general, as tremendous impact on health, such as behavioural factors
prisons are part of communities, and incarcerated people and the prison environment. This latest report shows that
will return to them upon completing their sentences. inequalities still exist across the Region, as incarcerated
people continue to have higher prevalence of disease
This publication was guided by the European Programme and worse outcomes when compared to the general
of Work, 2020–2025 – “United Action for Better Health” population. This means that there are many challenges
and provides important insights in the context of prison that remain to be tackled over the coming years and that
health into one of its core priorities: moving towards higher priority must be given to addressing the health-
universal health coverage. We must always bear in mind care needs of this vulnerable group. In addition, the report
that incarcerated people have the right to access the same shows how important it is to invest in robust surveillance
standards of health care, across prevention, diagnosis and systems in prisons that allow enhanced data collection and
treatment services, as the general population. Therefore, storage, and highlights the importance of integrating these
efforts must be made to drive equitable access and systems into national health information systems to ensure
coverage of services to people in prison, who so often have continuity of care.
been left behind.
Nevertheless – and in spite of the challenges that remain
However, we are only able to monitor and improve what – we are confident that the latest iteration of this report
we know, and this is no less true of prison health than it is will inspire Member States in their efforts, providing
of other areas. It is often said that information is the new a comprehensive basis for action towards achieving
gold, but data about prison health have historically been better prison health and better public health in the
as difficult to collect as the precious metal itself. This limits WHO European Region.
our ability to design and implement effective interventions
Dr NinO Berdzuli
Director, Division of Country Health Programmes,
Dr Carina Ferreira-Borges
Re gional Advisor, Alcohol, Illicit Drugs and Prison He alth,
ix
Executive summary
Background with their evolution and outcome, undoubtedly contributed

to a greater capacity to provide reliable data in a timely
Established in 1995, the WHO Health in Prisons Programme manner.
(HIPP) is committed to addressing the health needs of
people in prison. Given that such people are typically In 2021 HIPP was recognized as the United Nations
excluded from population health data collections, HIPP has information hub for health in prisons data, clearly
recognized the need for comparable data on the health of acknowledging the enormous contribution it had made in
people in prison and on prison health governance, systems the area. Notwithstanding, it was recognized that there were
and administration. The availability of these data is an still many limitations in the information that was available
essential component in the monitoring of prison health or could be extracted or shared; the aim is to progressively
system performance, and can ultimately be used to improve address these limitations, apparent in the current report,
health services in prisons and reduce health inequalities. over the coming years. In 2021 the WHO Prison Health
Framework was published, which provides a framework
To bridge the gap between evidence and policy, between for assessing prison health system performance and which
2014 and 2016 HIPP led the development of the WHO was used to standardize data collection and reporting and
Health in Prisons European Database (HIPED), which to structure revision of HIPEDS. The development of this
represents one of the first attempts to provide comparable framework may be considered a first step in the process of
data on prison health systems in the WHO European improving data quality.
Region and lays a foundation for future work to generate
comprehensive and comparable data on prison health in
Europe and globally. The data contained in this database Methodology
are obtained through answers provided by Member States
in the HIPED survey (HIPEDS), which focuses mainly on All health ministries of the 53 Member States of the WHO
the health of people in prison and the health systems and European Region were invited to nominate a focal point
services that exist to serve this population. to answer HIPEDS. After nominations had been received,
all focal points were sent a token to enter their responses
The previous edition of the current report, Status report on online. Whenever necessary, Member States also had the
prison health, published in 2019, has been widely used by option of filling in HIPEDS in writing and data were then
policy-makers, researchers and practitioners, attesting to entered centrally. HIPEDS was operationalized in eight
its utility. Nonetheless, this same publication also revealed sections as follows:
that many areas of prison health were still “black holes” of A. Penal statistics
information and that health information systems had to be B. Prison health systems
improved. Following this publication, HIPP did not allow C. Health service delivery
the COVID-19 pandemic to stop its work. On the contrary, D. Health outcomes
this challenge was turned into an opportunity to strengthen E. Prison environment
health information systems, and it was during this period F. Health behaviours
that a minimum dataset was developed and implemented G. Adherence to equivalence and other international
to help monitor the evolution of the epidemiological standards
situation and the responses devised at country level. H. Reducing health inequalities and addressing the
This voluntary exercise, which involved Member States needs of special populations.
periodically reporting cases identified in prison, together
x
Further information on the correlation between the Post-exposure prophylaxis (PEP) against HIV was available
structure of HIPEDS and the structure of the current report in all prisons in 75.0% of Member States. However, less than
is given in section 1.2 below. 60% of Member States had pre-exposure prophylaxis (PrEP)
available in all prisons.
All data collected are from the year 2020, except when not
available; in such cases, the period of reporting is duly Only three Member States (8.3%) offered needles and
acknowledged. Data were mainly analysed descriptively. syringes free of charge in all prisons. Other products offering
Bivariate analysis was used to evaluate if countries where protection against bloodborne infections from risky drug-
the responsibility for delivery of prison health care lies related or sexual behaviours (such as disinfectants and
with the Ministry of Health perform differently from others lubricants) were also scarce; the most commonly available
(section 3). product was condoms, which were still offered by less than
half of Member States in all prisons. One Member State did
not offer soap free of charge in any of its prisons.
Key findings
The majority of Member States (62.9%) had policies in
Prison population place to promote physical activity, the lack of which is an
A total of 613 497 people living in prison establishments important risk factor for many noncommunicable diseases
was reported in the represented European countries. The (NCDs).
average number of people in prison per 100 000 inhabitants
in Europe was 107.3, ranging from 23.0 in San Marino to However, 60.0% of Member States reported that they
246.0 in Georgia. provided treatment areas for people with drug use
disorders either in a minority of prisons or not at all, while
Only five countries in the WHO European Region did not over 60% did not provide any promotional materials on safe
legally permit the use of life sentences. tattooing practices.
Prison health-care systems Rehabilitation

The most common situation in 2020 was for responsibility Educational opportunities were offered by all Member
for the delivery of prison health care to be shared between States in all or most of their prisons. Employment
the Ministry of Health and the Ministry of Justice/the Interior opportunities, meanwhile, were available in all but one
(n = 21). There were eight countries where the responsibility Member State in all or most prisons.
lay with the Ministry of Justice alone, and seven where it lay
with the Ministry of Health alone. Primary care
Primary care is the main pillar of high-quality health care.
In half of all responding Member States (n = 18), the Ministry Many Member States experienced difficulties reporting
of Justice was responsible for financing prison health care. individual data that would allow the quality of primary
care to be characterized. Only about a third of Member
Preventive services States could do so. Cardiovascular disease (CVD) was
All Member States reported that they had COVID-19 particularly well managed in these countries, with nearly
vaccination services available in all or most prisons. 97% having implemented one or more routine health-care
However, for other vaccine-preventable diseases, visits in the previous year, and over 92% providing access
availability was more variable and qualified in many to pharmacological treatment. Diabetes management,
cases. Of particular note, 16.7% of Member States did not by contrast, was suboptimal, with 86.1% of people with
offer vaccination against hepatitis B (HBV) or diphtheria– this condition having had access to at least two routine
tetanus–pertussis (DTP) in any prisons, both of which are health-care visits in the previous year, and 65.5% having
recommended for all people on admission to prison. at least one ophthalmology visit over the same period;
xi
the most favourable indicator for diabetes was access Secondary and tertiary care
to pharmacological treatment, which was provided for Arrangements/protocols were in place for transferring
over 95% of individuals. Oral health was an area calling people in all prisons to specialized institutions to treat
for greater investment of resources, as only 72.8% of cancer in 83.3% of Member States. In the case of severe
individuals had had access to one or more oral health visits mental health disorders, the comparable figure was 86.1%
in the previous year. of Member States.
Prevention and management of infectious diseases, Continuity of care

especially COVID-19, were considered quite good, as In more than 72% of Member States, there was a procedure
nearly 80% of Member States had contingency plans for in place to ensure medication reconciliation at time of
managing the impact of an infectious disease, over 94% admission. However, less than half of Member States
said that all individuals had access to laboratory tests when (n = 17; 47.2%) reported that they had a support service
required, and all Member States provided access to hand to register people with community health services upon
sanitizer/soap and water and face masks. Whatever other release, and 11.1% did not provide any medication upon
difficulties health systems may have faced, several efficient release. Of those Member States providing medication at
solutions were put in place to address COVID-19, and over time of release, 14 did so for all conditions. Among the
97% of Member States reported that access was available other 18 Member States, which provided medication for
to everyone’s immunization status. Only two Member certain conditions only, medication was provided, in order
States said that prisons were not mentioned in their of decreasing frequency, for HIV, TB, HCV and drug use
national vaccination plans. The weakest aspect of COVID-19 disorders.
prevention and control was the procedure followed prior to
release, when nearly 80% of Member States said that they Performance
did not test individuals before they were released. There were 36.4 health-care staff per 1000 people in
prison, with higher values for nurses and physicians when
All Member States reported that history of tuberculosis (TB), compared to the community. Conversely, there were fewer
and current signs and symptoms of TB, were assessed at dentists than expected (1.4 per 1000 vs 6.2 in the general
or close to admission for all people in prison. Almost 70% population). There were similar numbers of psychiatrists
of Member States offered diagnostic tests in addition to (1.3 vs 1.4 per 1000), which – given the high levels of drug
clinical evaluation, and half of Member States provided use and mental health disorders in prisons – suggests that
additional assessment for multidrug-resistant TB (MDR-TB) more investment in staff is need in order to assure equity
in the event of a positive test. of care.
Access to and completion of treatment for HIV and hepatitis Morbidity

C (HCV) fell below the levels recommended by the United Between 14 and 28 Member States were able to provide
Nations Programme on HIV and AIDS (UNAIDS). Only 91.1% figures on the number of individuals with diagnoses on
of individuals with HIV had access to treatment, and just record. However, only four could provide data on oral
52.5% completed it. In the case of HCV, only 48.7% had health status. The most prevalent condition reported was
access to treatment and 54.5% completed it. mental health disorders (32.8% of the population). Drug
use disorders represented nearly 8% of the population.
Access to pharmacological treatment for hypertension, The most common NCD was hypertension (10.9%),
CVD, diabetes and cancer was made available by over followed by CVD (6.1%) and diabetes (3.0%). HCV and
90% of Member States able to report it. Lower values were HIV represented, respectively, 3.8% and 2.6% of the
reported for access to pharmacological treatment of drug population. These figures should be interpreted cautiously,
use (64.9%) and mental health disorders (80.9%). as underreporting is very likely given what is known about
the profile of the prison population.
xii
Mortality the most prevalent behaviours were smoking (63.1%
All Member States reported mortality data, 35 of which of the population) and drug use (17.8%). Overweight
could also indicate cause of death. The standardized (BMI 25.0–29.9 kg/m2) was found in 34.8% of the population;
all-cause mortality rate per 100 000 incarcerated people obesity (BMI ≥ 30.0 kg/m2) in 9.7%. Only 10.5% of the
was 42.5, as compared to 136.9 in the general population population could be considered physically active. Even
for the same region. The most common cause of death was though the data were derived from a minority of Member
suicide, followed by COVID-19 and then drug overdose. States, the estimates seem relatively well aligned with the
wider literature.
Prison environment
In more than 94% of Member States, people in all prisons Adherence to equivalence and
had access to showering and bathing facilities, with other international standards
water at a temperature appropriate to the climate. The In most Member States, health-care services were subject
situation was less good with respect to access to a toilet to the same accreditation procedures as in the general
in-cell in all prisons, which was reported in only 69.4% of community. In all Member States, health-care professionals
Member States. were subject to exactly the same ethical and professional
standards. However, despite these good practices,
In all Member States, people in all prisons were given the more than 22% of Member States reported that clinical
opportunity to spend at least one hour per day outdoors. decisions could be overruled or ignored by non-health-
In over 90% of Member States, in all prisons, facilities for care prison staff.
physical activity were available that people were allowed
to use at least once a week. Reducing health inequalities and addressing
the needs of special populations
The least favourable indicator in this domain was National standards to meet the needs of special
overcrowding, where nearly 20% of Member States (seven populations were mentioned by a majority of Member
countries) exceeded their official capacity. Also, nutritional States – most commonly for pregnant women and people
options available were suboptimal, with only 44.4% of who use drugs (both 90.0% of Member States), followed
Member States having diets adapted to meet gender needs. by people with physical disabilities (86.7%). Over a third
of Member States said that access to pregnancy tests
Health behaviours was not given upon admission. In 2020, 105 women were
Only 4–10 Member States (11.1–27.8%) were able to reported by 27 Member States to have given birth in prison,
provide data on health behaviours. Among those reporting, representing 0.6% of the females detained.
xiii
xiv
Introduction
The European prison population Prison health systems
It is estimated that around 11.5 million people are held in The Universal Declaration of Human Rights of 1948 (4) was
prison globally (1) and around 13% of those are detained created to ensure that:
in Europe. The number of people living in prison in
the European Union (EU) was around 463 700 in 2020, everyone has the right to a standard of living
a decrease of around 6.6% compared to 2019, which was adequate for the health and well-being of himself
mainly due to COVID-19 measures (2). and of his family, including food, clothing, housing
and medical care and necessary social services, and
According to Eurostat, the average incarceration rate in the right to security in the event of unemployment,
the EU in 2020 was 104 people per 100 000 population (2), sickness, disability, widowhood, old age or other
but this value varies widely from country to country. Other lack of livelihood in circumstances beyond his
sources that include countries outside the EU indicate that control.
the figure ranges from 30.7 per 100 000 in Liechtenstein up
to 328.1 per 100 000 in the Russian Federation (3). This declaration does not exclude people living in prison.
On the contrary, it specifically states that “everyone is
Imprisonment comprises both jails, where unsentenced entitled to all the rights and freedoms set forth in this
people are held, and prisons, where sentenced individuals Declaration, without distinction of any kind”.
are held. According to Eurostat (2), 19.1% of people
incarcerated were unsentenced. There is also wide Nonetheless, because it was felt that there was a need to
variability in this indicator, with the highest value (43.3%) provide States with detailed guidelines for protecting the
found in Luxembourg and the lowest in Romania (7.8%). rights of persons deprived of their liberty, from pretrial
The share of unsentenced people increased in 2020, again detainees to sentenced prisoners, the United Nations
probably as a result of the COVID-19 pandemic. developed the Standard Minimum Rules for the Treatment
of Prisoners, known as the Mandela Rules (5). In these
The variability in these figures is principally due to rules, a specific section is devoted to the right to health
differences in the penal systems and criminal laws that care, several aspects of which are highlighted. Rule 24
exist nationally. Some offences may be punishable by states that “The provision of health care for prisoners is
law in some countries but not in others; drug offences, a State responsibility” and that “Prisoners should enjoy
for example, are severely punished in some countries, the same standards of health care that are available in the
while in others consumption is addressed by noncriminal community, and should have access to necessary health-
diversion schemes. care services free of charge without discrimination on the
grounds of their legal status”. Rule 25 states that “Every
The profile of the prison population has consistently shown prison shall have in place a health-care service tasked
that females represent approximately 5% of the total prison with evaluating, promoting, protecting and improving the
population, with a slight increase observed from 2019 to physical and mental health of prisoners, paying particular
2020 (from 5.3% to 5.4%) (2). attention to prisoners with special health-care needs or
with health issues that hamper their rehabilitation”.
Introduction 1
However, such rules are intended to offer guidance (they substantially prevent disease transmission not only in
are not legally binding), and mechanisms and support are prison settings but also in the communities to which people
needed to facilitate their uptake. For this reason, structures leaving prison return (10).
such as the European Committee for the Prevention
of Torture and Inhuman or Degrading Treatment or In comparison with the general population, there is a high
Punishment (CPT) were created (6). According to this body, incidence of psychiatric conditions among people in prison.
“An inadequate level of health care can lead rapidly to Consequently, a doctor qualified in psychiatry should be
situations falling within the scope of the term ‘inhuman and attached to the health-care service of each prison, and
degrading treatment’” (7). The CPT performs regular visits to some of the nurses employed there should have had
prisons during which health-care services are audited and training in this field (7). While some mental health care
the following aspects are taken into consideration: can be provided in the primary care context, severe forms
of mental illness may require specialized treatment, so
(a) access to a doctor
mechanisms to ensure referral of severe cases are needed.
(b) equivalence of care
Suicide remains the leading cause of mortality in prisons
(c) patient’s consent and confidentiality
worldwide, but noncommunicable diseases (NCDs) are
(d) preventive health care
increasing and were reported (in 2018) to be the leading
(e) humanitarian assistance
cause of mortality in England and Wales (11). Among NCDs,
(f) professional independence
cardiovascular disease (CVD) and cancer play a central role,
(g) professional competence.
and while most cardiovascular conditions may be treated
and managed in primary care, the same is not true of
In addition to the CPT, some countries have created many types and stages of cancer. In such circumstances,
national bodies that have similar purposes. One example mechanisms to ensure access to specialized care are also
is His Majesty’s (HM) Inspectorate of Prisons, which is essential for people in prison living with cancer.
responsible for evaluating the extent and quality of
health care in prisons in England and Wales. In one of this
organization’s reports (8), it was stated that the quality of The interface between public
care varied greatly and that equivalence of health-care and prison health systems
services and health-care providers’ training were not always
ensured. In many countries in the WHO European Region, The Helsinki Conclusions – a set of conclusions reached
there are currently agencies in charge of inspecting prison following a major international prison health conference
services and a major concern of these agencies is evaluating that took place in Helsinki, Finland, in 2019 – highlight
equivalence of health care, compared to community the need to recognize health care delivered to people in
health services. prison as part of a pathway to and from community health
services (12). Therefore, in order to ensure that universal
Primary care is the most effective and efficient element of health coverage reaches those most in need – the poorest,
health care in any public health system; it is the foundation the most marginalized, women, children, and people
of prison health services and, as such, should be available with disabilities, as well as people in prison – efforts must
to every person living in prison. At a minimum, primary care be made to drive equitable access for these groups. The
interventions are required at the times of highest risk to the Mandela Rules (5) also state that:
health of those in prison – namely, at time of admission
and release. However, such interventions are also needed Health-care services should be organized in
to address health matters that arise in the course of close relationship to the general public health
imprisonment (9). administration and in a way that ensures
continuity of treatment and care, including for HIV,
It has also been acknowledged that testing for infectious tuberculosis and other infectious diseases, as well
diseases in European correctional facilities could as for drug dependence.
2 Status report on prison health in the WHO European Region 2022

This general notion of continuity of care also holds true It has been well established that people in prison often
for NCDs. come from marginalized groups of society. For example,
social inequalities are evident in United States penitentiary
It is important to consider that transitions of care occur both systems (20). It is little surprise, therefore, that, compared
ways, on both admission to and release from prison, and at with the general population, people in prison tend to have a
these moments errors are prone to occur because of missing higher prevalence of infections such as HIV, hepatitis B virus
information. As such, mechanisms to ensure safe transition (HBV), hepatitis C virus (HCV), other sexually transmitted
of care are recommended, and these include (for instance) infections (STIs), and tuberculosis (TB) (21,22). However, it
medication reconciliation (13). Another important aspect has also been noted that the incarceration period itself may
to bear in mind is that, for many people, there are severe further increase the risk of acquiring such infections (23).
barriers, including lack of insurance, that prevent them The literature suggests that prisons are burdened with a
from accessing health care, and prison may be their first high prevalence not only of infectious diseases but also of
opportunity to make contact with health-care providers. the risk behaviours that encourage transmission of these
diseases (24).
It has been demonstrated that the period immediately
following release is crucial to prevent overdoses and One of the environmental factors that has a major impact
suicide. Studies show that, particularly during the first on the prison population is overcrowding, which has both
two weeks following release, there is an increased risk of a direct impact on health, for example by enhancing the
opioid overdose death (14). Also, in this same period, the transmission risk of airborne diseases such as TB (25),
risk of death from any cause is more than 12 times higher and an indirect impact, as it significantly diminishes the
for people leaving prison than it is for their counterparts in capacity of the prison health-care system to meet the needs
the outside community (15). of its patients (26). Other prison-specific environmental
risk factors have been identified as potentially increasing
These are the main reasons that have led to transition the risk of self-harm; these include solitary confinement,
clinics being developed and progressively expanding in disciplinary infractions, and sexual or physical victimization
various locations (16). There are already studies published experienced while in prison.
demonstrating that creating such structures represents a
good investment – they encourage better use of existing Mental health and drug use disorders are both highly
health-care resources and reduced recidivism, and hence prevalent in the prison population. Recent data suggest
produce cost savings (17,18). that around half the prison population with nonaffective
psychosis or major depression have a comorbid drug use
disorder (27).
The health profile of people
in European prisons Finally, NCDs and their risk factors are of growing concern
in the prison population. Weight gain during incarceration
Health is influenced by many factors, generally referred appears to be common (28), with a consequent high
to as health determinants. These may be categorized in prevalence of CVD and diabetes (29). Rates of smoking
broad groups, such as genetic, behavioural, environmental, in the prison population as high as 80% have been
medical and social. Social determinants of health comprise reported (30), with consequences for both respiratory
economic and social conditions, which are shaped conditions and cancers (29).
and influenced by socioeconomic and political factors,
including education, occupation and income (19).
Introduction 3
1
4
1. Methods
1.1 The WHO Prison 1.2 HIPEDS

Health Framework The initial version of HIPEDS was presented to the WHO
Health in Prisons Programme (HIPP) Steering Group, with
The Health in Prisons European Database (HIPED), first a request for input on wording, clarity and appropriateness
developed in 2016, relies on periodic data collected through of the proposed indicators. Expert feedback was then
a survey sent out to all Member States of the WHO European incorporated into a refined version.
Region. Data collated through this survey, first published
in 2019, contained information provided by 39 Member At the planning stage of the survey, two focus group
States. In view of the data gaps identified in this first report, discussions were held with the aim of exploring potential
further validation work was carried out in 2020 to refine difficulties in the collection, aggregation and sharing of
the indicators and to develop strategies for improving the data. The selection of countries to participate in these
quality of country reports. discussions was guided by a number of criteria; they should
be countries:
In 2021 the WHO Prison Health Framework, a new
• where there were multiple regions or nationalities
framework for assessing prison health system performance,
was developed to support Member States in improving their • where there were different health financing systems
prison health systems (31). The purpose of the framework is • where data information systems varied in level of
to enhance Member States’ capacity to evaluate the impact development and complexity
of changing governance models or improving service • where there were different health governance
provision and to assess the impact that such initiatives arrangements.
have on the health status of people in prison. The published
framework was then used to guide and optimize data Only participants who signed an informed consent form
collection in the second HIPEDS round, conducted in 2021. were included. The focus groups were facilitated by
two WHO staff, audio-recorded and transcribed for data
The current framework is built on two cross-cutting analysis. Following this, further modifications were made
principles: adhering to international standards on human to HIPEDS.
rights and reducing health inequalities (Fig. 1). The first
block of the framework captures system-level aspects of The current status report broadly follows the format of
prison health care (i.e. inputs); the second block captures the modified HIPEDS. The correlation between the eight
provision/delivery aspects of prison health care (i.e. HIPEDS sections and the sections of this report are shown
outputs). These building blocks are in turn modified by two in Table 1.
influencing factors: the prison environment and the health
behaviours of people in prison. Ultimately, all these various
elements affect health outcomes.
1. Methods 5
Fig. 1. The WHO Prison Health Framework
Fig. 2. The WHO Prison Health Framework
Health Health service

system delivery
[INPUTS] [OUTPUTS]
Organization Preventive services

→ Disease prevention
→ Health protection
Financing
→ Health promotion
Prison health system vision
and strategy Rehabilitation
Health information Medical care

→ Provision of primary care
→ Arrangements for secondary
Health and tertiary care
workforce See → Continuity of care
Health service
Cross-cutting Medical delivery – Performance Cross-cutting
principle 1 products Performance → Availability principle 2
Adherence to (medicines) (workforce and medicines) Reducing health
international standards → Accessibility inequalities and
for human rights and → Acceptability addressing the
good prison health → Quality needs of special
populations
Health [INFLUENCING
outcomes FACTORS]
[IMPACTS]
Health and well-being CONCEPTUALIZATION AND DEVELOPMENT OF THE FRAMEWORK
Communicable
Morbidity diseases Prison environment
NCDs
Mortality Mental health
Health behaviours
Oral health
As explained above, the various elements in the WHO Prison Health Framework are defined on the
basis of their specific relevance to prison health systems. The rationale for their selection is explained in
greater detail in the following sections.
Source: WHO Prison Health Framework (31)

Table 1. Eight HIPEDS sections and their relation to the status report
HIPEDS section Section in status report
A Penal statistics 2.1
B Prison health systems 2.2
C Health service delivery 2.3
D Health outcomes 2.4
E Prison environment 2.5.1
F Health behaviours 2.5.2
G Adherence to equivalence and other international standards 2.6.1

H Reducing health inequalities and addressing 2.6.2
the needs of special populations
Inputs to prison health systems (B) were assessed under (1) Health and well-being
four domains: (2) Morbidity
(3) Mortality.
(1) Responsible level of government administration
and responsible organization (2.2.1)
Morbidity was operationalized by requesting Member
(2) Financing of prison health care (2.2.2) States to report “diagnosis on record”, which could be
(3) Vision and strategic approach to prison health (2.2.3) used to estimate prevalence by dividing by the total prison
population. The conditions considered in this domain
(4) Health information system used to monitor the
were: TB, MDR-TB, HIV, HBV, HCV, STIs, COVID-19, mental
prison health system (2.2.4).
health disorders, drug use disorders, oral health problems,
diabetes, hypertension, CVDs and cancers.
The outputs of the prison health system (C) were also
assessed under four domains: For mortality, the main focus was on mortality rates of the
most important and common causes of death in prisons.
(1) Preventive services (2.3.1)
Mortality rates were considered for suicide, drug overdose
(2) Rehabilitation (2.3.2) and COVID-19. Other causes of death, categorized as
(3) Medical care (including primary care, secondary “other”, included CVDs, HIV/AIDS, cancers, and other
and tertiary care, and continuity of care) (2.3.3) broader categories that could not be disaggregated, such
as “natural causes”.
(4) Performance of the health-care system (including
availability of health-care staff and medicinal
The survey also aimed to assess two cross-cutting
products; accessibility; acceptability; and quality
principles: adherence to international standards for human
of care) (2.3.4).
rights; and addressing inequalities (assessed through the
availability/existence of standards and guidelines). We also
The areas assessed in HIPEDS in order to operationalize attempted to assess inequalities in the prison population
each of these four domains are shown in Table 2. by comparing the availability of health staff in prisons and
in the general population and by comparing mortality rates
The impact of the prison health system on health outcomes of the most common causes of death in prisons with the
(D) was assessed under three domains: values obtained in the general population.
1. Methods 7
Table 2. Domains and areas assessed in HIPEDS
Domain Area assessed to operationalize domain
Preventive services
Disease prevention Assessment of NCD risk factors, mental health problems, oral health, chronic
disease, COVID-19 immunization status, screening for infectious diseases (HIV, HBV,
HCV, STIs, COVID-19)
Screening for cancer (breast, cervical, colorectal)
Health protection Availability of hygienic and sanitary products
Health promotion Existence of health promotion materials and policies for physical activity in prisons
Smokefree policies in the prison setting
Treatment areas available for people with drug use disorders
Rehabilitation
Access to education and employment opportunities
Allocation to prison close to home (to maintain family links)
Medical care
Primary care Availability of contingency plans for managing the impact of infectious disease
outbreaks
Accessibility of laboratory tests for suspected infectious disease cases
Access to treatment: TB, HIV, HBV, HCV, STIs, mental health problems, drug use
disorders, diabetes mellitus, hypertension, CVD, cancer
Secondary and tertiary care Existence of transfer mechanisms for specialized care for severe mental health
disorders and cancer
Continuity of care Medication reconciliation at admission
Registration with community health services upon release from prison for HIV, TB,
HCV, drug dependence
COVID-19 testing upon release
Performance
Availability of health care Availability of health workforce
Acceptability Obtaining and documenting informed consent for health assessments and
interventions
Accessibility Availability of immunization for vaccine-preventable diseases
Access to HIV prophylaxis
Quality of care Regular assessments of availability of essential medicines
Availability of standardized procedures for reporting adverse drug reactions and
medication errors
Mechanisms in place for patient involvement in health care

1.3 Data collection procedure
The process used for reaching the target audience was For the main part of this report, indicators were mostly
multistaged and initiated by an invitation sent by HIPP to calculated and analysed at European level, for which only
the Ministries of Health of all 53 Member States of the WHO Member States with complete data on that indicator were
European Region, requesting nomination of a focal point. included. For some variables of interest, indicators were
Where prison health services were not under the authority calculated at Member State level and the distribution
of the Ministry of Health, invitations were forwarded to analysed, either graphically or by presenting the mean,
the responsible ministry (such as the justice or interior standard deviation (SD) or range of values. Annex 1 includes
ministry). Irrespective of the option taken by the focal point, detailed country profiles, with indicators calculated at
interministerial cooperation was encouraged and explicitly Member State level whenever data were available.
requested in the survey instructions.
1.4.1 Penal statistics
As nominations were made, focal points were sent Incarceration rates per 100 000 inhabitants and the number
HIPEDS, together with an explanation of the process, of people newly admitted to prison per 100 000 inhabitants
and given two months to respond. When this timeline were calculated using the total number of incarcerated
was deemed unsuitable, an alternative date for delivery people by 31 December 2020 and the total number of
of responses was agreed between HIPP and the Member unique individuals entering prison over 2020, respectively
State concerned. A permanent helpdesk was created to as numerators, both collected by this survey, and total
respond to any difficulties experienced in answering the population data as denominator.
survey. Individualized tokens were sent to focal points for
Incarceration rates per 100 000 inhabitants were calculated
online submission of their responses. At the same time,
using data collected in the survey on the total number of
in anticipation of potential limitations in Internet access,
incarcerated people as of 31 December 2020 as numerator
paper-based submission was also allowed, after which
and total population data as denominator. Likewise, the
data were entered manually into the system by HIPP
number of people newly admitted to prison each year
staff. The system used for the online survey was WHO
per 100 000 inhabitants was calculated using the total
Dataform, which is an online survey application based on
number of unique individuals entering prison over 2020
the open-source platform LimeSurvey. This web server-
(collected in the survey) as numerator and total population
based software supports data collection by enabling the
data as denominator. In the case of Member States with
development and publishing of complex online surveys
various regions, nations, federal states or cantons, such as
that are used to collect responses and export the resulting
Germany, where data were provided independently, the
data to other applications.
World Prison Brief (33) was used to obtain data on the total
population of each constituent region.
1.4 Data analysis The percentages of people who were unsentenced or
serving life sentences were calculated by dividing the total
Data received or entered in the online survey were exported number of each subgroup by the total prison population as
into a CSV file and imported and analysed using R software, reported for 31 December 2020. A similar method was used
version 3.6.3. For all analyses, a significance level of α = 0.05 in the case of distribution by sex and gender, age structure,
was assumed. origin or other relevant characteristic.
Data analysis comprised descriptive analysis of all variables Occupancy level (an aspect of the prison environment as
and indicators, as well as composite indicators created from influencing factor) was calculated by using the total number
two or more variables, or data on total population obtained of people incarcerated by 31 December 2020 as numerator
from external sources (32–35). and the total official capacity as denominator.
1. Methods 9
1.4.2 Governance arrangements for
delivery of prison health care
Bivariate analysis was used to evaluate if countries where absolute numbers. Data from the prison dataset were given
responsibility for delivery of prison health care lay with the as full-time equivalents (FTEs), which were considered to be
Ministry of Health performed differently from others. For a reliable estimate, as in many countries – and particularly
this, marginal distributions were analysed. In view of the for certain specialties – use of part-time staff is common in
small number of observations, the variables of interest for the prison context.
this study were recoded as two-class variables according
to their natural tendency, and significant differences were 1.4.4 Morbidity data
assessed using Fisher’s exact test. Morbidity data were derived by adding together the total
number of people reported to have each of the diagnoses
1.4.3 Health-care staff availability on record during 2020, as indicated by the reporting
Ratios of prison staff and health-care staff per 1000 people Member States. The proportion of people with each of
incarcerated were calculated using the total number the diagnoses was calculated by dividing this figure by
of staff and the total number of people incarcerated by the prison population reported as of 31 December 2020 in
31 December 2020. Availability of health workforce was each Member State that provided data. All data presented
assessed only for the main categories of physicians, were compared with the scientific literature on prisons to
psychiatrists, dentists, nurses and total health-care staff. evaluate their reliability and against data reported for the
To make an assessment of the availability of health-care prison population taken from an external source, in this
staff whenever health-care access was needed, only full- case Global Burden of Disease 2019 (34). However, as 95%
time staff (or estimated full-time equivalent staff) was of the prison population is male, only data for males were
considered. For example, if a Member State said that two considered when using this source.
contract staff visited a prison for 2.5 days each per week, this
was considered as one full-time member of staff. 1.4.5 Access to treatment
Access to health-care and pharmacological treatment
As an indication of equality in availability of human is presented as absolute and relative frequencies; in the
resources for health, these data were compared with data case of the latter, the denominator was the total number
for the same categories of health-care staff available for of people diagnosed with the particular disease for a
the general population obtained from Eurostat and the given Member State, with both diagnosis and treatment
WHO Global Health Observatory database (36). Eurostat reported. As an exception, TB and MDR-TB were given
gives preference to the concept “practising staff”, as it best only as absolute frequencies, as the number of individuals
describes the availability of health-care resources (37). receiving treatment might be higher than the number
Common definitions of the distinct categories of health-care diagnosed, depending on the guidelines for treatment
professionals (doctors, dentists, etc.) were agreed with the adopted and the reporting period.
Organisation for Economic Co-operation and Development
and WHO; detailed definitions are available in CIRCABC Completion of treatment is presented as a relative
(Communication and Information Resource Centre for frequency of people with access to treatment.
Administrations, Businesses and Citizens) (37). For purposes
of comparison with the prison dataset, five indicators were 1.4.6 Behaviour data
extracted: total health-care staff (derived by adding health Behaviour data were derived by adding together the total
personnel to nursing and caring professionals), medical number of people reported to have engaged in each of
doctors, dentists (both extracted from health personnel) the relevant behaviours during 2020, as indicated by
and psychiatrists (extracted by disaggregating physicians the reporting Member States. The proportion of people
by medical specialty). showing each of the behaviours was calculated by dividing
this figure by the total prison population reported as of 31
Data obtained from Eurostat relate to human resources December 2020 in the Member States that provided data. All
available to provide health-care services in a country, data presented were compared with the scientific literature
irrespective of the sector of employment, and are given in on prisons to evaluate their reliability and against data

reported for the prison population taken from an external identified and dealt with on a case-by-case basis, as time
source, in this case the European Health Information and resources permitted. External sources were also used
Gateway (38). As in the case of morbidity data, only data to identify possible impossible or implausible data. Where
for males were considered. It should be noted that data it was not possible to address discrepancies in the data
reported in this source are from 2016. individually, they were resolved through logic checks,
as Dataform permits skip logic/branching (i.e. setting
1.4.7 Mortality data conditions for questions based on previous answers) and
The mortality rate per 100 000 people in prison was piping. In rare instances where issues could not be resolved,
calculated using the total number of deaths reported for a conservative approach of not reporting data for that
the calendar year 2020 and the total number of people indicator was adopted.
living in prison as of 31 December 2020. Causes of death
were pre-coded in four categories: suicide, drug overdose, The term “No national data” was used for responses where
COVID-19 and other. The first three are always presented Member States indicated that they did not have data for the
in the country profiles and in the status report. Analysis indicator of interest or in the format required by HIPED. “No
of the “other” category depended on the level of coding national data” was also used for instances where Member
available; in some countries, only the highest level of States with a federal structure indicated that they did not
classification (e.g. natural causes) could be used, while in have data available for all jurisdictions and the reported
others it was possible to use a lower level of classification data were considered insufficient to provide a valid country
(e.g. neoplasms, CVDs, HIV). All codable causes that are profile. “Missing” refers to data that were not provided
presented were contrasted with information reported for and for which no explanation was given, or to data that
the general population; this was obtained from the Global were identified as out of range and could not be resolved
Burden of Disease study (34), where available, and from Our through logic checks. “Not applicable” refers to responses
World in Data for COVID-19-related deaths (35). As the prison that did not apply to a Member State based on its previous
population data were considered from age 20 and over, responses. Some countries, including those that reported
we used the crude mortality rate for the same age group. “No national data” in cases where data were not available in
However, the most recent population-level mortality data the HIPED format, provided more detailed information for
were from 2019 or 2018 (depending on the Member State), indicators as comment in an open field; whenever possible,
while the prison data were from 2020. this was used to supplement or correct the responses to
which it applied.
1.5 Data validation The second round of validation was conducted following
the data analysis and involved comparison with general
Data validation was conducted in two stages. The first round population data as far as possible. When numbers varied
of data validation, carried out between August 2021 and significantly, Member States were made aware and asked
January 2022, was conducted ahead of analysis. Focal to provide clarification of the data provided. The completed
points were contacted as needed to provide clarification country profiles were approved and validated by the
of missing or inconsistent data. Out-of-range values were focal points.
1. Methods 11
2
12
2. Findings
Nominations were received from 41 Member States. Switzerland

However, only 36 Member States succeeded in submitting Ukraine
a response to HIPEDS within the agreed timeline. United Kingdom.
The complete list of participating Member States was, in

alphabetical order: Switzerland and the United Kingdom, being countries with
multiple nations/cantons/jurisdictions, worked internally
Albania to provide a single answer that represented the country as
Armenia a whole; where necessary, limitations to the data reported
Austria are indicated in their country profiles. Germany opted to
Belgium provide independent data for its 16 federal states, which
Bosnia and Herzegovina were then analysed and aggregated by HIPP and sent
Bulgaria back to the focal point to be validated. Germany’s profile
Croatia includes specific information on criteria adopted to deal
Cyprus with variations across regions and reach a unique profile.
Czechia
Denmark
Estonia 2.1 Penal statistics
Finland
France There were a total of 613 497 people living in prison
Georgia establishments in the represented countries of the
Germany WHO European Region as of 31 December 2020. The
Greece total number of people held in custody nationally as of
Hungary 31 December 2020 ranged from eight in San Marino to
Ireland 87 019 in the United Kingdom. On average, there were
Italy 108.8 people living in prison per 100 000 inhabitants in
Latvia Europe. The highest values were observed in Georgia and
Lithuania the Republic of Moldova, with values in excess of 200 people
Luxembourg per 100 000 in each case (246.0 and 245.3, respectively).
Malta The countries with the lowest values were Finland (47.0),
Monaco Monaco (38.2) and San Marino (23.0) (Fig. 2).
Netherlands
Poland Most countries (n = 34) specified the number of
Portugal unsentenced/remand prisoners. In total, there were 124 678
Republic of Moldova such individuals, equivalent to a European mean of 3667
Romania individuals per 100 000 population (range: 7–18 205),
San Marino representing 22.6% of the prison population. According to
Slovakia Global prison trends 2022 (39), the global share of people in
Slovenia pretrial detention ranged between 29% and 31%, a figure
Spain similar to the one given in the current report.
2. Findings 13
Fig. 2. Proportion of people in prison per 100 000 inhabitants, WHO European Region, 2020
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Bosnia and Herzegovina 72.4
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
WHO European Region 108.8
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
United Kingdom 129.8
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Republic of Moldova 245.3
Georgia 246.0
0 50 100 150 200 250
People living in prison per 100 000 inhabitants

Disaggregation of the prison population by The average mean duration of a sentence reported in the
sociodemographic characteristics was not possible for all European Region was 22.9 months (SD = 23.4; range: 1–78),
countries, as shown in Table 3. across the 15 countries that could answer this question.
The mean number of times an individual had entered
On average, in Europe, there were 50 prison establishments prison in the previous year was reported to be, on
per country (range: 1–279; n = 35 countries). average, 1.1 (n = 8 Member States).
Table 3. Sociodemographic structure of the European prison population
Number of countries Absolute frequency (n) Relative frequency (%)
Sex and gender distribution

Females 36 28 943 4.7
Pregnant 14 27 0.1
LGBTQI+ 7 23 0.2
Age structure
Elderly (> 50 years) 28 66 303 15.3
Elderly (> 65 years) 23 14 723 3.9
Youth (< 18 years) 32 2352 0.6
Origin
Migrants 29 107 497 23.4
Ethnic minority 6 22 195 24.4
Other relevant characteristics

Disabled 16 8465 3.8
Intellectual disabilities 7 742 0.9
Physical disabilities 10 2107 1.5
2. Findings 15
Fig. 3 shows the number of people newly admitted to newly admitted to prison, representing 102.7 people per
prison per 100 000 inhabitants in Europe in the previous 100 000 inhabitants. This indicator ranged from 9.8 newly
year (2020). In the 28 countries in the European Region that admitted people per 100 000 inhabitants in Poland to 206.1
answered this question, there were a total of 366 701 people in France.
Fig. 3. Number of people newly admitted to prison per 100 000 inhabitants,
WHO European Region, 2020
Poland 9.8
San Marino 23.0
Armenia 35.2
Portugal 42.3
Estonia 48.5
Croatia 53.8
Lithuania 58.3
Greece 58.5
Italy 59.2
Bulgaria 76.1
Czechia 86.5
Finland 95.5
Austria 96.9
Slovenia 101.4
Ireland 106.0
Netherlands 106.2
Slovakia 116.5
Monaco 117.2
Hungary 120.2
Albania 125.8
Latvia 141.6
Denmark 156.8
Georgia 186.1
Cyprus 188.1
France 206.1
0 50 100 150 200 250
People newly admitted to prison per 100 000 inhabitants

Only five countries in the WHO European Region did individuals serving life sentences in 2020, which added up
not legally permit the use of life sentences: Bosnia and to a total of 17 311 people, 3.2% of the prison population of
Herzegovina, Croatia, Portugal, San Marino and Spain. For the countries concerned (Fig. 4).
the remaining 31 countries, 30 reported the number of
Fig. 4. Percentage of people in prison serving life sentences, WHO European Region, 2020
Ireland 9.9%
United Kingdom 9.4%
Greece 8.1%
Armenia 4.5%
Cyprus 4.2%
Albania 3.6%
Italy 3.3%
Luxembourg 3.2%
WHO European Region 3.2%
Ukraine 3.1%
Germany 3.1%
Bulgaria 3.0%
Belgium 2.1%
Latvia 2.1%
Lithuania 2.0%
Republic of Moldova 1.9%
Austria 1.7%
Estonia 1.7%
Malta 1.3%
Romania 0.9%
Georgia 0.8%
France 0.8%
Denmark 0.7%
Poland 0.7%
Slovakia 0.5%
Switzerland 0.5%
Netherlands 0.4%
Hungary 0.4%
Czechia 0.2%
Slovenia 0.0%
Monaco 0.0%
0 2 4 6 8 10
People in prison serving life sentence (%)
2. Findings 17
2.2 Inputs: prison health system
2.2.1 Organization
Organization of the prison health system was reported by seven Members States (19.4%); the most
operationalized using four questions. common situation was that the national government had
responsibility for prison health care but that national and
The first and second questions addressed responsibility for subnational governments were jointly responsible for the
health care, both in prisons and in the general community. general population (n = 3). All 36 Member States answered
The most common situation in the WHO European Region this question.
was that this responsibility was held by the national
government, for both prisons (n = 21) and the general The third question considered the government ministry
population (n = 18) (Fig. 5). All 36 Member States answered responsible for delivering prison health care. In 2020
this question. the most common situation was for this responsibility
to be shared between the Ministry of Health and the
In 29 of the 36 Member States (80.6%), the level of Ministry of Justice/the Interior (n = 20), followed by
government responsible for health care in prisons and responsibility falling exclusively to the Ministry of Justice/
the general population was the same; in most cases, the Interior (n = 8) (Fig. 7). There were seven countries where
responsibility belonged to the national government (n = 17) responsibility belonged to the Ministry of Health alone, and
or jointly to both national and subnational governments one where responsibility was attributed to the Ministry of
(n = 6) (Fig. 6). Different levels of responsibility for Health and the Ministry of Citizen Protection. All 36 Member
health care in prisons and the general population were States answered this question.
Fig. 5. Level of government responsible for health care in prisons and in the
general population
National government is 58.3% (n = 21)

Other situation
responsible for health care 50.0% ( n = 18)
National and subnational governments 19.4% (n = 7)

Only subnational governments
both have responsibility
have responsibility 27.8% (n = 10)
Only subnational governments 11.1% (n = 4)

National and subnational
havegovernments
responsibility
both have responsibility 13.9% (n = 5)
Other situation 11.1% (n = 4)

National government is
responsible for health care 8.3% (n = 3)
0 10 20 30 40 50 60 70
MemberStates
Member States(%)
(%)
General population Prisons
Prisons General population

Fig. 6. Correspondence between level of government responsible for health care in prisons
and in the general population
Different 19.4% Only subnational governments have

(n = 7) responsibility in prisons and the
Other situation 10.3% (n = 3)
general population 10.3%
(n = 3)
National and subnational

governments both have
responsibility in prisons and
the general population 20.7%
(n = 6)
National government is responsible for

health care in prisons and the general
population 58.6%
(n = 17)
Same in prisons and the
general population 80.6%
(n = 29)
Fig. 7. Ministries responsible for delivering health care in European prisons
Ministry responsible for delivery of health care
Shared between the Ministry of Health only Ministry of Health and Ministry of Justice/the
Ministry of Health and Ministry of Citizen Interior only
the Ministry of Protection
Justice/the Interior
Countries where this situation applies
Armenia, Bulgaria, Croatia, Finland, France, Italy, Greece Albania, Austria,

Cyprus, Czechia, Denmark, Luxembourg, San Marino, Belgium, Bosnia and
Estonia, Georgia, Hungary, Slovenia, United Kingdom Herzegovina, Germany,
Ireland, Latvia, Lithuania, Monaco, Netherlands,
Malta, Poland, Portugal, Republic of Moldova
Romania, Slovakia, Spain,
Switzerland, Ukraine
2. Findings 19
The fourth and final question addressed responsibility for 2.2.2 Financing
the inspection of hygiene, nutrition and living conditions. Health financing in the prison health-care system is
In this domain, the most common situation was to have presented in three variables: the agency responsible for
responsibility shared between the Ministry of Health and funding the health-care system; how it is funded; and if
the Ministry of Justice/the Interior (n = 20), followed by the people in prison must pay out of pocket for their health-care
Ministry of Justice alone (n = 6) and the Ministry of Health service or products.
or health authorities alone (n = 5) (Fig. 8). There were two
Member States that mentioned other arrangements – In half of Member States, the Ministry of Justice was
namely, where the responsibility was attributed to an responsible for financing prison health care (n = 18),
inspector of prisons or to subnational governments. There followed by responsibility being shared between the
was one Member State that did not answer this question. Ministry of Health and the Ministry of Justice/the Interior
(n = 11) (Fig. 9). All 36 Member States answered this question.
Fig. 8. Agency or agencies responsible for inspection of prison hygiene, nutrition and
living conditions
Both Ministry of Healthsituation

Another and Ministry 57.1% (n = 20)
of Justice/the Interior
Both Ministry of Health and
Ministry of Justice only 17.1% (n = 6)
Ministry of Justice/the Interior
Other ministry in isolation

Ministry of Healthoronly 14.3% (n = 5)
independent organization
(or health authorities)
Other ministry
Ministry in isolation
of Justice only or 5.7% (n = 2)
independent organization
Ministry of Health only
Another situation 5.7% (n = 2)
(or health authorities)
0 10 20 30 40 50 60 70
Member States (%)

Fig. 9. Agency or agencies responsible for financing health care
MinistryBoth MinistryMinistry
of Health, of Healthofand
Ministry of and
Justice/the Interior 30.6% (n = 11)
Citizen Protection competent
Ministry
Ministry of Justice
of Justice onlyonly
50.0% (n = 18)
Ministry of Health only

Ministry of the Interior only 13.9% (n = 5)
Ministry of the Interior only

Ministry of Health only 2.8% (n = 1)
Bothof
Ministry Ministry
Health, of Healthofand
Ministry Citizen
2.8% (n = 1)
Ministry
Protection and of Justice/the
competent Interior
health districts
0 10 20 30 40 50 60 70
Member States (%)
The second variable assessed the coverage given to people insurance (n = 20), it was worrying that nine Member States
in prison by any form of health insurance, either private or reported that there was no coverage by health insurance of
public, and how it compared with what was available to the any kind (Fig. 10). There was one Member State that did not
general population. Although the most common answer answer this question.
was that health care in prison was fully covered by health
Fig. 10. Health-care insurance coverage for people in prison
Not covered
Fully byby
covered anyhealth
healthinsurance
insurance 57.1% (n = 20)
Partly covered
Covered by health
by a separate healthinsurance
insurance 8.6% (n = 3)
Covered by a separate health insurance

Partly covered by health insurance 8.6% (n = 3)
Not covered by any health insurance

Fully covered by health insurance 25.7% (n = 9)
0 10 20 30 40 50 60 70
Member
MemberStates
States(%)(%)
2. Findings 21
For this variable, three Member States indicated “other any costs associated with general health-care services
situation”. This has been recoded as “fully covered by health (Fig. 11). However, in the case of prescription medication,
insurance” as the explanations given were that: this was true of only 26 Member States. Other health-care
expenses that might be incurred, such as visual aids,
(i) in general, health care for people in prison is fully prosthetics and supplements, were fully covered only in
covered by the prison system, but there are exceptions a minority of Member States (n = 16). All 36 Member States
in state-funded treatment programmes; answered this question.
(ii) primary care is covered by the prison system and the 2.2.3 Prison health system
remainder by the general public health system; and vision and strategy
This subdomain was operationalized by two variables: the
(iii) people in prison are entitled to necessary, sufficient first assessed the existence of health policies and strategies,
and appropriate medical services as dictated by law, the second their implementation.
considering economic efficiency and general standard
health insurance; thus, the statutory health-care Less than half the Member States (n = 15, 41.7%) reported
system must be equivalent; entitlement to medical that they had a national or subnational policy or strategy
benefits is suspended if the person in prison (or in for prison health, although an additional nine (25.0%)
preventive detention) has health insurance by virtue reported that such a policy was embedded in their wider
of a free employment relationship. national policy (Fig. 12). All 36 Member States answered
this question.
Irrespective of the existence (and type) of health insurance,
in 34 out of 36 Member States people in prison did not cover
Fig. 11. Health-care expenses covered
100 94.4% 72.2% 48.5%

(n = 34) (n = 26) (n = 16)
80
(%)(%)
60
States
People in prison do not cover any costs

States
39.4% People in prison do not cover any costs

(n = 13)
People in prison cover some costs
Member
People in prison cover some costs

Member
40 People in prison cover all costs

People in prison cover all costs
25%
(n = 9)
20
12.1%
(n = 4)
5.6% 2.8%
(n = 2) (n = 1)
0
General health care Prescription medication Other expenses

Fig. 12. Existence of prison health policies and strategies
There
There is no policy/strategy at present, and is a national/subnational
no intention to develop one
41.7% (n = 15)
in the near future
prison health policy/strategy
There is no policy/strategyPrison health

at present, butisone
partisof another for
envisaged national/
the
25.0% ( n = 9)
future
subnational (health) policy/strategy
There isnational/subnational
Prison health is part of another no policy/strategy at present,
(health)
2.8% (n = 1)
but one is envisaged for the future
policy/strategy
There is no policy/strategy at present, and no

There is a national/subnational prison health policy/strategy 30.6% (n = 11)
intention to develop one in the near future
0 10 20 30 40 50 60 70
Member
MemberStates
States(%)
(%)
Of the 24 countries saying that they had a prison health for the policy or strategy had been adopted or was being
policy, either as a standalone policy or as part of another developed/planned (three did not answer) (Fig. 13).
policy, 21 (57.1%) mentioned that an implementation plan
Fig. 13. Proportion of Member States with an implementation plan for policy/strategy
14.3% (n = 3) Implementation plan has already been adopted
Implementation plan is under development

or there are plans for development
Implementation plan has already been adopted
NoImplementation
implementation plan at is
plan present
under development
and no such plan will be developed
or there are plans for development
No implementation plan at present

and no such plan will be developed
57.1% (n = 12)
28.6% (n = 6)
2. Findings 23
2.2.4 Health information
Thirty-four of 36 countries (94.4%) reported that they had With respect to disease registration, prisons in most
a system for tracking deaths in prisons. Of these 34, all but Member States (n = 33) informed public health authorities
one recorded the cause of death and 14 regularly assessed about diseases among people living in prison. However,
the completeness and quality of all data on deaths sent only 15 Member States preserved individual imprisonment
to the national body responsible for civil registration and status in the process of transferring information to all
vital statistics (17 countries reported that they did not do disease registries, 15 preserved imprisonment status only
such an assessment, and two did not give a response for for infectious diseases, and three did not capture it in either
this indicator). disease registries or surveillance data. Of Member States
that stated that they informed public health authorities,
Thirty-one Member States explained the way in which only seven were able to provide a link to NCD datasets and
data on deaths and causes of death were transferred from nine in the case of infectious diseases.
the prison registration system to the body responsible for
national civil registration and vital statistics. There was a All Member States reported that they kept clinical health
formal data transfer system in 18 Member States; of these, records of people in prison. The most common format for
three stated that there was an electronic system to transfer health records in European prisons was still paper-based
death data, while four said that there was no regular (n = 16, 44.5%). However, 12 Member States said that they
formal mechanism to transfer death registration data to used a mixture of formats (33.3%), and eight kept electronic
the national registry. Seven Member States did not provide clinical health records (22.2%).
any further information on the process of data transfer (raw
data on the various transfer systems is given in Annex 3). In almost all Member States, all relevant information was
Training for physicians in filling in death certificates was recorded in health records (Fig. 14). All 36 Member States
provided in only 18 Member States (50.0%), while one answered this question.
Member State stated that death certificates were not filled
in by physicians (missing = 1).
Fig. 14. Proportion of Member States recording various types of information in the clinical
health record system
97.2% (n = 35)
Treatment and medication
Diagnoses established
2.8%
(n = 1)
97.2% (n = 35)
Visits to external care providers
Health behaviours
2.8%
(n = 1)
97.2% (n = 35)
2.8%
Diagnoses
Treatment established
and medication (n = 1)
97.2% (n = 35)
Health behaviours 2.8%
Vaccination (n = 1)
94.4% (n = 34)
5.6%
Vaccination
Screening test results (n = 2)
94.4% (n = 34)
5.6%
Visits toScreening testproviders
external care results (n = 2)
91.7% (n = 33)
8.3%
Screening tests performed
Screening tests performed (n = 3)
0 10 20 30 40 50 60 70 80 90 100
Member
MemberStates
States(%)
(%)
No Yes
Yes No

There appeared to be considerable scope for improving 2.3 Outputs: health
compatibility of health records between prison and
community as more than half of Member States (n = 18,
service delivery
51.4%) stated that they did not have interoperable systems
(Fig. 15). One Member State did not answer this question. 2.3.1 Preventive services
2.3.1.1 Disease prevention
However, the situation was markedly different for COVID-19 As described elsewhere (40), prison may be an opportunity
vaccination status, where 34 Member States (94.4%) stated to access health care. Indeed, all Member States stated that
that the current system implemented specifically for this an initial urgent health needs assessment was conducted
purpose was interoperable with general health records. in the first 24 hours following detention, and most (n = 32;
This finding suggests that interoperability can be achieved. 88.9%) also conducted a more detailed review within
the first week. However, only 16 Member States provided
Despite the generally poor condition of prison health a precise number of individuals who received a health
information systems, most Member States (n = 31; 86.1%) examination following admission, which overall was 93.8%
stated that they had capacity to provide surveillance data of newly admitted people. The most common arrangement
of COVID-19 cases identified in prisons, with respect to was for such assessments to be made mainly by nurses,
both people living in prison and custodial staff, in a timely with referral to a physician when necessary (Fig. 16).
manner (i.e. to a standard equivalent to that achieved in the One Member State did not answer this question.
outside community). All Member States (n = 36) indicated
that contact-tracing was undertaken in all prisons.
Fig. 15. Compatibility of health record systems used in prison and in the general population
Same health record system used 28.6% (n = 10)
Same or interoperable system used, allowing

exchange of individual health data across community– 2.9% (n = 1)
prison interface, but only for certain conditions
Different but interoperable system used,

allowing exchange of individual health data 17.1% (n = 6)
across community–prison interface
No compatible health record system 51.4% (n = 18)
0 10 20 30 40 50 60 70
Member States (%)
2. Findings 25
Fig. 16. Staff involved in making initial health assessments following admission
Physician or or
Physician “medical
“medicalassistant”
assistant” 2.9% (n = 1)
Physician only at admission andonly

Physician second assessment
at admission by physician
and second and
assessment
nurse/other health-care professional 5.7% (n = 2)
by physician and nurse/other health-care professional
Physician
Physician only
only 31.4% (n = 11)
Physician
Physician andand nurse
nurse 20.0% (n = 7)
Nurse predominantly, but with

Nurse predominantly, but with referral to physician available 37.1% (n = 13)
referral to physician available
Initial assessment can beInitial
made by non-health-care
assessment can be madeprofessional, most
by non-health-care
commonly a nurse 2.9% (n = 1)
professional, most commonly a nurse
0 10 20 30 40 50 60 70
Member States (%)
Member States (%)
In the case of most Member States, these assessments were in all prisons in the country concerned (Fig. 17). One or two
very detailed, covering a wide range of diseases, vaccination Member States did not answer this question, depending
status and health behaviours, and were generally conducted on the variable.
Fig. 17. Types of disease and health behaviour covered in prison assessments
97.1% (n = 34) 2.9% (n = 1)

COVID status and/or COVID
immunization status
94.1% (n = 32) 5.9% (n = 2)
Chronic conditions requiring
treatment (e.g. HIV, CVDs) 91.4% (n = 32) 8.6% (n = 3)
Blood pressure measurement
88.6% (n = 31) 5.7% (n = 2)
Drug use 5.7% (n = 2)
88.6% (n = 31) 5.7% (n = 2)
Injection drug use 5.7% (n = 2)
85.7% (n = 30) 5.7% (n = 2) 2.9% (n = 1)
Alcohol use 5.7% (n = 2)
82.9% (n = 29) 11.4% (n = 4) 2.9% (n = 1)
Smoking status 2.9% (n = 1)
80.0% (n = 28) 14.3% (n = 5) 2.9% (n = 1)
Mental health problems 2.9% (n = 1)
(e.g. psychosis)
79.4% (n = 27) 11.8% (n = 4) 5.9% (n = 2)
Respiratory conditions (e.g. COPD) 2.9% (n = 1)
73.5% (n = 25) 11.8% (n = 4) 5.9% (n = 2)
Oral health problems 8.8% (n = 3)
(e.g. tooth decay)
62.9% (n = 22) 11.4% (n = 4) 14.3% (n = 5)
Body mass index 11.4% (n = 4)
(BMI) calculation
0 10 20 30 40 50 60 70 80 90 100
Member States (%)
All prisons Most prisons A minority of prisons No prisons

It is noteworthy that BMI, though one of the easiest admission and all Member States screened for HIV, HCV
indicators to collect, was assessed in the fewest and HBV. One or two Member States did not answer this
Member States. question, depending on the variable.
History of TB and current signs and symptoms were It should be noted that WHO recommends voluntary STI
reported by all Member States to be assessed at or soon after screening for all people in prison and that the United
reception for all people in prison. Almost 70% of Member Nations comprehensive package of services to address HIV,
States (n = 25) reported that diagnostic tests were offered HBV and HCV is used (41). Prison systems must therefore
in addition to clinical evaluation, and half of Member States ensure that all people in prison have easy access to testing,
(n = 18) reported that an additional assessment for MDR-TB which should never be mandatory, thus favouring an
was provided in the event of a positive test. opt-out approach.
Screening for diseases was common in most Member States The outlook was slightly different when it came to NCDs
and for most infectious diseases at or soon after admission, and particularly cancer, where two thirds of Member States
even though the methodology used to determine inclusion screened for cervical and breast cancer, and 58.3% for
varied from country to country (Fig. 18). There was only one colorectal cancer (Fig. 19). All 36 Member States answered
Member State that said that it did not screen for STIs upon this question.
Fig. 18. Screening for various infectious diseases at or soon after admission
20
18
18
16 15
14
States
MemberStates
14 13
12
12 11 11
ofofMember
10
10 9 9 9
8
8
Number
6
Number
4
2
2 1 1 1
0 0 0 0
0
HIV HCV HBV STI
HIV HCV HBV STIs
Opt-in Opt-out Risk-based Not screened Missing
Opt-out Opt-in Risk-based Not screened Missing
2. Findings 27
Fig. 19. Screening for various types of cancer in prisons
Colorectal Colorectal 58.3% (n = 21)
Breast Breast 66.7% (n = 24)
Cervical Cervical 66.7% (n = 24)
0 10 20 30 40 50 60 70 80
Member States States

Member (%) (%)
According to the Bangkok Rules (Rule 8), preventive syringes as part of an exchange programme (43). However,
health-care measures of relevance to women, such as Pap this same study found that there were more Member States
tests and screening for breast and gynaecological cancer, distributing lubricants free of charge. All 36 Member States
should be offered to female prisoners on the same basis as answered this question, but some variables were left blank
women of the same age in the outside community (42). Data in certain cases (one missing value for dental dams, two for
obtained in the survey suggest that this was not the case in condoms and three for lubricants).
around a third of Member States.
The situation was clearly much better in terms of offering
All Member States screening for cancer in prisons stated that protection from COVID-19 infection. All Member States
the same criteria applied as in the outside community and stated that people in prison had had access to hand
that there were no restrictions or differences in screening sanitizer/soap and water and face masks since the
practices in prison and the community. emergence of the pandemic, even though HIPEDS did not
assess whether such products were provided free of charge.
2.3.1.2 Health protection
Health protection was probably the area where most Space was created for adequate quarantine of contacts
diversity was found across Member States. In 35 Member and isolation of COVID-19 cases in all prisons in 33 Member
States, in all prisons, soap was provided free of charge to States (91.7%) and in most prisons in the other three
people living in prison (Fig. 20). Conversely, needles and (Fig. 21). However, the space created did not always follow
syringes were provided free of charge in only three Member CPT rules in all Member States (6). All 36 Member States
States, and lubricants in only four. An earlier study points to answered the initial question, but only 34 referred to the
a similar number of Member States providing needles and respect for CPT rules.

Fig. 20. Products offered free of charge to people in prison
97.2% (n = 35) 2.8% (n = 1)

Soap
72.2% (n = 26) 13.9% (n = 5) 13.9% (n = 5) 5.6% (n = 2)
Tampons/sanitary towels
44.1% (n = 15) 11.8% (n = 4) 17.6% (n = 6) 26.5% (n = 9)
Condoms
30.6% (n = 11) 5.6% (n = 2) 13.9% (n = 5) 50.0% (n = 18)
Disinfectants
28.6% (n = 10) 5.7% (n = 2) 11.4% (n = 4) 54.3% (n = 19)
Dental dams
12.1% (n = 4) 15.2% (n = 5) 3% (n = 1) 69.7% (n = 23)
Lubricants
8.3% (n = 3) 2.8% (n = 1) 5.6% (n = 2) 83.3 (n = 30)
Needles and syringes
0 10 20 30 40 50 60 70 80 90 100
Member States (%)
Fig. 21. Percentage of Member States providing space in prisons for quarantine and
isolation of COVID-19 cases
Space for adequate quarantine Space provided following

of contacts and isolation of CPT rulesa
COVID-19 cases
2.9% (n = 1)
8.3% (n = 3)
17.6% (n = 6)
50.0% (n = 17)
All prisons
6 m²
Most prisons
A minority of prisons
29.4% (n = 10)
No prisons
91.7% (n = 33)
a
CPT rules state that the minimum living space for a single-occupancy cell – excluding toilet space – should be 6 m², with a further
4 m² for each additional person (6).
2. Findings 29
2.3.1.3 Health promotion
Health promotion is a vast area, so only four indicators A better result was obtained for policies to promote
were chosen to characterize it: one focused on prevention physical activity, which 63.9% of Member States (n = 23)
of transmission of infectious diseases, two on prevention of reported that they had introduced (Fig. 23). All 36 Member
NCDs and one related to drug use. States answered this question. However, only two were
able to provide an Internet link to these policies and to
Less than half of Member States (n = 14) stated that they had describe them.
materials to promote safe tattooing practices, a relevant
health promotion strategy to prevent transmission of
bloodborne diseases (Fig. 22). All 36 Member States
answered this question.
Fig. 22. Percentage of Member States providing promotional materials on safe tattooing
practices in prisons
38.9% (n = 14)
Yes
No
61.1% (n = 22)

Fig. 23. Percentage of Member States having policies or procedures to promote physical
activity in prisons
63.9% (n = 23)
Yes
No
36.1% (n = 13)
In terms of exposure to smoke, nearly three quarters Member States (5.6%) had such a policy in specific regions
of Member States (72.2%; n = 26) stated that they had a of the country (Fig. 24). All 36 Member States answered
smokefree policy implemented nationwide, while two this question.
Fig. 24. Percentage of Member States having a smokefree policy in prisons
22.2% (n = 8)
Nationwide smokefree policy
5.6% (n = 2) Regional smokefree policy
No smokefree policy
72.2% (n = 26)
2. Findings 31
However, it is important to note that partial regulations, 2.3.2 Rehabilitation
such as availability of smokefree cells, are insufficient, as Access to education and training opportunities was
they do not provide adequate protection against the harms reported by all Member States to be available in all
of secondhand smoke, which is known to have damaging (n = 27; 75.0%) or most prisons (n = 9; 25.0%) (Fig. 26).
health effects, including an increased risk of heart disease Only a single Member State reported providing access
and lung cancer (by 20% to 30%) in nonsmokers. to employment opportunities only in a minority of
prisons; most commonly, such access was provided in all
As reported in Global prison trends 2022 (44), around 20% (n = 32; 88.9%) or most prisons (n = 3; 8.3%). All 36 Member
of the worldwide prison population are held for drug States answered both these questions.
offences, suggesting that there is a high need for drug-
related services. Despite this, four Member States (11.4%) It was reported that people’s home location was taken
said that they had no treatment areas available to tackle into account “as much as possible” when allocating them
drug problems in any prison (Fig. 25), and nearly three to prisons in order to help maintain family relationships
quarters (65.7%) reported that accessibility was restricted. (n = 23; 63.9%), while another four Member States (11.2%)
One Member State did not answer this question. said that proximity to home was always considered.
However, nine Member States (25.0%) said that they
considered other factors when allocating people to prisons.
Fig. 25. Percentage of Member States with treatment areas for people with drug problems
11.4% (n = 4)
22.9% (n = 8)
In all prisons
In most prisons
In a minority of prisons
In no prisons
17.1% (n = 6)
48.6% (n = 17)

Fig. 26. Access to education and training and employment opportunities
88.9% (n = 32) 8.3% (n = 3)
Employment opportunities 2.8% (n = 1)

Employment opportunities
75.0% (n = 27) 25.0% (n = 9)
Education and training

Education and training
0 10 20 30 40 50 60 70 80 90 100
Member States (%)
Member States (%)
In all prisons In most prisons In a minority of prisons
Communication permitted to help maintain family all but one imposed time restrictions and only three did so
relationships varied, as shown in Fig. 27, even within free of charge. Use of the Internet was less common; only
the same Member States (n = 35). Communication by 22 Member States allowed it, and all but two of these
telephone was allowed by all 36 Member States, although imposed time restrictions.
Fig. 27. Means of communication allowed to help maintain family relationships
40
36 35
Number of Member States
30
25
22
20
14
10
10
0 0
0
Telephone Internet/web Physical visit on Physical visit outside

prison premises detention facility
Yes No
2. Findings 33
According to the Council of Europe’s prison rules, revised 2.3.3 Medical care
in 2020 (45): 2.3.3.1 Primary care
While most health-care services provided to people in prison
Prisoners shall be allowed to communicate as often are part of primary care, two main indicators were chosen to
as possible – by letter, telephone or other forms of characterize service delivery that were particularly relevant
communication – with their families, other persons in the context of the COVID-19 pandemic. Member States
and representatives of outside organisations, and to were asked if they had any preparedness contingency plans
receive visits from these persons … Communication for managing the impacts of infectious disease outbreaks
and visits may be subject to restrictions and (in general); and if suspected cases of infectious diseases
monitoring necessary for the requirements of had access to laboratory tests.
continuing criminal investigations, maintenance
of good order, safety and security, prevention of While most Member States reported that they had
criminal offences and protection of victims of crime, contingency plans in place in all prisons (n = 28; 77.8%), six
but such restrictions, including specific restrictions countries had no such plans in any prison (Fig. 28). All 36
ordered by a judicial authority, shall nevertheless Member States answered this question. However, when
allow an acceptable minimum level of contact. asked to provide links to any existing pandemic response
plans, only three Member States could do so, while five
could do so for policy response plans. The majority said
The survey data suggest that these rules were broadly that their plans were either not published or not publicly
followed, though the situation could be improved if more available, or that no link was available.
modern means of communication were adopted.
Access to laboratory tests was available in all prisons in
34 Member States (94.4%) (Fig. 29). One Member State
reported that no access to tests was provided; another that
access was limited to priority cases.
Fig. 28. Percentage of Member States having contingency plans for managing the impact of
an infectious disease outbreak in prisons
16.7% (n = 6)
2.8% (n = 1)
2.8% (n = 1) In all prisons
In most prisons
In no prisons
77.8% (n = 28)

Fig. 29. Percentage of Member States providing access to laboratory tests for suspected
infectious disease cases in prisons
2.8% (n = 1)
2.8% (n = 1)
Yes, everyone has

access as required
Yes, but resources are limited,

so only priority/vulnerable
groups have access
No
94.4% (n = 34)
Primary care was also characterized by exploring access Access to treatment in 2020 was assessed by considering
to pharmacological treatment and to recommended disease areas as indicators of primary care access (Table 4).
appointments for specific conditions.
Table 4. Access to and completion of treatment for various infectious diseases in prisons
Access to treatment Completion of treatment
Condition Number of Member n (%)a Number of Member n (%)b

States reporting (%) States reporting (%)
TB 24 (66.7) 1425c 25 (69.4) 982 (65.4)
MDR-TB 23 (63.9) 883c 22 (61.1) 438 (49.6)
HIV 22 (61.1) 7373 (91.1) 16 (44.4) 3184 (52.5)
HCV 19 (52.8) 4385 (48.7) 13 (36.1) 1974 (54.5)
HBV 16 (44.4) 1757 (93.3) 12 (33.3) 259 (15.1)
STIs 14 (38.9) 2314 (98.8) 11 (30.6) 1432 (91.7)
a
Percentage is calculated by dividing the number of individuals receiving treatment in 2020 by the total number of individuals with diagnosis on
record, using the same reference year. Only countries providing both figures are considered for the calculations.
b
Percentage is calculated by dividing the number of individuals completing treatment in 2020 by the total number of individuals with access to
treatment, using the same reference year. Only countries providing both figures are considered for the calculations.
c
Percentage not reported as number of individuals receiving treatment might be higher than individuals diagnosed.
2. Findings 35
In the case of NCDs, in most situations, treatment is Information on access to recommended primary care
instituted and tends to be continuous, without there visits was requested for oral health, diabetes and CVD, as
necessarily being a defined treatment end. For this reason, these have specific European guidelines where a minimum
a modified version of the previous table is used to present frequency for good-quality care is stipulated (46) (Table 6).
access to treatment of NCDs as a primary care indicator
(Table 5).
Table 5. Access to treatment for various NCDs in prisons
Access to pharmacological treatment

Condition Number of Member n (%)
States reporting (%)
Mental health disorder 10 (27.8) 18 005 (80.9)
Drug use disorder 13 (36.1) 5920 (64.9)
Diabetes mellitus 13 (36.1) 1823 (95.2)
Hypertension 12 (33.3) 7494 (96.6)
CVD 12 (33.3) 5431 (92.1)
Cancer 12 (33.3) 1167 (90.2)
Table 6. Primary care visits as indicator of quality of care for selected NCDs in prisons
Number of Diabetes CVD Oral health

Member States n (%) n (%) n (%)
reporting
Unique individuals with oral health

visits over the previous 12-month 28 207 (72.8)
10
period, expressed as a proportion
of the total prison population
Unique individuals with a diabetes
mellitus diagnosis who had at least two
routine health-care visits (excluding 10 810 (86.1)
ophthalmology and other specialty visits)
over the previous 12-month period
Unique individuals with a diabetes
mellitus diagnosis who had at least 616 (65.5)
10
one ophthalmology visit over the
previous 12-month period
Unique individuals with a CVD diagnosis 5711 (96.9)
who had at least one routine health-care 12
visit over the previous 12-month period

2.3.3.2 Secondary and tertiary care Thirty Member States (83.3%) stated that they had such
Access to secondary care was characterized by asking arrangements or protocols in place in all prisons for cancers.
whether arrangements were in place to ensure access to In this case, however, it is noteworthy that three Member
specialized treatment and institutions for mental health States said that they did not have such arrangements in
and for cancer. place in any prisons (Fig. 31). All 36 Member States answered
this question.
Thirty-one Member States (86.1%) stated that they had such
arrangements or protocols in place in all prisons for mental
health disorders (Fig. 30). All 36 Member States answered
this question.
Fig. 30. Percentage of Member States having arrangements/protocols for specialized

treatment of mental health disorders in prisons
2.8% (n = 1) 2.8% (n = 1)
8.3% (n = 3)
In all prisons
In most prisons
In no prisons
86.1% (n = 31)
2. Findings 37
Fig. 31. Percentage of Member States having arrangements/protocols for specialized
treatment of cancers in prisons
8.3% (n = 3)
2.8% (n = 1)
5.6% (n = 2)
In all prisons
In most prisons
In no prisons
83.3% (n = 30)
2.3.3.3 Continuity of care

Three variables were used to characterize continuity to ensure medication reconciliation. Twenty-six Member
of care. The first focused on admission processes and States (72.2%) stated that they had such a procedure in
asked Member States if there was a procedure in place place (Fig. 32). All 36 Member States answered this question.
Fig. 32. Percentage of Member States having procedures to ensure medication

reconciliation at admission
27.8% (n = 10)
Yes
No
72.2% (n = 26)

The remaining variables assessed procedures at time of Of course, continuity of care involves a great deal more than
release, including registration with community health is covered by the domains assessed in the survey, and there
services, provision of medication, and testing for COVID-19. are certain areas that are especially relevant, such as suicide
and overdose prevention in the first period following
Only 17 Member States (47.2%) had a support service to release. It has been shown that the risk of overdose-
register people with community health services upon related death is higher among people with a history of
release. Of those providing such a service, eight stated incarceration, particularly in the first two weeks following
that the service included both scheduling a medical release (47,48). Various explanations of this have been
appointment upon release and developing a care plan given, including poor links established between prison and
to be shared with external providers. Four Member States community health care. Indeed, research has suggested
provided only the first of these services, five only the second. that ensuring that community health-care visits occur
shortly after release may help to provide significant support
Upon release, only a minority of Member States in reducing and preventing overdose risk and harm (49).
(n = 4; 11.1%) did not provide any medication (Fig. 33).
The most common arrangement was to provide medication Finally, another aspect that was evaluated related to
for certain conditions only (n = 18; 50.0%). There were four response measures adopted to prevent transmission,
Member States that did not answer this question. Among both within prison and in the interface between prison
the 18 Member States that said they provided medication and community. In this regard, it was surprising to find
only for certain conditions, the medication most commonly that, even though the survey was conducted during the
provided upon release was for HIV, followed by medication COVID-19 pandemic, the majority of Member States (77.8%)
for TB, HCV and drug use disorders. did not test individuals upon release from prison.
Fig. 33. Medication provided upon release from prison
11.1% (n = 4)
38.9% (n = 14) HIV

HIV 31
TB
TB 27
HCV
HCV 26
Druguse
Drug usedisorders
disorders 22
50.0% (n = 18)
0 5 10 15 20 25 30 40
Yes, for all conditions
Yes, for some conditions
No
2. Findings 39
2.3.4 Health system performance
2.3.4.1 Availability
The availability of the health service delivery system was One important aspect to bear in mind when comparing and
assessed by considering the availability of health-care staff. interpreting the rates of health-care staff per 1000 people in
Table 7 shows the number of health-care staff in prisons in prison and in the community is the meaning of the concept
Europe, in total and disaggregated by category; also shown of equivalence of care. Equivalence does not in fact imply
is the number of staff per 1000 people in prison and in the equality in the distribution of resources so much as equity,
general population. in the sense that resources should be allocated in a way that
fairly reflects different needs. It has been established that
According to the Association for the Prevention of people in detention more frequently have mental health
Torture (53): and drug use disorders, so a greater investment is needed,
for example, to achieve a higher ratio of psychiatrists to
The number and specialty of the health care staff people in prison (53).
available will be dependent on the size of the
prison, but as a minimum there should be a general In 72.2% of Member States (n = 26) there was access in
physician and sufficient nursing staff to meet the all prisons to mental health counsellors (including peer
daily needs. A psychiatrist, as well as a psychologist support and external providers – not specifically for mental
and nurses with training in psychiatric care, should health disorders but offering support for maintenance of
also be available at a frequency related to the size of well-being as required) (Fig. 34). Only one Member State
the prison population. Again, their role must not be reported that this option was not available in any of
confined simply to the treatment of mental illness its prisons. All 36 Member States answered this question.
but must include the promotion of the mental
well-being of the prison population and staff, and
the prevention of self-harm and suicide, as well as
all forms of physical or psychological violence.
Table 7. Number of health-care staff (including external service providers) in prisons,

expressed as full-time equivalents (FTEs)a
Staff category Number of Prisons General population

Member States
reporting
Total (FTEs) Per 1000 people Per 1000 inhabitants
living in prison
Nurses 30 7919.8 20.4 8.3 (50)
Physicians 31 3561.9 8.0 3.6 (51)
Dentists 28 460.2 1.4 6.2 (52)
Psychiatrists 30 489.9 1.3 1.4 (38)
Total staff 31 12 424.3 36.4 –
a
Data for physicians and dentists are available for 2020, while the latest available data for psychiatrists are from 2013. Data for the category of
nurses in the general population also include midwifery staff and are available for 2020.

Fig. 34. Access to mental health counsellors in prisons
2.8% (n = 1)
13.9% (n = 5)
In all prisons
11.1% (n = 4)
In most prisons
In no prisons
72.2% (n = 26)
2.3.4.2 Accessibility
Access to immunization against vaccine-preventable as recommended by WHO (54), was reported to be available
diseases was very good across all Member States, with the in all prisons in only 24 Member States (66.7%); clearly there
highest access observed for COVID-19, for which 88.6% of is room for improvement in this area. Moreover, availability
Member States stated that they provided vaccination in was assessed but not coverage. Coverage data through the
all prisons (Fig. 35). There were between one and three RISE-Vac project (55) is likely to provide some additional
Member States not answering this question, depending on useful information from participating Member States.
the variable. On a negative note, vaccination against HBV,
Fig. 35. Percentage of Member States providing vaccination against various infections in prisons
88.6% (n = 31) 2.8% (n = 1)

COVID-19
83.3% (n = 30) 5.6% (n = 2) 5.6% (n = 2)
Seasonal flu 5.6% (n = 2)
72.2% (n = 26) 8.3% (n = 3) 2.8% (n = 1) 16.7% (n = 6)
DTP
66.7% (n = 24) 11.1% (n = 4) 5.6% (n = 2) 16.7% (n = 6)
HBV
58.8% (n = 20) 14.7% (n = 5) 5.9% (n = 2) 20.6% (n = 7)
MMR
52.9% (n = 18) 14.7% (n = 5) 5.9% (n = 2) 26.5% (n = 9)
Hepatitis A
51.5% (n = 17) 9.1% (n = 3) 18.2% (n = 6) 21.2% (n = 7)
Pneumococcal vaccination
50.0% (n = 17) 8.8% (n = 3) 14.7% (n = 5) 26.5% (n = 9)
HPV
47.1% (n = 16) 11.8% (n = 4) 11.8% (n = 4) 29.4% (n = 10)
Meningococcal vaccination
0 10 20 30 40 50 60 70 80 90 100
Member States (%)
2. Findings 41
Access to HIV prophylaxis, including pre-exposure 2.3.4.3 Acceptability
prophylaxis (PrEP) and post-exposure prophylaxis The most common situation in the WHO European Region
(PEP), was relatively high across Member States (Fig. 36). is that informed consent is obtained before any health
All 36 Member States answered this question. However, intervention is provided, including health assessments and
the level of access still fell short of the recommendations screening tests. However, this process was documented
made by the United Nations Programme on HIV and AIDS in only 15 Member States (41.7%) (Fig. 37). All 36 Member
(UNAIDS) (56): according to the 2025 global AIDS targets, States answered this question. It is a matter of concern that
15% of people in prison should use PrEP in high-risk two Member States acknowledged that they did not even
settings, and 90% should have access to PEP. seek informed consent.
Fig. 36. Percentage of Member States providing access to HIV prophylaxis in prisons
58.3% (n = 21) 5.6% (n = 2) 16.7% (n = 6) 19.4% (n = 7)
PrEP
PrEP
75.0% (n = 27) 11.1% (n = 4) 5.6% (n = 2) 8.3% (n = 3)
PEP
PEP
0 10 20 30 40 50 60 70 80 90 100
Member States (%)
Fig. 37. Informed consent for screening tests and health assessments obtained from people
in prison
Informed consent obtained and

Informed consent not obtained for health interventions 41.7% (n = 15)
documented for any health intervention
Informed consent
Informed consent obtained and documented for any obtained for
intervention 52.8% (n = 19)
any health intervention
Informed
Informed consent obtained consent
for any healthnot obtained
intervention 5.6% (n = 2)
for health interventions
0 10 20 30 40 50 60 70
Member States
Member States (%)
(%)

2.3.4.4 Quality of care higher, at 55.6%, it should be noted that this function is one
Five main indicators were used to characterize quality of of the responsibilities of most health-care professionals in
care, four of which are displayed in Fig. 38. All 36 Member countries under the influence of the European Medicines
States answered these five questions. Agency. Even worse – the area where most work needs to
be done – was the development and implementation of
This figure shows that, although regular assessment of mechanisms for patient involvement in health care, which
the availability of essential medicines was widespread was reported by only 27.8% of Member States.
in the WHO European Region, reported by 32 Member
States (88.9%), the same could not be said of the other The fifth indicator evaluated whether standardized
quality-of-care criteria. Only 41.7% of Member States protocols were in place to identify and help people at
reported that they had a standardized process for reporting risk of suicide or self-harm, or both. This was reported by
medication errors. Although the number of countries that 27 Member States (75.0%) (Fig. 39).
had a system for reporting adverse drug reactions was
Fig. 38. Quality of care in prisons
88.9% (n = 32) 11.1% (n = 4)

Regular assessment of availability
of essential medicines
55.6% (n = 20) 44.4% (n = 16)

Standardized process for reporting
Mechanism for ensuring patient involvement
adversein drug
health-care
eventsplanning and
in prisons
reform
41.7% (n = 15) 58.3% (n = 21)

Standardized process forStandardized
reporting adverse drug events
process in prisons
for reporting
medication errors in prisons
No
Standardized process for reporting medication errors in prisons
Yes
27.8% (n = 10) 72.2% (n = 26)
Mechanism for ensuring patient involvement
Regular assessment of availability of essential medicines
in health-care planning and reform
0 10 20 30 40 50 60 70 80 90 100
MemberStates
Member States (%)
(%)
Yes No
2. Findings 43
Fig. 39. Standardized protocol in place for identifying and helping people at risk of
suicide/self-harm
13.9% (n = 5)
11.1% (n = 4)
Standardized protocol for

self-harm and suicide
Standardized protocol
for suicide
No protocol for either

self-harm or suicide
75.0% (n = 27)
2.4 Impacts: health outcomes

2.4.1 Health and well-being
The domain of health and well-being was evaluated by assessments either regularly (n = 7; 19.4%) or on an ad
considering whether assessments of perceived well-being hoc basis (n = 18; 50.0%), 11 Member States (30.6%) had
(or life satisfaction) of people in prison were conducted. never done so (Fig. 40). All 36 Member States answered this
While the majority of Member States conducted such question.
Fig. 40. Percentage of Member States conducting assessments of perceived well-being of

people in prison
30.6% (n = 11) 50.0% (n = 18)
Yes, assessments conducted regularly

(e.g. once a year or every two years)
Yes, assessments conducted

on an ad hoc basis
No, assessments
never conducted
19.4% (n = 7)

2.4.2 Morbidity
Not all Member States could provide data on the number proportion was able to further disaggregate by gender
of people with a given condition, and only a very small (Table 8).
Table 8. Morbidity in prison

Condition Number of Number of people in Expected prevalence (from Prevalence in
Member States prison with a diagnosis literature on prisons) the general
reporting on record (%)a community (%)b
TB 28 1771 (0.46) 1000 (95% CI: 510–1770) per 9.6 cases reported per
(95% CI: 0.44–0.48) 100 000 people in prison (25) 100 000 people (2019)
2.8% active TB (57)
0.8–6.0% (58)
MDR-TB 25 1062 (0.35) 0.48% (95% CI: 0.02–1.32)– 0.01
(95% CI: 0.33–0.37) 1.15% (95% CI: 0.15–2.73)
depending on detection
methods (59)
HIV 25 9506 (2.60) 5.0% (95% CI: 0.0–11.0) (60) 0.43
(95% CI: 2.55–2.65) 3.8% (57)
HCV 23 13 491 (3.75) 26% (95% CI: 23–29) (61) 0.006
(95% CI: 3.69–3.82) 15.1% (57)
HBV 20 3003 (1.20) 2.05 (95% CI: 1.54–2.72) (62) 0.025
(95% CI: 1.16–1.25) 4.8% (57)
STIs 16 2367 (1.07) Syphilis, 1.1% ; herpes 13.6
(95% CI: 1.02–1.11) simplex virus 2, 22.4% (63)
COVID-19 29 15 497 (3.55) By 23 September 2020, –
(95% CI: 3.49–3.60) cumulative incidence rate
for people in federal prisons,
11 710.1 per 100 000 (64)
Oral health 4 27 266 (42.88) 67.0% decayed teeth/tooth –
(individuals (95% CI: 42.50–43.27) missing due to caries (65);
keeping 21 or more equivalent to 33% preserving
natural teeth) 21 or more natural teeth
Mental health 15 79 857 (32.76) 29%, common mental 13.1
disorder (95% CI: 32.57–32.94) health disorders (66)
Psychotic 11 2021 (1.37) 6.2% (67) –
disorder (95% CI: 1.31–1.43)
Recorded 11 366 (0.39) Only “completed –
suicide (95% CI: 0.35–0.43) suicide” studies
attempt events
Drug use disorder 18 20 059 (7.84) Men: 30% (95% CI: 22–38) 1.3
(95% CI: 7.73–7.94) Women: 51%
(95% CI: 43–58) (68)
Diabetes 16 5456 (3.04) 14% (95% CI: 12–16) (29) 10.8
(95% CI: 2.96–3.12)
Hypertension 14 18 812 (10.89) 39% (95% CI: 32–47) (29) –
(95% CI: 10.74–11.04)
CVD 15 10 933 (6.14) 38% (95% CI: 33–42) (29) 13.3
(95% CI: 6.03–6.25)
Cancer 16 2748 (1.38) 8% (95% CI: 6–10) (29) 13.6
(95% CI: 1.33–1.43)
a
Percentage is calculated by dividing the number of people with a diagnosis on record in 2020 by the total number of people in prison in the same
country (but only where data have been provided for the same reference year).
b
Data from Global Burden of Disease 2019 (34); reported for males only.
2. Findings 45
This table suggests that, across all conditions, there may be Previous reports have acknowledged gaps in knowledge of
some underreporting by Member States, when comparison the prevalence of certain conditions in European prisons,
is made with systematic reviews published on prevalence namely on active and latent TB (58).
of such conditions in similar populations (for some
conditions, however, the literature identified for prisons
was not considered to be suitable, either because of the 2.4.3 Mortality
low quality of the studies or lack of comparability of the All Member States reported mortality data. Disaggregation
data reported). The differences identified are more visible by cause of death was possible only for 27–35 Member
for NCDs, which may result from there being less focus on States, depending on the cause. Standardized all-cause
these in prisons. mortality rate per 100 000 incarcerated people was 42.5,
as compared to 136.9 in the general population (Table 9).
Nonetheless, assuming that some values are underreported,
the prevalence of most infectious diseases is considerably The data obtained confirm that suicide remained a major
higher in prisons than in the general community, the cause of death in prisons. Previous reports had suggested
exception being STIs, for which only 16 Member States that the risk of suicide among people in European
reported data. Mental health and drug use disorders were prisons was seven times higher than that of the general
also reported to represent a considerably higher share population (70). This is a higher ratio than the one identified
of the prison population compared to the community. in the current report, even though the standardized rate in
Conversely, prevalence of NCDs was lower in prisons prison was very similar (105 per 100 000 people in prison).
than in the community, although careful interpretation of It has also been suggested that a considerable proportion
these data is needed as very few Member States reported of people who commit suicide in prison have drug-related
them. Moreover, in certain situations, the values reported problems (58).
were zero (even after validation had been requested from
Member States), which suggests that NCDs may be ignored
in some prisons.
Table 9. Main causes of death in prison (compared to the general community)
Deaths Number of Member Number of cases Rate/100 000 Rate/100 000

States reporting people in prison people in the
community
All causes 36 2598 424.9 1369.2 (34)
Suicide 35 626 103.0 39.5 (34)
Overdose 27 92 24.5 4.4 (34)
COVID-19 33 163 31.2 126.8a
a
The cumulative mortality rate for COVID-19 was estimated by combining the total cumulative number of deaths due to COVID-19 between 22
January 2020 and 31 December 2020 obtained from the Our World in Data database (35) and the EU population as of 1 January 2020 obtained
from Eurostat (69). Data were reported for males only.

2.5 Influencing factors
2.5.1 Prison environment
The prison environment was characterized using five Malta (Fig. 41). There were a total of seven Member States
indicators. The first of these looked at occupancy rate. The that exceeded their official capacity and thus had prisons
overall occupancy rate in the WHO European Region was in a state of overcrowding.
84.4%, ranging between 18.8% in Monaco and 205.5% in
Fig. 41. Occupancy rate in prisons in the WHO European Region
Monaco 18.8% Full occupancy

Armenia 36.8%
Ukraine 60.3%
Spain 60.8%
Bosnia and Herzegovina 62.6%
Latvia 64.2%
Estonia 71.4%
Lithuania 72.6%
Bulgaria 76.6%
Georgia 78.4%
Germany 80.1%
Poland 80.5%
Luxembourg 83.2%
Ireland 83.4%
WHO European Region 84.4%
Albania 86.1%
Finland 86.3%
Croatia 87.4%
Slovakia 90.5%
Portugal 90.6%
Romania 94.6%
United Kingdom 95.4%
Republic of Moldova 95.5%
Austria 95.6%
Switzerland 95.7%
Hungary 96.1%
Slovenia 96.5%
Czechia 97.7%
Netherlands 99.8%
San Marino 100.0%
Denmark 100.3%
France 103.4%
Italy 105.1%
Belgium 110.8%
Cyprus 110.9%
Greece 111.8%
Malta 205.5%
0 50 100 150 200 250
Occupancy rate (%)
2. Findings 47
It is important to remember two stipulations of the Mandela confinement; specific stipulations are given, such as that
Rules (5), neither of which is likely to be respected in the maximum duration should never amount to “more
situations of overcrowding: than 22 hours a day without meaningful human contact”
and that it should only be used exceptionally and “for the
[Rule 12.1] Where sleeping accommodation is in shortest period possible and never amount to torture or
individual cells or rooms, each prisoner shall occupy inhuman or degrading treatment or punishment”. However,
by night a cell or room by himself or herself. If for the maximum duration of solitary confinement is in practice
special reasons, such as temporary overcrowding, set by national law. When solitary confinement is imposed,
it becomes necessary for the central prison the people affected “shall be visited daily”. However, there
administration to make an exception to this rule, it is are also reports suggesting that such measures, particularly
not desirable to have two prisoners in a cell or room. for pretrial detention, have been part of Scandinavian
prison practice for many years (71), which may explain
[Rule 13] All accommodation provided for the the higher values reported by such countries. Moreover,
use of prisoners and in particular all sleeping the current survey was conducted during the COVID-19
accommodation shall meet all requirements of pandemic; according to Penal Reform International, prisons
health, due regard being paid to climatic conditions in the United States saw a 500% increase over previous
and particularly to cubic content of air, minimum levels in the use of solitary confinement in June 2020 (72).
floor space, lighting, heating and ventilation.
The third indicator looked at sanitation conditions,
The second indicator looked at the use of solitary which were subdivided into having access to a toilet
confinement as a punitive measure. In the 22 Member States in-cell and having access to showering and bathing
that answered the question, a total of 7978 individuals were facilities of appropriate temperature. While the second
held in solitary confinement in 2020, representing 2.9% of of these facilities was ensured in all prisons in 94.4% of
the annual prison population. A higher value (4.3%) was Member States, only 69.4% reported in-cell toilets in all
reported in Global prison trends 2022 (39). The Council of prisons (Fig. 42). All 36 Member States answered these
Europe’s prison rules, revised in 2020 (45), regulate solitary two questions.
Fig. 42. Sanitation conditions in prisons
94.4% (n = 34) 5.6% (n = 2)
Showering and
Showering and bathing facilities
bathing facilities
69.4% (n = 25) 27.8% (n = 10) 2.8% (n = 1)
Toilet
Toiletin-cell
in-cell
0 10 20 30 40 50 60 70 80 90 100
Member
Member States
States (%)(%)
In all prisons In most prisons In no prisons

In all prisons In most prisons In no prisons

It is important to highlight the Mandela Rules that focus on fresh air and the opportunity to engage in physical activity,
these two specific aspects (5): as stipulated by Mandela Rule 23 (5):
[Rule 15] The sanitary installations shall be adequate 1. Every prisoner who is not employed in outdoor work
to enable every prisoner to comply with the needs shall have at least one hour of suitable exercise in
of nature when necessary and in a clean and decent the open air daily if the weather permits.
manner.
2. Young prisoners, and others of suitable age and
[Rule 16] Adequate bathing and shower installations physique, shall receive physical and recreational
shall be provided so that every prisoner can, and training during the period of exercise. To this end,
may be required to, have a bath or shower, at a space, installations and equipment should be
temperature suitable to the climate, as frequently as provided.
necessary for general hygiene according to season
and geographical region, but at least once a week in
a temperate climate. Every Member State respected the first part of this rule,
stipulating that people in prison should be allowed to
Insufficient sanitation facilities have also been reported in spend at least one hour per day outdoors (Fig. 43). However,
Global prison trends 2022 (39). two Member States did not make physical activity facilities
available in all prisons, and three did not give people the
The fourth indicator looked at available infrastructure and opportunity to use these facilities at least once a week. All
procedures to ensure that people in prison have access to 36 Member States answered these three questions.
Fig. 43. Access to fresh air and the opportunity and means to engage in physical activity
in prisons
100.0% (n = 36)
Allowed to spend at least

Allowed to spend at least one hour per day outdoors
one hour per day outdoors
91.7% (n = 33) 8.3% (n = 3)
Opportunity to use
physical
ty to use physical activity facilities activity
at least once facilities
a week
at least once a week
94.4% (n = 34) 5.6% (n = 2)
Access to physical
Access to physical activity facilities
activity facilities
0 10 20 30 40 50 60 70 80 90 100
MemberStates
Member States (%)
(%)
In all prisons In all prisons

In most prisons In most prisons
2. Findings 49
The fifth indicator looked at access to food and nutritional obesity more frequently (73). Consumption habits, notably
options and their adaptation to cultural and gender needs, of ultraprocessed foods during detention (74), have also
as stipulated by Mandela Rule 22 (5): been held accountable for short- and long-term negative
consequences, including the development or aggravation
Every prisoner shall be provided by the prison of NCDs.
administration at the usual hours with food of
nutritional value adequate for health and strength, It should be mentioned that having nutritional options
of wholesome quality and well prepared and served. adapted to health needs is, of course, equally important,
but this information was not collected in HIPEDS.
The survey data indicate that adaptation to cultural needs
was respected in most Member States, but more needed to
be done to ensure that women in detention were also given 2.5.2 Health behaviours
food of adequate nutritional value for their health needs Health behaviours were characterized by asking Member
(Fig. 44). All 36 Member States answered both questions. States, for a total of seven variables, the number of people in
prison adopting a certain behaviour (Table 10). Even though
Previous research has shown that people in prison tend to all Member States said that this information was recorded
gain weight (28) and – even though women represent only in their clinical records, most also acknowledged that there
around 5% of the prison population – women are more were limitations in their ability to extract such data. For this
vulnerable to have low physical activity and to be diagnosed reason, this was the domain where Member States had most
with eating disorders, and thus to display abdominal difficulty in providing valid information.
Fig. 44. Access to food and nutritional options in prisons
Diets adapted to cultural needs Diets adapted to gender needs

2.8% (n = 1)
8.3% (n = 3)
44.4% (n = 16) 55.6% (n = 20)
In all prisons
In a minority Yes
of prisons No
In no prisons
88.9% (n = 32)

Table 10. Health behaviours in prison
Behaviour Number of Number of people Values reported Values reported

Member States in prison (% of for prisons in for the general
reporting prison population) the literature population
Overweight 5 4989 (34.81) 55.8% for UK (75) 62.9% (38)a

(BMI 25.0–29.9 kg/m2) (95% CI: 34.04–35.60)
Obese (BMI ≥ 30.0 kg/m2) 4 1764 (9.71) 8.0–56.0% (76) 21.8% (38)a
(95% CI: 9.29–10.15) Important gender
inequalities (75)
Smokersb 6 15 528 (63.13) 72.3% (95% CI: 38.1% (38)a

(95% CI: 62.53–63.73) 54.8–84.7) (77) –
western Europe
Drinkers (last 12 months)c 10 7382 (12.98) Males only, 12-month

(95% CI: 12.70–13.26) 18–30% (78) prevalence rates
for alcohol use
dependence
6.1% for males
in Europe (79)
Drug users (last 12 months)b 10 10 129 (17.81) Male prisoners 5.6% of people
(95% CI: 17.49–18.12) 10–48% aged 15–64 used
Females 30–60% (78) drugs at least once
Injectable drug users 7 1551 (6.52) 17.3% (24) 0.2% of people

(last 12 months)b (95% CI: 6.21–6.84) aged 15–64 used
drugs at least once
Physically active (exercising 4 638 (10.48) 46.2% for UK (75) 75% (81)
≥ 150 minutes/week) (95% CI: 9.74–11.28)
a
European Health Information Gateway 2016 data for males only.
b
We cannot verify when these statistics were collected in prisons. The point of assessment would imply if the people in prison had consumed
alcohol, drugs or tobacco while in prison or if they had consumed them within the 12 months before they entered prison.
c
For the reason given in the previous note, the population-level statistic for current alcohol drinkers is not given here; instead, we give the
population-level statistics and prison statistics reported in the literature to indicate alcohol use dependence, which we believe will add more
value to this discussion.
In spite of the low level of reporting by Member States, this morbidity domain, this is apparent when comparisons are
table suggests that, across all behaviours, there may be made with published systematic reviews on the prevalence
some underreporting. Even though less visible than in the of such conditions in similar populations.
2. Findings 51
2.6 Cross-cutting principles
2.6.1 Adherence to international standards
for human rights and good prison health
Nine indicators were taken into account when (9) existence of national health-care complaints system for
characterizing the first cross-cutting principle. These were: people in prison.
(1) equivalence in the scope of services offered;

All Member States stated that they offered the same range of
(2) equivalence in access to vaccination by plans health-care services to people in prison as those available
established; in the outside community.
(3) equivalence in standards and accreditation procedures
for health-care services; Of the 36 Member States, 34 reported that they had
a national vaccine implementation plan establishing
(4) equivalence in professional standards established for
access to COVID-19 vaccine for people in prison, with such
the workforce;
people being given priority status in 12 Member States (Fig.
(5) equivalence in ethical standards established for the 45). All 36 Member States answered this question. People
workforce; in prison were not mentioned in the national vaccine
(6) provisions of international law on the health of people implementation plans of the two other Member States.
in detention incorporated into national law; WHO has worked jointly with the United Nations Office on
Drugs and Crime and Penal Reform International to call
(7) clinical independence;
for people living and working in prisons to be included in
(8) publicly available reports of prison hygiene, nutrition national COVID-19 vaccination plans, but it appears that
and living conditions; and more work still needs to be done (82).
Fig. 45. Existence of national COVID-19 vaccination implementation plans mentioning

access for people in prison
Unsure, people in prison are not mentioned in the national vaccine

Yes, following principle of equivalence 61.1% (n = 22)
implementation plan
Yes, with people in prison

Yes, following principle of equivalence 33.3% (n = 12)
considered a priority group
Unsure, people in prison are not mentioned

Yes, with people in prison considered a priority group 5.6% (n = 2)
in the national vaccine implementation plan
0 10 20 30 40 50 60 70 80
Member
Member States
States (%) (%)

Eighteen Member States (50.0%) stated that their All Member States stated that the provisions of international
health-care services were subject to the same accreditation law regarding the health of people in prisons and
procedures across all type of services, while another other places of detention were incorporated into their
16 Member States stated these procedures applied only to national law.
publicly contracted services (Fig. 46). All 36 Member States
answered this question. Even though most Member States (n = 28; 77.8%) stated
that clinical decisions could not be overruled or ignored
All 36 Member States reported that their prison health by nonhealth prison staff, eight Member States reported
workforce was subject to the same professional standards that prison health staff did not have clinical independence,
as the health workforce in the community. Moreover, of which is a basic principle of good prison health (83,84)
the 35 Member States that provided an answer, all stated (Fig. 47). All 36 Member States answered this question.
that their prison health workforce was subject to the same
ethical standards as the health workforce in the community.
Fig. 46. Standards and accreditation procedures for health-care services in prisons
and the community
5.6% (n = 2)
44.4% (n = 16)
Same procedures for prison and community,

for both public and private services
Same procedures for prison and community,

but for publicly contracted services only
Different procedures for

prison and community
50.0% (n = 18)
2. Findings 53
Fig. 47. Clinical independence of prison health staff
22.2% (n = 8)
Clinical decisions taken by health

staff cannot be overruled or ignored
by nonhealth prison staff
Clinical decisions taken by health staff can be

overruled or ignored by nonhealth prison staff
77.8% (n = 28)
Most Member States (n = 24; 68.6%) stated that they did not and living conditions (Fig. 48). One Member State did not
have publicly available reports on prison hygiene, nutrition answer this question.
Fig. 48. Public availability of reports on prison hygiene, nutrition and living conditions
31.4% (n = 11)
Reports publicly available
Reports not publicly available
68.6% (n = 24)

Most Member States reported that they had a complaints Most indicators in this domain seem to be broadly aligned
system in place (n = 26; 72.2%) (Fig. 49). All 36 Member with this recommendation. However, more needs to be
States answered this question. However, when asked done to ensure clinical independence and transparency in
how many complaints had been received in 2020, only reports on prison hygiene, nutrition and living conditions
15 of these 26 (57.7%) were able to provide a figure. There and in the number of complaints received.
were, on average, 380.5 complaints per Member State
(SD = 718.54); assuming these complaints were made 2.6.2 Reducing health inequalities and
by unique individuals, this corresponds to 4.1% of the addressing the needs of special populations
prison population. Member States were asked if they had national standards
to meet the health needs of special populations in
According to the updated Mandela Rules (5): prison. There were six Member States that did not answer
this question. In the remaining 30 Member States, the
[Rule 24] Prisoners should enjoy the same standards population subgroups given the most consideration were
of health care that are available in the community pregnant women and people who use drugs, followed by
and should have access to necessary health-care people with physical disabilities, children and youth, and
services free of charge without discrimination on women (Fig. 50).
the grounds of their legal status.
Fig. 49. Availability of a complaints system in prison
27.8% (n = 10)
Available
Not available
72.2% (n = 26)
2. Findings 55
Fig. 50. Availability of national standards to meet the health needs of special populations
in prison
90.0% (n = 27) 10.0% (n = 3)

People who
Ethnicuse drugs
minorities
90.0% (n = 27) 10.0% (n = 3)
People withPregnant women
learning disabilities
86.7% (n = 26) 13.3% (n = 4)
PeoplePeople
with with
physical disabilities
physical disabilities
83.3% (n = 25) 16.7% (n = 5)
Elderly people
Children and youth
83.3% (n = 25) 16.7% (n = 5)
People whuse drugs
Women
70.0% (n = 21) 30.0% (n = 9)
Foreign nationals
Elderly people
LGBTQI+ persons 56.7% (n = 17) 43.3% (n = 13)
People with learning disabilities
Children and youth 43.3% (n = 13) 56.7% (n = 17)
Foreign nationals
Pregnant women 36.7% (n = 11) 63.3% (n = 19)
Ethnic minorities
Women 33.3% (n = 10) 66.7% (n = 20)
LGBTQI+ persons
0 10 20 30 40 50 60 70 80 90 100
No MemberStates
Yes
Member States (%)
(%)
Yes No
When asked if these national standards were based on had the option to be attended by female health-care staff.
international ones, six Member States answered “no” and Three quarters of Member States (n = 27; 75.0%) answered
20 answered “yes” (four did not answer). positively, while nine stated that such an arrangement
could not be guaranteed.
There are several standards and guidance documents
issued to support population subgroups in the general There was a range of positions adopted on access to
population, such as the International Standards for People pregnancy tests. Most commonly, pregnancy tests were
with Drug Use Disorders (85), that are also applicable to not made available (n = 14; 38.9%), but in around a third
people in detention. of Member States they were made available at regular
intervals (n = 12; 33.3%), and in the remainder they
Member States were asked if their prisons had were made available only once (n = 10; 27.8%) (Fig. 52).
health-related information products for people in prison, All 22 Member States that gave access to pregnancy tests
such as brochures and leaflets, in multiple languages. Just stated that the option of prenatal care or termination was
over half (n = 19; 52.8%) reported that these were available available in the event of a positive result.
in all prisons (Fig. 51). All 36 Member States answered
this question. In the 27 Member States that responded to the third
question, a total number of 105 women were reported to
There were three questions dealing with women’s health have given birth in prison in 2020, representing 0.6% of the
and specific needs. All 36 Member States answered the females in prison.
first two questions. The first asked if women in prison

Fig. 51. Availability of health-related information products for people in prison in
multiple languages
19.4% (n = 7)
In all prisons
In most prisons
In no prisons
16.7% (n = 6)
52.8% (n = 19)
11.1% (n = 4)
Fig. 52. Access to pregnancy tests in prisons
27.8% (n = 10)
38.9% (n = 14)
Yes, at regular intervals
Yes, only once
No
33.3% (n = 12)
2. Findings 57
3
58
3. Exploring the effects of governance arrangements for
the delivery of health care in prisons
WHO and the United Nations Office on Drugs and Crime hypothesized that two possible models could lead to better
have concluded that (i) managing and coordinating all health-care provision: responsibility lying exclusively with
relevant agencies and resources contributing to the health the Ministry of Health; and responsibility shared between
and well-being of prisoners is a whole-of-government the Ministry of Health and the Ministry of Justice. We tried
responsibility; and (ii) health ministries should provide to put countries into one or other of these groups, and then
and be accountable for health-care services in prisons used the grouping as the main variable in an attempt to
and advocate healthy prison conditions (84). However, understand four major aspects that characterize prison
there is insufficient evidence about the effects of different health systems.
governance arrangements, beyond case studies of good
practice that illustrate these principles.
3.1 Health information systems
In 2020 WHO issued a policy brief which described the
governance arrangements for prison health in three First, we considered health information systems –
European countries (86). In two of these countries, specifically, their ability to provide data on behaviours,
responsibility for prison health lay with the Ministry of morbidity and mortality indicators (Table 11).
Health; in the other, responsibility lay with the Ministry
of Justice, but health-care delivery was assured through Regardless of the groupings made, the data suggest
a formal collaboration with the Ministry of Health. The that the differences identified in the ability to report
arrangements in each country seemed to show positive health information data cannot be explained by diverse
results, although there was some room for improvement in arrangements in the responsibility for the delivery of health
terms of documenting health outcomes. In light of this, we care in prisons.
Table 11. Association between governance arrangements and health information systems
in prison
Ministry Ministry p-valuea Ministry of Ministry p-valuea

of Health of Justice Health or both of
or both Justice
Number of Member States (%) Number of Member States (%)
Mortality data (both sexes)
complete data 4 (57.1) 23 (79.3) 20 (71.4) 7 (87.5)
incomplete data 3 (42.9) 6 (20.7) 0.333 8 (28.6) 1 (12.5) 0.648
Morbidity data (both sexes)
complete or incomplete data 5 (71.4) 26 (89.7) 24 (85.7) 7 (87.5)
no data 2 (28.6) 3 (10.3) 0.244 4 (14.3) 1 (12.5) 1.000
Health behaviour
data (both sexes)
incomplete data 2 (28.6) 11 (37.9) 9 (32.1) 4 (50.0)
no data 5 (71.4) 18 (62.1) 1.000 19 (67.9) 4 (50.0) 0.422
a
Two-tailed Fisher’s exact test. Values below 0.05 show significant differences in proportions, according to the significance level defined for the
statistical analysis. Values between 0.05 and 0.10 are considered trends.
3.2 Delivery of health-care services
Next, we looked at delivery of health-care services (iii) availability of PrEP and PEP (preventive services)
(Table 12). This was operationalized by considering:
(iv) primary care quality (following recommendations
(i) availability of needles and syringes (health for oral health visits and ophthalmology visits in the
protection) case of diabetes).
(ii) treatment areas for people with drug use disorders

(health promotion)
Table 12. Association between governance arrangements and delivery of health-care

services in prison
Ministry of Ministry p-valuea Ministry of Ministry p-valuea

Health of Justice Health or both of Justice
or both
Available in all prisons 2 (28.6) 1 (3.4) 3 (10.7) 0 (0.0)
Not available in all prisons 5 (71.4) 28 (96.6) 0.089 25 (89.3) 8 (100.0) 1.000
Treatment areas for people
with drug problems
Available in all or most prisons 4 (66.7) 10 (34.5) 12 (44.4) 2 (25.0)
Available in a minority or no prisons 2 (33.3) 19 (65.5) 0.191 15 (55.6) 6 (75.0) 0.431
Access to mental health counsellors
Available in all or most prisons 6 (85.7) 24 (82.8) 23 (82.1) 7 (87.5)
Available in a minority of or no prisons 1 (14.3) 5 (17.2) 1.000 5 (17.9) 1 (12.5) 1.000
PEP
PrEP
Oral health visit
Frequency meets recommendations 0 (0.0) 3 (37.5) 2 (25.0) 1 (50.0)
Frequency does not meet
2 (100.0) 5 (62.5) 1.000 6 (75.0) 1 (50.0) 1.000
recommendations
a

Table 12 (contd)
Ministry of Ministry p-value Ministry of Ministry p-value

Health of Justice Health or both of Justice
or both
Care provided to people
with diabetes mellitus
Routine health care meets
recommendations (at least two 1 (100.0) 6 (66.7) 4 (57.1) 3 (100.0)
routine health-care visits per year)
Routine health care does not meet
recommendations (less than two 0 (0.0) 3 (33.3) 1.000 3 (42.9) 0 (0.0) 1.000
routine health-care visits per year)
Ophthalmology care meets
recommendations (at least one 0 (0.0) 4 (44.4) 3 (42.9) 1 (33.3)
ophthalmology visit per year)
Ophthalmology care does not meet
recommendations (less than one 1 (100.0) 5 (55.6) 1.000 4 (57.1) 2 (66.7) 1.000
ophthalmology visit per year)
Care provided to people
with CVD diagnosis
Care meets recommendations (at least
1 (100.0) 9 (81.8) 7 (77.8) 3 (100.0)
one routine health-care visit per year)
Care does not meet recommendations
(less than one routine health- 0 (0.0) 2 (18.2) 1.000 2 (22.2) 0 (0.0) 1.000
care visit per year)
Needles and syringes tended to be distributed more There was a marginally significant increase in the frequency
frequently when responsibility for delivery of health services of PEP distribution when responsibility for delivery of health
was exclusively under the Ministry of Health, even though services was shared between the Ministry of Health and
the difference only indicated a trend (p-value = 0.089). This the Ministry of Justice. No further differences were noted
trend was not, however, replicated in the distribution of in preventive services.
other health protection products.
There were no differences found in access to treatment

areas for people with drug use disorders or in access to
mental health counsellors.
3.3 Environmental factors
Next, we looked at the effect of different governance The data suggest that, when responsibility for delivery of
arrangements on environmental factors, using adaptation health services was exclusively under the Ministry of Health,
of diets to meet gender needs as an example (Table 13). there was more frequent adoption of national standards for
However, no significant differences were identified. special populations – notably, LGBTQI+ (80.0% vs 24.0%,
p-value = 0.031) and ethnic minorities (80.0% vs 28.0%,
p-value = 0.047). The same trend was observed for people
3.4 Adherence to the principle with learning disabilities, despite the lack of power for
statistically significant results (100.0% vs 48.0%). However,
of equivalence and other
an arrangement in which responsibilities were under the
international standards Ministry of Health or shared between the Ministry of Health
and the Ministry of Justice seemed to be more favourable
Finally, we looked at the relationship between prison with respect to clinical independence, when compared to
governance arrangements and the level of adherence to the being exclusively under the Ministry of Justice (10.7% vs
principle of equivalence and other international standards 62.5%, p-value = 0.006).
(Table 14).
Table 13. Association between governance arrangements and adaptation of diets to

gender needs
Ministry Ministry of p-valuea Ministry of Ministry of p-valuea

of Health Justice or both Health or both Justice
Gender-adapted diets
Yes 1 (14.3) 15 (51.7) 11 (39.3) 5 (62.5)
No 6 (85.7) 14 (48.3) 0.104 17 (60.7) 3 (37.5) 0.422
a

Table 14. Association between governance arrangements and the principle of equivalence
and other international standards in prison
Ministry Ministry of p-valuea Ministry of Ministry p-valuea

of Health Justice or both Health or both of Justice
COVID-19 vaccine
implementation plan
People in prison are 6 (85.7) 28 (96.6) 26 (92.9) 8 (100.0)

prioritized or the principle
of equivalence is followed
People in prison are 1 (14.3) 1 (3.4) 0.356 2 (7.1) 0 (0.0) 1.000

not mentioned or are
the last covered
National standards for

special populations
LGBTQI+
Yes 4 (80.0) 6 (24.0) 9 (37.5) 1 (16.7)
No 1 (20.0) 19 (76.0) 0.031 15 (62.5) 5 (83.3) 0.633
Yes 5 (100.0) 12 (48.0) 15 (62.5) 2 (33.3)
No 0 (0.0) 13 (52.0) 0.052 9 (37.5) 4 (66.7) 0.360
Ethnic minorities
Yes 4 (80.0) 7 (28.0) 10 (41.7) 1 (16.7)
No 1 (20.0) 18 (72.0) 0.047 14 (58.3) 5 (83.3) 0.372
Clinical independence
Yes 7 (100.0) 21 (72.4) 25 (89.3) 3 (37.5)
No 0 (0.0) 8 (27.6) 0.309 3 (10.7) 5 (62.5) 0.006
a
Two-tailed Fisher’s exact test. Values below 0.05 show significant differences in proportions, according to the significance level
defined for the statistical analysis. Values between 0.05 and 0.10 are considered trends.
4
64
4. Limitations
The mortality and prevalence data in prisons used for cannot easily be made with these data. Rates adjusted
this report were calculated using the number of people for age, sex and social class would be needed to allow
in detention as of 31 December 2020 as the population of sound conclusions to be drawn, and these were not
exposure, while we used the cumulative number of cases available for the prison population. We attempted to
and deaths for the year 2020. While it is acknowledged that correct for this by using mortality and prevalence rates
the prison population is relatively small yet dynamic, it was for the general population over 20 years of age and by
assumed for the report that the rate of change of the prison drawing comparisons with males only, since the female
population stayed relatively constant, allowing the end-of- representation in prisons is only 5% of the total population.
year population figure to be used.
When exploring governance arrangements for the delivery
An important limitation of this report is that, while its aim of prison health care (section 3), some trends were revealed.
is to provide an overview of the performance of prison However, the limited sample size reduced the potential to
health systems and of the health status profile of people further explore the effect of different organizational models,
living in prison in the whole WHO European Region, only as shown by p-values that often could only point towards
36 of 53 Member States responded. While comparisons trends. Notwithstanding, given the limited data published
are made with WHO European Region data for the general on evidence of the impact of governance in the delivery of
population, these should be interpreted with caution as prison health care, we believe the data provided are still of
some of the missing countries are large and represent an value, even though cautious interpretation is needed.
important share of the prison population of the Region.
Moreover, irrespective of their size, these missing countries For most countries, the period to which HIPEDS data refer
may also have particular features in their organization and was 2020. However, for some external sources, the reference
functioning that would be relevant in characterizing the year was different, making direct comparison more difficult.
prison health system as a whole.
Countries that consist of multiple regions, cantons or
For those countries that were represented, there were also nations posed a particular challenge, as the option to use
substantial limitations in the availability of data across nationally aggregated data presented in a uniform and
many indicators, notably for behaviour and morbidity consistent manner was not generally available. Some
variables. This may be because some countries do not countries (such as Switzerland in the case of workforce)
collect these data at national level; because data are opted to indicate “missing data” whenever there were no
collected but cannot be extracted in an aggregate manner; aggregate national data, while others (such as England and
or perhaps – in the case of certain variables (such as Wales in the case of the United Kingdom) indicated the
those associated with population profiles) – because of situation in the regions that represented a larger proportion
inconsistencies between the HIPED indicators and the of the prison population and highlighted any exceptions
countries’ data collection processes and systems (such as whenever appropriate. Others still (such as Germany)
the age cutoff used). delivered a regional report, leaving national aggregation to
be done by HIPP. For this reason, the validity of the country
Comparisons of conditions and risk factors between the profiles of these countries may vary.
incarcerated population and the community at large
4. Limitations 65
5
66 Introduction 66
5. Discussion and conclusions
This report builds on the evidence gathered in a previous (such as insufficient capacity for health service delivery).
report on prison health in the WHO European Region Therefore, it is recommended that alternative measures
published in 2019 (87). Although this earlier report was of incarceration should be considered for offences that
innovative in creating a source of information that explored do not present a high risk to society and for which more
the prison health system, adopting for the most part a effective measures, such as diversion to treatment for drug
health systems perspective, several limitations or caveats use disorders, exist (88).
were nevertheless acknowledged. In particular, there were
difficulties obtaining valid data on behaviours. For example, The aim of Strategic Objective 3, as stated in Annex 3 to the
only 0.5% of Member States reported the proportion of Follow-up to the Political Declaration of the Third High-level
people who were overweight; in the current report, we Meeting of the General Assembly on the Prevention
were able to obtain estimates from 13.9% of Member and Control of Non-communicable Diseases (89), is to
States, which is far from ideal but represents a significant ensure that there is an adequate number, availability and
improvement in countries’ capacity to extract data from distribution of skilled health workers to deliver an essential
their health information systems. A similar improvement package of oral health services to meet population needs.
was seen in other domains described in the Prison Health However, our data showed that there are severe deficiencies
Framework, notably in the morbidity domain. For example, in the number of dentists working in prison, suggesting that
in the previous report 20.5% of Member States were able to additional investments in this skilled workforce are needed.
give the proportion of people diagnosed with hypertension,
while 51.3% and 41.0% did so for TB and HIV, respectively; In addition, the median number of mental health workers,
in the current report, the respective figures for hypertension worldwide, is 13 per 100 000 in the general population.
were 77.8% of Member States, and for TB and HIV 69.4%. However, the current report shows that there are some
Nonetheless, we are aware that, for all morbidity estimates, deficiencies in the ratio between the size of the prison
underreporting is very likely, which suggests that it is a high health workforce and the number of people in prison,
priority to invest in health information systems that particularly with respect to psychiatrists, given the high
allow aggregate data to be extractible, to assist monitoring demand for mental health services in the prison population.
of individuals over time, including at moments of transition According to the Mandela Rules (Rule 25), prisons should
to and from the community. retain a sufficient number of specialists on their staff,
including psychiatrists and psychologists (5). Therefore, it is
Even though we did not ascertain respect for all Mandela important that there is investment in the mental health
Rules, compliance with some of those assessed was workforce in prisons so that equity of care can be assured.
seen in the great majority of Member States (5). However,
there are still improvements needed in ensuring clinical People with disabilities have the right to equal recognition
independence in more than one fifth of Member States. before the law (90). This includes people with intellectual
Moreover, greater investment is needed in assuring equity disabilities, cognitive impairments, psychosocial
in standards of care, for example, by achieving a higher disabilities and other mental disabilities. There are also
ratio of psychiatrists to people in prison. Equally worrying well-established principles to protect persons with mental
is that one fifth of Member States reported overcrowding, illness (91). However, WHO recognizes that some people
which has various negative consequences on health with mental health disorders may be admitted to prison for
both directly (such as violence, mental health impacts relatively minor offences, which could potentially be dealt
and transmission of infectious diseases) and indirectly with in the community if appropriate treatment and support

were available (92). The mental health disorders of those during incarceration because the risk is amplified by
committing more serious offences could be better treated overcrowding, poor infrastructure and often inadequate
in secure and specialized hospitals (54). Ideally, therefore, access to health-care services. Practices and behaviours
the primary consideration in dealing with mental common in prisons that contribute to enhanced
health disorders should be the most appropriate transmission risk of HIV, HBV and HCV and occurrence
treatment. In the case of those for whom no alternative of outbreaks in prison establishments include exchange
exists, medical assessments at admission to prison must of contaminated/used needles, tattooing and piercing,
include screening for mental health conditions and the consensual or coercive sexual activity, sharing of shaving
risk of suicide and self-harm (Mandela Rule 30) and, where razors, and episodes of violence. For this reason, the
appropriate, referral to relevant specialist professional European Monitoring Centre for Drugs and Drug Addiction
treatment (Mandela Rule 27). Equally important is that and the European Centre for Disease Prevention and
people with mental health disorders are protected from Control recommend that a comprehensive package of
restrictive measures, including solitary confinement, that prevention measures be implemented in prison settings;
would inevitably lead to aggravation of their condition this includes health promotion and education focused on
(Mandela Rule 46). safer injecting behaviour, reduced sexual risk behaviour,
distribution of sterile injecting equipment, condom
As the current report shows, suicide remains the main cause and lubricant distribution, opioid substitution therapy,
of death in prison. Nevertheless, nearly 90% of Member vaccination, PrEP and PEP, early testing and treatment,
States reported that they had standardized protocols in prevention of mother-to-child transmission, and safe health
place to help identify and support people at risk of suicide. services (58,94).
This suggests that such protocols may be insufficient and
that more effective practices to prevent suicide are WHO also recommends that all people should be tested
needed in prisons. These, in turn, should be accompanied on entry into prison for viral hepatitis, on an opt-out
by more intensive visits undertaken by responsible bodies basis (95,96), and that all people in closed settings,
such as the national preventive mechanisms established including in prisons, should be vaccinated against
by the Association for the Prevention of Torture (93) or HBV (97). All people admitted to prison who have not been
the Committee for the Prevention of Torture (6), so that vaccinated should be offered HBV vaccination, without
situations and practices that contribute to the problem the need to check serological status before vaccination
may be rapidly identified. if there is no suspicion of HBV infection (54). Previous
studies have indicated that HBV vaccination was available
Investment should be made in the prevention and in prison in 21 out of 30 European countries (43), a similar
treatment of the most common disorders that affect result to the one reported here (24 out of 36 Member States,
the prison population, notably mental health and drug or 66.7%). Viral hepatitis is the leading cause of cirrhosis
use disorders. Such measures should include ensuring and liver cancer and is an important cause of cancer death
access to vaccines in all prisons, availability of HIV PrEP worldwide. People living in prison are disproportionately
and PEP, access to health protection equipment such as affected by bloodborne viruses because of several
needles, condoms and lubricants, and access to mental behaviours, including injecting drug use, tattooing and
health counsellors, treatment areas for people with drug risky sexual behaviour. In addition, vaccination against
use disorders, and the most cost–effective pharmacological seasonal influenza, DTP, and measles, mumps and rubella
treatments. In the current report, it was shown that only (MMR) is also recommended to all incoming people without
around 80% of people with mental health disorders and a reliable vaccination history. Hepatitis A vaccination is also
less than 65% of people with drug use disorders have recommended to all nonimmune people entering prison,
access to pharmacological treatments. and pneumococcal vaccination to those aged over 65 years
or with HIV/AIDS.
Prisons are considered a high-risk environment for the
transmission of infectious diseases, which is exacerbated

All Member States reported that they had COVID-19 infectious diseases; continuation of care after release
vaccination services available in all or most prisons. should also be ensured (100). The fact that, in most
However, for other vaccine-preventable diseases, Member States, prison health information systems are not
availability was restricted in many cases. Of particular note, interoperable with community health information systems
16.7% of Member States did not offer vaccination against makes it more difficult to verify successful completion of
HBV and DTP in any of their prisons, both of which are treatment, potentially leading to resources already invested
recommended for all people admitted into prison without being wasted.
a reliable vaccination history (54). It is therefore important
that all Member States consider including people living in Promotion and protection of people’s health and
prison among groups targeted for adult immunization well-being through the development of strong health
within the national immunization plan. New admissions systems have been recommended as a priority for
to prison present an excellent opportunity to update governments by the Astana Declaration (101). This cannot
vaccination status and consider recommendations be achieved unless enabling and health-conducive
according to age, gender and other risk factors. environments are established so that individuals are
empowered and engaged in maintaining and enhancing
HIV PEP was available in all prisons in 75.0% of Member their health and well-being – a recommendation that
States (n = 27), but less than 60% of Member States had covers all environments, including detention settings.
PrEP available. Previous studies indicated that 20 countries This implies that preventive care should be a cornerstone.
(out of 30) provided PEP, suggesting that there has been Cancers and CVDs are the leading causes of death in the
some improvement in recent years (43). According to the WHO European Region (102).
United Nations Office on Drugs and Crime, the International
Labour Organization, the United Nations Development Each country should meet the 90–70–90 (vaccination–
Programme, UNAIDS and WHO (98), PEP should be screening–treatment) targets for cancer screening by
part of a comprehensive response to HIV in prisons, 2030 in order to get on track to eliminate cervical cancer
alongside other interventions that target identification within the next century (103). However, our report showed
of cases, prevent risk factors contributing to bloodborne, that only two thirds of Member States offered cervical
sexual and vertical transmission, and treat the infections cancer screening to people in prison and that only half
and behaviours that lead to them (54). More recently, PrEP offered HPV vaccination free of charge in all prisons. Even
has also been recognized as an additional and effective a low level of screening, or early-detection programmes,
measure to prevent HIV transmission for all key populations could potentially lead to more cases being identified at
at substantial risk (41,94). earlier stages of development, thereby enhancing the
prospects of recovery/survival. The most positive indicator
TB in prisons is a major public health problem (99). found for cancer was access to pharmacological treatment,
Assessment of TB history and current signs and symptoms which was guaranteed in 90.2% of Member States, and this
for all people at or close to admission was reported by may also be linked to mechanisms and protocols put in
all Member States. However, only half of Member States place to ensure appropriate transfer to specialized care.
implemented an additional assessment for MDR-TB in the It is essential that screening for the three cancers shown
event of a positive test. Prompt detection of TB among to be most cost–effective (breast, cervical and colorectal)
people in prison should be ensured through a combination is adopted by all Member States as, for many people,
of screening methods (screening on entry, mass screening prison may be their first opportunity to benefit from
at regular intervals, passive screening, contact screening). preventive care.
Moreover, active and latent infection case finding
is recommended in prison settings (94), coupled Moments of transition from and to the community are
with effective treatment of all types of TB, including inevitably moments that may lead to errors in transmission
drug-resistant TB and TB coinfection with HIV and/or other of health information and disruptions in access to

health-care services and treatments. In many health-care medication upon release, this was generally restricted
systems, there are barriers restricting access to care for to certain conditions and available for limited periods of
people with involvement in the criminal justice system. time, potentially leading to treatment being discontinued
The current report shows that more than 50% of Member and all resources invested during incarceration being lost.
States did not have health information systems that For all these reasons, it is recommended that Member
were compatible between prison and community health States create structures that facilitate transition to the
services. However, in the context of the COVID-19 pandemic, community and help ensure continued access to health
this apparent barrier to the interoperability of health care, thereby preventing treatment disruptions, negative
information systems was overcome by 34 of 36 Member health outcomes and recidivism (12).
States with respect to vaccination status, suggesting it is
feasible if sufficiently prioritized. Data suggest that governance arrangements are likely to
affect clinical independence, reinforcing WHO’s previous
Moreover, less than half of Member States had a support recommendation that health ministries should be
service to register people with community health services involved in health-care delivery in prisons.
upon release. Even though most Member States provided

71
6
72
6. Key messages
1. Consider adoption of noncustodial measures in 7. Consider prisons as an ideal setting to ensure access
place of incarceration for offences where diversion to immunization for vaccine-preventable diseases,
to treatment promises to be more beneficial and by providing a full course of vaccination against
effective. HBV, seasonal influenza, DTP and MMR for all newly
admitted people.
2. Invest in the prison health workforce by providing
conditions and career pathways that encourage 8. Create structures that facilitate transition to the
professionals to dedicate themselves to working community and ensure continued access to health
for this vulnerable population. Set up the necessary care.
conditions that allow international standards,
especially clinical independence, to be respected. 9. Invest in health information systems that
allow aggregate data to be extractible, to assist
3. Include prison settings and people living in prison monitoring of individuals over time, including at
in all relevant national health strategies, from moments of transition to and from the community
preparedness plans to prevention of disease (interoperability).
(including immunization and screening) and disease
control and management.
The data collected in HIPEDS represent an important
4. Increase access to psychosocial support and attempt to provide comparable data on prison health
pharmacological treatment for mental health systems in the WHO European Region. This report builds
disorders. on previous findings published in the 2019 Status report on
prison health (87) and lays a foundation for future work to
5. Invest in a comprehensive response to bloodborne generate comprehensive and comparable data on prison
viruses in prisons, which must include at minimum: health in Europe and globally. Interest has been expressed
access to screening for drug use and drug use in expanding HIPEDS to other regions beyond Europe and to
disorders; referral to appropriate support and, if extend its scope to include children in juvenile detention. It
necessary, treatment interventions with referral to has been argued that exclusion of people in prison from the
treatment services for drug use disorders and to PEP; service coverage index contributes to an overestimation of
and access to materials and products that prevent coverage and masks inequities in care, hampering progress
risk factors and unsafe practices contributing to towards the United Nations Sustainable Development
bloodborne, sexual and vertical transmission. Goals (104). However, for full coverage information, health
information systems must progress to the point where
6. Assure screening and referral for breast, cervical and coverage can be consistently assessed before, during and
colorectal cancer in all Member States. after periods of incarceration.
6. Key messages 73
74
References*
1 Global prison trends 2022. London: Penal Reform 11 Stürup-Toft S, O’Moore EJ, Plugge EH. Looking behind
International; 2022 (https://cdn.penalreform.org/ the bars: emerging health issues for people in prison. Br
wp-content/uploads/2022/05/GPT2022.pdf). Med Bull. 2018;125(1):15–23. doi: 10.1093/bmb/ldx052.
2 Prison statistics. Luxembourg City: Eurostat; 12 Leaving no one behind in prison health: the
2022 (https://ec.europa.eu/eurostat/statistics- Helsinki conclusions. Copenhagen: WHO
explained/index.php?title=Prison_statistics). Regional Office for Europe; 2020 (https://apps.
who.int/iris/handle/10665/352128).
3 Incarceration rates in selected European countries in
2021. Hamburg: Statista; 2021 (https://www.statista. 13 High 5s project: standard operating protocol assuring
com/statistics/957501/incarceration-rate-in-europe). medication accuracy at transitions in care. Geneva:
World Health Organization; 2014 (https://cdn.
4 Universal Declaration of Human Rights. New York
who.int/media/docs/default-source/integrated-
(NY): United Nations; 1948 (https://www.un.org/en/
health-services-(ihs)/psf/high5s/h5s-sop.pdf).
about-us/universal-declaration-of-human-rights).
14 Ranapurwala SI, Shanahan ME, Alexandridis AA,
5 United Nations standard minimum rules for the
Proescholdbell SK, Naumann RB, Edwards D Jr et
treatment of prisoners (Mandela Rules). Vienna: United
al. Opioid overdose mortality among former North
Nations Office on Drugs and Crime; 2015 (https://
Carolina inmates: 2000–2015. Am J Public Health.
www.unodc.org/documents/justice-and-prison-
2018;108(9):1207–13. doi: 10.2105/AJPH.2018.304514.
reform/Nelson_Mandela_Rules-E-ebook.pdf).
15 Binswanger IA, Stern MF, Deyo RA, Heagerty PJ,
6 European committee for the prevention of torture and
Cheadle A, Elmore JG et al. Release from prison: a
inhuman or degrading treatment or punishment (CPT)
high risk of death for former inmates. N Engl J Med.
[about page]. Strasbourg: Council of Europe; 2022
2007;356(2):157–65. doi: 10.1056/NEJMsa064115.
(https://www.coe.int/en/web/cpt/about-the-cpt).
16 Waters R. After prison, healthy lives built on access
7 Health care services in prisons. European Committee
to care and community. Health Aff (Millwood).
for the Prevention of Torture and Inhuman or Degrading
2019;38(10):1616–21. doi: 10.1377/hlthaff.2019.01163.
Treatment or Punishment. Strasbourg: Council of
Europe; 1993 (https://rm.coe.int/16806ce943). 17 Wang EA, Hong CS, Shavit S, Sanders R, Kessell E,
Kushel MB. Engaging individuals recently released
8 Reed J, Lyne M. The quality of health care in prison:
from prison into primary care: a randomized
results of a year’s programme of semistructured
trial. Am J Public Health. 2012;102(9):e22–
inspections. BMJ. 1997;315(7120):1420–4.
e29. doi: 10.2105/AJPH.2012.300894.
doi: 10.1136/bmj.315.7120.1420.
18 Wang EA, Lin HJ, Aminawung JA, Busch SH,
9 Fraser A. Primary health care in prisons. In:
Gallagher C, Maurer K et al. Propensity-matched
Moeller L, Stöver H, Jürgens R, Gatherer A, Nikogosian
study of enhanced primary care on contact with the
H et al., editors. Health in prisons: a WHO guide
criminal justice system among individuals recently
to the essentials in prison health. Copenhagen:
released from prison to New Haven. BMJ Open.
WHO Regional Office for Europe; 2007 (https://
2019;9(5):e028097. doi: 10.1136/bmjopen-2018-028097.
apps.who.int/iris/handle/10665/107829).
19 What are social determinants of health? National
10 Tavoschi L, Vroling H, Madeddu G, Babudieri S,
Center for HIV, Viral Hepatitis, STD, and TB
Monarca R, Vonk Noordegraaf-Schouten M et al.
Prevention (NCHHSTP) social determinants of
Active case finding for communicable diseases in
health: frequently asked questions. Atlanta (GA):
prison settings: increasing testing coverage and
Centers for Disease Control and Prevention (https://
uptake among the prison population in the European
www.cdc.gov/nchhstp/socialdeterminants/
Union/European Economic Area. Epidemiol Rev.
faq.html#what-are-social-determinants).
2018;40(1):105–20. doi: 10.1093/epirev/mxy001.
*
All references were accessed on 12 August 2022.
References 75
20 Western B, Pettit B. Incarceration and social 30 Brose LS, Simonavicius E, McNeill A. Maintaining
inequality. Daedalus. 2010;139(3):8–19. abstinence from smoking after a period of enforced
doi: 10.1162/daed_a_00019. abstinence: systematic review, meta-analysis
21 Dolan K, Wirtz AL, Moazen B, Ndeffo-Mbah M, and analysis of behaviour change techniques
Galvani A, Kinner SA et al. Global burden of HIV, with a focus on mental health. Psychol Med.
viral hepatitis, and tuberculosis in prisoners and 2018;48(4):669–78. doi: 10.1017/S0033291717002021.
detainees. Lancet. 2016;388(10049):1089–1102. 31 WHO prison health framework: a framework for
doi: 10.1016/S0140-6736(16)30466-4. assessment of prison health system performance.
Copenhagen: WHO Regional Office for Europe; 2021
22 Hofstraat SHI, Falla AM, Duffell EF, Hahné SJM,
(https://apps.who.int/iris/handle/10665/344561).
Amato-Gauci AJ, Veldhuijzen IK et al. Current
prevalence of chronic hepatitis B and C virus 32 Eurostat [online database]. Luxembourg City:
infection in the general population, blood donors Eurostat (https://ec.europa.eu/eurostat/
and pregnant women in the EU/EEA: a systematic en/web/main/data/database).
review. Epidemiol Infect. 2017;145(14):2873–85. 33 World Prison Brief [online database]. London:
doi: 10.1017/S0950268817001947. Institute for Crime and Justice Policy Research
23 Kamarulzaman A, Reid SE, Schwitters A, Wiessing L, (https://www.prisonstudies.org).
El-Bassel N, Dolan K et al. Prevention of transmission of 34 Global Burden of Disease (GBD) 2019 study results.
HIV, hepatitis B virus, hepatitis C virus, and tuberculosis Seattle (WA): Institute for Health Metrics and Evaluation;
in prisoners. Lancet. 2016;388(10049):1115–26. 2019 (https://vizhub.healthdata.org/gbd-results).
doi: 10.1016/S0140-6736(16)30769-3. 35 Cumulative confirmed COVID-19 deaths by
24 Moazen B, Saeedi Moghaddam S, Silbernagl MA, world region. In: Our World in Data [online
Lotfizadeh M, Bosworth RJ, Alammehrjerdi Z et al. database] (https://ourworldindata.org/
Prevalence of drug injection, sexual activity, tattooing, grapher/cumulative-covid-deaths-region?c
and piercing among prison inmates. Epidemiol Rev. ountry=IND~USA~GBR~CAN~DEU~FRA).
2018;40(1):58–69. doi: 10.1093/epirev/mxy002. 36 Health workforce. Global Health Observatory: themes.
25 Cords O, Martinez L, Warren JL, O’Marr JM, Walter KS, Geneva: World Health Organization; 2022 (https://www.
Cohen T et al. Incidence and prevalence of tuberculosis who.int/data/gho/data/themes/health-workforce).
in incarcerated populations: a systematic review and 37 Health care resources. Eurostat metadata. Luxembourg
meta-analysis. Lancet Public Health. 2021;6(5):e300– City: Eurostat (https://ec.europa.eu/eurostat/
e308. doi: 10.1016/S2468-2667(21)00025-6. cache/metadata/en/hlth_res_esms.htm).
26 Warmsley R. Prison health care and the extent 38 European Health Information Gateway: indicators
of prison overcrowding. Int J Prisoner Health. explorer. Copenhagen: WHO Regional Office for Europe;
2005;1(1):3–12. doi: 10.1080/17449200500156897. 2022 (https://gateway.euro.who.int/en/hfa-explorer).
27 Baranyi G, Fazel S, Langerfeldt SD, Mundt AP. 39 Global prison trends 2022: executive summary.
The prevalence of comorbid serious mental London: Penal Reform International; 2022
illnesses and substance use disorders in prison (https://cdn.penalreform.org/wp-content/
populations: a systematic review and meta- uploads/2022/05/GPT2022-Exec-summary-EN.pdf).
analysis. Lancet Public Health. 2022;7(6):e557– 40 Wang EA, Pletcher M, Lin F, Vittinghoff E, Kertesz SG,
e568. doi: 10.1016/S2468-2667(22)00093-7. Kiefe CI et al. Incarceration, incident hypertension,
and access to health care: findings from the
28 Gebremariam MK, Nianogo RA, Arah OA.
Coronary Artery Risk Development in Young Adults
Weight gain during incarceration: systematic
(CARDIA) study. Arch Intern Med. 2009;169(7):687–
review and meta-analysis. Obes Rev.
93. doi: 10.1001/archinternmed.2009.26.
2018;19(1):98–110. doi: 10.1111/obr.12622.
41 HIV prevention, treatment and care in prisons and
29 Munday D, Leaman J, O’Moore É, Plugge E. The other closed settings: a comprehensive package
prevalence of non-communicable disease in of interventions. Vienna: United Nations Office
older people in prison: a systematic review and on Drugs and Crime; 2013 (https://www.unodc.
meta-analysis. Age Ageing. 2019;48(2):204– org/documents/hiv-aids/HIV_comprehensive_
12. doi: 10.1093/ageing/afy186. package_prison_2013_eBook.pdf).

42 United Nations rules for the treatment of women 52 Dentists. Global Health Observatory: indicators.
prisoners and non-custodial measures for Geneva: World Health Organization; 2022 (www.
women offenders (Bangkok rules). New York who.int/data/gho/data/indicators/indicator-
(NY): United Nations; 2010 (https://www.unodc. details/GHO/dentists-(per-10-000-population)).
org/documents/justice-and-prison-reform/
53 Health care services: key elements. Geneva: Association
Bangkok_Rules_ENG_22032015.pdf).
for the Prevention of Torture; 2019 (https://www.
43 Stöver H, Tarján A, Horváth G, Montanari L. The apt.ch/en/knowledge-hub/detention-focus-
state of harm reduction in prisons in 30 European database/health-care/health-care-services).
countries with a focus on people who inject
54 Enggist S, Møller L, Galea G, Udesen C, editors.
drugs and infectious diseases. Harm Reduct J.
Prisons and health. Copenhagen: WHO
2021;18(1):67. doi: 10.1186/s12954-021-00506-3.
Regional Office for Europe; 2014 (https://apps.
44 Global prison trends [annual series]. London: Penal who.int/iris/handle/10665/128603).
Reform International; 2015–22 (https://www.
55 RISE-Vac project [information page]. Worldwide
penalreform.org/resource/global-prison-trends).
Prison Health Research and Engagement Network
45 Recommendation of the Committee of Ministers to (WEPHREN); 2022 (https://wephren.tghn.org/rise-vac).
member states on the European prison rules. Adopted
56 HIV and people in prisons and other closed settings
January 2006, revised July 2020. Strasbourg: Council
[online fact sheet]. Geneva: Joint United Nations
of Europe; 2020 (https://search.coe.int/cm/Pages/
Programme on HIV and AIDS (UNAIDS); 2021 (https://
result_details.aspx?ObjectID=09000016809ee581).
www.unaids.org/sites/default/files/media_asset/
46 Visseren F, Mach F, Smulders YM, Carballo D, Koskinas 06-hiv-human-rights-factsheet-prisons_en.pdf).
KC, Bäck M et al. ESC guidelines on cardiovascular
57 Dolan K, Rodas A. Detection of drugs in Australian
disease prevention in clinical practice. Eur Heart J.
prisons: supply reduction strategies. Int J Prison Health.
2021;42(34):3227–337. doi: 10.1093/eurheartj/ehab484.
2014;10(2):111–17. doi: 10.1108/IJPH-06-2013-0025.
47 Gan WQ, Kinner SA, Nicholls TL, Xavier CG,
58 Prison and drugs in Europe: current and future
Urbanoski K, Greiner L et al. Risk of overdose-related
challenges. Lisbon: European Monitoring Centre
death for people with a history of incarceration.
for Drugs and Drug Addiction (EMCDDA); 2022
Addiction. 2021;116(6):1460–71. doi: 10.1111/add.15293.
(https://www.emcdda.europa.eu/system/files/
48 Bukten A, Stavseth MR, Skurtveit S, Tverdal A, publications/13904/TDXD21001ENN.pdf).
Strang J, Clausen T. High risk of overdose death
59 Moreira TR, Passos IBJ, Bueno JVL, Maffacciolli R,
following release from prison: variations in mortality
Colodette RM, Miguel PS. Prevalence of multidrug-
during a 15-year observation period. Addiction.
resistant tuberculosis in prisons: systematic
2017;112(8):1432–9. doi: 10.1111/add.13803.
review and meta-analysis. Indian J Med Microbiol.
49 McLeod KE, Karim ME, Buxton JA, Martin RE, Scow M, 2022;40(2):193–9. doi: 10.1016/j.ijmmb.2022.01.004.
Felicella G et al. Use of community healthcare and
60 Sayyah M, Rahim F, Kayedani GA, Shirbandi K,
overdose in the 30 days following release from
Saki-Malehi A. Global view of HIV prevalence in
provincial correctional facilities in British Columbia.
prisons: a systematic review and meta-analysis. Iran
Drug Alcohol Depend. 2021;229(Pt A):109113.
J Public Health. 2019;48(2):217–26. PMID: 31205875.
doi: 10.1016/j.drugalcdep.2021.109113.
61 Larney S, Kopinski H, Beckwith CG, Zaller ND, Jarlais
50 Nursing and midwifery personnel. Global Health
DD, Hagan H et al. Incidence and prevalence of hepatitis
Observatory: indicators. Geneva: World Health
C in prisons and other closed settings: results of a
Organization; 2022 (https://www.who.int/data/gho/
systematic review and meta-analysis. Hepatology.
data/indicators/indicator-details/GHO/nursing-and-
2013;58(4):1215–24. doi: 10.1002/hep.26387.
midwifery-personnel-(per-10-000-population)).
62 Wirtz AL, Yeh PT, Flath NL, Beyrer C,
51 Medical doctors. Global Health Observatory: indicators.
Dolan K. HIV and viral hepatitis among
Geneva: World Health Organization; 2022 (https://www.
imprisoned key populations. Epidemiol Rev.
who.int/data/gho/data/indicators/indicator-details/
2018;40(1):12–26. doi: 10.1093/epirev/mxy003.
GHO/medical-doctors-(per-10-000-population)).
References 77
63 Chacowry Pala K, Baggio S, Tran NT, 73 Lagarrigue A, Ajana S, Capuron L, Féart C, Moisan
Girardin F, Wolff H, Gétaz L. Blood-borne and MP. Obesity in French inmates: gender differences
sexually transmitted infections: a cross-sectional and relationship with mood, eating behavior and
study in a Swiss prison. BMC Infect Dis. physical activity. PLoS One. 2017;12(1):e0170413.
2018;18(1):539. doi: 10.1186/s12879-018-3445-6. doi: 10.1371/journal.pone.0170413.
64 Kim H, Hughes E, Cavanagh A, Norris E, 74 Audi C, Santiago SM, Andrade M,
Gao A, Bondy SJ et al. The health impacts of the Assumpção D, Francisco P, Segall-Corrêa AM et al.
COVID-19 pandemic on adults who experience Ultra-processed foods consumption among inmates
imprisonment globally: a mixed methods in a women’s prison in São Paulo, Brazil. Rev Esp
systematic review. PLoS One. 2022;17(5):e0268866. Sanid Penit. 2018;20(3):87–94. PMID: 30908571.
doi: 10.1371/journal.pone.0268866. 75 Herbert K, Plugge E, Foster C, Doll H. Prevalence
65 Akaji E, Ashiwaju M. Oral health status of a sample of risk factors for non-communicable diseases
of prisoners in Enugu: a disadvantaged population. in prison populations worldwide: a systematic
Ann Med Health Sci Res. 2014;4(4):650–3. review. Lancet. 2012;379(9830):1975–82.
doi: 10.4103/2141-9248.139365. doi: 10.1016/S0140-6736(12)60319-5.
66 Steel Z, Marnane C, Iranpour C, Chey T, Jackson 76 Choudhry K, Armstrong D, Dregan A. Systematic
JW, Patel V et al. The global prevalence of review into obesity and weight gain within male
common mental disorders: a systematic review prisons. Obes Res Clin Pract. 2018;12(4):327–
and meta-analysis 1980–2013. Int J Epidemiol. 35. doi: 10.1016/j.orcp.2018.02.003.
2014;43(2):476–93. doi: 10.1093/ije/dyu038. 77 Alokan DS, Kabir Z. Tobacco use among
67 Baranyi G, Scholl C, Fazel S, Patel V, Priebe S, Mundt people incarcerated in western Europe: a
AP. Severe mental illness and substance use disorders systematic review and meta-analysis. Tob
in prisoners in low-income and middle-income Use Insights. 2022;15:1179173X221096641.
countries: a systematic review and meta-analysis of doi: 10.1177/1179173X221096641.
prevalence studies. Lancet Glob Health. 2019;7(4):e461– 78 Fazel S, Bains P, Doll H. Substance abuse
e471. doi: 10.1016/S2214-109X(18)30539-4. and dependence in prisoners: a systematic
68 Fazel S, Yoon IA, Hayes AJ. Substance use review. Addiction. 2006;101(2):181–91.
disorders in prisoners: an updated systematic doi: 10.1111/j.1360-0443.2006.01316.x.
review and meta-regression analysis in recently 79 Global status report on alcohol and health 2018.
incarcerated men and women. Addiction. Geneva: World Health Organization; 2018 (https://
2017;112(10):1725–39. doi: 10.1111/add.13877. apps.who.int/iris/handle/10665/274603).
69 EU population in 2020: almost 448 million 80 World drug report 2022. Vienna: United Nations
[news release]. Luxembourg City: Eurostat; Office on Drugs and Crime; 2022 (https://
2020 (https://ec.europa.eu/eurostat/ www.unodc.org/unodc/en/data-and-
documents/2995521/11081093/3- analysis/world-drug-report-2022.html).
10072020-AP-EN.pdf/d2f799bf-4412-05cc-
81 Global action plan on physical activity 2018–2030:
a357-7b49b93615f1#:~:text=On%201%20
more active people for a healthier world. Geneva:
January%202020%2C%20the,States%20
World Health Organization; 2018 (https://apps.
on%201%20January%202019).
who.int/iris/handle/10665/272722).
70 Rabe K. Prison structure, inmate mortality and
82 Why people living and working in detention
suicide risk in Europe. Int J Law Psychiatry.
facilities should be included in national COVID-19
2012;35(3):222–30. doi: 10.1016/j.ijlp.2012.02.012.
vaccination plans: advocacy brief. Copenhagen:
71 Solitary confinement. London: Penal Reform WHO Regional Office for Europe; 2021 (https://
International (https://www.penalreform.org/issues/ apps.who.int/iris/handle/10665/341497).
prison-conditions/key-facts/solitary-confinement).
83 Pont J, Enggist S, Stöver H, Williams B, Greifinger R,
72 Global prison trends 2021: solitary confinement. Wolff H. Prison health care governance: guaranteeing
London: Penal Reform International; 2021 clinical independence. Am J Public Health.
(https://www.penalreform.org/global-prison- 2018;108(4):472–6. doi: 10.2105/AJPH.2017.304248.
trends-2021/solitary-confinement).

84 Good governance for prison health in the 21st century: 94 Public health guidance on prevention and control
a policy brief on the organization of prison health. of blood-borne viruses in prison settings. Lisbon:
Copenhagen: WHO Regional Office for Europe; 2013 European Monitoring Centre for Drugs and Drug
(https://apps.who.int/iris/handle/10665/326388). Addiction (EMCDDA); 2018 (https://www.emcdda.
85 International standards for the treatment of drug use europa.eu/system/files/publications/9103/
disorders: revised edition incorporating results of Guidance-on-BBV-in-prisons-web.pdf).
field-testing. Geneva: World Health Organization; 2020 95 Hepatitis B is preventable with safe and effective
(https://apps.who.int/iris/handle/10665/331635). vaccine. New Delhi: WHO Regional Office for
86 Organizational models of prison health: South-East Asia; 2022 (https://www.who.
considerations for better governance. Copenhagen: int/southeastasia/activities/hepatitis-b-is-
WHO Regional Office for Europe; 2020 (https:// preventable-with-safe-and-effective-vaccines).
apps.who.int/iris/handle/10665/336214). 96 Action plan for the health sector response to
87 Status report on prison health in the WHO viral hepatitis in the WHO European Region.
European Region. Copenhagen: WHO Regional Copenhagen: WHO Regional Office for Europe; 2017
Office for Europe; 2019 (https://apps.who. (https://apps.who.int/iris/handle/10665/344154).
int/iris/handle/10665/329943). 97 Hepatitis B in the WHO European Region: factsheet
88 United Nations system common position on July 2022. Copenhagen: WHO Regional Office for
incarceration. Vienna: United Nations Office on Drugs Europe; 2022 (https://www.who.int/europe/
and Crime; 2021 (https://www.unodc.org/res/justice- publications/m/item/hepatitis-b-in-the-who-
and-prison-reform/nelsonmandelarules-GoF/UN_ european-region-factsheet-july-2022).
System_Common_Position_on_Incarceration.pdf). 98 Consolidated guidelines on HIV prevention, diagnosis,
89 Follow-up to the political declaration of the third treatment and care for key populations, 2016
high-level meeting of the General Assembly on the update. Geneva: World Health Organization; 2016
prevention and control of non-communicable diseases. (https://apps.who.int/iris/handle/10665/246200).
Annex 3: draft global strategy on oral health. Geneva: 99 Dara M, Chorgoliani D, de Colombani P. TB
World Health Organization; 2022 (https://apps.who.int/ prevention and control care in prisons. In: Enggist S,
gb/ebwha/pdf_files/WHA75/A75_10Add1-en.pdf). Møller L, Galea G, Udesen C, editors. Prisons and health.
90 Series L, Nilsson A. Convention on the rights of persons Copenhagen: WHO Regional Office for Europe; 2014
with disabilities (CRPD): equal recognition before the (https://apps.who.int/iris/handle/10665/128603).
law. In: Bantekas I, Stein MA, Anastasiou D, editors. 100 Tuberculosis in prisons: a growing public
The UN convention on the rights of persons with health challenge. Washington (DC): United
disabilities: a commentary. Oxford (UK): Oxford States Agency for International Development
University Press; 2018 (https://library.oapen. (https://www.usaid.gov/sites/default/files/
org/bitstream/handle/20.500.12657/48874/ documents/1864/USAID-TB-Brochure.pdf).
Bookshelf_NBK539188.pdf). 101 Declaration of Astana: global conference on primary
91 Principles for the protection of persons with mental health care: Astana, Kazakhstan, 25–26 October
illness and the improvement of mental health 2018. Geneva: World Health Organization; 2019
care. Geneva: Office of the United Nations High (https://apps.who.int/iris/handle/10665/328123).
Commissioner for Human Rights; 1991 (https:// 102 Main causes of mortality. In: Health at a glance:
www.ohchr.org/en/instruments-mechanisms/ Europe 2020: state of health in the EU cycle. Paris:
instruments/principles-protection-persons- OECD Publishing; 2020. doi: 10.1787/82129230-en.
mental-illness-and-improvement).
103 Global strategy to accelerate the elimination
92 Durcan G, Zwemstra JC. Mental health in prison. of cervical cancer as a public health problem.
In: Enggist S, Møller L, Galea G, Udesen C, editors. Geneva: World Health Organization; 2020
Prisons and health. Copenhagen: WHO Regional (https://apps.who.int/iris/handle/10665/336583).
Office for Europe; 2014 (https://apps.who.
104 Winkelman TNA, Dasrath KC, Young JT, Kinner
int/iris/handle/10665/128603).
SA. Universal health coverage and incarceration.
93 Establishment and designation of national preventive Lancet Public Health. 2022;7(6):e569–e572.
mechanisms. Geneva: Association for the Prevention doi: 10.1016/S2468-2667(22)00113-X.
of Torture; 2006 (https://www.apt.ch/sites/default/
files/publications/NPM.Guide%20%281%29.pdf).
References 79
80 Introduction 80
Annex 1. Country profiles
Albania Armenia Austria Belgium Bosnia and

Herzegovina
Bulgaria Croatia Cyprus Czechia Denmark
Estonia Finland France Georgia Germany
Greece Hungary Ireland Italy Latvia
Lithuania Luxembourg Malta Monaco Netherlands
Poland Portugal Republic of Romania San Marino

Moldova
Slovakia Slovenia Spain Switzerland Ukraine
United Kingdom
Annex 1. Country profiles 81

Albania 2 845 955
Population, 2020
Upper middle
Income group
US$ 5 332
Gross national income per capita
A: PENAL STATISTICS 2016 2020
OFFICIAL PRISON CAPACITY: OCCUPANCY LEVEL (%) 99.0 86.1

5714
INCARCERATION RATE 189.0 172.8
NUMBER OF PEOPLE IN PRISON: Per 100 000 of national population
4917
NUMBER NEWLY ADMITTED IN THE PREVIOUS YEAR:
3579
Figure 1.1: Incarceration rate per 100 000 inhabitants in Europe
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9 Albania
Belgium 90.1
France
Austria
93.1
95.3 172.8
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
82
Albania
Social characterization of people in prison
23
Number of prison
n %
establishments
Females 77 1.6
in the country
Pregnant 0 0.0
LGBTIQ 2 0.0
Mean length of incarceration per individual Under 18 21 0.4
over the last 12-month period: MISSING Above 50 863 17.6
Above 65 174 3.5
Unsentenced and serving life Migrants 87 1.8
sentences individuals: Minorities MISSING MISSING
n (%) Disabled 9 0.2

Number of unsentenced/remand prisoners 2276 (46.3) Physically disabled 3 33.3
Number of individuals serving life sentences 176 (3.6)
Intellectually disabled MISSING MISSING
B: PRISON HEALTH SYSTEMS
HEALTH SYSTEM FINANCING

Agency or agencies are responsible for delivering prison health care:
Ministry of Justice only, with 16.7% of Member States reporting Ministry of
Health only (or health authorities) (n =36).
Agency or agencies are responsible for financing prison health care:
Ministry of Justice only. Most Member States (50%, out of n=36) are
financed by Ministry of Justice only.
To what extent is health care of people in prison covered by any health
insurance systems: Fully covered by health insurance. Health care fully
covered by health insurance was reported by 41.7% of Member States (n =36).
HEALTH SYSTEM PERFORMANCE

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) in
prisons on full-time equivalents (FTEs) and ratio (per 1000 incarcerated people) for a known year:
Figure 1.2: Health-care staff available in prison

Ratio per 1000 people
FTE
Total staff 238
Nurses 159
Physicians 48
Psychiatrists 6
Dentists 20
83
Albania
ACCEPTABILITY
Proportion of prison established with vaccines available:
Offered at % Member States with “All prisons”

DTP No prisons 72.2
Human Papilloma virus No prisons 52.9
Hepatitis A No prisons 55.9
Hepatitis B No prisons 69.4
Seasonal flu A minority of prisons 83.3
MMR No prisons 61.8
Meningococcal vaccination No prisons 52.9
Pneumococcal vaccination No prisons 57.6
COVID-19 Most prisons 91.4
Proportion of prison establishments where

people in prison have access to HIV prophylaxis:
Post Exposure Pre-exposure
In no prisons In a minority of prisons
% Member States with “All prisons”

77.8 58.3
QUALITY OF CARE
Yes/No % Member States with “Yes”
Assessments performed in prisons on YES 88.9
the availability of essential medicines
Standardized process for reporting NO 41.7


adverse drug events in prisons
84
Albania
HEALTH INFORMATION
Inform public health authorities
about diseases amongst prisoners:
Yes, for infectious diseases only (IDs).
Public health authorities being informed
for both IDs and for NCDs was reported
by 45.5% of Member States (n =33).
Keep clinical health records Information registered in clinical records:

of people in prison:
Yes, in some prisons we keep Yes/No % Member
States with
paper-based clinical health-records “Yes”
and in others we keep electronic Screening tests performed NO 91.7
clinical health records. Electronic clinical
Screening tests results NO 94.4
health records in all prisons was reported
by 22.2% of Member States (n =36). Vaccination YES 97.2
Health behaviours YES 97.2
Diagnoses established YES 97.2
Visits to external care providers YES 94.4
Treatment and medications YES 97.2
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION
History of TB and current signs and symptoms assessed

on or close to reception for all people in prison:
Yes, a clinical evaluation of signs and symptoms is made,
including evaluation of previous history. Most Member
States report “Yes, clinical assessment and diagnostic tests are
made and when the test is positive, additional assessment for
MDR-TB is ensured” (50%, out of n =36).
85
Albania
Screening for infectious diseases:
HIV HCV HBV STI

Yes, risk-based Yes, risk-based Yes, risk-based Yes, risk-based
screening screening screening screening
% Member States with 50.0 42.9 37.1 32.4

“Yes, on an opt-out basis”
Cancer screening offered to prisoners:
Cervical Colon Breast

YES
NO NO YES
% Member States with “Yes 66.7 58.3 66.7
HEALTH PROTECTION
Products offered free of charge:
Soap Condoms Lubricants Needles and

syringes
Offered at All prisons A minority of prisons No prisons No prisons
% Member States
97.2 47.1 12.1 8.3
with “All prisons”
Disinfectants Dental dams Tampons/

sanitary towels
Offered at No prisons No prisons A minority of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION
Smoke free policy implemented in the country

applicable to prisons: No. Most Member States
report “Yes nationwide” (72.2%, out of n =36).
86
Albania
PROVISION OF PRIMARY CARE

Suspected cases of an infectious disease with access to laboratory tests:
Yes, but there are limited resources, so only the priority/vulnerable groups have access. Most
Member States report “Yes, everyone in prison has access to laboratory tests when these are necessary”
(94.4%, out of n =36).
Number and proportion of people diagnosed that received 1 or completed 2 treatment over the
last 12 months:
Tuberculosis (TB) n (%)

Individuals receiving TB treatment over the last 12-month period 0 (-)a
Individuals completing TB treatment over the last 12-month period 0 (-)
Multidrug-resistant Tuberculosis (MDRTB)
Individuals receiving MDR-TB treatment over the last 12-month period 0 (-)a
Individuals completing MDR-TB treatment over the last 12-month period 0 (-)
HIV
Individuals with HIV who received treatment over the last 12-month period 8 (100.0)
Individuals completing HIV treatment over the last 12-month period MISSING
Hepatitis C
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period 2 (7.7)
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period MISSING
Hepatitis B
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period MISSING
Sexually Transmitted Infections (STIs)

Individuals with STIs who received treatment over the last 12-month period 1 (100.0)
Individuals completing STI treatment over the last 12-month period MISSING
Oral health
Individuals with oral health visit over the last 12-month period MISSING
Mental health disorders

Individuals who have received treatment for any mental health disorder over the last 12-month period MISSING
Substance Use Disorders

Individuals who have received pharmacological treatment for a substance use disorder over the last 12-month period 102 (100.0)
Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period MISSING
Diabetes Mellitus
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits MISSING
(excluding ophthalmology and other specialty visits) over the last 12-month period
Individuals with a diabetes mellitus diagnosis who had at least one ophthalmology visit over the last 12-month period MISSING
Individuals who have received pharmacological treatment for diabetes over the last 12-month period MISSING
Hypertension
Individuals who have received pharmacological treatment for hypertension over the last 12-month period MISSING
Cardiovascular Disease
Individuals with a CVD diagnosis who had at least one routine health-care visit over the last 12-month period MISSING
Individuals who have received pharmacological treatment for cardiovascular disease over the last 12-month period MISSING
Cancer
Individuals who have received treatment for cancer over the last 12-month period MISSING
a
1
Percentage is calculated by dividing the number of individuals receiving treatment in 2020 by the total number of individuals with diagnosis on record, using the same
reference year.
2
Percentage is calculated by dividing the number of individuals completing treatment in 2020 by the total number of individuals with access to treatment, using the same
reference year.
87
Albania
ARRANGEMENTS FOR SECONDARY CONTINUITY OF CARE

AND TERTIARY CARE Support service to register people released from
Arrangements/protocols established for prison with a GP/community health service:
transferring people in prison to specialized No. Having this support service was reported
institutions to treat: by 47.2% of Member States (n =36).
D: HEALTH OUTCOMES
Mental health
disorders
Cancer HEALTH AND WELL-BEING
Assessments of perceived well-being (or life

satisfaction):
In all prisons In no prisons
Yes, on an ad hoc basis. Assessments conducted
regularly were reported by 19.4% of Member States
% Member States with “All prisons” (n = 7).
Mental health disorders Cancer Access to mental health counsellors:

86.1 83.3 In a minority of prisons. Having mental health
counsellors in all prisons was reported by 72.2% of
Member States (n =36).
REHABILITATION
Access to: MORTALITY
Total Mortality Mortality
mortality rates per rates per
100 000 100 000 people
incarcerated (general pop.)
people
Total deaths 26 528.8 1223.9a
Education and training Employment Suicide 5 101.7 13.9a

programmes opportunities
Drug 0 0.0 2.2a
overdose
COVID-19 2 40.7 41.1b
In most prisons In a minority of prisons

a
Source: Global Burden of Disease database, according to the most recent data
available (2019), (As female prison population is 1.6%, the general population data is
% Member States with “All prisons” given only for males over 20 years)
b
Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data
Education and training Employment was not available in open source).
75.0 88.9
People are allowed to continue their family

relationships by web communication:
MISSING Most Member States report “Yes,
with time restrictions” (38.9%, out of n =36).
88
Albania
MORBIDITY
Number and proportion 1 of unique individuals living in prison diagnosed with:
n (%)
Tuberculosis (TB)
Active TB diagnosis 0 (0.0)

Active MDR-TB diagnosis 0 (0.0)
HIV
Active HIV diagnosis 8 (0.2)
Hepatitis C
Chronic HCV infection (HCV RNA positive) 26 (0.5)
Hepatitis B
Chronic HBV (HBsAg) 31 (0.6)

STI diagnosis (last 12-month) 1 (0.0)
COVID-19
SARS-Co-V2 infection laboratory confirmed 142 (2.9)
Oral health
MISSING
Individuals keeping 21 or more natural teeth

Mental disorder diagnosis on record 341 (6.9)
Psychotic disorder diagnosis on record MISSING
Recorded suicide attempt events (last 12-month) MISSING

Active drug use disorder (last 12-month) 102 (2.1)
Diabetes Mellitus
Diagnosis on record 157 (3.2)
Hypertension
Cancer
1
Percentage is calculated by considering the number of people with a diagnosis on record in 2020 divided by the total number of people in prison in the same country where data
has been provided for the same reference year.
89
Albania
E: PRISON ENVIRONMENT
Access to a Facilities available Able to use Diets in prison adapted

toilet in-cell for physical facilities at least to cultural needs (at least
activity once a week two options of food)
A minority
Offered at Most prisons Most prisons Most prisons
of prisons
% Member States with

“All prisons” 69.4 94.4 91.7 88.9
F: HEALTH BEHAVIOURS
Both sexes, n (%) Male, n (%) Female, n (%)
BMI≥ 25 MISSING MISSING MISSING
Currently use tobacco products MISSING MISSING MISSING
Drink/have drank alcohol

MISSING MISSING MISSING
(last 12 months)
Use/have used drugs (last 12 months) MISSING MISSING MISSING
Inject/have injected drugs

(last 12 months)
Regularly exercise for a minimum

of 150 minutes/week
90
Albania
G: ADHERENCE TO THE PRINCIPLE

OF EQUIVALENCE AND OTHER
INTERNATIONAL STANDARDS
Decisions taken by health staff

can be overruled or ignored
by non-health prison staff:
No. Most Member States report
“No” (77.8%, out of n =36).
National health-care complaints

system, available to prisoners:
“Yes” (72.2%, out of n =36).
H: REDUCING HEALTH INEQUALITIES AND ADDRESSING THE NEEDS OF

SPECIAL POPULATIONS
Health related information products for

people in prison in multiple languages:
In no prisons. Most Member States report
“In all prisons” (52.8%, out of n =36).
Option to be Pregnancy test Possibility of prenatal care

attended by female on admission or termination, in case
health-care staff to prison of a positive result
YES Yes, only once YES
% Member States with“Yes” 75.0 61.1 100.0
Number of women who gave birth whilst

in prison in the last 12 months:
n =0 (0.0% of all women living in prison).
91
Armenia 2 959 694
Population, 2020
Upper middle
Income group
US$ 4 266
OFFICIAL PRISON CAPACITY: OCCUPANCY LEVEL (%) * 36.8

5346
INCARCERATION RATE * 66.5
1967 * Not available
1042
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8 Armenia
Germany 69.7
Denmark
Bosnia and Herzegovina
70.2
72.4 66.5
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
92
Armenia
12
Number of prison
n %
establishments
Females 46 2.3
in the country
Pregnant 3 6.5
LGBTIQ MISSING MISSING
Under 18 5 0.3
Mean length of incarceration per individual
Above 50 MISSING MISSING
over the last 12-month period: MISSING
Migrants 107 5.4

Unsentenced and serving life
Minorities MISSING MISSING
sentences individuals:
Number of unsentenced/remand prisoners 914 (46.5) Physically disabled MISSING MISSING


Agency or agencies are responsible for delivering prison health
care: Both Ministry of Health and Ministry of Justice/ Ministry of
Interior, with 16.7% of Member States reporting Ministry of Health only
(or health authorities) (n =36).
Both Ministry of Health and Ministry of Justice/ Ministry of Interior.
Most Member States (50%, out of n =36) are financed by Ministry of Justice only.
insurance systems:
Another situation: MISSING Health care fully covered by health
insurance was reported by 41.7% of Member States (n =36).

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) in prisons on full-time
equivalents (FTEs) and ratio (per 1000 incarcerated people) for a known year:

FTE
Total staff 171
Nurses 76
Physicians 56
Psychiatrists 6
Dentists 8
93
Armenia
ACCEPTABILITY

DTP All prisons 72.2
Human Papilloma virus All prisons 52.9
Hepatitis A All prisons 55.9
Hepatitis B All prisons 69.4
Seasonal flu All prisons 83.3
MMR All prisons 61.8
Meningococcal vaccination All prisons 52.9
Pneumococcal vaccination All prisons 57.6
COVID-19 All prisons 91.4


77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”
NO
Standardized process for reporting 41.7
NO
94
Armenia
HEALTH INFORMATION

Yes, we keep paper-based clinical % Member
health-records. Electronic clinical Yes/No States with
“Yes”
Screening tests performed YES 91.7
Screening tests results YES 94.4
Vaccination YES 97.2
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

Yes, clinical assessment and diagnostic tests are made
and when the test is positive, additional assessment for
MDR-TB is ensured. Most Member States report “Yes, clinical
assessment and diagnostic tests are made and when the test
is positive, additional assessment for MDR-TB is ensured”
(50%, out of n =36).
95
Armenia
HIV HCV HBV STI

Yes, on an Yes, on an Yes, on an MISSING
opt-out basis opt-out basis opt-out basis


YES NO NO
HEALTH PROTECTION

syringes
Offered at All prisons No prisons No prisons No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at All prisons No prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

applicable to prisons: Yes, nationwide. Most Member
States report “Yes, nationwide” (72.2%, out of n =36).
96
Armenia

Yes, everyone in prison has access to laboratory tests when these are necessary.
Most Member States report “Yes, everyone in prison has access to laboratory tests when these are necessary”
(94.4%, out of n =36).
last 12 months:

Individuals receiving TB treatment over the last 12-month period 6a
Individuals completing TB treatment over the last 12-month period 1 (16.7)
Individuals receiving MDR-TB treatment over the last 12-month period 4a
Individuals completing MDR-TB treatment over the last 12-month period 1 (25.0)
HIV
Individuals completing HIV treatment over the last 12-month period 0 (0.0)
Hepatitis C
Hepatitis B
0 (0.0)
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period

Individuals completing STI treatment over the last 12-month period 1 (100.0)
Oral health
Individuals with oral health visit over the last 12-month period 1439 (73.2)

Individuals who have received treatment for any mental health disorder over the last 12-month period 249 (100.0)
Diabetes Mellitus
Individuals who have received pharmacological treatment for diabetes over the last 12-month period 60 (100.0)
Hypertension
Individuals who have received pharmacological treatment for hypertension over the last 12-month period 311 (100.0)
Individuals with a CVD diagnosis who had at least one routine health-care visit over the last 12-month period 311 (100.0)
Individuals who have received pharmacological treatment for cardiovascular disease over the last 12-month period 311 (100.0)
Cancer
a
1
Percentage is c alculated by dividing the number of individuals receiving treatment in 2020 by the total number of individuals with diagnosis on record, using the same reference year.
2
Percentage is calculated by dividing the number of individuals completing treatment in 2020 by the total number of individuals with access to treatment, using the same reference
year.
97
Armenia

transferring people in prison to specialized Yes. Having this support service was reported
Components included in the support service
Yes/No % Member States

with “Yes”
Mental health Cancer
disorders Scheduling medical YES 70.6
appointment upon release
Development of a Care NO 76.5

Plan to be shared with
In all prisons In all prisons external providers

D: HEALTH OUTCOMES
Mental health disorders Cancer
86.1 83.3
HEALTH AND WELL-BEING
Assessments of perceived well-being
(or life satisfaction):
REHABILITATION Yes, regularly (for example once every year or once
Access to: every two years). Assessments conducted regularly
were reported by 19.4% of Member States (n = 7).
Access to mental health counsellors:
In all prisons. Having mental health counsellors
in all prisons was reported by 72.2% of
Education and training Employment
MORTALITY
100 000 100 000 people
In all prisons In all prisons incarcerated (general pop.)
people
% Member States with “All prisons” Total deaths 5 254.2 1343.0a
Education and training Employment Suicide 1 50.8 31.2a

Drug overdose 0 0.0 0.6a
75.0 88.9
COVID-19 0 0.0 95.1b
Natural causes 4 203.4 -

Yes, with time restrictions/Yes, free of a
Source: Global Burden of Disease database, according to the most recent data available
(2019), (As the female prison population is 2.3%, the general population data is given only for
charge. Most Member States report “Yes, with males over 20 years)
time restrictions” (38.9%, out of n =36). b
Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data was not
available in open source).
98
Armenia
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
Percentage is calculated by considering the number of people with a diagnosis on record in 2020 divided by the total number of people in prison in the same country where
data has been provided for the same reference year.
99
Armenia

Offered at All prisons All prisons All prisons All prisons

“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
100
Armenia

Decisions taken by health staff can be overruled

or ignored by non-health prison staff:
“No” (77.8%, out of n =36).

Yes. Most Member States report “Yes” (72.2%, out
of n =36). Number of complaints received: missing.
H: REDUCING HEALTH INEQUALITIES AND ADDRESSING THE

NEEDS OF SPECIAL POPULATIONS


YES
Yes, and they are repeated YES
at regular intervals
% Member States with “Yes” 75.0 61.1 100.0

101
Austria 8 901 064
Population, 2020
High
Income group
US$ 48 588

8869
8482 * Did not participate
8626
San Marino 23.023.0

Monaco 38.238.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia
Cyprus
66.5
67.8
Austria
95.3
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2 2
Malta 168.1 1
Hungary 171.3 3
Albania 172.8 8
Estonia 176.2 2
Poland 178.9 9
Czechia 180.4 4
Lithuania 190.4 4
Slovakia 192.7
Georgia 246.0 0
0 50 100 150 200 250
102
Austria

Number of prison
establishments
in the country
28 Females
n
552 6.5
%
Pregnant MISSING MISSING
Under 18 85 1.0
Above 50 1 364 16.1
over the last 12-month period: 27 months
Above 65 224 2.6
Migrants 4 292 50.6
n (%) Disabled MISSING MISSING
Number of unsentenced/remand prisoners 1684 (19.9)
Number of individuals serving life sentences 147 (1.7) Physically disabled MISSING MISSING

Ministry of Justice only. Most Member States (50%, out of n =36) are financed
by Ministry of Justice only.
insurance systems:
Not covered by any health insurance. Health care fully covered by health

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) on
full-time equivalents (FTEs) and ratio (per 1000 people) for a known year:
Figure 3.2: Health-care staff available in prison and in the general population
FTE
Total staff 271.3
Nurses 233.7
a
Source: Eurostat (2020)
Physicians 24.8
Psychiatrists 12.8
Dentists Missing
prison population general population a

103
Austria
ACCEPTABILITY
Proportion of prison establishments where these are available to be administered to eligible prisoners:
Offered at % Member States

DTP A minority of prisons 72.2
Hepatitis A Most prisons 55.9
Hepatitis B Most prisons 69.4
MMR No prisons 61.8
Pneumococcal vaccination A minority of prisons 57.6

prisoners have access to HIV prophylaxis:

77.8 58.3
QUALITY OF CARE


Standardized process for reporting YES 55.6

104
Austria
HEALTH INFORMATION
Yes, both for IDs and for NCDs.

Yes, we keep electronic clinical health % Member States
records. Electronic clinical health Yes/No with “Yes”
records in all prisons was reported by Screening tests performed 91.7
YES
22.2% of Member States (n =36).
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
105
Austria
HIV HCV HBV STI

Yes, on an Yes, on an Yes, on an Yes, risk-based
opt-in basis opt-in basis opt-in basis screening


NO NO NO
HEALTH PROTECTION

syringes
Offered at All prisons All prisons No prisons No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
A minority
Offered at All prisons All prisons
of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION
Smoke free policy implemented in the

country applicable to prisons: Yes, in specific
regions of the country. Most Member States
report “Yes, nationwide” (72.2%, out of n =36).
106
Austria

Yes, everyone in prison has access to laboratory tests when these are necessary. Most Member States
report “Yes, everyone in prison has access to laboratory tests when these are necessary” (94.4%, out of n =36).
Number and proportion of people diagnosed that received 1 or completed 2 treatment over
the last 12 months:
n (%)
Tuberculosis (TB)
Individuals receiving TB treatment over the last 12-month period 6(-) a
Individuals receiving MDR-TB treatment over the last 12-month period 1(-) a
HIV
Hepatitis C
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period 64 (100.0)
Hepatitis B

Individuals with STIs who received treatment over the last 12-month period MISSING
Oral health


Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period 980 (100.0)
Diabetes Mellitus
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits 130 (100.0)
Individuals with a diabetes mellitus diagnosis who had at least one ophthalmology visit over the last 12-month period 130 (100.0)
Hypertension
Cancer
Individuals who have received treatment for cancer over the last 12-month period 14 (100.0)
a
1
Percentage is calculated by dividing the number of individuals receiving treatment in 2020 by the total number of individuals with diagnosis on record, using the same reference year.
2
Percentage is calculated by dividing the number of individuals completing treatment in 2020 by the total number of individuals with access to treatment, using the same reference year.
107
Austria

D: HEALTH OUTCOMES
Mental health
Cancer Assessments of perceived well-being (or
disorders
life satisfaction): No, it has never been done.
Assessments conducted regularly were reported by
19.4% of Member States (n = 7).

% Member States with “All prisons” In all prisons. Having mental health counsellors in
all prisons was reported by 72.2% of Member States
(n =36).
86.1 83.3
MORTALITY
REHABILITATION Total Mortality Mortality
Access to: 100 000 100 000 people
people
Total deaths 29 341.9 1139.3 a
Suicide 8 94.3 31.3 a
Drug overdose 7 82.5 2.8 a

programmes opportunities COVID-19 0 0.0 68.8 b
Cardiovascular 2 23.6 417.3 a

disease
In most prisons In all prisons a

males over 20 years)

b

75.0 88.9

relationships by web communication: Yes, with
time restrictions. Most Member States report
“Yes, with time restrictions” (38.9%, out of n =36).
108
Austria
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

MISSING
STI diagnosis (last 12-month)
COVID-19
Oral health
MISSING

Mental disorder diagnosis on record MISSING

Diabetes Mellitus
Hypertension
Cancer
1
109
Austria


“All prisons” 69.4 94.4 91.7 88.9
BMI≥ 25 4462 (52.6) 4227 (53.3) 232 (42.1)
BMI≥ 30 1569 (18.5) 1459 (18.4) 109 (19.8)
Currently use tobacco products 6285 (74.1) 5916 (74.6) 370 (67.1)

3554 (41.9) 3394 (42.8) 163 (29.5)
(last 12 months)
Use/have used drugs (last 12 months) 3350 (39.5) 3172 (40) 182 (32.9)

(last 12 months)

of 150 minutes/week
Clarification: Absolute numbers estimated from reported percentages, females and total number of people living in prison.
110
Austria


Yes. Most Member States report
“No” (77.8%, out of n =36).

“Yes” (72.2%, out of n =36).
H: HEALTH INEQUALITIES AND ADDRESSING THE NEEDS OF

SPECIAL POPULATIONS

In all prisons. Most Member States report


111
Belgium 11 522 440
Population, 2020
High
Income group
US$ 45 189

9372
10 381
MISSING
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9 Belgium
Armenia 66.5
Cyprus
Germany
67.8
69.7 90.1
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
San Marino 23.0
Estonia 176.2
Monaco 38.2
Poland 178.9
Finland 47.0
Czechia 180.4
Lithuania Netherlands 54.5 190.4
Slovakia Slovenia 61.9 192.7
Republic of Moldova Armenia 66.5 245.3
Georgia Cyprus 67.8 246.0
Germany 69.7
0 50 100 150 200 250
Denmark 70.2
Ireland People living in prison per 10073.5
000 inhabitants
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
112 Bulgaria 89.9
Belgium 90.1
Belgium

Number of prison
establishments
in the country
35 Females
n
470
%
4.5

over the last 12-month period: MISSING Above 50 1 638 15.8
Above 65 224 2.2
Unsentenced and serving life sentences Migrants 3 173 30.6
individuals: Minorities MISSING MISSING
n (%)
Number of unsentenced/remand prisoners 3762 (36.2) Disabled MISSING MISSING

Agency or agencies are responsible for delivering prison
health care: Ministry of Justice only 1, with 16.7% of Member States
reporting Ministry of Health only (or health authorities) (n =36).
1
Although the deliver is currently under the responsibility of Ministry of Justice, there is an ongoing project
to transfer it to the Ministry of Health, albeit no information was obtained on timeline for implementation.

Ministry of Justice only. Most Member States (50%, out of n =36) are
To what extent is health care of people in prison covered by any
health insurance systems:
Not covered by any health insurance. Health care fully covered by
health insurance was reported by 41.7% of Member States (n =36).

AVAILABILITY
FTE
Total staff 306
Nurses 205
8
Physicians 30
a
Psychiatrists 17
8
Dentists 10

113
Belgium
ACCEPTABILITY
Proportion of prison establishments where these are available to be administered
to eligible prisoners:

prisoners have access to HIV prophylaxis:

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”
Assessments performed in prisons on NO 88.9


114
Belgium
HEALTH INFORMATION
Yes, for infectious diseases legally
required (notifiable diseases). Public
health authorities being informed for
both IDs and for NCDs was reported

Yes, we keep electronic
% Member States
clinical health records. Yes/No
with “Yes”
Electronic clinical health records in
all prisons was reported by 22.2%
of Member States (n =36). Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

Yes, and a diagnostic test is offered in addition to the
clinical evaluation. Most Member States report “Yes, clinical
(50%, out of n =36).
115
Belgium
HIV HCV HBV STI

Yes, on an Yes, on an Yes, on an Yes, on an
opt-in basis opt-in basis opt-in basis opt-in basis


YES YES YES
Note: cancer screening was indicated to be performed whenever indicated by the physician or on request of the patient if considered useful by the physician.
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

applicable to prisons: No1. Most Member States
1
Clarification: Staff can only smoke in designated spaces, while inmates can smoke in their cells or outside.
116
Belgium

last 12 months:
n (%)
Tuberculosis (TB)
Individuals receiving TB treatment over the last 12-month period 13 (-) a
Individuals receiving MDR-TB treatment over the last 12-month period 1 (-) a
HIV
Individuals with HIV who received treatment over the last 12-month period MISSING
Hepatitis C
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period 54 (missing)
Hepatitis B

Oral health


Individuals who have received pharmacological treatment for a substance use disorder over the last 12-month period MISSING
Diabetes Mellitus
Hypertension
Cancer
a
1
2
117
Belgium

Components included in the support service:

with “Yes”
Development of a Care YES 76.5

In no prisons In all prisonss external providers
% Member States with “All prisons” D: HEALTH OUTCOMES

86.1 83.3

satisfaction):
REHABILITATION No, it has never been done. Assessments
Access to: conducted regularly were reported by 19.4% of
Member States (n = 7).
In all prisons. Having mental health counsellors in
(n =36).
MORTALITY
Total Mortality rates Mortality
mortality per 100 000 rates per
incarcerated 100 000 people
In all prisons In all prisons people (general pop.)
Total 32 308.3 1294.1a

% Member States with “All prisons” deaths
Education and training Employment Suicide 16 154.1 37.9 a

Drug MISSING MISSING 3.5 a
75.0 88.9 overdose
COVID-19 5 48.2 167.9 b

relationships by web communication: Yes, with a
time restrictions. Most Member States report (2019), (As the female prison population is 4.5%, the general population data is given only for
“Yes, with time restrictions” (38.9%, out of n =36). b
available in open source)
118
Belgium
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
MISSING
Active HIV diagnosis
Hepatitis C
MISSING
Chronic HCV infection (HCV RNA positive)
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


MISSING
Active drug use disorder (last 12-month)
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
119
Belgium


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Data recorded in individual electronic clinical files but not available for extraction in aggregate manner.
120
Belgium


Yes 1. Most Member States report
“No” (77.8%, out of n =36).
National health-care complaints 1

This was further clarified by stating “Clinical decisions
can be overruled by staff; if a prison governor decides
system, available to prisoners: to ignore a decision of a health worker, he becomes
Yes. Most Member States report “Yes” (72.2%, out legally responsible for the consequences. However, a
prison governor cannot oblige a medical staff member
of n =36). Number of complaints received: MISSING to administer any form of treatment or medication.”


Option to be Pregnancy test

attended by female on admission
health-care staff to prison
YES NO
% Member States with“Yes” 75.0 61.1

in prison in the last 12 months: MISSING
121
Bosnia and 3 280 815 Upper middle US$ 6 082
Herzegovina Population, 2020 Income group Gross national income per capita

3792
2374
2535
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7 Bosnia
Denmark 70.2 and Herzegovina
Ireland
Luxembourg
Switzerland
73.5
79.7
80.1
72.4
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
122
Bosnia and
Herzegovina
14
Number of prison
establishments n %
in the country Females 60 2.5
Pregnant 1 1.7
LGBTIQ 3 0.1
over the last 12-month period: 40 months Above 50 319 13.4
Above 65 148 6.2
Minorities 53 2.2
Intellectually disabled 8 5.6
Not legally permitted
Number of individuals serving life sentences
in the country

Agency or agencies are responsible for delivering prison health
care: Ministry of Justice only, with 16.7% of Member States reporting
Ministry of Health only (or health authorities) (n =36).
Fully covered by health insurance. Health care fully covered by health

AVAILABILITY

FTE
Total staff 90
Nurses 64
Physicians 22
Psychiatrists 3
Dentists 6
123
Bosnia and
Herzegovina
ACCEPTABILITY

Meningococcal vaccination Most prisons 52.9
Pneumococcal vaccination Most prisons 57.6

In most prisons In most prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


124
Bosnia and
Herzegovina
HEALTH INFORMATION
Yes, both for IDs and for NCDs. Public

Yes, in some prisons we keep Yes/No % Member
paper-based clinical health-records States with
“Yes”
and in others we keep electronic
clinical health records. Electronic clinical
health records in all prisons was reported Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

States report “Yes, clinical assessment and diagnostic
tests are made and when the test is positive, additional
assessment for MDR-TB is ensured” (50%, out of n =36).
125
Bosnia and
Herzegovina
HIV HCV HBV STI



NO YES YES
% Member States
with “Yes 66.7 58.3 66.7
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at A minority of prisons A minority of prisons Most prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION
Smoke free policy implemented in

the country applicable to prisons:
No. Most Member States report “Yes,
nationwide” (72.2%, out of n =36).
126
Bosnia and
Herzegovina

last 12 months:

Individuals receiving MDR-TB treatment over the last 12-month period MISSING
Individuals completing MDR-TB treatment over the last 12-month period MISSING
HIV
Hepatitis C
Hepatitis B
Oral health


Diabetes Mellitus
80 (43.2)
Individuals with a diabetes mellitus diagnosis who had at least one ophthalmology visit over the last 12-month period
Hypertension
322 (90.4)
Individuals with a CVD diagnosis who had at least one routine health-care visit over the last 12-month period
Cancer
a
1
2
127
Bosnia and
Herzegovina

D: HEALTH OUTCOMES
Mental health
Cancer
disorders Assessments of perceived well-being (or life
satisfaction):
Yes, regularly (for example once every year or
once every two years). Assessments conducted
(n = 7).
Mental health disorders Cancer In most prisons. Having mental health counsellors
86.1 83.3 in all prisons was reported by 72.2% of Member
States (n =36).
REHABILITATION MORTALITY
Access to: Total Mortality rates Mortality
people (general pop.)
Suicide 3 126.4 27.1 a
Education and training Employment COVID-19 3 126.4 124.1 b
programmes opportunities Cardiovascular 2 84.3 678.2 a
disease
a
In most prisons In most prisons (2019), (As the female prison population is 2.5%, the general population data is given only for
b

75.0 88.9

No. Most Member States report “Yes, with
time restrictions” (38.9%, out of n =36).
128
Bosnia and
Herzegovina
MORBIDITY

MISSING
Active MDR-TB diagnosis
HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
Individuals keeping 21 or more natural teeth 532 (22.4)

Psychotic disorder diagnosis on record 51 (2.1)
Recorded suicide attempt events (last 12-month) 19 (0.8)

Diabetes Mellitus
Hypertension
Cancer
1
Percentage is calculated by considering the number of people with a diagnosis on record in 2020 divided by the total number of people in prison in the same country where data has
been provided for the same reference year.
129
Bosnia and
Herzegovina


“All prisons” 69.4 94.4 91.7 88.9
BMI≥ 25 296 (12.5) 291 (12.6) 5 (8.3)
BMI≥ 30 20 (0.8) 13 (0.6) 7 (11.7)

217 (9.1) 217 (9.4) 0 (0.0)
(last 12 months)
Use/have used drugs (last 12 months) 178 (7.5) 173 (7.5) 5 (8.3)

10 (0.4) 8 (0.3) 2 (3.3)
(last 12 months)

159 (6.7) 159 (6.9) 0 (0.0)
of 150 minutes/week
130
Bosnia and
Herzegovina
G: ADHERENCE TO THE PRINCIPLE OF EQUIVALENCE

AND OTHER INTERNATIONAL STANDARDS

No. No. Most Member States report
“No” (77.8%, out of n =36).

“Yes” (72.2%, out of n =36).
H: REDUCING HEALTH INEQUALITIES AND ADDRESSING THE NEEDS OF SPECIAL

POPULATIONS

In a minority of prisons. Most Member States
report “In all prisons” (52.8%, out of n =36).

YES
% Member States 75.0 61.1 100.0

with“Yes”
Number of women who gave birth

whilst in prison in the last 12 months:
131
Bulgaria 6 951 482 Upper middle US$ 10 079
Population, 2021 Income group Gross national income per capita

8161
6251
5287
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7 Bulgaria
89.9
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
132
Bulgaria
Number of prison
establishments
in the country
12 Social characterization of people in prison
n %
Females 192 3.1
Under 18 30 0.5
Above 50 936 15.0
Migrants MISSING MISSING
Unsentenced and serving life Minorities MISSING MISSING
sentences individuals: Disabled 18 0.3

n (%)
Number of individuals serving life sentences 186 (3.0) Intellectually disabled MISSING MISSING

Clarification: Health care for inmates in prisons in
Agency or agencies are responsible for delivering prison Bulgaria is provided in medical institutions under
health care: Both Ministry of Health and Ministry of Justice/ the Ministry of Justice. These are two Specialized
Hospitals for Active Treatment of Inmates
Ministry of Interior, with 16.7% of Member States reporting (SHATI) in Sofia and Lovech, and 12 Medical
Centers (MC) under the respective prisons. Both
Ministry of Health only (or health authorities) (n =36). hospitals provide medical care to inmates from
all over the country and in this sense, they are
Agency or agencies are responsible for financing prison health care: the only ones with specific functions related
to the regime, security and safety during the
Ministry of Justice only. Most Member States (50%, out of n =36) are serving of the sentence “imprisonment”.
According to Art. 128 of the Law on Execution
of Sentences and Detention is provided an
To what extent is health care of people in prison covered by any opportunity to conduct treatment of inmates
health insurance systems: in medical institutions outside the places of
imprisonment, as health insured persons with
Health care for people in prison is covered by a separate health continuous health insurance rights. In this way
the access to medical care is ensured, which is
insurance system (different to what is available in the general guaranteed by the package of health services of
community). Health care fully covered by health insurance was reported the National Health Insurance Fund, according
to the National Framework Agreement.

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) in prisons on full-time
equivalents (FTEs) and ratio (per 1000 people) for a known year:
FTE
9.1
Total staff 206
33.0
Nurses 65 4.4
10.4
Physicians 23 a
3.7
3 0.1
Psychiatrists 0.5
1.1
Dentists 6
1.0
prison population general population a 133

Bulgaria
ACCEPTABILITY

DTP No prisons 72.2
Human Papilloma virus MISSING 52.9
Hepatitis A MISSING 55.9

Seasonal flu No prisons 83.3
MMR MISSING 61.8
Meningococcal vaccination MISSING 52.9
Pneumococcal vaccination MISSING 57.6



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


134
Bulgaria
HEALTH INFORMATION
for both IDs and for NCDs was reported Information registered in clinical records:
% Member
Keep clinical health records Yes/No States with
of people in prison: “Yes”
Yes, in some prisons we keep paper- Screening tests performed YES 91.7
based clinical health-records and in Screening tests results YES 94.4
others we keep electronic clinical
Vaccination 97.2
health records. Electronic clinical health YES
records in all prisons were reported Health behaviours YES 97.2

by 22.2% of Member States (n =36). Diagnoses established 97.2
YES
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

Yes, clinical assessment and diagnostic tests are
made and when the test is positive, additional
assessment for MDR-TB is ensured. Most Member
135
Bulgaria
HIV HCV HBV STI



NO NO NO
HEALTH PROTECTION

syringes
Offered at All prisons MISSING MISSING No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at All prisons All prisons No prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

country applicable to prisons: Yes,
nationwide. Most Member States report
“Yes, nationwide” (72.2%, out of n =36).
136
Bulgaria

(94.4%, out of n =36).
last 12 months:

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
137
Bulgaria

D: HEALTH OUTCOMES
Mental health
disorders
satisfaction):
(n = 7).
Mental health disorders Cancer In all prisons. Having mental health counsellors in
86.1 83.3 all prisons was reported by 72.2% of Member States
(n =36).
Access to: Total Mortality Mortality
100 000 100 000 people
people
Total 47 751.9 2334.3 a

deaths
Suicide 1 16.0 35.1 a

programmes opportunities Drug 1 16.0 1.9 a
overdose
COVID-19 3 48.0 109.9 b
In all prisons In all prisons a

% Member States with “All prisons” b

75.0 88.9

relationships by web communication: Yes,
free of charge. Most Member States report “Yes,
with time restrictions” (38.9%, out of n =36).
138
Bulgaria
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
MISSING
SARS-Co-V2 infection laboratory confirmed
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
139
Bulgaria


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Though these indicators are recorded in the clinical file of each inmate, the country could not provide an aggregate value that can be reported here.
140
Bulgaria


“No” (77.8%, out of n =36).

“Yes” (72.2%, out of n =36).



YES NO

in prison in the last 12 months: n =2
(1.0% of all women living in prison).
141
Croatia 4 058 165
Population, 2020
High
Income group
US$ 14 132

4041
3531
2185
Figure 7.1: Incarceration rate per 100 000 inhabitants in Europe.
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands
Slovenia
54.5 Croatia
61.9
Armenia
Cyprus
Germany
66.5
67.8
69.7
87.0
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 0 50 5 100 150 200 250
142
Croatia
23
Number of prison
n %
establishments
Pregnant 2 1.1
Mean length of incarceration per individual LGBTIQ MISSING MISSING
Under 18 32 0.9
Unsentenced and serving life Above 50 548 15.5

sentences individuals: Above 65 205 5.8
Migrants 381 10.8
n (%)
Number of unsentenced/ Minorities MISSING MISSING
1281 (36.3)
remand prisoners Disabled 62 1.8
Number of individuals Not legally permitted Physically disabled 59 95.2
serving life sentences in the country Intellectually disabled 3 4.8

Agency or agencies are responsible for delivering prison health care: Both Ministry of
Health and Ministry of Justice/ Ministry of Interior, with 16.7% of Member States reporting
To what extent is health care of people in prison covered by any health insurance
systems:
Partly covered by health insurance 1. Health care fully covered by
1
Clarification: “Foreign nationals living in prison do not have their health care covered by the national health insurance and are
therefore provided with health care from the budget of the prison service (Ministry of Justice and Public Administration)”

AVAILABILITY
Figure 7.2: Health-care staff a available in prison and in the general population
FTE 0 10 20 30 40 50
10.9
Total staff 151
42.8
Nurses 84 6.8 a
Outsourced medical staff
23.8 working only part-time not
included. Therefore, data is
Physicians 28 3.5 not comparable with
7.9 other profiles.
b
Psychiatrists 7 0.2
2.0
Dentists 0.9
4
1.1
prison population general population b
143
Croatia
ACCEPTABILITY

DTP No prisons 72.2
A minority
Hepatitis B 69.4
of prisons
MMR No prisons 61.8

a
In general, prisoners have access to health care
and treatment measures in the same extent as other
% Member States with “All prisons” citizens. Therefore, if prison health-care cannot
provide some measure within the prison system it is
Post Exposure a Pre-exposure provided in the public health system, including HIV
postexposure prophylaxis (PEP). So, in all prisons,
77.8 58.3 PEP would be available for prisoners, if necessary.
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


144
Croatia
HEALTH INFORMATION

Yes, we keep paper-based clinical Yes/No % Member
health-records 1. Electronic clinical States with
“Yes”
Screening tests performed 91.7
by 22.2% of Member States (n =36). YES

1
During 2020, there was a pilot for electronic health records that Vaccination YES 97.2
finished by the end of the year, resulting in keeping data in both
electronic and paper version. According to the Enforcement of
the Prison Sentence Act, all data in the prisoner’s file, including
the medical file must be kept both electronically and in paper.
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

145
Croatia
HIV HCV HBV STI

% Member States with “Yes, 50.0 42.9 37.1 32.4

on an opt-out basis”

NO NO NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prisons No prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

applicable to prisons: Yes, nationwide 1. Most Member
1
Pursuant to the Law on Restricting the Use of Tobacco Products, smoking is allowed in special rooms designated for smokers.
These rooms must be marked with a special sign that smoking is allowed.
146
Croatia

Yes, everyone in prison has access to laboratory tests when these are necessary. Most Member
States report “Yes, everyone in prison has access to laboratory tests when these are necessary” (94.4%,
out of n =36).
Number and proportion of people diagnosed that received or completed treatment over the
last 12 months:
n (%)
Tuberculosis (TB)
Individuals receiving TB treatment over the last 12-month period MISSING
Individuals completing TB treatment over the last 12-month period MISSING

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
147
Croatia


with “Yes”
disorders Scheduling medical NO 70.6


D: HEALTH OUTCOMES
86.1 83.3
REHABILITATION Assessments of perceived well-being (or life
satisfaction):
Access to:
No, it has never been done. Assessments
conducted regularly were reported by 19.4% of
Education and training Employment all prisons was reported by 72.2% of Member States
programmes opportunities (n =36).
MORTALITY
In most prisons In all prisons a Total Mortality Mortality
100 000 100 000 people
% Member States with “All prisons” incarcerated (general pop.)
people
Education and training Employment Total deaths 9 254.9 1 568.8 a

75.0 88.9 Suicide 0 0.0 33.1 a
a
In all prisons but limited depending to the size and type of prison Drug overdose 0 0.0 2.9 a
COVID-19 2 56.7 96.0 b

relationships by web communication: a
Yes, with time restrictions / Yes, free of (2019), (As the female prison population is 5.3%, the general population data is given only for
charge. Most Member States report “Yes, with males over 20 years)
b
time restrictions” (38.9%, out of n =36). available in open source
148
Croatia
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
MISSING
Oral health
MISSING


Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
149
Croatia

Offered at Most prisons All prisons Most prisons All prisons

“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

360 (59.8) MISSING MISSING
of 150 minutes/week
Clarification: Records are kept in each prisoner’s individual medical file. However, no records for requested diagnosis are kept on national level, so the data could only be
extracted by manually searching the individual files.
150
Croatia


“No” (77.8%, out of n =36).
National health-care complaints system, available to prisoners:
Yes. Most Member States report “Yes” (72.2%, out of n =36). Most Member
States report “Yes” (72.2%, out of n =36). Number of complaints received:
109 complaints on prison health care submitted to prison directors, 34
complaints on prison health-care submitted to the Head Office of the Prison
System, 18 requests for protection of rights regarding health care submitted
to the enforcement judges. No data available on number of complaints
submitted to the Ministry of Health, Ombudsperson or other authorities.



health-care staff to prison a
YES
NO NO
a
Only if women ask for the test, or the medical doctor indicates testing

.
151
Cyprus 888 005
Population, 2020
High
Income group
US$ 27 681

543
602 * Not available
1670
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland
72.4 Cyprus
73.5
Luxembourg
Switzerland
Croatia
79.7
80.1
87.0
67.8
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
152
Cyprus
5
Number of prison
n %
establishments
Females 30 5.0
in the country
Pregnant 0 0.0
LGBTIQ 1 0.2
Under 18 4 0.7
Mean length of incarceration per individual over
the last 12-month period: MISSING
Migrants 260 43.2

Minorities 12 2.0

Both Ministry of Health and Ministry of Justice/ Ministry of Interior,
with 16.7% of Member States reporting Ministry of Health only (or health
authorities) (n =36).
Ministry of Health only. Most Member States (50%, out of n =36) are
Separate health insurance system. Health care fully covered by health

AVAILABILITY
FTE
Total staff 29
48.2
5.5
Nurses 17.5
29.9
4.3
Physicians 3
5.0 a
Psychiatrists 1 0.1
1.7
Dentists 1 1.1
1.7
153
Cyprus
ACCEPTABILITY
Proportion of prison establishments where these are available to be administered to eligible prisoners:



77.8 58.3
QUALITY OF CARE


154
Cyprus
HEALTH INFORMATION

% Member
Yes, we keep paper-based clinical Yes/No States with
health-records. Electronic clinical health “Yes”
records in all prisons were reported by Screening tests performed YES 91.7
22.2% of Member States (n =36). Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

assessment and diagnostic tests are made and when the test is
positive, additional assessment for MDR-TB is ensured” (50%,
out of n =36).
155
Cyprus
HIV HCV HBV STI

opt-out basis opt-out basis opt-out basis opt-out basis

50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

156
Cyprus

No. Most Member States report “Yes, everyone in prison has access to laboratory tests when these are
necessary” (94.4%, out of n =36).
last 12 months:

HIV
Hepatitis C
Hepatitis B

Oral health
Individuals who have received treatment for any mental health disorder over the last 12-month period 260 (missing)
Individuals who have received pharmacological treatment for a substance use disorder over the last 12-month period 114 (missing)
Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period 49 (missing)
Diabetes Mellitus
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits (excluding ophthalmology and 9 (100.0)
other specialty visits) over the last 12-month period
Hypertension
Cancer
a
1
2
157
Cyprus


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
REHABILITATION Yes, regularly (for example once every year or
Access to: once every two years). Assessments conducted
(n = 7).
Education and training Employment (n =36).
MORTALITY
In all prisons In all prisons mortality per 100 000 rates per
% Member States with “All prisons” Total deaths 1 166.1 896.8 a

75.0 88.9
COVID-19 0 0.0 13.4 b

Yes, with time restrictions / Yes, free of a
Source: Global Burden of Disease database, according to the most recent data
charge. Most Member States report “Yes, with available (2019), (As the female prison population is 5.0%, the general population data is given
only for males over 20 years)
time restrictions” (38.9%, out of n =36). b
158
Cyprus
MORBIDITY

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
Hypertension
Cancer
1
159
Cyprus

activity a once a week two options of food) b

“All prisons” 69.4 94.4 91.7 88.9
a
Prisoners can use exercise facilities every day
b
Besides the normal menu, 7 different menus meeting religion, health and vegetarian needs are offered.

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Even though health behaviours are evaluated during the initial interview but are not kept in a database. They are kept in the personal files of the inmates. These
evaluations help the administration on their decision inter alia regarding the distribution (allocation) of the inmates to wings and specifically to cells with inmates that they have
compatible features and needs in order to make their accommodation more comfortable and reduce any stressful factors.
160
Cyprus


“No” (77.8%, out of n =36).

of n =36). Number of complaints received: 0.
H: REDUCING HEALTH INEQUALITIES AND ADDRESSING

THE NEEDS OF SPECIAL POPULATIONS


YES

161
Czechia 10 693 939
Population, 2020
High
Income group
US$ 22 933

19733
19286
9251
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7 Czechia
Switzerland 80.1
Croatia
Italy
87.0
89.5 180.4
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
162
Czechia
35
Number of prison
n %
establishments
Females 1 574 8.2
in the country
Under 18 44 0.2
Above 50 3 023 15.7
Above 65 337 1.8z
Migrants 1 531 7.9

Physically disabled MISSING MISSING

Ministry of Justice only. Most Member States (50%, out
of n =36) are financed by Ministry of Justice only.
Partly covered by health insurance. Health care fully covered by

AVAILABILITY
FTE 0 5 10 15 20 25
15.4
Total staff 480.1
24.9
8.6
Nurses 348.6
18.1
4.1
Physicians 131.5 6.8 a
0.2
Psychiatrists 4.6 0.2
0.7
Dentists 20.4 1.1
163
Czechia
ACCEPTABILITY


In no prisons In no prisons

77.8 58.3
QUALITY OF CARE


164
Czechia
HEALTH INFORMATION

% Member
Yes, we keep paper-based clinical Yes/No States with
22.2% of Member States (n =36). Screening tests results 94.4
YES
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

out of n =36).
165
Czechia
HIV HCV HBV STI

% Member States with “Yes,

50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

166
Czechia

last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period 131(missing)
Diabetes Mellitus
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits (excluding ophthalmology MISSING
and other specialty visits) over the last 12-month period

MISSING
Individuals who have received pharmacological treatment for diabetes over the last 12-month period
Hypertension
Cancer
a
1
2
Percentage is calculated by dividing the number of individuals completing treatment in 2020 by the total number of individuals with access to treatment, using the same ref-
erence year.
167
Czechia

D: HEALTH OUTCOMES
Mental health
disorders
satisfaction):
(n = 7).
(n =36).
Access to: mortality per 100 000 rates per
Total deaths 41 212.6 1 389.9 a
Suicide 19 98.5 30.0 a

Neoplasm 4 20.7 413.5 a

disease
Other natural 3 15.5 -
causes
Education and training Employment a

programmes opportunities males over 20 years)
75.0 88.9 b
Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data was
not available in open source).

168
Czechia
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

MISSING
COVID-19
MISSING
Oral health
MISSING


Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
169
Czechia


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)
Use/have used drugs (last 12 months) 1094 (5.7) MISSING MISSING

(last 12 months)

of 150 minutes/week
Clarification: Although all data are recorded in individual electronic clinical files, the coding system used does not allow extraction in aggregate manner. The only exception is
drug use (including alcohol), because these behaviors are monitored throughout imprisonment.
170
Czechia


“No” (77.8%, out of n =36).




NO Yes, only once YES

n =0.0 (0.0% of all women living in prison).
171
Denmark 5 822 763
Population, 2020
High
Income group
US$ 61 063

4073
4085 * Not possible to compare
9132
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark
70.2
72.4
Denmark
70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
172
Denmark
55
Number of prison
n %
establishments
Females 185 4.5
in the country
Under 18 9 0.2
Above 50 474 11.6
Migrants 1 194 29.2

n (%)
Disabled MISSING MISSING

Both Ministry of Health and Ministry of Justice/
Ministry of Interior. Most Member States (50%, out of
n =36) are financed by Ministry of Justice only.
Fully covered by health insurance. Health care fully covered by

AVAILABILITY
FTE
30.8
Total staff 103
25.2
Nurses 71 10.1
17.4
Physicians 4.2
13 a
3.2
Psychiatrists 0.2
0 0.0
Dentists 0.7
2
0.5

173
Denmark
ACCEPTABILITY

Human Papilloma virus Most prisons 52.9
MMR Most prisons 61.8
Meningococcal vaccination Most prisons 52.9


77.8 58.3
QUALITY OF CARE


174
Denmark
HEALTH INFORMATION

% Member
Yes, in some prisons we keep paper- Yes/No States with
based clinical health-records and in “Yes”
others we keep electronic clinical Screening tests performed YES 91.7
health records. Electronic clinical health Screening tests results 94.4
YES
records in all prisons were reported by
22.2% of Member States (n =36). Vaccination YES 97.2
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

175
Denmark
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
Offered at All prisons All prisons Most prisons No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prisons Most prisons Most prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

176
Denmark

last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health

Diabetes Mellitus
Hypertension
Cancer
1
2
Clarification: Data recorded in individual health journals but not available for extraction in aggregate manner due to data confidentiality.
177
Denmark


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
REHABILITATION Yes, on an ad hoc basis. Assessments conducted
Access to: regularly were reported by 19.4% of Member States
(n = 7).
(n =36).
MORTALITY
In most prisons In all prisons people (general pop.)
% Member States with “All prisons” Suicide 4 97.9 22.7 a

75.0 88.9
a
People are allowed to continue their family males over 20 years)
relationships by web communication: b
No. Most Member States report “Yes, with available in open source).
178
Denmark
MORBIDITY
Number and proportion of unique individuals living in prison diagnosed with:
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
MISSING
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
179
Denmark

Offered at Most prisons All prisons All prisons All prisons

“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
180
Denmark


“No” (77.8%, out of n =36).



In most prisons. Most Member States report

NO Yes, only once YES

181
Estonia 1 328 889
Population, 2020
High
Income group
US$ 23 054

3278
2341
644
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2 Estonia
Ireland
Luxembourg
73.5
79.7
176.2
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
182
Estonia
3
Number of prison
n %
establishments
Females 96 4.1
in the country
Mean length of incarceration per individual over Under 18 5 0.2

the last 12-month period: 16 months Above 50 463 19.8
Above 65 60 2.6
Migrants 783 33.5


Ministry of Justice only. Most Member States (50%, out

AVAILABILITY
FTE 0 10 20 30 40 50
13.1
Total staff 108.7
46.5
Nurses 60 6.3
25.6
3.5
Physicians 16.5 a
7.1

3.2
Dentists 2.7 1.0

1.2

183
Estonia
ACCEPTABILITY

Human Papilloma virus MISSING 52.9
Hepatitis A MISSING 55.9

MMR MISSING 61.8
Meningococcal vaccination MISSING 52.9



77.8 58.3
QUALITY OF CARE


184
Estonia
HEALTH INFORMATION
No. Public health authorities being informed

% Member
Yes, we keep electronic clinical health Yes/No States with
records. Electronic clinical health “Yes”
22.2% of Member States (n =36). Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

out of n =36).
185
Estonia
HIV HCV HBV STI

Yes, on an Yes, risk-based Yes, risk-based Yes, risk-based
opt-out basis screening screening screening


NO NO NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

186
Estonia

last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
Clarification: Data on NCD diagnoses and treatment is recorded in individual clinical files but not available for extraction in aggregate manner.
187
Estonia


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
(n = 7).
(n =36).
MORTALITY

75.0 88.9
disease
People are allowed to continue their family Other natural 6 256.3 -

relationships by web communication: causes

time restrictions” (38.9%, out of n =36). Source: Global Burden of Disease database, according to the most recent data available
a
b
188
Estonia
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

MISSING
COVID-19
Oral health
MISSING


Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
189
Estonia


“All prisons” 69.4 94.4 91.7 88.9
Currently use tobacco products a 0 (0.0) 0 (0.0) 0 (0.0)

(last 12 months)

(last 12 months)

of 150 minutes/week
a
Reported as zero as consequence of the smoke free policy implemented in prisons nationwide.
190
Estonia


“No” (77.8%, out of n =36).

No. Most Member States report “Yes” (72.2%, out



YES NO

191
Finland 5 525 292
Population, 2020
High
Income group
US$ 49 160

3007
2595
5278
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5 Finland
47.0
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
192
Finland
26
Number of prison
n %
establishments
Females 182 7.4
in the country
Under 18 MISSING MISSING

the last 12-month period: 6 months Above 50 MISSING MISSING
Unsentenced and serving life Migrants MISSING MISSING
n (%) Minorities MISSING MISSING

Number of individuals serving life sentences MISSING


Ministry of Health only (or health authorities), with 16.7% of Member
States reporting Ministry of Health only (or health authorities) (n =36).
Ministry of Health only. Most Member States (50%, out

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) on full-
time equivalents (FTEs) and ratio (per 1000 people) for a known year:
FTE 0 10 20 30 40 50 60 70 80
37.0
Total staff 190 73.2
14.1
Nurses 127 48.9
3.2
Physicians 6 2.3 a
0.2
Psychiatrists
6 2.3
Dentists 0.7
5 1.9

193
Finland
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE


194
Finland
HEALTH INFORMATION

% Member
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
195
Finland
HIV HCV HBV STI

opt-out basis opt-out basis opt-in basis opt-in basis

50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
Offered at All prisons All prisons All prisons No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

196
Finland

report “Yes, everyone in prison has access to laboratory tests when these are necessary”
(94.4%, out of n =36).
last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
Clarification: Although data are recorded in individual electronic clinical files but not available for extraction in aggregate manner.
197
Finland


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
(n = 7).
(n =36).
MORTALITY
100 000 100 000
incarcerated people
In all prisons In all prisons people (general pop.)

Suicide 4 154.1 33.4 a
Drug overdose MISSING MISSING 10.3 a
75.0 88.9
COVID-19 1 38.5 10.7 b
People are allowed to continue their family a

relationships by web communication: Yes, (2019), (As the female prison population is 7.4%, the general population data is given only for
free of charge. Most Member States report “Yes, b
with time restrictions” (38.9%, out of n =36). available in open source).
198
Finland
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
MISSING
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
199
Finland


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
200
Finland


“No” (77.8%, out of n =36).




YES

in prison in the last 12 months: MISSING
201
France 66 859 768
Population, 2020
High
Income group
US$ 38 780

60585
62673
138711
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7 France
93.1
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
202
France
188
Number of prison
n %
establishments
Females 791 1.3
in the country
Under 18 775 1.2

Above 50 7 700 12.3
the last 12-month period: 11 months
Above 65 1 323 2.1
Migrants 15 418 24.6
n (%) Disabled 1 250 2.0
Number of unsentenced/remand prisoners 17856 (28.5%) Physically disabled 453 36.2
Number of individuals serving life sentences 487 (0.8%) Intellectually disabled MISSING MISSING

Ministry of Health only. Most Member States (50%, out
Separate health insurance system. Health care fully covered by

AVAILABILITY
FTE 0 10 20 30 40 50
Total staff 2 596.1

41.4
Nurses 1 414.0
22.6
Physicians 392.0 3.2 a

6.3

2.3
Dentists 70.0 0.6

1.1
203
France
ACCEPTABILITY


In a minority of prisons In a minority of prisons

77.8 58.3
QUALITY OF CARE


204
France
HEALTH INFORMATION
No 1. Public health authorities being informed
1
Clarification: In France, the law provides for the creation of an information
system to identify people with notifiable diseases (article L3113-1 of the public
health code). These are subject to the mandatory transmission of individual
data to the health authority by doctors and managers of public and private
medical biology services and laboratories. However, there is no operating
system for notifiable diseases specific to the penitentiary environment.
Information registered in clinical records:
% Member
Yes/No States with
“Yes”
Keep clinical health records Screening tests performed NO 91.7
of people in prison: Screening tests results NO 94.4

Yes, in some prisons we keep paper-based
Vaccination NO 97.2
clinical health-records and in others
we keep electronic clinical health Health behaviours NO 97.2
records 2. Electronic clinical health Diagnoses established NO 97.2
records in all prisons was reported by
Visits to external care providers 94.4
22.2% of Member States (n =36). NO
Treatment and medications NO 97.2

2
Clarification: Different record system are used for clinical health records.
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

205
France
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
Offered at All prisons Most prisons Most prisons No prisons
% Member States
with “All prisons” 97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

No. Most Member States report “Yes
206
France

Yes, but there are limited resources, so only the priority/vulnerable groups have access.
Most Member States report “Yes, everyone in prison has access to laboratory tests when these
are necessary” (94.4%, out of n =36).
Number and proportion of people diagnosed that received or completed treatment
over the last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
MISSING
Individuals with a diabetes mellitus diagnosis who had at least one ophthalmology visit over the last 12-month period
Hypertension
Cancer
Clarification: In France, the law provides for the creation of an information system to identify people with notifiable diseases. The rest is subject to medical secrecy.
207
France


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
(n = 7).
(n =36).
MORTALITY
In all prisons In most prisons incarcerated 100 000 people
Total deaths 175 279.2 1242.6 a

Suicide 119 189.9 35.4 a
programmes opportunities Drug overdose MISSING MISSING 4.0 a
75.0 88.9
COVID-19 5 8.0 95.9 b

relationships by web communication: (2019), (As the female prison population is 1.3%, the general population data is given only for
No. Most Member States report “Yes, with b
time restrictions” (38.9%, out of n =36). available in open source).
208
France
MORBIDITY
n (%)
Tuberculosis (TB)

MISSING
HIV
Hepatitis C
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
Clarification: In France, the law provides for the creation of an information system to identify people with notifiable diseases. The rest is subject to medical secrecy. Therefore, all
data reported is extracted from ad-hoc studies published in the scientific literature (selected by the prison focal point).
209
France


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: In France, the law provides for the creation of an information system to identify people with notifiable diseases. The rest is subject to medical secrecy. “Any person treated by a
health professional or a health establishment has the right to respect for his private life and to the secrecy of medical information concerning him.” (Regulation No. 2016/679 of the European
Parliament and of the Council of April 27, 2016). Although the prison focal point provided data from the Ministry of Social Affairs and Health for the proportion of individuals in prison smoking
and drinking, these data were not considered as it was from 2012.
210
France


“Yes” (72.2%, out of n =36).


Option to be Pregnancy test Number of women who

attended by female on admission gave birth whilst in prison
health-care staff to prison in the last 12 months
YES NO MISSING
% Member States 75.0 61.1

with “Yes”
211
Georgia 3 716 858
Population, 2020
Upper middle
Income group
US$ 4 255

11656
9143
6918
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5 Georgia
Luxembourg 79.7
Switzerland
Croatia
80.1
87.0 246.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
212
Georgia
Number of prison
establishments
in the country
Females 333
n %
3.6
Pregnant 2 0.6

Under 18 5 0.1
Above 50 97 1.1
Above 65 17 0.2
Migrants 66 0.7
Unsentenced and serving life sentences
individuals:
n (%)

Agency or agencies are responsible for delivering prison health care: Ministry of Justice and State
Subordinate Institution – Special Penitentiary Service (SPS) of the Ministry of Justice and in terms
of the state funded programs - the Ministry of IDPs from the Occupied Territories, Health, Labour
and Social Affairs of Georgia, with 16.7% of Member States reporting Ministry of Health only (or health
Ministry of Justice and Special Penitentiary Service (SPS) of the Ministry of Justice.
To what extent is health care of people in prison covered by any health insurance systems:
Another situation: Health-care for people in prison is fully covered by the SPS with exception of
state funded treatment programs for Hepatitis B, Hepatitis C, HIV, TB, Drug detox treatment, etc.
Health care fully covered by health insurance was reported by 41.7% of Member States (n =36).

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) in prisons on
full-time equivalents (FTEs) and ratio (per 1000 incarcerated people) for a known year:

FTE
Nurses 209 22.9
Physicians 167 18.3
Psychiatrists 12 1.3
Dentists 9 1.0
213
Georgia
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


214
Georgia
HEALTH INFORMATION

States with
records in all prisons were reported Screening tests performed YES 91.7
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
215
Georgia
HIV HCV HBV STI

opt-out opt-out basis opt-out basis opt-out basis
basis
50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
All prisons A minority
Offered at All prisons No prisons
of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

216
Georgia

last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
217
Georgia

D: HEALTH OUTCOMES
Mental health
disorders
satisfaction):

86.1 83.3 In all prisons. Having mental health counsellors in
(n =36).
REHABILITATION
Access to: MORTALITY

Suicide 5 54.7 27.7 a
COVID-19 0 0.0 62.9 b

In all prisons In all prisons disease

% Member States with “All prisons” causes

75.0 88.9
b

218
Georgia
MORBIDITY

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
219
Georgia


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: SPS is currently working on the new advanced IT infrastructure where medical module will be covered. Hence, in the future we will be in a position to include and
provide indicated data on health behaviors.
220
Georgia


“No” (77.8%, out of n =36).




YES

221
Germany 83 166 711
Population, 2020
High
Income group
US$ 46 252
OFFICIAL PRISON CAPACITY: OCCUPANCY LEVEL (%) 80.1

*
72385
NUMBER NEWLY ADMITTED IN THE PREVIOUS YEAR: Per 100 000 of national population
MISSING
*Not possible to aggregate
NUMBER OF PEOPLE IN PRISON:
58004
Federal state people living in prison n (%)
National data 58004 (100.0)

Baden-Württemberg (BW) 6570 (11.1)
Bayern-Bavaria (BY) 9653 (16.3)
Berlin (BE) 3222 (5.5)
Brandenburg (BB) 1118 (1.9)
Bremen (HB) 560 (0.9)
Hamburg (HH) 1829 (3.1)
Hessen-Hesse (HE) 4233 (7.2)
Meckenburg-Vorpommern – Mecklenburg-West Pomerania (MV) 1001 (1.7)
Niedersachsen- Lower Saxony (NI) 4620 (7.8)
Nordhein-Westfalen – North Rhine-Westphalia (NW) 15726 (26.6)
Rhineland-Palatine (RP) 2838 (4.8)
Saarland (SL) 761 (1.3)
Sachsen - Saxony (SN) 2796 (4.7)
Sachsen-Anhalt - Saxony-Anhalt (ST) 1657 (2.8)
Schleswig-Holstein (SH) 1072 (1.8)
Thüringen – Thuringia (TH) 1402 (2.4)
Methodological note: Germany is divided into 16 federal states (Länder), who have the competence for legislation on prison law and for the execution of the prison sentence. Therefore, the
focal point has considered more correct to provide an answer per federal state, which was analysed independently and then aggregated. Aggregation was conducted taking three approaches,
depending on the type of variable: Nominal or dichotomous variables (e.g., yes/no): assuming the response of most Länder and indicating in the profile how many Länder gave such an
answer. Whenever there are exceptions believed to be relevant, these are indicated as a comment or footnote to the data presented.
Ordinal data (e.g., all prisons, most prisons…): an intermediate response was considered to account for the diversity of federal states, with extreme answers (all prisons vs no prisons) only
being assumed in case answered by all federal states.
Numerical data (mortality, morbidity and behaviors), a similar approach could not be used because most federal states provided no data. Therefore, two types of data have been used:
a. Published data from external sources indicating the federal state and year it refers to, and also indicating the proportion of prison population covered (as indicated by World Prisons Brief).
b. Whenever data has been reported by federal states, the sum of federal states providing complete answers is given and using the sum of population as denominator to estimate proportions.
In certain variables, when the national response for Germany is presented, a comparison is made with the most common answer from the other Member States that have participated in
HIPEDS.
222
Germany
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9 France
93.1
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark
70.2
72.4 Germany
69.7
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
People living in prison per 100 000 inhabitant s

Number of prison
establishments
in the country
279 Females
n
3 307 5.7
%
Under 18 649 1.1

Above 50 8 669 15.0
over the last 12-month period: missing
MISSING

individuals:
n (%)
Number of unsentenced/remand prisoners 12 064 (20.8)a Physically disabled MISSING MISSING

a
Remand prisoners
223
Germany

Agency or agencies are responsible for delivering prison
health care: Ministry of Justice only (indicated by 10 federal
states in Germany)1, with 16.7% of the 36 Member States reporting
1
There were some federal states (BY and HE) indicating the option “Both Ministry of Health and
Ministry of Justice” but adding “the focus of the responsibility lies in the ministry of Justice”
and therefore considered equivalent to the answer provided in most federal states.

Ministry of Justice only (answer provided by 12 federal states)2. Most
Member States (50%, out of n =36) are financed by the Ministry of Justice only.
2
BY indicated “Both Ministry of Health and Ministry of Justice” and RP indicated “Another situation” but adding “The Ministry
of Justice applies to the Ministry of Finance, which is responsible for the allocation of funds, for the expected funds required
as part of the budget planning” and therefore considered equivalent to the answer provided in most federal states.

insurance systems: Another situation: In in all of Germany, health
services are provided by or through the prison / prison administration;
the statutory health insurance is not in charge of (sentenced) prisoners.
The principle of equivalence states that the standards of health
services provided by or through the prison must be equivalent to the
standards of service covered by the statutory health insurance.
Health care fully covered by health insurance was
reported by 38.9% of Member States (n =36).

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) on full-time equivalents
(FTEs) and ratio (per 1000 people) for a known year:
FTE
Total staff MISSING 24.1
Nurses MISSING 14.0
a
Physicians 329 4.5
5.7
Psychiatrists MISSING 0.3
224
Germany
ACCEPTABILITY
% Member States
Offered at
Most prisons (15 federal states all; 1 federal state
DTP 72.2
most; % FS with “all prisons”: 93.75)
Most prisons (9 federal states all prisons; 1 federal state most; 5 federal
Human Papilloma virus 52.9
states minority; 2 federal states none; % FS with “all prisons”: 56.25)
Most prisons (12 federal states all; 3 federal states most;
Hepatitis A 55.9
1 federal state none; % FS with “all prisons”: 75.00)
Hepatitis B 69.4
1 federal state none; % FS with “all prisons”: 75.00)
Most prisons (14 federal states all; 2 federal states
Seasonal flu 83.3
Most prisons (11 federal states all; 2 federal states most; 2 federal
MMR 61.8
states minority; 1 federal state none; % FS with “all prisons”: 68.75)
Most prisons (10 federal states all; 2 federal states most; 1 federal
Meningococcal vaccination 52.9
state minority; 3 federal states none; % FS with “all prisons”: 62.50)
Pneumococcal vaccination 57.6
2 federal states none; % FS with “all prisons”:68.75)
Most prisons (15 federal states all; 1 federal state
COVID-19 91.4
Proportion of prison establishments where people in prison have access to HIV prophylaxis:
Post Exposure Post Exposure
In most prisons (14 federal states In a minority of prisons (5 federal

all; 2 federal states most; % FS states all; 1 federal state most; % Member States with “All prisons”
with “all prisons”: 87.50) 6 federal states none; 2 missing;
% FS with “all prisons”: 31.25) Post Exposure Pre-exposure
77.8 58.3
QUALITY OF CARE % Member

Yes/No States with
“Yes”

(14 federal states; 2 FS stated
no; % FS with “yes”: 87.50)

(14 federal states; 2 FS stated
yes; % FS with “yes” 12.50)

No (10 federal states; 6 FS stated
Yes; % FS with “yes”: 37.5)
225
Germany
HEALTH INFORMATION
Inform public health
authorities about diseases
amongst prisoners:
Yes, for infectious diseases
only (11 FS: 73.33%; 2 FS stated
“for both IDs and NCDs”: Information registered in clinical records:
13.33; 2 FS stated “no”:13.33;
% Member
and 1 FS could not provide an Yes/No States with
answer given the diversity “Yes”
of arrangements within the Screening tests performed YES 91.7
state). Public health authorities (all FS: 100.00)
being informed for both IDs and Screening tests results YES 94.4
for NCDs was reported by 45.50% (all FS: 100.00)
of Member States (n =33).
(all FS: 100.00)
Keep clinical health records Health behaviours YES 97.2
of people in prison: (all FS: 100.00)
Yes, in some prisons we keep paper- Diagnoses established YES 97.2
based clinical health-records and in (all FS: 100.00)
health records (reported by 9 federal
(all FS: 100.00)
states; 7 federal states reported paper-
Treatment and medications 97.2
based only). Electronic clinical health YES
records in all prisons were reported by (all FS: 100.00)

C: HEALTH SERVICES
PREVENTIVE SERVICES
Number of unique individuals receiving a health examination following admission:
Not available (21 113 provided by 7 regions; the other 9 stated data was not recorded, even if in
many a comment was added to say “all people entering prison undergo an initial evaluation”)
DISEASE PREVENTION
History of TB and current signs and symptoms assessed on or close to reception for all
people in prison:
Yes, clinical assessment and diagnostic tests are made and when the test is positive, additional
assessment for MDR-TB is ensured (9 regions marked this option). Most Member States report “Yes,
clinical assessment and diagnostic tests are made and when the test is positive, additional assessment for
226
Germany
HIV HCV HBV STI

screening/ opt- screening/ opt- screening/ opt- screening/ opt-
in / opt-out 1 in / opt-out 1 in / opt-out 1 in / opt-out 1

50.0 42.9 37.1 32.4
1
Risk-based for 6 federal states, opt-in for 6 federal states (37.5% of FS) and opt-out for 4 federal states

YES YES YES
(13 federal states; 3 FS stated Yes (14 federal states; 2 FS stated Yes (13 federal states; 3 FS stated
no; % FS with “yes”:81.25) no; % FS with “yes”:87.5) no; % FS with “yes”: 81.25)
% Member
States with “Yes” 66.7 58.3 66.7
In BW, although yes was answered, a comment was added to say “if necessary”; therefore, not counted
HEALTH PROTECTION

syringes
All prisons (16 federal Most prisons (9 federal states A minority of prisons A minority of prisons
states; % FS with “all all; 2 federal states most; (2 federal states all; 2 (1 federal state
prisons”: 100.00) 3 federal states minority; 2 federal states most;3 minority; 15 federal
federal states none; % FS federal states minority; 9 states none; % FS with
with “all prisons”: 56.25) federal states none; % FS “all prisons”: 0.00)
with “all prisons”:12.50)
% Member States
97.2 47.1 12.1 8.3

sanitary towels
A minority of prisons (2 federal A minority of prisons (1 federal All prisons (16 federal states;
states all; 1 federal state state minority; 14 federal states % FS with “all prisons”: 100.00)
minority; 13 federal states none; none; 1 federal state missing;
% FS with “all prisons”:12.50) % FS with “all prisons”:0.00)
% Member States
30.6 28.6 72.2
227
Germany
HEALTH PROMOTION

country applicable to prisons: Yes, nationwide
(marked by 13 federal states and refer
exceptions to the policy, cell and outside;
% FS with “yes”: 81.25). Most Member States
Health promotion materials like

brochures and leaflets available on safe
tattooing practices: Yes, in 12 federal
states (75.00%; 4 FS stated No).

Therapeutic spaces available for people with drug
use problems: A minority of prisons (8 federal states
answering “no prisons”, 3 federal states “minority”, 2
federal states answering “all prisons”, 1 federal state
“most prisons”; 2 federal states did not answer). Most
Member States reported “In a minority of prisons” (48.6%,
out of n =35)
Suspected cases of an infectious disease with

access to laboratory tests: Yes, everyone in prison
has access to laboratory tests when these are
necessary (16 federal states; % FS with “yes”:
100.00). Most Member States report “Yes, everyone in
prison has access to laboratory tests when these are
necessary” (94.4%, out of n =36).
last 12 months:
n (%)
Tuberculosis (TB)
Individuals receiving TB treatment over the last 12-month period 21 (-) a (reported by BB,
BW, TH and SN)
Individuals completing TB treatment over the last 12-month period 12 (92.3) (reported by BB and SN)
Individuals receiving MDR-TB treatment over the last 12-month period 2 (-) a (reported by BB, SN and BW)
Individuals completing MDR-TB treatment over the last 12-month period 0 (100) (reported by BB and SN)
HIV
Individuals with HIV who received treatment over the last 12-month period 25 (47.2) b
18 (94.7) c
228
Germany
Number and proportion of people diagnosed that received or completed 1 2
treatment over the last 12 months (contd):
Hepatitis C
Individuals with chronic HCV infection who received antiviral treatment over the last 31 (5.2) b
12-month period 52 (24.8) c
Individuals who following antiviral treatment achieved sustained viral response over the last 16 (30.8) c
12-month period
Hepatitis B
Individuals with chronic HCV infection who received antiviral treatment over the last 8 (100.0) c
12-month period
Individuals who following antiviral treatment achieved sustained viral response over the last 3 (37.5) c
12-month period
Individuals with STIs who received treatment over the last 12-month period 10 (100.0) c
Individuals completing STI treatment over the last 12-month period 10 (100.0) c
Oral health
Individuals with oral health visit over the last 12-month period 8390 (14.5) c
Individuals who have received treatment for any mental health disorder over the last 12-month 1083 (94.1) c
period
Individuals who have received pharmacological treatment for a substance use disorder over the 1341 (88.7) b
last 12-month period 1543 (86.7) (reported by TH and SN)
Individuals who have received pharmacological treatment for an opioid use disorder over the last 497 (Not available) b
12-month period 295 (19.1) c
3.357 (41.9) d
Diabetes Mellitus
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits 94 (80.3) c
Individuals with a diabetes mellitus diagnosis who had at least one ophthalmology visit over the 57 (48.7) c
last 12-month period
Individuals who have received pharmacological treatment for diabetes over the last 12-month 111 (94.9) c
period
Hypertension
Individuals who have received pharmacological treatment for hypertension over the last 579 (92.2) c
12-month period
Individuals with a CVD diagnosis who had at least one routine health-care visit over the last 151 (68.0) c
12-month period
Individuals who have received pharmacological treatment for cardiovascular disease over the 115 (51.8) c
last 12-month period
Cancer
Individuals who have received treatment for cancer over the last 12-month period 16 (64.0) c
a
b
Absolute numbers and prevalence data indicated for infectious diseases extracted from a published report which represents the region of Baden-Wuerttemberg, which hosts 6568
people in prison (11% of total prison population). This option was taken because data for this region is up to date (2019) and more exhaustive and most of the regions were not able to
provide morbidity data.
c
HCV data reported by 4 regions and proportion calculated using the total number of HCV diagnosis reported for the same 4 regions. HIV, TB and oral health data reported by 3 regions.
Diabetes, cancer and hypertension data reported by 2 regions. CVD reported by one region. The same methodology was used.
d
Data on substitution therapy obtained from a national report, where the total number of people with Opioid use disorder reported was 8.014
1
2
229
Germany

transferring people in prison to specialized Yes (answered provided by 10 regions; 3 regions
institutions to treat: stated “no”). Having this support service was

Mental health
Cancer
disorders Yes/No % Member States
with “Yes”
Scheduling medical YES

a
70.6
appointment
In all prisons a In most prisons b upon release
(% FS with “all (% FS with “all
prisons”:100.00) prisons”:87.50) Development of a Care YES
b
76.5
external providers
% Member States with “All prisons” a
mentioned by 3 regions and in another 2 stated “if needed”; b
mentioned by 4 regions and in 1 region stated “if needed”

86.1 83.3 Procedure in place to ensure
a
Answer indicated by all 16 regions; b medication is reconciled:
Reported as “in all prisons” by 14 regions, “in a minority of prisons” by 1 region and Not reconciled in most regions (10
“in no prisons” in 1 region, therefore considered to be “most prisons”.
regions stated "No" and 6 stated "Yes").
Most members states stated to have this
procedure in place (72.2%, out of n =36).
REHABILITATION
Access to: Medication provided upon release:
Yes in 15 regions (for all diseases in
6 regions, "case dependent" in 1 region
and for some diseases in 8 regions; not
provided in 1 region). Most members states
stated to provide medication upon release
for some conditions (50.0%, out of n =36).
In most prisons In all prisons (16 federal

(15 federal states states; % FS with “all
all; 1 federal state prisons”: 100.00) People are allowed to continue their family
most; % FS with “all relationships by web communication:
prisons”: 93.75)
Yes, with time restrictions (11 federal
states (68.75%); 5 federal states said
“no”). Most Member States report “Yes, with
In 9 federal states, people are placed
75.0 88.9
considering the location of their home “as
much as possible” and in 7 federal states
this is not done; no FS stated “always”.
230
Germany
D: HEALTH OUTCOMES
HEALTH AND WELL-BEING MORTALITY

Total mortality and mortality rates per 100 000
Assessments of perceived well-being incarcerated person year:
Yes, on an ad hoc basis (answer given by Total Mortality Mortality
7 regions; 5 regions mentioned “regularly” 100 000 100 000 people
and 4 regions mentioned “never”). incarcerated (general pop.)
people
Assessments conducted regularly were
reported by 19.4% of Member States (n = 7). Total deaths 172 a 237.6 a 1 155.1b
Access to mental health counsellors: Suicide 78 a 107.8 a 11.4 b

In all prisons (16 regions). Having mental
Drug 1a 0.00 0.9 b
health counsellors in all prisons was reported overdose
COVID-19 0 0.00 40.3 c
a
Values indicated are a sum of all federal states (n =16)
b
c
Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data
was not available in open source).
MORBIDITY
n (%)
Tuberculosis (TB)
Active TB diagnosis 9 (0.1) a
39 (0.2) b
Active MDR-TB diagnosis 0 (0.0) a
2 (0.0) a.a
HIV
Active HIV diagnosis 53 (0.8) a
112 (0.4) c
Hepatitis C
Chronic HCV infection (HCV RNA positive) 596 (9.1) a
1411 (6.6) b
Hepatitis B
Chronic HBV (HBsAg) 264 (4.0) a
347 (1.6) b
STI diagnosis (last 12-month) 8 (0.1) a
18 (0.2) d
COVID-19
SARS-Co-V2 infection laboratory confirmed 857 (1.6) e
Oral health
Individuals keeping 21 or more natural teeth MISSING
231
Germany
Number and proportion 1 of unique individuals living in prison diagnosed with (contd):
n (%)
Mental disorder diagnosis on record 6437 (98.0) a
5838 (54.2) f
Psychotic disorder diagnosis on record 529 (18.9) g
Recorded suicide attempt events (last 12-month) 7 (0.3) g
35 (0.5) a
Active drug use disorder (last 12-month) 15,726 (27.0) h
11,212 (40.8) i
Diabetes Mellitus
Diagnosis on record 117 (2.8) j
Hypertension
Diagnosis on record 222 (7.9) g
Cancer
a
Absolute numbers and prevalence data indicated for infectious diseases only represents the region of Baden-Wuerttemberg, which hosts 6568 people in prison (11% of total prison
population). This option was taken because data for this region is up to date (2019) and more exhaustive and most of the regions were not able to provide morbidity data.
a.a
Baden-Wuerttemberg reported data for HIPEDS. Total population considered 6570.
b
Data reported by five regions, the prevalence is estimated considering the total population in these same regions (Baden-Wurtenburg, 6568; Bavaria, 9653; Bradenburg, 118; Sachen,
2796; Thueringern, 1402; total=21,537)
c
Data reported by six regions, the prevalence is estimated considering the total population in these same regions (Baden-Wurtenburg, 6568; Bavaria, 9653; Bradenburg, 118; Hessen,
4233; Sachen, 2796; Thueringern, 1402; total=25,770)
d
Data reported by four regions, the prevalence is estimated considering the total population in these same regions (Bradenburg, 118; Thueringern, 1402; Sachen, 2796; Baden-
Wurtenburg, 6568; total=11,886)
e
Data reported by 13 regions, the prevalence is estimated considering the total population in these same regions (n =53,178)
f
Data reported by three regions, the prevalence is estimated considering the total population in these same regions (Baden-Wutenburg, 6570; Sachen, 2796; Thueringern, 1402;
total=10768)
g
Data reported by one region, the prevalence is estimated considering the total population in this same region (Sachen, 2796).
h
Obtained from the Annual fact sheet on substance-related addiction problems in German prisons (03/2021) which includes data from 15 of the 16 federal states, available at https://
www.berlin.de/justizvollzug/_assets/senjustv/sonstiges/fact-sheet_sucht_substitution_im_justizvollzug_2021.pdf
i
Data reported by 6 regions (Thueringern, 1402; Sachen, 2796; Bavaria, 9653; Baden-Wurtenburg, 6568; Hessen, 4233; Rhineland-Palatine; total=27,492)
j
Data reported by 2 regions (Thueringern, 1402 and Sachen, 2796; total=4198)
1
Note that the numbers presented are not national, but they represent figures provided by some of the federal states, as indicated between brackets and in footnotes to the table.
Whenever percentages are presented, these are calculated considering the total population only in the same federal states providing the data. In addition, it is important to note
that the prevalence estimates are presented considering all diagnoses on record throughout the year, but the denominator only considers the total number of prison population by
31.12.2020, so values should be interpreted with caution.
Note: there were 3 regions that indicated missing for all diseases listed.
232
Germany

Offered at All prisons a All prisons a All prisons a Yes b

“All prisons” 69.4 94.4 91.7 88.9
a
Answer provided by 16 regions.
b
Answer provided by 8 regions; 7 regions answered “no” and 1 region said “not applicable” as only men are hosted
BMI≥ 25 1050 (37.55) a MISSING MISSING
BMI≥ 30 160 (5.72) a MISSING MISSING
Currently use tobacco products 5517 (84.0) b MISSING MISSING

2600 (92.99) a MISSING MISSING
(last 12 months)
Use/have used drugs

3193 (25.65) c MISSING MISSING
(last 12 months)

1240 (18.88) b MISSING MISSING
(last 12 months)

7385 (48.31) d MISSING MISSING
of 150 minutes/week
a
Data reported by one federal state and proportions estimated for the same federal state (SN, which hosts a total of 2796 individuals in prison).
b
Absolute numbers and prevalence data indicated extracted from a published report which represents the federal state of Baden-Wuerttemberg, which holds 6568 people in prison
(11% of total prison population).
c
Data reported by two federal states (SN, 2796; BY, 9653; total=12,449) and proportions estimated for the same federal states.
d
Data reported by three federal states (SN, 2796; BY, 9653; RP, 2838; total=15,287) and proportions estimated for the same federal states.
233
Germany
G: ADHERENCE TO THE PRINCIPLE OF EQUIVALENCE AND OTHER

Decisions taken by health staff can be overruled or

ignored by non-health prison staff: No (indicated
by 12 regions; 4 regions stated yes, out of which
2 stated “in justified exceptional cases”). Most
Member States report “No” (77.8%, out of n =36).
National health-care complaints system, available

to prisoners: Yes (15 federal states (93.75%).
Most Member States report “Yes” (69.4%, out of
n =36). Number of complaints received: 194.
H: REDUCING HEALTH INEQUALITIES AND ADDRESSING THE NEEDS OF

SPECIAL POPULATIONS
National standards to meet the health needs of special populations in prison: Yes, for all special
populations (most standards referred by 2-4 regions, in 6 regions “none”, in 4 regions “same
as outside”, in 2 regions “not applicable at the federal level” and in 1 region “unknown”).
National standards to meet the health needs of special populations based on
relevant international standards: No (answer indicated by 7 regions).
Health related information products for people in prison in multiple languages: In all prisons
(answer indicated by 12 regions). Most Member States report “In all prisons” (52.8%, out of n =36).
Option to be Pregnancy test Possibility of

attended by female on admission prenatal care or
health care staff to prison termination, in case
of a positive result
a b c
% Member States 75.0 61.1 100.0

with “Yes”
a
Answer indicated by 14 regions (1 not applicable and 1 invalid); b Answer indicated by 6 regions, which stated “not by routine, only when needed/upon
suspicion” (2 answered “yes, and regularly repeated” and 6 answered “no”); c Answer provided by 7 regions (2 answered “no” and 7 “missing/NA”)
Number of women who gave birth whilst in prison in the last 12 months:
n =37 (1.12% of all women living in prison) – data obtained from 13 regions
(2 regions provided no data and another region indicated “not applicable).
234
235
Greece 10 718 565
Population, 2020
High
Income group
US$ 17 647

10175
11379 *Did not participate
6267
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia
Cyprus
66.5
67.8 Greece
Germany
106.2
69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
236
Greece
Number of prison
establishments
in the country
n %
Females 527 4.6
Pregnant 2 0.4

over the last 12-month period: 1.5 months Above 50 2 134 18.8
Above 65 261 2.3
Migrants a
6 799 59.8
Number of individuals serving life sentences 925 (8.1) Intellectually disabled 139 61.2
a
Foreign inmates, i.e., inmates with a nationality other than Greek

Both Ministry of Health and Ministry of Citizen Protection, with 16.7% of
Member States reporting Ministry of Health only (or health authorities) (n =36).
The Ministry of Health, the Ministry of Citizen Protection
and the Competent Health Districts. Most Member States
(50%, out of n =36) are financed by Ministry of Justice only.
insurance systems:

AVAILABILITY
FTE 0 2 4 6 8 10 12
Total staff 128

11.3
3.4
Nurses 71
6.2
Physicians 50 a
4.3
0.3
Psychiatrists 2
0.2
Dentists 5
0.4

237
Greece
ACCEPTABILITY

DTP Most prisons 72.2
A minority
of prisons
A minority
Hepatitis A 55.9
of prisons
A minority
Seasonal flu 83.3
of prisons
A minority
of prisons

In most prisons In a minority of prisons

77.8 58.3
QUALITY OF CARE


238
Greece
HEALTH INFORMATION
Missing. Public health authorities being
informed for both IDs and for NCDs was

Yes, in some prisons we keep paper- Yes/No % Member
based clinical health-records and in States with
“Yes”
health records. Electronic clinical health
records in all prisons were reported Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
239
Greece
HIV HCV HBV STI

Yes, on an Yes, on an Yes, on an
opt-in basis opt-in basis opt-in basis NO

50.0 42.9 37.1 32.4

NO NO NO
HEALTH PROTECTION

syringes
Offered at No prisons No prisons No prisons No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

240
Greece

last 12 months:
n (%)
Tuberculosis (TB)
HIV
Hepatitis C
Hepatitis B

Oral health

Diabetes Mellitus
75 (62.5)
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits
Hypertension
Cancer
a
1
2
241
Greece

D: HEALTH OUTCOMES
Mental health
disorders
In most prisons In all prisons
In a minority of prisons. Having mental health
86.1 83.3 counsellors in all prisons was reported by 72.2% of
REHABILITATION
MORTALITY
Access to:
Total deaths 69 606.4 1 600.7 a
Suicide 6 52.7 12.3 a
Education and training Employment Drug overdose 0 0.0 1.5 a

COVID-19 4 35.2 46.7 b
Homicide 1 8.8 -
a
% Member States with “All prisons” males over 20 years)
b
Education and training Employment available in open source).
75.0 88.9

Yes, with time restrictions / Yes, free of
charge. Most Member States report “Yes, with
242
Greece
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health


Diabetes Mellitus
Hypertension
Cancer
1
243
Greece

Offered at All prisons Most prisons All prisons All prisons

“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification 1: SPS is currently working on the new advanced IT infrastructure where medical module will be covered. Hence, in the future we will be in a position to include and
provide indicated data on health behaviors.
Clarification 2: Smoking status is part of the initial assessment made but it is not tracked during imprisonment, considered a constantly changing variable. The remaining variables
are not part of the initial assessment.
244
Greece


“No” (77.8%, out of n =36).




NO NO

with“Yes”
Number of women
who gave birth
whilst in prison in
the last 12 months:
n =5 (1.0% of all women
living in prison).
245
Hungary 9 769 526
Population, 2020
High
Income group
US$ 16 075

17402
16732 *Did not participate
11740
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2 Hungary
Ireland
Luxembourg
Switzerland
73.5
79.7
80.1
171.3
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
246
Hungary
33
Number of prison
establishments n %
in the country Females 1 288 7.7
Under 18 29 0.2
Above 50 2 952 17.6
Above 65 289 1.7
Migrants 997 6.0
Disabled 251 1.5
n (%)

Agency or agencies are responsible for delivering prison health care: Both
Ministry of Health and Ministry of Justice/ Ministry of Interior, with 16.7% of
Member States reporting Ministry of Health only (or health authorities) (n =36).
Both Ministry of Health and Ministry of Justice/ Ministry of Interior. Most
Member States (50%, out of n =36) are financed by Ministry of Justice only.
insurance systems:
Separate health insurance system. Health care fully covered by

AVAILABILITY
FTE 0 5 10 15 20 25 30 35
13.2
Total staff 509
30.4
Nurses 361 6.6

21.6
Physicians 95 3.5 a
5.7
1.0
Dentists 0.7
34
2.0
247
Hungary
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


248
Hungary
HEALTH INFORMATION
Keep clinical health records

Yes, in some prisons we keep paper-
based clinical health-records and in % Member
others we keep electronic clinical Yes/No States with
“Yes”
records in all prisons were reported YES
by 22.2% of Member States (n =36). Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
249
Hungary
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES NO NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

250
Hungary

Yes, everyone in prison has access to laboratory tests when these are necessary. Most Member
States report “Yes, everyone in prison has access to laboratory tests when these are necessary”
(94.4%, out of n =36).
last 12 months:

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
Clarification: Most data are recorded in individual electronic clinical files but not available for extraction in aggregate manner.
251
Hungary


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
(n =36).
programmes opportunities MORTALITY
100 000 100 000 people
people
Total deaths 71 424.3 1 691.8 a
Education and training Employment Drug overdose MISSING MISSING 1.3 a

COVID-19 5 29.9 99.0 b
75.0 88.9
Neoplasm 38 227.1 502.9 a

People are allowed to continue their family disease
with time restrictions.Most Member States report a
“Yes, with time restrictions” (38.9%, out of n =36). (2019), (As the female prison population is 7.7%, the general population data is given only for
b
252
Hungary
MORBIDITY


MISSING
HIV
Hepatitis C
Hepatitis B

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
has been provided for the same reference year
Clarification: Most data are recorded in individual electronic clinical files but not available for extraction in aggregate manner.
253
Hungary


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
254
Hungary


“No” (77.8%, out of n =36).




YES NO

with“Yes”

255
Ireland 4 964 440
Population, 2020
High
Income group
US$ 85 422

4375
3650
5263
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7 Ireland
Switzerland 80.1
Croatia
Italy
Bulgaria
87.0
89.5
89.9
73.5
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
256
Ireland
12
Number of prison
n %
establishments
Females 146 4.0
in the country
Pregnant 6 4.1
Under 18 0 0.0
Above 50 478 13.1
Above 65 114 3.1
Migrants 569 15.6
Unsentenced and serving life sentences Minorities MISSING MISSING
individuals:
n (%)

Both Ministry of Health and Ministry of Justice/ Ministry of Interior, with 16.7%
of Member States reporting Ministry of Health only (or health authorities) (n =36).
Ministry of Justice only. Most Member States (50%, out of n =36) are financed by
Ministry of Justice only.
insurance systems:

AVAILABILITY
FTE 0 10 20 30 40 50 60
Total staff 208.3

57.1
Nurses 151.0
41.4
14.0 3.5
Physicians 3.8
a
7.0 0.2
Psychiatrists 1.9
2.5
Dentists 0.6
257
Ireland
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


258
Ireland
HEALTH INFORMATION
Yes, for infectious diseases only (IDs)
that are notifiable. Public health
authorities being informed for both
IDs and for NCDs was reported by

% Member
by 22.2% of Member States (n =36). Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

259
Ireland
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
All prisons A minority of on a No prisons No prisons

Offered at
case-by-case basis
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

country applicable to prisons: Yes, in specific
regions of the country. Most Member States
260
Ireland

Yes, everyone in prison has access to laboratory tests when these are necessary. Most Member States report
“Yes, everyone in prison has access to laboratory tests when these are necessary” (94.4%, out of n =36).
Number and proportion1 of people diagnosed that received or completed treatment over the
last 12 months:
n (%)
Tuberculosis (TB)
6 (1 active case &
Individuals receiving TB treatment over the last 12-month period
5 latent cases) a

HIV
Individuals with HIV who received treatment over the last 12-month period 96
Hepatitis C
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period 55
Hepatitis B

Oral health


Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period 1293 b
Diabetes Mellitus
Hypertension
Cancer
a
b
Data provided by the Drug Treatment Centre Board (DTCB).
1
Proportion cannot be presented as denominators (diagnoses) were missing.
Clarification: This data is recorded on each patient’s file, as part of their individual electronic record. However, it has not been possible to collate such data, as PHMS is an electronic health-
care record system, and not a reporting tool.
261
Ireland


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
(n =36).
MORTALITY
100 000 100 000 people
In all prisons In all prisons people

Suicide MISSING MISSING 20.0 a

Drug MISSING MISSING 8.0 a
programmes opportunities overdose
75.0 88.9
COVID-19 0 0.0 44.9 b

relationships by web communication: (2019), (As the female prison population is 4.0%, the general population data is given only for
No. Most Member States report “Yes, with males over 20 years)
time restrictions” (38.9%, out of n =36). Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data was
b
262
Ireland
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
263
Ireland


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
264
Ireland


“No” (77.8%, out of n =36).




Yes, but not in Yes, and they are repeated YES

prison at regular intervals

265
Italy 59 641 488
Population, 2020
High
Income group
US$ 31 834

50779
53364
35280
San Marino 23.0

Monaco 38.2
Finland
Netherlands
47.0
54.5
Italy
89.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
266
Italy
198
Number of prison
establishments n %

over the last 12-month period: 60 months Above 50 9 504 17.8
Above 65 4 630 8.7
individuals:
n (%)

Ministry of Health only (or health authorities), with 16.7% of Member States
Ministry of Health only. Most Member States (50%, out of n =36) are financed by
insurance systems:
Fully covered by health insurance. Health care fully covered by health insurance
was reported by 41.7% of Member States (n =36).

AVAILABILITY
FTE 0 5 10 15 20 25
20.8
Total staff MISSING
6.1
Nurses 1067
20.0
534 4.0 a
Physicians 10.0
0.2
Psychiatrists 107
2.0
0.9
Dentists 107
2.0
267
Italy
ACCEPTABILITY

A minority
of prisons
A minority
MMR 61.8
of prisons
A minority
of prisons
A minority
of prisons


77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


268
Italy
HEALTH INFORMATION
MISSING Public health authorities being
informed for both IDs and for NCDs was

Yes, in some prisons we keep paper- Yes/No % Member
States with
others we keep electronic clinical Screening tests performed 91.7
YES
records in all prisons were reported Screening tests results YES 94.4
Visits to external care providers NO 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
269
Italy
HIV HCV HBV STI



YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prisons All prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

270
Italy

last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
271
Italy


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
(n = 7).
counsellors in all prisons was reported by 72.2%
MORTALITY
100 000 100 000 people
In most prisons In all prisons people
Total deaths 186 348.6 1 294.4 a

Suicide 63 118.1 15.4 a
Education and training Employment Drug MISSING MISSING 1.8 a

programmes opportunities overdose
75.0 88.9
COVID-19 15 28.1 122.8 b
a
People are allowed to continue their family (2019), (As the female prison population is 4.2%, the general population data is given only for
relationships by web communication: males over 20 years)
No. Most Member States report “Yes, with Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data was not
b

272
Italy
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
273
Italy

All prisons All prisons Most prisons A minority

Offered at
of prisons

“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Although data are recorded in individual electronic clinical files, the current legislation in Italy on health care for prisoners (Legislative Decree 230/99 and subsequent
additions) does not allow the Department of the Penitentiary Administration to access this information, not even in aggregate form.
274
Italy


“No” (77.8%, out of n =36).





n =28 (1.2% of all women living
in prison).
275
Latvia 1 907 675
Population, 2020
High
Income group
US$ 17 703

4822
3095
2702
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8 Latvia
Germany
162.2
69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
276
Latvia
9
Number of prison Social characterization of people in prison
establishments
n %
in the country
Females 253 8.2
Under 18 11 0.4
Above 65 113 3.7
sentences individuals: Disabled MISSING MISSING
n (%) Physically disabled MISSING MISSING
Number of unsentenced/remand prisoners 2031 (65.6) Intellectually disabled MISSING MISSING

Agency or agencies are responsible for delivering prison health care: Both Ministry
of Health and Ministry of Justice/ Ministry of Interior, with 16.7% of Member States
To what extent is health care of people in prison covered by any health insurance
systems:
Not covered by any health insurance. Health care fully covered by health insurance was

AVAILABILITY
FTE
9.0
Total staff 99
32.0
4.4
Nurses 49
15.8
41 3.3
Physicians a
13.3
2 0.2
Psychiatrists
0.7
0 0.7
Dentists
0.0
277
Latvia
ACCEPTABILITY

MMR No prisons 61.8


77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


278
Latvia
HEALTH INFORMATION

Yes/No States with
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
279
Latvia
HIV HCV HBV STI

Yes, on an Yes, on an Yes, risk-based Yes, risk-based
opt-out basis opt-out basis screening screening


YES YES NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

280
Latvia

last 12 months:


HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
44 (45.8)
96 (100.0)
Individuals who have received pharmacological treatment for diabetes over the last 12-month period
Hypertension
Cancer
a
Percentage not reported as number of individuals receiving treatment might be higher than individuals diagnosed with active TB.
1
2
281
Latvia

D: HEALTH OUTCOMES
disorders
In most prisons In all prisons Yes, on an ad hoc basis. Assessments conducted
86.1 83.3
REHABILITATION
MORTALITY
Access to:
100 000 100 000 people
people
Total deaths 33 1 066.2 1 781.3 a

COVID-19 0 0.0 34.0 b
In most prisons In all prisons a

b

75.0 88.9

282
Latvia
MORBIDITY

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
283
Latvia


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
284
Latvia


“No” (77.8%, out of n =36).




% Member States 75.0 61.1 100.0

with“Yes”

MISSING
285
Lithuania 2 794 090
Population, 2020
High
Income group
US$ 20 232

7326
5320
1630
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany
Denmark
69.7
70.2
Lithuania
Ireland
Luxembourg
72.4
73.5
79.7
190.4
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
286
Lithuania
8
establishments n %
Pregnant 3 1.2
Under 18 22 0.4
Above 50 746 14.0
Migrants 102 1.9

sentences individuals: n (%)
Disabled 124 2.3

insurance systems:
Partly covered by health insurance. Health care fully covered by

AVAILABILITY
FTE
15.5
Total staff 167
31.4
101 7.7
Nurses 19.0
4.6 a
Physicians 25
4.7
0.2
Psychiatrists 8
1.5
1.0
Dentists 5
0.9
287
Lithuania
ACCEPTABILITY
DTP No prisons 72.2

MMR No prisons 61.8


77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


288
Lithuania
HEALTH INFORMATION

Yes, we keep paper-based % Member
Yes/No States with
clinical health-records. Electronic “Yes”
clinical health records in all Screening tests performed YES 91.7
prisons were reported by 22.2%
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
289
Lithuania
HIV HCV HBV STI

Yes, on an Yes, risk-based Yes, risk-based Yes, on an
opt-out basis screening screening opt-out basis

50.0 42.9 37.1 32.4
“yes, on an opt-out basis”

YES NO YES
% Member States with “yes 66.7 58.3 66.7
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at Most prisons All prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

290
Lithuania

last 12 months:
n (%)
Tuberculosis (TB)
Individuals receiving TB treatment over the last 12-month period 43 (-)a
Individuals receiving MDR-TB treatment over the last 12-month period 8 (-)a
HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
291
Lithuania

D: HEALTH OUTCOMES
Mental health
disorders
(n = 7).
(n =36).
100 000 100 000 people
people
Total deaths 27 507.5 1 778.0 a
Suicide 7 131.6 77.1 a

programmes opportunities Drug overdose 0 0.0 4.2 a
COVID-19 0 0.0 66.8 b

disease
a
Source: Global Burden of Disease database, according to the most recent data available (2019),
% Member States with “All prisons” (As the female prison population is 4.7%, the general population data is given only for males over
20 years)
Education and training Employment b

programmes opportunities available in open source).
75.0 88.9

292
Lithuania
MORBIDITY
Number and proportion1 of unique individuals living in prison diagnosed with:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
MISSING
Diagnosis on record
Cancer
1
293
Lithuania


“All prisons” 69.4 94.4 91.7 88.9

476 (8.9) 415 (8.2) 61 (24.2)
(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: The indicators with missing data are not collected upon admission.
294
Lithuania


“No” (77.8%, out of n =36).




YES NO

295
Luxembourg 626 108
Population, 2020
High
Income group
US$ 116 356

600

MISSING
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg
Switzerland
79.7
80.1
Luxembourg
79.7
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
296
Luxembourg

Number of prison
n %
establishments MISSING
Females 22 4.4
in the country
Pregnant 1 4.6
Under 18 1 0.2
Mean length of incarceration per individual Above 50 MISSING MISSING
Migrants 208 41.7

individuals:
n (%)
Number of unsentenced/remand prisoners MISSING


Centre Hospitalier de Luxembourg,with 16.7% of Member States reporting
insurance systems:

AVAILABILITY
FTE
20.6
Total staff 30
60.1
15 11.4
Nurses 30.1
4 2.9 a
Physicians 8.0
0.2
Psychiatrists 3
6.0
1.0
Dentists 1
2.0
297
Luxembourg
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


298
Luxembourg
HEALTH INFORMATION

Yes/No States with
clinical health-records. “Yes”
Electronic clinical health records Screening tests performed YES 91.7
in all prisons were reported by
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

299
Luxembourg
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
Offered at All prisons All prisons MISSING All prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at All prisons All prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

300
Luxembourg

last 12 months:
n (%)
Tuberculosis (TB)
HIV
Hepatitis C
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period 40
Hepatitis B
Oral health

Diabetes Mellitus
Hypertension
Cancer
a
1
2
301
Luxembourg

D: HEALTH OUTCOMES
Mental health
disorders
satisfaction):
(n = 7).
(n =36).
100 000 100 000 people
people
Suicide 1 200.4 22.2 a

COVID-19 0 0.0 78.0 b
a
In all prisons In all prisons (As the female prison population is 4.4%, the general population data is given only for males over
20 years)
b
% Member States with “All prisons” available in open source).

75.0 88.9

302
Luxembourg
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
303
Luxembourg


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
304
Luxembourg


“No” (77.8%, out of n =36).




YES
Number of women who gave

birth whilst in prison in the last
12 months: n =0 (0.0% of all
women living in prison).
305
Malta 514 564
Population, 2020
High
Income group
US$ 28 946

421
865
1090
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria
Belgium
89.9
90.1
Malta
168.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
306
Malta
3
establishments n %
Pregnant 2 3.5
LGBTIQ 15 1.7
Under 18 18 2.1
Mean length of incarceration per individual Above 50 96 11.1
Migrants 408 47.2
Unsentenced and serving life Minorities 276 31.9

sentences individuals: Disabled 5 0.6
n (%)
Physically disabled 3 60.0
Intellectually disabled 2 40.0

Both Ministry of Health and Ministry of Justice/ Ministry of Interior, with
16.7% of Member States reporting Ministry of Health only (or health authorities)
(n =36).
Both Ministry of Health and Ministry of Justice/Ministry of Interior. Most
insurance systems:

AVAILABILITY
Total number of health-care staff (physicians, nurses, nursing assistants, etc., including external service providers) on full-time
FTE
19.7
Total staff 34
39.3
7.9
Nurses 26
30.1
4.1
Physicians 4 a
4.6
3 0.1
Psychiatrists 3.5
0.5
Dentists 1
1.2
307
Malta
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


308
Malta
HEALTH INFORMATION

of people in prison: Information registered in clinical records:
Yes, we keep paper-based
clinical health-records. Electronic % Member
Yes/No States with
clinical health records in all “Yes”
prisons were reported by 22.2% Screening tests performed 91.7
YES
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
309
Malta
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

310
Malta

last 12 months:
n (%)
Tuberculosis (TB)
HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
311
Malta


with “Yes”


D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
(n = 7).
(n =36).
MORTALITY
100 000 100 000 people
people

Suicide 2 231.2 13.1 a
75.0 88.9 COVID-19 0 0.0 42.4 b

disease
time restrictions. Most Member States report a
“Yes, with time restrictions” (38.9%, out of n =36). (As the female prison population is 6.6%, the general population data is given only for males
over 20 years)
b
312
Malta
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
313
Malta


“All prisons” 69.4 94.4 91.7 88.9
BMI≥ 25 229 (26.5) 201 (24.9) 28 (49.1)
BMI≥ 30 81 (9.4) 70 (8.7) 11 (19.3)

92 (10.6) 72 (8.9) 20 (35.1)
(last 12 months)
Use/have used drugs (last 12 months) 337 (39) 302 (37.4) 35 (61.4)

47 (5.4) 40 (5) 7 (12.3)
(last 12 months)

of 150 minutes/week
314
Malta


“No” (77.8%, out of n =36).

“Yes” (72.2%, out of n =36). Number
of complaints received: 0.




315
Monaco 39 244
Population, 2020
High
Income group
US$ 173 688

80
15 * Not available
46
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1 Monaco
Croatia 87.0
Italy
Bulgaria
89.5
89.9
38.2
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
316
Monaco
1
Number of prison
establishments n %
in the country
Females 2 13.3
Pregnant 0 0.0
LGBTIQ 0 0.0

over the last 12-month period: 3.4 months Above 50 3 20.0
Above 65 0 0.0
Migrants 0 0.0
Minorities 0 0.0

insurance systems:

AVAILABILITY

FTE
Total staff 4 266.7
Nurses 3 200.0
1
Physicians 66.7
1 66.7
Psychiatrists
1
Dentists 66.7
317
Monaco
ACCEPTABILITY

COVID-19 MISSING 91.4

All prisons No prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


318
Monaco
HEALTH INFORMATION

Yes/No States with
records in all prisons were reported Screening tests performed NO 91.7
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

319
Monaco
HIV HCV HBV STI


50.0 42.9 37.1 32.4

NO NO NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at All prisons All prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

320
Monaco

last 12 months:


HIV
Individuals with HIV who received treatment over the last 12-month period 0 (-)
Individuals completing HIV treatment over the last 12-month period 0 (-)
Hepatitis C
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period 0 (-)
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period 0 (-)
Hepatitis B
Individuals with chronic HCV infection who received antiviral treatment over the last 12-month period 0 (-)
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period 0 (-)

Individuals with STIs who received treatment over the last 12-month period 0 (-)
Individuals completing STI treatment over the last 12-month period 0 (-)
Oral health
Individuals with oral health visit over the last 12-month period 0 (-)

Individuals who have received treatment for any mental health disorder over the last 12-month period 0 (-)

Individuals who have received pharmacological treatment for a substance use disorder over the last 12-month period 0 (-)
Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period 0 (-)
Diabetes Mellitus
Individuals with a diabetes mellitus diagnosis who had at least two routine health-care visits 0 (-)
Individuals with a diabetes mellitus diagnosis who had at least one ophthalmology visit over the last 12-month period 0 (-)
Individuals who have received pharmacological treatment for diabetes over the last 12-month period 0 (-)
Hypertension
Individuals who have received pharmacological treatment for hypertension over the last 12-month period 0 (-)
Individuals with a CVD diagnosis who had at least one routine health-care visit over the last 12-month period 0 (-)
Individuals who have received pharmacological treatment for cardiovascular disease over the last 12-month period 0 (-)
Cancer
Individuals who have received treatment for cancer over the last 12-month period 0 (-)
a
1
2
321
Monaco

D: HEALTH OUTCOMES
Mental health
Cancer
disorders Assessments of perceived well-being
(n = 7).
Mental health disorders Cancer In all prisons. Having mental health counsellors in
(n =36).
REHABILITATION
MORTALITY
Access to:
100 000 100 000 people
people
Total deaths 1 6 666.7 1786.3 a
Education and training Employment Suicide 1 6 666.7 25.5 a

COVID-19 0 0.0 7.8 b
Neoplasm 0 0.0 827.2 a
In all prisons In all prisons Cardiovascular 0 0.0 498.6 a

disease

a
Education and training Employment (2019), (The general population data is given only for males over 20 years, due to low female
prison population)
b
75.0 88.9 available in open source).

322
Monaco
MORBIDITY

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health


Diabetes Mellitus
Hypertension
Cancer
1
323
Monaco


“All prisons” 69.4 94.4 91.7 88.9
BMI≥ 25 1 (2.2) 0 (0.0) 1 (50.0)
BMI≥ 30 2 (4.3) 2 (4.5) 0 (0.0)

(last 12 months)

0 (0.0) 0 (0.0) 0 (0.0)
(last 12 months)

7 (15.2) 7 (15.9) 0 (0.0)
of 150 minutes/week
Clarification: The numbers reported are for the newly admitted people to prisons in 2020, instead number of people in prison by 31.12.2020.
324
Monaco


“No” (77.8%, out of n =36).





325
Netherlands 17 407 585
Population, 2020
High
Income group
US$ 52 396

9505
9483
18494
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg
Switzerland
79.7
80.1
Netherlands
54.5
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
326
Netherlands
30
Number of prison
establishments n %
Under 18 0 0.0
Above 50 1 504 15.9
Above 65 177 1.9
Migrants 2 032 21.4
n (%)

Ministry of Justice only, with 16.7% of Member States reporting Ministry
of Health only (or health authorities) (n =36).
To what extent is health-care of people in prison covered by any

AVAILABILITY
FTE

52.7
10.7
Nurses 250
26.4
3.7 Source: Eurostat (2019)
Physicians 25
a
2.6
0.2
Psychiatrists 10
1.1
Dentists 10
0.6
1.1

327
Netherlands
ACCEPTABILITY

DTP No prisons 72.2
A minority
MMR 61.8
of prisons
A minority
of prisons
A minority
of prisons

All prisons All prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


328
Netherlands
HEALTH INFORMATION

of people in prison: Information registered in clinical records:
Yes, we keep electronic clinical health % Member
records. Electronic clinical health Yes/No States with
records in all prisons were reported “Yes”
by 22.2% of Member States (n =36). Screening tests performed YES 91.7
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

329
Netherlands
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prison No prison A minority of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

330
Netherlands

(94.4%, out of n =36).
Number and proportion of people diagnosed that received 1 or completed 2 treatment over the last
12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
Clarification: Data recorded in individual electronic clinical files but not available for extraction in aggregate manner as a special module is needed for extraction.
331
Netherlands

D: HEALTH OUTCOMES
Mental health
Cancer
satisfaction):
(n = 7).
Mental health disorders Cancer all prisons was reported by 72.2% of Member States
86.1 83.3 (n =36).
MORTALITY
Access to: mortality rates per rates per
100 000 100 000 people
people
Suicide 12 126.5 21.7 a


disease
a
In all prisons In all prisons (As the female prison population is 4.7%, the general population data is given only for males
over 20 years)
b

75.0 88.9

332
Netherlands
MORBIDITY

HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
333
Netherlands


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
334
Netherlands


“No” (77.8%, out of n =36).




NO

MISSING
335
Poland 37 958 138
Population, 2020
High
Income group
US$ 15 742
Gross national income per capital

84328
67894
3725
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2 Poland
Ireland
Luxembourg
73.5
79.7
178.9
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
336
Poland
Number of prison
establishments
in the country
Females
n
3 056
%
4.5

over the last 12-month period: MISSING Above 50 MISSING MISSING
Unsentenced and serving life sentences Migrants MISSING MISSING
n (%)

(n =36).
insurance systems:

AVAILABILITY
FTE

23.0
5.1
Nurses 853
12.6
2.4
Physicians MISSING
a
0.1
Dentists MISSING
0.4

337
Poland
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


338
Poland
HEALTH INFORMATION
Public health authorities being
informed for both IDs and for
NCDs was reported by 45.5%

health-records. Electronic clinical health Yes/No States with
“Yes”
records in all prisons were reported
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

(50%, out of n =36).
339
Poland
HIV HCV HBV STI

opt-out basis opt-out basis opt-out basis screening

50.0 42.9 37.1 32.4

NO NO NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

340
Poland

last 12 months:


HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
MISSING
Hypertension
Cancer
Clarification: Missing data on diagnosis and treatment refers to data not collected.
341
Poland

D: HEALTH OUTCOMES
Mental health
Cancer
satisfaction):
In no prisons. Having mental health counsellors
Mental health disorders Cancer in all prisons was reported by 72.2% of Member
86.1 83.3 States (n =36).
MORTALITY
100 000 100 000 people
people
Total deaths 174 256.3 1 418.0 a
Suicide 27 39.8 41.1 a

COVID-19 MISSING MISSING 75.6 b
a
In all prisons In all prisons males over 20 years)
b

75.0 88.9

342
Poland
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
Clarification: Missing data on diagnosis and treatment refers to data not collected.
343
Poland


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Data on health behaviours not collected.
344
Poland


“No” (77.8%, out of n =36).




YES

345
Portugal 10 295 909
Population, 2020
High
Income group
US$ 22 194

12600
11412
4357
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7 Portugal
Denmark 70.2
Ireland
Luxembourg
72.4
73.5 110.8
79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
346
Portugal

Number of prison
establishments
in the country
49 Females
n
796
%
7.0
Under 18 38 0.3
Mean length of incarceration per individual Above 50 2 204 19.3
Above 65 474 4.2
Migrants 1 764 15.5

Not legally
Number of individuals serving life sentences permitted in Intellectually disabled MISSING MISSING
the country

(n =36).
insurance systems:

AVAILABILITY

FTE
Total staff 382

33.5
b
7.1
Nurses 318 27.9
b
5.3
Physicians 33
2.9
a
b
Health at a Glance (2021)
c
Health at a Glance (2020)
0.1 a
Psychiatrists 19
1.7
c
1.1
Dentists 12
1.1
347
Portugal
ACCEPTABILITY

A minority
of prisons

No prisons All prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


348
Portugal
HEALTH INFORMATION
Yes, for infectious diseases only
(IDs). Public health authorities
being informed for both IDs and
for NCDs was reported by 45.5%

Yes/No States with
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION
History of TB and current signs and symptoms

assessed on or close to reception for all people in
prison:
Yes, a clinical evaluation of signs and symptoms is
made, including evaluation of previous history. Most
Member States report “Yes, clinical assessment and
diagnostic tests are made and when the test is positive,
additional assessment for MDR-TB is ensured” (50%, out of
n =36).
349
Portugal
HIV HCV HBV STI

opt-out basis opt-out basis opt-out basis screening

50.0 42.9 37.1 32.4

YES NO YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prison No prison All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

350
Portugal

last 12 months:


HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
Clarification: Health data is recorded in a physical clinical process, thus not available for extraction and analysis.
351
Portugal

D: HEALTH OUTCOMES
Mental health
Cancer
satisfaction):
(n = 7).
86.1 83.3 (n =36).
MORTALITY
100 000 100 000 people
people
Total deaths 72 630.9 1 427.8 a
Suicide 21 184.0 27.9 a

COVID-19 0 0.0 67.9 b
a
In all prisons In all prisons males over 20 years)
b

75.0 88.9

352
Portugal
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
Hepatitis C
Hepatitis B

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
353
Portugal


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
354
Portugal


“No” (77.8%, out of n =36).

Yes. Most Member States report “Yes” (72.2%,
out of n =36). Number of complaints received: 0.



NO Yes, and they are repeated YES


355
Republic 2 620 495 Upper middle US$ 4 525
of Moldova Population, 2020 Income group Gross national income per capital

6735
2527
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9 Republic
Armenia 66.5
Cyprus 67.8 of Moldova
Germany
245.3
69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
356
Republic of Moldova
Number of prison
establishments
in the country
Females
n
372 5.8
%
LGBTIQ 2 0.0
Under 18 61 1.0
Migrants 53 0.8
individuals:

insurance systems:

AVAILABILITY

FTE
Total staff 247.5
Nurses 144.5
Physicians 105
Psychiatrists 11
Dentists 8
357
Republic of Moldova
ACCEPTABILITY

DTP No prisons 72.2
Seasonal flu No prisons 83.3
MMR No prisons 61.8

Most prisons Most prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”
88.9
Assessments performed in prisons on
NO

NO

358
Republic of Moldova
HEALTH INFORMATION

States with
records in all prisons were reported Screening tests performed 91.7
YES
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION
History of TB and current signs and symptoms

assessed on or close to reception for all people in
prison:
clinical evaluation. Most Member States report “Yes,
clinical assessment and diagnostic tests are made and
when the test is positive, additional assessment for MDR-
TB is ensured” (50%, out of n =36).
359
Republic of Moldova
HIV HCV HBV STI


50.0 42.9 37.1 32.4

NO NO YES
HEALTH PROTECTION

syringes
Offered at All prisons Most prisons Most prisons Most prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at Most prisons No prison A minority of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

360
Republic of Moldova

report “Yes, everyone in prison has access to laboratory tests when these are necessary” (94.4%, out of
n =36).
last 12 months:
n (%)
Tuberculosis (TB)
HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
79 (92.9)
Hypertension
Cancer
a
1
2
361
Republic of Moldova


with “Yes”

In all prisons In a minority of prisons external providers

D: HEALTH OUTCOMES
86.1 83.3
satisfaction):
In most prisons. Having mental health counsellors
in all prisons was reported by 72.2% of Member
States (n =36).
MORTALITY
100 000 100 000 people
In most prisons In most prisons people

Suicide 7 108.9 44.3 a
75.0 88.9 COVID-19 0 0.0 74.2 b
Neoplasm 12 186.7 265.7 a
People are allowed to continue their family Cardiovascular 14 217.8 785.5 a

relationships by web communication: Yes, with disease
time restrictions. Most Member States report Other natural 8 124.4 -
“Yes, with time restrictions” (38.9%, out of n =36). causes
a
b
362
Republic of Moldova
MORBIDITY


HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
Percentage is calculated by considering the number of people with a diagnosis on record in 2020 divided by the total number of people in prison in the same
country where data has been provided for the same reference year.
363
Republic of Moldova

A minority
Offered at All prisons All prisons All prisons of prisons

“All prisons” 69.4 94.4 91.7 88.9
BMI≥ 30 93 (1.4) MISSING MISSING

208 (3.2) 202 (3.3) 6 (1.6)
(last 12 months)

2 (0.0) 2 (0.0) 0 (0.0)
(last 12 months)

of 150 minutes/week
364
Republic of Moldova

Decisions taken by health staff

can be overruled or ignored by
non-health prison staff:
“No” (77.8%, out of n =36).

of n =36). Number of complaints received 611.



YES NO

365
Romania 19 328 838
Population, 2020
Upper middle
Income group
US$ 12 956

22978
MISSING
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2 Romania
Ireland
Luxembourg
73.5
79.7
112.4
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
366
Romania
Number of prison
establishments
in the country
Females
n
862
%
4.0
Under 18 218 1.0

Mean length of incarceration per individual Above 50 3 023 13.9
n (%)

(n =36).
insurance systems:

AVAILABILITY
FTE

34.3
7.5
Nurses 526
24.2
3.2
Physicians 168 a
7.7
10 0.1
Psychiatrists
0.5
Dentists 27 0.9
1.2

367
Romania
ACCEPTABILITY

MMR No prisons 61.8


77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”
88.9
Assessments performed in prisons on
YES

NO

368
Romania
HEALTH INFORMATION

Yes/No States with
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

369
Romania
HIV HCV HBV STI


50.0 42.9 37.1 32.4

NO NO NO
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

applicable to prisons: Yes, nationwide.
Most Member States report “Yes,
370
Romania

last 12 months:


HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
MISSING
Hypertension
Cancer
a
1
2
Clarification: Although all penitentiaries keep record of patients with chronic diseases, the information is not available via a digital register and could not be obtained in a short notice.
371
Romania

D: HEALTH OUTCOMES
Mental health
Cancer
satisfaction):
(n = 7).
86.1 83.3 (n =36).
100 000 100 000 people
people
Total deaths 107 492.3 1 841.8 a
Suicide 14 64.4 27.9 a

COVID-19 5 23.0 82.4 b
Neoplasm 24 110.4 426.5 a


% Member States with “All prisons” causes

75.0 88.9 b

372
Romania
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
1
373
Romania


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Records of health behaviors are kept within penitentiary units but are not available for extraction in aggregated manner.
374
Romania


“No” (77.8%, out of n =36).




YES NO

375
San Marino 34 735
Population, 2020
High
Income group
US$ 45 515

8
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7 San Marino
Switzerland 80.1
Croatia
Italy
87.0
89.5 23.0
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
376
San Marino
1
establishments n %
Pregnant 0 0.0
LGBTIQ 0 0.0
over the last 12-month period: 1 month Above 50 2 25.0
Above 65 1 12.5
Minorities 0 0.0
n (%)
Disabled 0 0.0
Not legally Physically disabled 0 MISSING
Number of individuals serving life sentences permitted in

the country Intellectually disabled 0 MISSING

To what extent is health care of people in prison covered by any health Clarification: Health care in prison
is guaranteed by the public health
insurance systems: personnel, who are always available
for routine and in case of emergency.

AVAILABILITY

FTE
Total staff 0.04
Nurses MISSING
Physicians MISSING
Psychiatrists MISSING
Dentists MISSING
377
San Marino
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


378
San Marino
HEALTH INFORMATION
No. Public health authorities

Yes/No States with
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

379
San Marino
HIV HCV HBV STI

Yes, on an MISSING MISSING MISSING
opt-out basis

“Yes, on an opt out basis”
50.0 42.9 37.1 32.4

NO NO NO
HEALTH PROTECTION

syringes
Offered at All prisons MISSING MISSING All prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at All prisons NoMISSING

prison All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

380
San Marino
last 12 months:


HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
MISSING
Hypertension
Cancer
a
1
2
381
San Marino

D: HEALTH OUTCOMES
Mental health
Cancer
satisfaction):
86.1 83.3 (n =36).
MORTALITY
100 000 100 000 people
people
Total deaths 0 0 1264.5 a
Suicide 0 0 26.7 a
Education and training Employment Drug overdose 0 0 0.6 a

programmes opportunities COVID-19 0 0 173.5 b
a
(As the female prison population is 12.5%, the general population data is given only for males
In all prisons In all prisons over 20 years)
b

75.0 88.9

382
San Marino
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
383
San Marino

Offered at No prisons All prisons All prisons All prisons

“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Despite keeping paper-based clinical health-records of each inmate, the country could not provide an aggregate value that can be reported here.
384
San Marino


“No” (77.8%, out of n =36).

of complaints received: 0.




385
Slovakia 5 457 873
Population, 2020
High
Income group
US$ 19 266

11625
10519
6360
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2 Slovakia
Ireland
Luxembourg
73.5
79.7
192.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
386
Slovakia
18
establishments n %
Under 18 24 0.2
Above 50 2 071 19.7
Above 65 164 1.6
Migrants 219 2.1



AVAILABILITY

FTE
Nurses 157 14.9
Physicians 79 7.5
Dentists 8 0.8
387
Slovakia
ACCEPTABILITY
Offered at % Member States

Human Papilloma virus A minority of prisons 52.9
Hepatitis A A minority of prisons 55.9
Hepatitis B A minority of prisons 69.4
Meningococcal vaccination A minority of prisons 52.9
Pneumococcal vaccination A minority of prisons 57.6

A minority of prisons No prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


388
Slovakia
HEALTH INFORMATION

Yes, for infectious
diseases only (IDs).
% Member
of people in prison: Yes/No States with
“Yes”
based clinical health-records and in YES
others we keep electronic clinical Screening tests results YES 94.4

by 22.2% of Member States (n =36). Health behaviours YES 97.2
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

389
Slovakia
HIV HCV HBV STI



YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prison No prisons No prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

390
Slovakia

last 12 months:


Individuals receiving MDR-TB treatment over the last 12-month period (-) a
HIV
Hepatitis C
Hepatitis B
MISSING
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period

Oral health
Individuals with oral health visit over the last 12-month period 16718


Diabetes Mellitus
Individuals who have received pharmacological treatment for diabetes over the last 12-month period 681 (missing)
Hypertension
Cancer
a
1
2
391
Slovakia

D: HEALTH OUTCOMES
Mental health
Cancer
disorders Assessments of perceived well-being (or
life satisfaction): No, it has never been done.
In most prisons In no prisons

Mental health disorders Cancer (n =36).
86.1 83.3
100 000 100 000 people
people
Suicide 4 38.0 31.4a

programmes opportunities Drug overdose 0 0.0 0.5a
COVID-19 1 9.5 39.2b
Neoplasm 6 57.0 379.3a
Cardiovascular 20 190.1 574.5a

a
% Member States with “All prisons” (2019), (As the female prison population is 6.3%, the general population data is given only for

b
75.0 88.9

392
Slovakia
MORBIDITY

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health
MISSING


Diabetes Mellitus
Hypertension
Cancer
1
393
Slovakia


“All prisons” 69.4 94.4 91.7 88.9
Currently use tobacco products 8158 (77.6) MISSING MISSING

1429 (13.6) 1351 (13.7) 78 (11.9)
(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: The missing data presented is justified by the insufficient adoption of the health information system by health professionals - data on blood pressure, height,
weight and BMI have separate fields in the electronic medical record, but health professionals put these data in the body of the medical report, from where the system
cannot extract these specific data.
394
Slovakia


“No” (77.8%, out of n =36).

of complaints received: 17
1
Clarification: Complaints about the provision of health care to both prisoners and civilians are handled by
the Office for the Supervision of Health Care (a total of 17 complaints from prisoners in 2020) and, in some
cases, by the Public Defender of Rights (a total of 28 complaints from prisoners in 2020).



NO NO

395
Slovenia 2 095 861
Population, 2020
High
Income group
US$ 25 489

1345
1298* *Average number throughout the year instead of by

31.12.2020
2125
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland
72.4
73.5
Slovenia
61.9
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
396
Slovenia
13
Number of prison %
n
establishments Females 41 3.2
in the country
Pregnant 5 12.2
Under 18 14 1.1
Above 65 24 1.8

n (%)

Ministry of Health only (or health authorities),with 16.7% of Member
Both Ministry of Health and Ministry of Justice/ Ministry of
Interior. Most Member States (50%, out of n =36) are financed by

AVAILABILITY
FTE
Total staff 18 14.9

13.9
15 10.3
Nurses
11.6
3 3.3
Physicians 2.3
a
0 0.2
Psychiatrists
0.0
0 0.7
Dentists
0.0

397
Slovenia
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


398
Slovenia
HEALTH INFORMATION
Yes, for infectious
diseases only (IDs).

Yes/No States with
clinical health-records. “Yes”
Electronic clinical health records in Screening tests performed YES 91.7
all prisons were reported by 22.2%
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

399
Slovenia
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at No prison No prisons All prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

400
Slovenia

last 12 months:


HIV n (%)
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
Clarification: Missing data is justified because NCDs are screened and treated in Slovenia upon symptoms or when a person is of specific age and this is a national policy for NCD. There is
no centralized database for NCDs in prisons – GPs, who are external providers, hold their records in various databases and thus cannot be extracted.
401
Slovenia

D: HEALTH OUTCOMES
Mental health
Cancer
satisfaction):
(n = 7).
86.1 83.3 (n =36).
100 000 100 000 people
people
Suicide 1 77.0 40.9a

programmes opportunities Drug overdose 0 0.0 2.7a
COVID-19 0 0.0 129.7b
a
In all prisons In all prisons (As the female prison population is 6.3%, the general population data is given only for males
over 20 years)
b

75.0 88.9

with time restrictions / Yes, free of charge.
Most Member States report “Yes, with time
restrictions” (38.9%, out of n =36).
402
Slovenia
MORBIDITY

HIV
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
a
There is no active search of tuberculin in Slovenia.
1
Clarification: Missing data is justified because NCDs are screened and treated in Slovenia upon symptoms or when a person is of specific age and this is a national policy for NCD.
There is no centralized database for NCDs in prisons – GPs, who are external providers, hold their records in various databases and thus cannot be extracted.
403
Slovenia


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Missing data is justified because there is no centralized database for NCDs in prisons – GPs, who are external providers, hold their records in various databases and thus
cannot be extracted.
404
Slovenia


“No” (77.8%, out of n =36).

of complaints received: 17



YES NO

405
Spain 39 680 230
Population, 2020
High
Income group
US$ 27 056

77 783
47 300
MISSING
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7 Spain
Denmark 70.2
Ireland
72.4
73.5 119.2
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
406
Spain
69
Number of prison
n %
establishments
Females 3 502 7.4
in the country
Under 18 0 0.0
Above 65 2 466 5.2

Unsentenced and serving life sentences Migrants 12 142 25.7
n (%)
Disabled 4 823 10.2
Physically disabled 1 356 28.1
Not legally
Number of individuals serving life sentences permitted in Intellectually disabled 339 7.0
the country

Ministry of Interior only. Most Member States (50%, out of n =36) are
insurance systems:
Another situation: primary care is provided by the prison health
system and the rest of the care by the general health system through
the regions (national public service). Health care fully covered by
AVAILABILITY
prisons on full-time equivalents (FTEs) and ratio (per 1000 people) for a known year:
FTE
Total staff 1 475

31.2
Nurses 539 5.9

11.4
Physicians 389 4.4 a

8.2
Psychiatrists 7 0.1
0.2
Dentists 0
prison population general population a 407

Spain
ACCEPTABILITY



77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


408
Spain
HEALTH INFORMATION


Yes, we keep electronic clinical health % Member
Yes/No States with
records1. Electronic clinical health “Yes”
1
However, the country reported not being able to obtain many
requested indicators due to lack of a computer tool to do so. Vaccination YES 97.2
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION
History of TB and current signs and symptoms assessed on

or close to reception for all people in prison: Yes, clinical
assessment and diagnostic tests are made and when
the test is positive, additional assessment for MDR-TB is
ensured. Most Member States report “Yes, clinical assessment
and diagnostic tests are made and when the test is positive,
additional assessment for MDR-TB is ensured” (50%, out of n =36).
409
Spain
HIV HCV HBV STI


50.0 42.9 37.1 32.4

YES YES YES
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
A minority
Offered at No prisons All prisons
of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

410
Spain

last 12 months:

HIV
Individuals with HIV who received treatment over the last 12-month period 1566 (-) a
Hepatitis C
Individuals who following antiviral treatment achieved sustained viral response over the last 12-month period 669 (136.8) b
Hepatitis B

Oral health


Individuals who have received pharmacological treatment for an opioid use disorder over the last 12-month period
4971 (missing)
Diabetes Mellitus
Hypertension
Individuals who have received pharmacological treatment for hypertension over the last 12-month period 3401 (missing)
Cancer
a
Percentage not reported as number of individuals receiving treatment might be higher than individuals diagnosed with active TB.
b
The number of individuals achieving sustained viral response is higher than those receiving treatment because the assessment is made some time after completion of treatment;
therefore, it may include individuals terminating treatment in the previous 12 months but also those completing treatment previously.
1
2
411
Spain

D: HEALTH OUTCOMES
Mental health
Cancer Assessments of perceived well-being (or
disorders
life satisfaction): Yes, regularly (for example
once every year or once every two years).
In all prisons In all prisons 19.4% of Member States (n = 7).
(n =36).
86.1 83.3
100 000 100 000 people
people
Total deaths 194 410.2 1 189.4a
Suicide 43 90.9 16.8a

Drug 38 80.3 2.9a
overdose
COVID-19 3 6.3 108.8b
HIV 1 2.1 3.0a
In all prisons In all prisons Natural 102 215.6 -

causes
% Member States with “All prisons” Accidental 5 10.6 -

a
(2019), (As the female prison population is 7.4%, the general population data is given only
75.0 88.9 for males over 20 years)
b
Source: Our World Data Database (2020) (Given for both sexes, as disaggregated data was

412
Spain
MORBIDITY


HIV
Hepatitis C
Hepatitis B
Chronic HBV (HBsAg) MISSING

COVID-19
Oral health
Individuals keeping 21 or more natural teeth MISSING


Active drug use disorder (last 12-month) MISSING
Diabetes Mellitus
Diagnosis on record MISSING
Hypertension
Cancer
a
The numbers reported do not include any latent TB cases. There is a very extensive active case-finding programme for active and latent TB cases. The priorities of the programme are
as follows:
• Active case finding, health education and investigation of inmates with clinical compatible TB, in order to improve early diagnosis. Respiratory isolation during the infectious
period. Communication to extra-penitentiary services of inmates undergoing treatment.
• Investigation of the disease/infection situation in contacts close to each case of TB and administration of treatment for latent TB if necessary.
Source: http://www.interior.gob.es/documents/642317/1201664 Programa+de+prevenci%C3%B3n+y+control+de+la+tuberculosis+en+el+medio+penitenciari-
o+%28NIPO+126-10-136-9%29.pdf/a60d4338-79ef-4ee6-9c78-57ecedbb2dde#:~:text=En%20los%20centros%20penitenciarios%20se,los%20infectados%20por%20esta%20enferme-
dad.
1
Clarification: Missing values presented in the table are explained because even though an anamnesis is carried out both on admission and during the clinical follow-up of the digital
history, it is not possible to extract these data globally.
413
Spain


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Even though this data is collected as part of the anamnesis carried out both on admission and during the clinical follow-up of the digital history, it is not
possible to extract these data globally.
414
Spain


“No” (77.8%, out of n =36).

Yes. Most Member States report “Yes” (72.2%, out of
n =36). In 2020, 567 complaints were received by the
Ombudsman and 143 by the Andalusian Ombudsman.



YES Yes, and they are repeated YES

% Member States 75.0 61.1 100.0

with“Yes”

birth whilst in prison in the
last 12 months: MISSING
415
Switzerland 8 606 033
Population, 2020
High
Income group
US$ 87 100

7209
6897
MISSING In Switzerland, the total number of entries is collected
but not the number of “unique individuals” entering
prisons. Considering all types of incarceration, the total
number recorded in the previous year was 34203.
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7 Switzerland
Denmark 70.2
Ireland
72.4
73.5
80.1
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
416
Switzerland
87
Number of prison n %
establishments Females 347 5.0
in the country Pregnant MISSING MISSING
Under 18 52 0.8
c
over the last 12-month period: 2.1 months Above 50 MISSING MISSING

Migrants 4 340 62.9
n (%) Minorities MISSING MISSING

a
Number of individuals serving life sentences 34b (0.5)
a
Unsentenced/remand prisoners includes all early execution of a custodial sentence or
measure, in addition to remand prisoners. Intellectually disabled MISSING MISSING
b
The term “serving life sentences” is nor the right indicator for the Swiss penal system.
In the Statistics on the Execution of Sanctions (SVS), there was an average of 34 persons
(thereof 2 female) in execution of a life sentence in 2020. However, in the same year, there
c
Data officially published (Exécution des peines et des mesures: effectif moyen des
was an average of 151 persons (thereof 1 female) in execution of internment in a Swiss penal personnes âgées au-dessus de 49 ans - 1984-2019 | Table | Federal Statistical Office
institution. (Internment refers to persons who have served their sentence but who must (admin.ch) indicates general demographic data statistic of persons entering and
remain in custody until further notice for reasons of public safety). leaving Swiss prisons but only on those who are in early execution of a sentence, early
execution of a measure, execution of a sentence or execution of a measure (gender,
age, nationality, etc.). There is no statistic available to inform about the whole of the
prison population.

Both Ministry of Health and Ministry of Justice/ Ministry of Interior (answer
given applies to 20/26 cantons), with 16.7% of Member States reporting Ministry
of Health only (or health authorities) (n =36).
Member States (50%, out of n =36) are financed by Ministry of Justice only. 1
Clarification: Prisoners without legal
residence in Switzerland are not eligible
To what extent is health care of people in prison covered by any health for mandatory health insurance. Their
expenses are either covered by social welfare
insurance systems: or by the prison establishment. This is
Fully covered by health insurance 1. Health care fully covered by health the case for approximately 1/3 of the total
prison population (rough estimation).

AVAILABILITY
FTE
30.5
Total staff 197
28.6
18.0
Nurses MISSING prison population
general population a
4.4
Physicians MISSING
a
0.5
Psychiatrists MISSING
Dentists MISSING 0.4
417
Switzerland
ACCEPTABILITY

A minority
of prisons
Seasonal flu Most prisons 83.3
A minority
of prisons
A minority
of prisons

In all prisons In a minority of prisons

77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


418
Switzerland
HEALTH INFORMATION
Yes, for infectious diseases only (IDs)1
1
Clarification: Mandatory reporting only for infectious diseases
according to Federal Epidemics Act.. However, the reporting
responsibility lies with medical doctors; compliance varies – some MD Information registered in clinical records 2:
report, others do not report - yet, there are no data available on this.
% Member
Yes/No States with
“Yes”
Keep clinical health records Screening tests performed YES 91.7
Vaccination 97.2
based clinical health-records and in YES
others we keep electronic clinical Health behaviours YES 97.2

health records. Electronic clinical health Diagnoses established 97.2
YES
by 22.2% of Member States (n =36). Visits to external care providers YES 94.4
2
The clinical record captures all elements, but not systematically in all prisons; this is under
cantonal sovereignty and varies accordingly as there is no national standard available.
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

or close to reception for all people in prison:
MDR-TB is ensured 3. Most Member States report “Yes, clinical
out of n =36).
3
Clarification: In some prisons MDR-TB assessment is made; in others only clinical evaluation.
419
Switzerland
HIV HCV HBV STI

screening a screening screening screening

50.0 42.9 37.1 32.4
a
Some cantons (GE) follow
an opt-in or out strategy.

YES YES YES
% Member States with “yes” 66.7 58.3 66.7
Note: All 3 screening tests

are being offered only in
a minority of prisons. HEALTH PROTECTION

syringes
All prisons A minority

Offered at Most prisons Most prisons
of prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
A minority A minority
Offered at All prisons
of prisons of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

1
Clarification: The national non-smoking policy includes the Federal law on protection from passive smoking and the public
campaign SmokeFree. For prisons, this usually means, smoking is allowed only in the cell and in the yard. However, there are certain
exceptions to the provisions of the smoke free policy in the context of prisons.
420
Switzerland

last 12 months:
n (%)
Tuberculosis (TB)
HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Individuals who have received pharmacological treatment for hypertension over the last 12-month period 3401 (missing)
Cancer
1
2
421
Switzerland


with “Yes”

In a minority of prisons In all prisons external providers
% Member States with “All prisons” D: HEALTH OUTCOMES

86.1 83.3
Note: Access to mental health care is granted, but frequently delayed
due to insufficient staffing of nurses, psychologists / psychiatrists,
satisfaction): No, it has never been done.
especially in remand prisons. Assessments conducted regularly were reported by
REHABILITATION
Access to:
MORTALITY
Education and training Employment Total Mortality Mortality
programmes opportunities mortality rates per rates per
100 000 100 000 people
people
Total deaths 9c 130.5 965.3a

Suicide 2c 29.0 24.6a
Drug overdose MISSING MISSING 4.0a

COVID-19 1d 14.5 90.3b
a
75.0 88.9 (2019), (As the female prison population is 5.0%, the general population data is given only for
b
People are allowed to continue their family c
The Federal Statistical Office (FSO) provides the statistic on deprivation of liberty on the total
relationships by web communication: Yes, with number of deaths and suicides occurring in the prison population, whether the death occurred
in an institution of deprivation of liberty or in hospital.
time restrictions. Most Member States report d
This is not official data provided by the FSO, and it is provided by the correctional authorities.
“Yes, with time restrictions” (38.9%, out of n =36). Therefore, should be interpreted with caution.
422
Switzerland
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
1
Clarification: There is no data available on a national level. Such data is not collected. Except to the Federal Epidemic Act, which requires reporting of all newly detected cases of
a defined number of communicable diseases, which, in principle, should cater for the provision of the respective data also from the prison population, there are no national legal
norms, standards, regulations, recommendations or concepts which could serve as a basis for a systematic collection of morbidity data in the prison population. Currently, the
JMIR Research Protocols - The Swiss Prison Study (SWIPS): Protocol for Establishing a Public Health Registry of Prisoners in Switzerland is collecting data on morbidity in prisons
in the region of Zurich. (https://www.researchprotocols.org/2020/12/e23973). Results to be expected late 2021/beginning 2022. Additionally, some more studies are available with
regional/local data, however, no national data is available whatsoever for 2020.
423
Switzerland


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
Clarification: Even though this data is collected as part of the anamnesis carried out both on admission and during the clinical follow-up of the digital history, it is not possible to
extract these data globally.
424
Switzerland


“No” (77.8%, out of n =36).
1
Clarification: for people without health insurance clinical decisions may
be overruled; however, in urgent cases access to care is always granted.

“Yes” (72.2%, out of n =36).
Number of complaints received: MISSING



YES NO

birth whilst in prison in the
last 12 months: MISSING
425
Ukraine 41 732 779
Population, 2020
Lower middle
Income group
US$ 3 751

82610

MISSING
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2 Ukraine
Ireland
Luxembourg
73.5
79.7 119.4
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain 119.2
Ukraine 119.4
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
426
Ukraine
109
establishments n %

n (%)
Number of unsentenced/remand prisoners 18205 (36.5) Disabled 1 244 2.5


AVAILABILITY

FTE 0 10 20 30 40 50
Nurses 1076 21.6
Physicians 686 13.8
Dentists 69 1.4
427
Ukraine
ACCEPTABILITY




77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


428
Ukraine
HEALTH INFORMATION

% Member
Yes, in some prisons we keep paper- Yes/No States with
others we keep electronic clinical Screening tests performed YES 91.7
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION
History of TB and current signs and symptoms assessed on or close

to reception for all people in prison:
Yes, clinical assessment and diagnostic tests are made and when
the test is positive, additional assessment for MDR-TB is ensured 1.
Most Member States report “Yes, clinical assessment and diagnostic tests
are made and when the test is positive, additional assessment for MDR-TB
is ensured” (50%, out of n =36).
1
Clarification: In some prisons MDR-TB assessment is made; in others only clinical evaluation.
429
Ukraine
HIV HCV HBV STI

Yes, on an Yes, on an opt- Yes, on an Yes, on an
opt-out basis out basis opt-out basis opt-out basis

“yes, on an opt-out basis”
50.0 42.9 37.1 32.4

YES YES YES
% Member States with “yes 66.7 58.3 66.7
HEALTH PROTECTION

syringes
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at All prisons All prisons Most prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

1
Clarification: The national non-smoking policy includes the Federal law on protection from passive smoking and the public
campaign SmokeFree. For prisons, this usually means, smoking is allowed only in the cell and in the yard. However, there are certain
exceptions to the provisions of the smoke free policy in the context of prisons.
430
Ukraine

last 12 months:


HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
a
1
2
431
Ukraine


with “Yes”

In all prisons In most prisons external providers

D: HEALTH OUTCOMES
86.1 83.3
Note: Access to mental health care is granted, but frequently
delayed due to insufficient staffing of nurses, psychologists
Assessments of perceived well-being (or
/ psychiatrists, especially in remand prisons. life satisfaction): Yes, on an ad hoc basis.
REHABILITATION
Access to: Access to mental health counsellors:
In most prisons. Having mental health
Education and training Employment MORTALITY

programmes opportunities Total Mortality Mortality
100 000 100 000 people
people
In all prisons In all prisons Total deaths 485 973.5 2264.8 a
Suicide 48 96.3 97.7 a

Education and training Employment COVID-19 0 0.0 44.4 b
HIV 57 114.4 26.3 a
75.0 88.9
disease
relationships by web communication: causes
Yes, with time restrictions. Most
Member States report “Yes, with time
a
(As the female prison population is 5.0%, the general population data is given only for males over
restrictions” (38.9%, out of n =36). 20 years)
b
432
Ukraine
MORBIDITY
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

COVID-19
Oral health


Diabetes Mellitus
Hypertension
Cancer
1
433
Ukraine


“All prisons” 69.4 94.4 91.7 88.9

(last 12 months)

(last 12 months)

of 150 minutes/week
434
Ukraine


“No” (77.8%, out of n =36).

Yes 1. Most Member States report “Yes” (72.2%, out
1
https://coz.kvs.gov.ua/?page_id=117



YES NO

435
United Kingdom 67 025 542 High US$ 41 098
Population, 2020 Income group Gross national income per capita

91175
87019
71319
San Marino 23.0

Monaco 38.2
Finland 47.0
Netherlands 54.5
Slovenia 61.9
Armenia 66.5
Cyprus 67.8
Germany 69.7
Denmark 70.2
Ireland 73.5
Luxembourg 79.7
Switzerland 80.1
Croatia 87.0
Italy 89.5
Bulgaria 89.9
Belgium 90.1
France 93.1
Austria 95.3
Greece 106.2
Portugal 110.8
Romania 112.4
Spain
Ukraine
119.2
119.4
United Kingdom
129.8
Latvia 162.2
Malta 168.1
Hungary 171.3
Albania 172.8
Estonia 176.2
Poland 178.9
Czechia 180.4
Lithuania 190.4
Slovakia 192.7
Georgia 246.0
0 50 100 150 200 250
436
United Kingdom
Number of prison
establishments
in the country
138 Unsentenced and serving life
n (%)
Number of unsentenced/
14567 (16.7)
remand prisoners
Mean length of incarceration per Number of individuals
8213 (9.4)
individual over the last 12-month serving life sentences
period: 15.3 months 1
1
Considering prisons from England and Wales.
The United Kingdom England and Wales Scotland Northern Ireland

n (%) n n n
Females 3 490 (4.0) - - -

Pregnant - - 0 1
LGBTIQ - 2104 186 -
Under 18 - 381 25
Above 50 14 458 (16.6) - - -
Above 65 3 251 (3.7) - - -
Migrants 10 086 (11.6) - - -
Minorities 21 854 (25.1) - - -
Disabled - - 664 511
Physically -
disabled
- - 178
Intellectually -
disabled
- - 333

Ministry of Health only. Most Member States (50%, out of n =36) are
Health care for people in prison is fully covered by health insurance
(the same as for the general community)2. Health care fully covered by
2
Access to all health care is free at the point of entry and is therefore covered by the state for people in secure settings as it is for people in the community. Access to NHS Dental
services has a cost attached for some people in the community, for those on benefits /limited income it is free and people in prison meet these criteria too. In Scotland only, dental
provision for people in prison is at no cost to them and treatments provided are the same as NHS in the community.
437
United Kingdom

AVAILABILITY
Figure 36.2: Health-care staff available in the general population

0 5 10 15 20 25 30
Total staff 27.3
Nurses 7.8
Physicians 3.0
Psychiatrists 0.2
Dentists 0.5
ACCEPTABILITY
Offered at % Member States Proportion of prison establishments where

Human
Most prisons 52.9
Papilloma virus
MMR Most prisons 61.8 In all prisons In a minority of prisons
Meningococcal
Most prisons 52.9
vaccination
Pneumococcal % Member States with “All prisons”
Most prisons 57.6
vaccination
77.8 58.3
QUALITY OF CARE
% Member States
Yes/No
with “Yes”


438
United Kingdom
HEALTH INFORMATION
Yes, both for IDs and for NCDs1.
1
Clarification: In Wales, only IDs are reported. In Scotland, a minority didn’t
inform public health authorities, and some prisons did it only for IDs.
% Member
Keep clinical health records Yes/No States with
of people in prison: “Yes”
Yes, we keep electronic clinical health Screening tests performed YES 91.7
records. Electronic clinical health Screening tests results YES 94.4
C: HEALTH SERVICES
PREVENTIVE SERVICES
DISEASE PREVENTION

or close to reception for all people in prison:
Yes, clinical assessment and diagnostic
tests are made and when the test is positive,
additional assessment for MDR-TB is ensured2.
Most Member States report “Yes, clinical assessment
and diagnostic tests are made and when the test is
positive, additional assessment for MDR-TB is ensured”
(50%, out of n =36).
2
Clarification: Wales, Scotland and Northern Ireland didn’t offer a diagnostic test.
439
United Kingdom
HIV HCV HBV STI

% Member States with “yes,

50.0 42.9 37.1 32.4

YES YES YES
% Member States with “yes” 66.7 58.3 66.7
HEALTH PROTECTION

syringes
Offered at All prisons All prisons Most prisons No prisons
% Member States
97.2 47.1 12.1 8.3

sanitary towels
Offered at A minority Most prisons All prisons

of prisons
% Member States
30.6 28.6 72.2
HEALTH PROMOTION

440
United Kingdom

last 12 months:
n (%)
Tuberculosis (TB)

HIV
Hepatitis C
Hepatitis B

Oral health


Diabetes Mellitus
Hypertension
Cancer
Clarification: Due to the COVID-19 pandemic the collection of these data was considered insufficiently robust for reporting.
441
United Kingdom

transferring people in prison to specialized Yes 2. Having this support service was reported
2
Not in Wales. In Scotland arrangements are in place for people currently receiving
treatment.

Mental health Cancer with “Yes”
disorders
Scheduling medical a 70.6
YES
Development of a Care 76.5

In all prisons In all prisons YES
external providers
% Member States with “All prisons” a

Considering prisons in England. Northern Ireland does not have scheduling medical
appointment upon release. No data for this question from Wales nor Scotland.
Mental health disorders Cancer a

86.1 83.3 D: HEALTH OUTCOMES
a
In Scotland where there are no prison specific protocols in place, treatment would
be provided in line with community guidance. HEALTH AND WELL-BEING
Assessments of perceived well-
REHABILITATION being (or life satisfaction):
Access to: Yes, regularly (for example once
every year or once every two years)3.
3
On an ad-hoc basis in Scotland
Education and training Employment Access to mental health counsellors:

In most prisons. Having mental health

MORTALITY
% Member States with “All prisons” mortality rates per rates per
100 000 100 000 people
Education and training Employment people
Total deaths 435 499.9 1217.0 a
75.0 88.9
Suicide 87 100.0 17.3 a

relationships by web communication:Yes,
with time restrictions / Yes, free of charge1. COVID-19 105 120.7 107.9 b
Most Member States report “Yes, with time
restrictions” (38.9%, out of n =36). a
(As the female prison population is 4.0%, the general population data is given only for males over
20 years)
1
In England and Wales web communication is only used due to COVID-19
restrictions on visiting. Physical visits outside the prisons are only carried out in b
England and Wales, and eligibility is strictly limited, this is not a universal offer. available in open source).
442
United Kingdom
MORBIDITY
n (%)
Tuberculosis (TB)
MISSING
Active TB diagnosis

MISSING
HIV
MISSING
Hepatitis C
MISSING
Hepatitis B
MISSING
Chronic HBV (HBsAg)

MISSING
COVID-19
MISSING
Oral health
MISSING


MISSING
Diabetes Mellitus
MISSING
Diagnosis on record
Hypertension
MISSING
Diagnosis on record
MISSING
Diagnosis on record
Cancer
MISSING
Diagnosis on record
443
United Kingdom

toilet in-cell a for physical facilities at least to cultural needs (at least
activity once a week b two options of food)

“All prisons” 69.4 94.4 91.7 88.9
a
All in Northern Ireland.
b
The absolute minimum mandated in England and Wales is 30 mins outdoors, but the general position where a regime is operating normally is a minimum of 1h.

(last 12 months)

(last 12 months)

of 150 minutes/week
444
United Kingdom


No 1. Most Member States report
“No” (77.8%, out of n =36).

1
Clarification: The prison service in England, Wales and Northern Ireland is committed to acting on expert clinical and public health advice. When the prison service cannot fully implement
specific clinical advice because of specific operational or logistical considerations, there is dialogue with the health-care/public health agencies to explain the situation and actions /advice
they can take or implement and those they cannot and agreement sought on appropriate mitigations. In Scotland, Scottish Prison Service will work in collaboration with NHS colleagues,
to come to a mutually acceptable position, taking cognizance of the significance of the decision and the impact on the individual concerned and others, however on rare occasions there
will be occurrences where SPS will overrule NHS decisions on the grounds of security, and NHS should ensure evidence is available to support what Scottish Prison Service are refusing.



NO
a Yes, and they are repeated YES
c
at regular intervals b
a
Yes in Scotland and Northern Ireland, no answer for Wales.
b
No data from Wales, in Scotland 5 prisons (out of a total of 15) answered “Yes”.
c
No answer for Wales.

n =1 (no data for Wales and therefore
percentage is not estimated).
445
Annex 2. Health in Prisons European Database Survey
(HIPEDS)
National questionnaire for minimum public health

dataset for prisons in the WHO European Region
The Health in Prisons European Database (HIPED), is an initiative led by WHO Europe
to build on evidence around the health of people in prison and the services provided to
them. As part of this initiative, we request Member States to periodically provide data
to contribute to HIPED through a survey.
The current survey builds on the WHO Framework for Prison health system’s performance
assessment. This framework describes eight domains for which a selected list of key
indicators has been identified to reflect the prison environment, issues of availability,
accessibility, care provision, health behaviours and health outcomes. It is a long survey,
but not exhaustive so that all domains may be captured.
Guidance on completing the questionnaire

This survey is addressed at the survey focal point nominated by the Member State’s Ministry of Health. However, you may
find it useful to involve other Ministries with responsibility shared for health care in prisons, several national experts or an
expert group in the completion of this questionnaire. If possible, please list all experts consulted in the section provided
below as appropriate, so that they can be acknowledged in the final Report to be produced. We specifically ask for the
identification of the survey focal point in case any additional contact is requested to request further clarifications.
1. The data requested refers to the most recent year, i.e., from 01.01.2020 to 31.12.2020. In case it is not possible
to provide such updated data, please refer to the previous homologous period (01.01.2019-31.12.2019) and
indicate that in the comments.
2. Where a question refers to the prisoners in your country, please provide a response which applies to all persons
in the prisons of your country, including those held in pre-trial detention (e.g. in remand prison/jail) wherever
available. Questions which refer to the prisons of your country likewise require a response which applies to all
the prisons in your country. Note: even though WHO adopts person-centred wording in all external publications
(people living in prisons, for simplicity of the survey, throughout the questions we will use the term “prisoner”).
3. Wherever your responses refer to a different base (e.g., prisoners excluding those in pre-trial detention), please
indicate this clearly with a comment.
4. This survey does not refer to other prescribed places of detention (e.g. immigration detention centres and
police custody or their equivalent).

5. Where questions ask about national practice, if there is substantial regional variation in practice please provide
detail about this in a comment.
6. Where answer categories provided do not apply to the situation in your country, please write a comment.
7. Please document each source that contributed to the data provided, including whether it was obtained from a
published report and if so, the nature of that publication (i.e., scientific journal or government agency), and if any
data was obtained from an unpublished source. Whenever possible, please indicate the links to the source data.
Experts consulted
For the completion of this survey, comprising the sections: A. Penal Statistics; B. Prison Health Systems; C. Health
Services; D. Health Outcomes; E. Prison Environment; F. Health Behaviours; G. Adherence to Equivalence and
Other International Standards; and H. Reducing Health Inequalities, you are encouraged to contact and consult
additional experts. These experts could come from the following areas:
• Person in charge of or involved in prison health in the Ministry of Health/Ministry of Justice/Ministry of Interior of your
country, or the most senior government official in charge of prison health conditions;
• The head of a prominent non-governmental organization dedicated to prison health;
• A health professional (e.g., medical doctor, nurse, pharmacist, social worker, psychologist) specialized in prison
health-related services;
• A faculty member of a university department;
• A police or other law enforcement officer;
• A person at the Ministry of Finance, tax agency or statistical office.
For countries with regional or sub-national arrangements, alternatively you can also select experts from each
of the different regions and eventually then set up meetings to evaluate and decide the comparability of data
and the possibility for national aggregation.
Contact for questions or clarifications: azevedof@who.int
Contact information
Date: _ _ / _ _ / _ _ _ _ (Day/Month/Year)
WHO Region: __________________________
Country: ______________________________
Questionnaire completed by:
Last name: _____________________________ First name: _______________________
Title/Position: _____________________________________________________________
Institute/Ministry/etc. _______________________________________________________
Address: _________________________________________________________________
Telephone: _____________________________
Fax: ___________________________________
E-mail: _________________________________
For those whom you did consult, please enter the following information accordingly:
Expert 1 –
Name:
Position:
Organization:
Expert 2 –
Name:
Position:
Organization:
Expert 3 –
Name:
Position:
Organization:
Comments:

SECTION A: PENAL STATISTICS
A1. What is the official prison capacity in your country?
Note: The official capacity of a prison is defined by the total number of detainees that it can accommodate while respecting the
standards set by the relevant authority in the country. When prison buildings are old, prison administrations are not always able
to give figures for the floor space allocated to each detainee or group of detainees. However, the official capacity of prisons at
the time of construction is usually known.
Data No data
A2. What is the total number of prisoners

in your country by 31.12.2020?
A2.1 Among those mentioned

in A2, how many are:
a) Female
i) Of those in a), how many
were pregnant during
the last 12 months?
b) Lesbian, gay, bisexual, transgender,
intersex and queer people (LGBTIQ)
c) Young people (under 18 years of age)
d) Older people (above 50 years of age)
e) Older people (above 65 years of age)
f) Migrants (i.e. not national citizens

in the country of detention)
g) From an ethnic/racial minority
h) People living with disabilities
i) Physical disabilities
ii) Intellectual disabilities
Data No data
A3. What is the number of

unsentenced/remand prisoners in
your country (excluding those in
police custody) by 31.12.2020?
A4. What is the number of unique

individuals entering prison over
the most recent 12-month period
(01.01.2020–31.12.2020)?
A5. What is the mean number of occasions

a unique individual entered prison
over the last 12-month period?
A6. What was the mean length of

incarceration per individual over
the last 12-month period (please
indicate your answer in months)?
A7. What is the total number of prison

establishments in your country?
Not legally
Data No data permitted in
the country
A8. What is the number of individuals

serving life sentences?

SECTION B: PRISON HEALTH SYSTEMS
Health system organization
B1. In your country, what level of government is responsible for prison health care? Please choose the answer
that best describes your country. If none of the options perfectly describes it, please choose “other” and specify.
a. National government is responsible for prison health care

b. National government and sub-national governments both have responsibilities
c. Sub-national governments have responsibility and national government does not have responsibility
d. Other. Please specify:
B2. In your country, what level of government is responsible for the delivery of health care for the general
population (i.e., outside of prisons and can include primary and secondary care)? Please choose the answer that
best describes your country. If none of the options perfectly describes it, please choose “other” and specify.
a. National government is responsible for health care

b. National government and sub-national governments both have responsibilities
c. Sub-national governments have responsibility and national government does not have responsibility
d. Other. Please specify:
B3. In your country, which agency or agencies are responsible for delivering prison health care. Please choose
the answer that best describes your country. If none of the options perfectly describes it, please choose “other”
and specify.
a. Ministry of Health only (or health authorities)
b. Ministry of Justice only
c. Ministry of Interior only
d. Other ministry in isolation. Please state which:
e. Both Ministry of Health and Ministry of Justice/Ministry of Interior
f. Another situation. Please specify:
B4. In your country, which agency or agencies are responsible for the inspection of prison hygiene, nutrition and
living conditions? Please choose the answer that best describes your country. If none of the options perfectly
describes it, please choose “other” and specify.
a. Ministry of Health only (or health authorities)

d. Other ministry in isolation or independent organization. Please state which:
Health system financing
B5. In your country, which agency or agencies are responsible for financing prison health care (i.e., is responsible
for holding and managing the budget for these services).
Note: Financing refers to responsibility for managing the funding necessary for prison health-care services. This may be the
responsibility of one or more ministries. It may be the same agency which is responsible for the delivery of prison health-care
services, or a separate agency. Please choose the answer that best describes your country. If none of the options perfectly
describes it, please choose “another situation” and specify.
a. Ministry of Health only

d. Other ministry in isolation. Please state which:

B6. To what extent is health care of people in prison covered by any health insurance systems (includes the public
national health service) which apply to the general (non-prison) community? Please choose the answer (s) that
best describes your country. If none of the options perfectly describes it, please choose “another situation” and
specify.
a. Health care for people in prison is fully covered by health insurance (the same as for the general community)
b. Health care for people in prison is partly covered by health insurance (the same as for the general community)
c. Health care for people in prison is covered by a separate health insurance system (different to what is available in the
general community)
d. Health care for people in prison is not covered by any health insurance
e. Another situation. Please describe below the situation in your country:
B7. Are prisoners in your country obliged to cover any of the following expenses?
Prisoners cover Prisoners cover Prisoners do not

all costs some costs cover any costs
General health-care services
Prescription medication
Other expenses
(please specify):
Health system vision and strategy
B8. Is there a national/subnational prison health policy/strategy? Please choose the best answer.
a. Yes, there is a national/subnational prison health policy/strategy. Please attach or provide a link to the relevant
document(s):
b. Yes, prison health is part of another national/subnational (health) policy/strategy. Please specify and attach or
provide a link to the relevant document(s):
c. No, there is no such policy/strategy at present, but it is envisaged for the future. Please specify and attach or provide
a link to draft/plan/other evidence:
d. No, there is no such policy/strategy at present and there is currently no intention to develop one in the immediate
future
B8.1 If the answer to B8 is ‘Yes’ (a or b), is there an implementation plan for the policy/strategy?
a. Yes, implementation plan is already adopted. Please attach or provide link to evidence:
b. Yes, implementation plan is under development or there are plans for development. Please attach or provide link
to draft/plan/other evidence:
c. No, there is no implementation plan at present and no such plan will be developed
Health system performance
Availability
B9. Please indicate the total number of health-care staff (physicians, nurses, nursing assistants, etc., including
external service providers) in prisons on full-time equivalents (FTEs) for a known year.
Year
Number

B9.1 Among those in B9, please indicate the total number of:
Total Number No data
Physicians (including external service

providers) based FTEs
Nurses (including external service

providers) based on FTEs
Psychiatrists (including external service

Dentists (including external service

Acceptability
B10. In case screening tests and/or health assessments are being offered to prisoners, is informed consent
being obtained and documented (could be for all health assessments/interventions and not necessarily per
assessment/intervention)?
a. Yes, these are obtained

b. Yes, these are obtained and documented
c. No
B11. For each of the following programmes for vaccine-preventable diseases, please indicate the proportion of
prison establishments in your country where these are available to be administered to eligible prisoners?
All Most A minority No

prisons prisons of prisons prisons
DTP (diphtheria, tetanus, pertussis)
Human Papilloma virus
Hepatitis A
Hepatitis B
Seasonal flu
MMR (measles, mumps and rubeola)
Meningococcal vaccination
Pneumococcal vaccination
COVID-19
B12. Please indicate the proportion of prison establishments where prisoners have access to HIV prophylaxis?
All prisons Most prisons A minority No prisons

of prisons
Post Exposure
Pre-exposure
Quality of Care
B13. Are regular assessments performed in prisons on the availability of essential medicines?
a. Yes
b. No
B14. Is there a standardized process for reporting medication errors in prisons (Errors or mistakes committed by
health professionals which result in harm to the patient, source: https://meshb.nlm.nih.gov/record/ui?ui=D019300)?
a. Yes. Please specify:

b. No
B15. Is there a standardized process for reporting adverse drug events in prisons (Disorders that result from the
intended use of pharmaceuticals, source: https://meshb.nlm.nih.gov/record/ui?ui=D064420)?

b. No
B16. Is there a standardized protocol for identifying and helping people with suicide/self-harm risk in prisons?
a. Yes for suicide

b. Yes for self-harm and suicide
c. No

B17. Is there a mechanism in place for ensuring patient involvement in health-care planning and reform?

b. No
Health information
B18. Is there a registration system for keeping track of deaths in prisons?
a. Yes
b. No
B18.1 If the answer to B18 is ‘Yes’, does this also include the causes of the deaths that occurred in prison?
a. Yes
b. No
B18.2 Please explain how data on deaths and causes of death are being transferred from the prison registration
system to the national Civil Registration and Vital Statistics (CRVS) registration (open question).
B18.3 Are completeness and quality of the data on deaths that are being sent to the national CRVS registration
regularly assessed?
a. Yes. Please provide the most recent figure: (%)

b. No
B18.4 Do the physicians that work in the prison health systems receive training for filling in the death certificates?
a. Yes
b. No
B19. Do prisons inform public health authorities about diseases amongst prisoners?
a. Yes
b. No
B19.1 If the answer to B19 is ‘Yes’, is individual imprisonment status captured in the disease registries or
surveillance data (e.g. place of infection, place of diagnosis, risk factor)?
a. Yes, for infectious diseases only (IDs)

b. Yes, for Non communicable Diseases (NCDs) only
c. Yes, both for IDs and for NCDs
d. No
B19.2 If the answer to B19 is ‘Yes’, please provide the following:
Provide link to NCDs datasets or annual reports
Provide link to IDs datasets or annual reports
Indicate completeness of reporting for NCDs (%)
Indicate completeness of reporting for IDs (%)
B20. Do you keep clinical health records of people in prison?
a. Yes, we keep paper-based clinical health records

b. Yes, we keep electronic clinical health records
c. Yes, in some prisons we keep paper-based clinical health records and in others we keep electronic clinical health
records
d. No
B20.1 If the answer to B20 is ‘Yes’, does the clinical health record system include sections for recording information
on (please mark all that apply):
Screening tests performed

Screening tests results
Vaccination (e.g. vaccination history, vaccines administered during incarceration)
Health behaviours (e.g., tobacco use, alcohol use, drug use)
Diagnoses established
Visits to external care providers (e.g., hospital admissions or specialized care appointments)
Treatment and medications

B20.2 If the answer to B20 is ‘Yes’, is the clinical health record system used in prisons compatible with the health
record system used for the general population in the country?
a. Yes, the same system is being used which is interoperable and allows for individual health data exchange across
the community-prison interface
b. Yes, different systems are being used, but these are interoperable and allow for individual health data exchange
across the community-prison interface
c. Yes, the same system is used or is interoperable and allows for individual health data exchange across the
community-prison interface but only for certain conditions, interventions or population subgroups (e.g., HIV,
immunization). Please specify:
d. No
B21. Does your country have the capacity to provide timely (i.e., equivalent to general community standards)
surveillance data of COVID-19 cases identified in prisons (prisoners and custodial staff)?
a. Yes, we can provide exhaustive data in a timely manner

b. Yes, we can provide exhaustive data but not in a timely manner
c. Yes, we can provide data but not for all variables (e.g., age disaggregation, prisoners, custodial staff)
d. No, we cannot provide data. Please explain why below:
B22. Please indicate if prisons in your country undertake contact tracing in relation to COVID-19 cases?
a. Contact tracing is undertaken in all prisons

b. Contact tracing is undertaken in most prisons
c. Contact tracing is undertaken in a minority of prisons
d. Contact tracing is not undertaken in any prison
B23. If COVID-19 vaccination is implemented in at least one prison in your country, is the immunization
information system in prison interoperable with immunization information system in the community?
a. Yes
b. Yes, for some prisons
c. No
d. Not applicable
SECTION C: HEALTH SERVICES
Preventive services
Disease Prevention
C1. Is there an initial urgent health needs assessment undertaken in the first 24h after reception?
a. Yes
b. No
C2. Is a more detailed review of health needs subsequently conducted (e.g., within 7 days of admission)?
a. Yes
b. No
C2.1 If the answer to C1 or C2 is ‘Yes’, can you indicate how many unique individuals have received a health examination
following admission to prison in the past 12-month period? (Provide number)
C2.2. If the answer to C1 or C2 is ‘Yes’, who conducts these assessments?
a. Nurse only
b. Physician only
c. Nurse predominantly, but with referral to physician available
d. Another health-care worker. Please indicate who:
e. Member of custodial staff only
f. Other possibility. Please explain:

C2.3 If the answer to C1 or C2 is ‘Yes’, which of the following is part of the assessment? Please mark for each
possible assessment, the response option that best describes your country.
All Most A minority No

prisons prisons of prisons prisons
Alcohol use
Drug use
Injection drug use
Smoking status
Blood pressure measurement
Body mass index calculation
Mental health problems (e.g., psychosis)
Respiratory conditions (e.g., COPD)
Oral health problems (e.g., tooth decay)
Chronic conditions requiring treat-

ment (e.g. HIV, CVDs)
COVID-status and/or COVID immunization status
C3. Are history of TB and current signs and symptoms assessed on or close to reception for all people in prison?
a. No
b. Yes, a clinical evaluation of signs and symptoms is made, including evaluation of previous history
c. Yes, and a diagnostic test is offered in addition to the clinical evaluation
d. Yes, clinical assessment and diagnostic tests are made and when the test is positive, additional assessment for
MDR-TB is ensured
C4. Please mark for the following infectious diseases, if screening is being offered on or close to reception to all
prisoners? For each disease, please choose the situation that best describes your country.
Yes, on an opt Yes, on an Yes, risk-based

No
out basis opt in basis screening
HIV
HCV
HBV
STI
C5. Does your country have any of the following types of cancer screening offered to prisoners?
Yes No
Cervical
Colon
Breast
C6. Do these cancer screenings apply the same eligibility criteria (e.g., age cut-off) as those conducted in the
general population (community model) (please choose all that apply)
a. Yes, the same criteria apply in cervical cancer

b. Yes, the same criteria apply in colon cancer
c. Yes, the same criteria apply in breast cancer
C7. Are there any specific restrictions or differences on screening practices for prison and in the community
(please choose all that apply).
a. Yes, the methods used are different (e.g., FOBT or FIT vs colonoscopy for colorectal cancer; Pap test vs cytology for
cervical cancer)
b. Yes, the frequency used is different (e.g., annual vs biannual; this may happen as a result of availability of mobile
units properly equipped)
c. Yes, another situation. Please describe below:
d. No
C8. For each of the following products, please indicate if they are offered free of charge considering the response
options given.
Most A minority
All prisons No prisons
prisons of prisons
Soap
Condoms

Lubricants
Disinfectants (“bleach” to use in needles

or piercing/tattooing material)
Dental dams
Tampons/sanitary towels
C9. Since the emergence of COVID-19, did prisoners have access to:
Yes No
a) Hand sanitizer/soap and water
b) Face masks
C10. Did the prisons in your country create space for adequate quarantine of contacts and isolation of COVID-19
cases (e.g., single-cell accommodation or multiple occupation by cohorting?
a. In all prisons
b. In most prisons
c. In a minority of prisons
d. In no prisons
C10.1 If the answer to C10 is a, b or c, did this space consider the CPT rules (6m² of living space for a single-
occupancy cell – excluding toilet space – and adding 4m² per additional inmate)?
a. In all prisons
b. In most prisons
d. In no prisons
Health Promotion
C11. Are there health promotion materials like brochures and leaflets available on safe tattooing practices?
a. Yes
b. No
Health Protection
C12. Are there any policies or procedures in place to promote physical activity in prison?
a. Yes. Please provide link/describe below:
b. No
C13. Do prisons in your country have therapeutic spaces available for people with drug problems?
a. In all prisons
b. In most prisons
d. in no prisons
C14. Is there any smoke free policy implemented in your country applicable to prisons?
a. Yes, nationwide
b. Yes, in specific regions of the country
c. No
Provision of primary care
C15. Are there any preparedness contingency plans for managing the impact of an infectious disease outbreak
in prisons?
a. In all prisons
b. In most prisons
d. In no prisons
C15.1 If the answer to C15 is a, b or c, in case a pandemic response plan has been developed and is published,
please indicate the link.

C15.2 If the answer to C15 is a, b or c, in case a policy response plan has been developed for COVID-19 and is
published, please indicate the link.
C16. Do suspected cases of an infectious disease have access to laboratory tests?
a. Yes, everyone in prison has access to laboratory tests when these are necessary
b. Yes, but there are limited resources, so only the priority/vulnerable groups have access
c. No
Arrangements for secondary and tertiary care
C17. Are there any arrangements/protocols established to ensure access for people in prison to specialized
treatment of mental health disorders?
a. In all prisons
b. In most prisons
d. In no prisons
C18. Are there any arrangements/protocols established for transferring people in prison to specialized
institutions to treat cancer?
a. In all prisons
b. In most prisons
d. In no prisons
Continuity of care
C19. Is there any support service to register people released from prison with a GP/community health services?
a. Yes
b. No
C19.1 If the answer to C19 is ‘Yes’, does this service include any of the following:
1. Scheduling medical appointment upon release

2. Development of a Care Plan to be shared with external providers
C20. Is there a procedure in place to ensure medication is reconciled (procedure in place for transferring a list of
prescribed medication used by new entrants to prisons in the community to the prison health-care service) at admission
(first 24h)?
a. Yes
b. No
C21. When people are released from prison, are they provided with any medication?
a. Yes, for all conditions.

b. Yes, for some conditions.
c. No
C21.1 If the answer to C21 is b, medication for, choose what applies:
Drug Use Disorders

HIV
TB
HCV
Other disease, please specify which:
C22. When people are released from prison, are they tested for COVID-19 prior to release?
a. Yes
b. No

Rehabilitation
Education and Training
C23. Do people in prison have access to education and training programmes?
a. In all prisons
b. In most prisons
d. In no prisons
Employment Opportunities
C24. Do people in prison have access to employment opportunities while in prison?
a. In all prisons
b. In most prisons
d. In no prisons
Social Relationships
C25. Please indicate the conditions under which people are allowed to continue their family relationships.
Yes, with time

No Yes, free of charge
restrictions
By telephone
By web communication
By physical visits on the premises
By physical visits outside the detention facility
C26. Are people placed in prisons considering the location of their home to facilitate maintaining family
relationships?
a. Yes, always
b. Yes, as much as possible
c. No, allocation is made according to other factors
SECTION D: HEALTH OUTCOMES
D1. Are assessments of perceived well-being (or life satisfaction) of people in prison conducted?
a. Yes, regularly (for example once every year or once every two years)
b. Yes, on an ad hoc basis
c. No, it has never been done
D2. Do all people in prison have access to mental health counsellors (including peer support and external providers
– not specifically for mental health disorders but including support for maintenance of well-being when needed)?
a. In all prisons
b. In most prisons
d. In no prisons
Mortality
Data No data
D3. Please provide the number of unique individuals who died over past
12 months (any cause)
D3.1 Among those in D3, how many died as a result of:
a) Suicide
b) Drug overdose
c) COVID-19
Please indicate three additional top causes of death:
d) Cause 1:
e) Cause 2:
f) Cause 3:

Morbidity
D4. Please fill in the following table, which asks for data concerning medical care provision (3.1), diagnoses established
(before and during incarceration – 4.2) and treatment provided (including pharmacological and non-pharmacological). For
easier organization, indicators are organized by disease condition. We ask you to indicate in the first column the most recent
data (year 2020) and only in case this is unavailable, use the following column and add the reference year indicating the
year in the last column. For all data we request you to indicate numbers disaggregated by sex and only for a few conditions
(HIV, HCV, HBV and STIs), specify among females the number that were pregnant in the period considered. Please indicate
the reference year in the last column, for data provided in the first two columns, only if it does not refer to 2020.
2020 OTHER
REFERENCE
YEAR
Tuberculosis TB Both M F
sexes
Number of unique individuals with active TB

diagnosis (ICD code A15–19)
Number of unique individuals receiving TB

treatment over the last 12-month period
Number of unique individuals completing TB

Multidrug-resistant Tuberculosis (MDRTB) Both M F

sexes
Number of unique individuals with active MDR-TB

diagnosis (ICD code Z16.342)
Number of unique individuals receiving MDR-TB

Number of unique individuals completing MDR-TB

HIV Both M F Pregnant

sexes
Number of unique individuals with an active HIV

diagnosis (ICD code B20)
Number of unique individuals with HIV who

received treatment over the last 12-month period
Number of unique individuals completing HIV

2020 OTHER
REFERENCE
YEAR
Hepatitis C Both M F Pregnant

sexes
Number of unique individuals with chronic HCV

infection (HCV RNA positive) (ICD code B18.2)
Number of unique individuals with chronic

HCV infection (HCV RNA) who received antiviral
Number of unique individuals who following

antiviral treatment achieved sustained viral
response over the last 12-month period
Hepatitis B Both M F Pregnant

sexes
Number of unique individuals with chronic HBV

(HBsAg) (ICD code B18.0–18.1)

infection (HBsAg) who are receiving care whilst in
prison (treatment or long term follow up)

infection (HBsAg) and eligible for treatment
(according to international treatment guidelines)
who received antiviral treatment over the last
12-month period
Sexually Transmitted Infections Both M F Pregnant

(STIs) not formerly mentioned sexes
(incl. gonorrhoea, chlamydia,
syphilis, and genital herpes)
Number of unique individuals with an STI

diagnosis over the last 12-month period
Number of unique individuals with STIs who

received treatment over the last 12-month period
Number of unique individuals completing STI

COVID-19 Both M F
sexes
Number of unique individuals with a SARS-Co-V2

infection laboratory confirmed

2020 OTHER
REFERENCE
YEAR
Oral health Both M F

sexes
Number unique individuals with oral health

visit over the last 12-month period
Number of unique individuals keeping

21 or more natural teeth
Mental health disorders Both M F

sexes
Number of unique individuals with a mental

disorder diagnosis (ICD code F01-F99)
on record. Diagnosis made either prior
to incarceration or while in prison
Number of unique individuals with a

psychotic disorder diagnosis (ICD code
F20-29) on record. Diagnosis made either
prior to incarceration or while in prison.
Number of unique individuals with

recorded suicide attempt events (ICD code
T14-91) in the last 12-month period
Number of unique individuals who have

received treatment for any mental health
disorder over the last 12-month period
Substance Use Disorders Both M F

sexes
Number of unique individuals considered

to have an active drug use disorder
in the last 12-month period
Number of unique individuals who have received

pharmacological treatment for a substance
use disorder over the last 12-month period

pharmacological treatment for an opioid use
disorder over the last 12-month period
2020 OTHER
REFERENCE
YEAR
Diabetes Mellitus Both M F

sexes

diabetes mellitus diagnosis (ICD code
E08-E13) on record. Diagnosis made either
prior to incarceration or while in prison.
Number of unique individuals with a diabetes

mellitus diagnosis (ICD code E08-E13) who
had at least two routine health-care visits
(excluding ophthalmology and other specialty
visits) over the last 12-month period
Number of unique individuals with a diabetes

mellitus diagnosis (ICD code E08-E13)
who had at least one ophthalmology
visit over the last 12-month period

received pharmacological treatment for
diabetes over the last 12-month period
Hypertension Both M F
sexes

hypertension diagnosis (ICD code I10-I16)
on record. Diagnosis made either prior
to incarceration or while in prison.

received pharmacological treatment for
hypertension over the last 12-month period
Cardiovascular Disease Both M F

sexes
Number of unique individuals with a diagnosis for

cardiovascular disease (CVD) on record. Diagnosis
made either prior to incarceration or while in
prison. This includes Cardiovascular and Ischemic
Disease – ICD code I20-I25, I26-I28, I30-I52 AND
Circulatory System Diseases – ICD code I60-I79)
Number of unique individuals with a CVD

diagnosis who had at least one routine health-
care visit over the last 12-month period

2020 OTHER
REFERENCE
YEAR

pharmacological treatment for cardiovascular
disease over the last 12-month period
Cancer Both M F
sexes
Number unique individuals with a cancer diagnosis

(ICD codes C00-D48) on record. Diagnosis made
either prior to incarceration or while in prison.

treatment for cancer over the last 12-month period
SECTION E: PRISON ENVIRONMENT
E1. Please indicate the number of individuals put in solitary confinement for behaviour or security reasons (one
or more times during the last 12-month period):
E2. Do all people in prison have access to a toilet in-cell?
a. In all prisons
b. In most prisons
d. In no prisons
E3. Do all people have access to shower & bathing facilities, with water at a temperature suitable to the climate?
a. In all prisons
b. In most prisons
d. In no prisons
E4. Are there any facilities available for physical activity (e.g., gym, indoors or outdoors)?
a. In all prisons
b. In most prisons
d. In no prisons
E5. Are people given the opportunity to use these facilities at least once a week?
a. In all prisons
b. In most prisons
d. In no prisons
E6. Are people in prison given the chance to spend at least one hour per day outdoors?
a. In all prisons
b. In most prisons
d. In no prisons

E7. Are diets in prison adapted to cultural needs, by giving at least two options of food?
a. In all prisons
b. In most prisons
d. In no prisons
E8. Are diets adapted to gender needs (i.e., number of calories varies between female and male prisons)?
a. Yes
b. No
SECTION F: HEALTH BEHAVIOURS
F1. Please provide the following numbers in reference to the situation observed by 31.12.2020.
Both
Male Female No data
sexes
Number of unique individuals with BMI>=25
Number of unique individuals with BMI>=30
Number of unique individuals who currently use tobacco

products
Number of unique individuals who drink/have drank

alcohol (last 12 months)
Number unique individuals who use/have used drugs

(last 12 months)
Number of unique individuals who inject/have injected

drugs (over the last 12 months)
Number of unique individuals who regularly exercise for

a minimum of 150 minutes/week

SECTION G: ADHERENCE TO THE PRINCIPLE OF EQUIVALENCE AND OTHER
G1. Do health-care services for people in prisons offer the same scope of services as in the community?
a. Yes
b. No
G2. Is there a national vaccine implementation plan establishing the access for people in prison to COVID-19
vaccine?
a. Yes, people in prison are considered one of the priority groups.

b. Yes, the principle of equivalence is followed, so the same priority groups identified in the general community are
prioritised in prison (i.e., elderly and health-care staff, by phases)
c. Yes, people in prison are referred to in this plan but are only considered after all people in the community are
immunized
d. Unsure, people in prison are not mentioned in the national vaccine implementation plan
e. We have no national vaccine implementation plan established
G2.1 If the answer to G2 is a, please indicate the level of priority attributed (open question):
G3. Are health-care services in prisons subject to the same standards and accreditation procedures as health-care
services in the community?
a. Yes, for publicly contracted services only

b. Yes, for both public and private services
c. No
G4. Is the prison health workforce subject to the same professional standard as the health workforce in the
community?
a. Yes
b. No
G5. Is the prison health workforce subject to the same ethical standard as the health workforce in the community?
a. Yes
b. No
G6. Are the provisions of international law regarding the health of people in prisons and other places of detention
incorporated into national law?
a. Yes
b. No
G7. Can clinical decisions taken by health staff be overruled or ignored by non-health prison staff?
a. Yes
b. No
G8. Are there publicly available reports of prison hygiene, nutrition and living conditions?
a. Yes. If yes, please provide a link to the latest one:

b. No
G9. Does a national health-care complaints system exist in your country, and is it available to prisoners?
a. Yes
b. No
G9.1 If the answer to G9 is ‘Yes’, please indicate how many complaints were received in the last 12-month period
and provide a link to the latest one.
Number of complaints
Weblink

SECTION H: REDUCING HEALTH INEQUALITIES AND ADDRESSING THE NEEDS
OF SPECIAL POPULATIONS
H1. Are there national standards to meet the health needs of special populations in prison? (select all that apply)
Women
Pregnant
Children and youth
LGBTIQ persons
Foreign nationals
People who use drugs
Elderly prisoners
People with physical disabilities
Ethnic minorities
None of the above (exclusive choice)
H2. Are any of the national standards to meet the health needs of special populations based on relevant
international standards?
a. Yes
b. No
H3. Do prisons have health related information products for people in prison such as brochures and leaflets in
multiple languages?
a. In all prisons
b. In most prisons
d. In no prisons
H4. Do women in prison have the option to be attended by female health care staff?
a. Yes
b. No
H5. Are women offered a pregnancy test on admission to prison?
a. Yes, only once

b. Yes, and they are repeated at regular intervals
c. No
H5.1. If the answer to H5 is a) or b), are women offered the possibility of prenatal care or termination, in case
of a positive result?
a. Yes
b. No
H6. How many women gave birth whilst in prison in the last 12 months?
Thank you very much for your assistance!

Please give any other comments to this survey:

482
Annex 3. Raw data describing the process of death
data transfer to the national registration system
Member State Categorization Explanation
Albania No formal data transfer The relatives of the deceased take the death certificate to the
system. Depends Civil Registration.
on the individual to
register the death.
Armenia Unclear if a formal transfer Data are transferred from the Republic of Armenia penitentiary system
system exists and how into the registry system.
operationalized.
Austria Answer given does Report to police for further initiation.

not address the data
transfer process.
Bosnia and Answer given does In Bosnia and Herzegovina there is a registry book. In Republika Sprska,
Herzegovina not address the data in case of death, the prison immediately informs family, competent
transfer process. court and nearest municipal registry office to issue certificate. At the
state level, this is done in accordance with the laws on health care and
registry records.
Bulgaria A formal transfer The registration of deaths in the country is conducted according to
system in place. the Civil Registration Act by issuing a death certificate which is drawn
up on the basis of a death notice issued by a competent medical
person no later than 48 hours after the death. The certificate may be
drawn up after the expiration of the 48-hour period without the need
of a court order when a forensic medical examination of the corpse is
required under the conditions provided in the Penal Procedure Code.
The judicial authorities, appointing the forensic medical examination,
issue a document certifying the reason for delay. The death certificate
contains: place of drawing up the certificate – region, municipality,
settlement/region; number of the certificate and date of drawing
up; date – day, month, year, hour and minutes of the death; place of
the death – region, municipality, settlement or state, if it is not in the
Republic of Bulgaria, and where it occurred; names of the person; data
for the person – date and place of birth, identification number, age, sex,
citizenship, marital status, permanent address; document certifying
the death; official – names, identification number or birth date and
signature; notes. The circumstance that the death occurred in a place
of deprivation of liberty is not mentioned in the certificate. The cause of
death is also not mentioned in the death certificate.
Annex 3. Raw data describing the process of death data transfer to the national registration system 483
Croatia A formal transfer The bodies of all people who die in prison, regardless of the cause of
system in place. death, must undergo an autopsy performed in appropriate institutions
of the public health system. In addition to reports submitted to
the institutes of forensic medicine and criminology, prisons and
penitentiaries (prison hospital included) submit reports to the registry
of deaths kept by the Ministry of Justice and public administration.
Cyprus A formal transfer Via formal notification, by the doctor of prisons and by admissions and
system in place. release office
Czechia A formal transfer Each event is reported to both registries in parallel.

system in place.
Denmark No formal data transfer The Department of Prison and Probation Service and the Danish
process, but data are parliamentary ombudsman are informed about cases by email.
sent via email in an
aggregated manner.
Estonia A formal transfer Death is documented according to Establishment of Cause of Death

system in place. Act. Documentation is submitted through the Electronic National
Health Database. Process of registration and documentation is similar
to that used for the general public.
Finland Answer given does Causes of death are not determined by Health Services for Prisoners.
not address data
transfer process.
Georgia A formal transfer Data on deaths in prisons provided monthly to the National Statistics
system in place. Office of Georgia. Data are not yet being transferred automatically
though an e-system but with an official letter and attachments.
Germany A formal data transfer In 12 regions cause of death is recorded, but not all regions could
system not in place provide these data.
at national level.
Hungary A formal transfer If the death certificate form is completed online, the data migrate
system in place. automatically. If completed on paper, one of the six copies is mailed to
the registration office.
Ireland A formal transfer All deaths in custody are subject to an inquest held in a coroner’s
system in place. court. The cause of death is determined by a jury on the basis of the
information presented to the coroner’s court. On completion of the
inquest, the coroner issues a certificate to the Civil Registration Service
containing all the details to be registered. The Irish Prison Service is not
party to the death registration.
Italy A formal transfer Data are transmitted in real time by prisons to the statistical
system in place processing centre of the Ministry of Justice.
(electronic).
Lithuania A formal transfer The data are sent to national databases as provided for in national
system in place. legislation.
Luxembourg Answer given does Certificate “declaration of death”.

not address data
transfer process.
Malta A formal transfer Every death that occurs in the Maltese prison system is analysed via
system in place. a magisterial inquiry. Cause of death is then added to the national
government database.
Monaco Answer given does Death certificate.

not address data
transfer process.
Netherlands A formal transfer Every death is mandatorily reported to the Central Bureau of Statistics.
system in place. A physician fills in the form.
Poland Answer given does By death certificate.

not address data
transfer process.
Portugal A formal transfer Online registration using Death Certificate Information System (SICO).
system in place
(electronic).
Republic of Answer given does Death certificate.

Moldova not address data
transfer process.
Romania No formal data transfer Data are not transferred from the prison registration system to the
process in place. national civil registration and vital statistics registration. Prison staff do
not fill in death certificates.
San Marino A formal transfer A doctor from the public health system registers the death in the
system in place. relevant module and this registration is sent to the civil office.
Annex 3. Raw data describing the process of death data transfer to the national registration system 485
Slovakia A formal transfer Physicians examining the deceased issue a standardized form (letter on
system in place. the examination of the dead), which is forwarded to the relevant state
organizations, which process and archive it.
Slovenia A formal transfer General practitioner who works in prison transmits data via the national
system in place health information system.
(electronic).
Spain A formal transfer All cases are judicial deaths and are therefore subject to autopsy. The
system in place. cause of death is stated on the death certificate as determined during
autopsy.
Ukraine Answer given does Transferred to the Ministry of Health.

not address the data
transfer process.
United Kingdom A formal transfer In England and Wales, all deaths are reported to coroners for
system in place. independent investigation to determine the cause and circumstances.
In Scotland, when a death in prison occurs, Police Scotland is
responsible for managing the incident and reporting the death to the
Crown Office and Procurator Fiscal Service. In Northern Ireland, all
deaths in custody are recorded by the Northern Ireland Prison Service
and by the Northern Ireland Coroner’s Service. All deaths in custody
require an inquest to be held by the Coroner’s Service and cause of
death is decided at the inquest.
487
THE WHO REGIONAL OFFICE FOR EUROPE
The World Health Organization (WHO) is a specialized agency of the United Nations created in
1948 with the primary responsibility for international health matters and public health. The WHO
Regional Office for Europe is one of six regional offices throughout the world, each with its own
programme geared to the particular health conditions of the countries it serves.
MEMBER STATES
Albania Greece Portugal
Andorra Hungary Republic of Moldova
Armenia Iceland Romania
Austria Ireland Russian Federation
Azerbaijan Israel San Marino
Belarus Italy Serbia
Belgium Kazakhstan Slovakia
Bosnia and Herzegovina Kyrgyzstan Slovenia
Bulgaria Latvia Spain
Croatia Lithuania Sweden
Cyprus Luxembourg Switzerland
Czechia Malta Tajikistan
Denmark Monaco Türkiye
Estonia Montenegro Turkmenistan
Finland Netherlands Ukraine
France North Macedonia United Kingdom
Georgia Norway Uzbekistan
Germany Poland
World Health Organization

Regional Office for Europe
UN City, Marmorvej 51,
DK-2100, Copenhagen Ø, Denmark
Tel.:+4545337000; Fax:+4545337001
488
Email: eurocontact@who.int
Website: www.who.int/europe

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© World Health Organization 2023

This correction was incorporated into the electronic file on 9

5. Discussion and conclusions 67

Annex 1. Country profiles 81

Annex 2. Health in Prisons European Database Survey (HIPEDS) 447

BMI body mass index

One of the key elements in improving health in prison

Background with their evolution and outcome, undoubtedly contributed

Prison health-care systems Rehabilitation

Prevention and management of infectious diseases, Continuity of care

Access to and completion of treatment for HIV and hepatitis Morbidity

The European prison population Prison health systems

2 Status report on prison health in the WHO European Region 2022

1.1 The WHO Prison 1.2 HIPEDS

Fig. 2. The WHO Prison Health Framework

Health Health service

Organization Preventive services

Health information Medical care

Source: WHO Prison Health Framework (31)

6 Status report on prison health in the WHO European Region 2022

HIPEDS section Section in status report

A Penal statistics 2.1

B Prison health systems 2.2

C Health service delivery 2.3

D Health outcomes 2.4

E Prison environment 2.5.1

F Health behaviours 2.5.2

G Adherence to equivalence and other international standards 2.6.1

Domain Area assessed to operationalize domain

8 Status report on prison health in the WHO European Region 2022

10 Status report on prison health in the WHO European Region 2022

Nominations were received from 41 Member States. Switzerland

The complete list of participating Member States was, in

San Marino 23.0

14 Status report on prison health in the WHO European Region 2022

Table 3. Sociodemographic structure of the European prison population

Number of countries Absolute frequency (n) Relative frequency (%)

Sex and gender distribution

Other relevant characteristics

People newly admitted to prison per 100 000 inhabitants

16 Status report on prison health in the WHO European Region 2022

National government is 58.3% (n = 21)

National and subnational governments 19.4% (n = 7)

Only subnational governments 11.1% (n = 4)

Other situation 11.1% (n = 4)

Prisons General population

18 Status report on prison health in the WHO European Region 2022

Different 19.4% Only subnational governments have

National and subnational

National government is responsible for

Fig. 7. Ministries responsible for delivering health care in European prisons

Ministry responsible for delivery of health care

Countries where this situation applies

Armenia, Bulgaria, Croatia, Finland, France, Italy, Greece Albania, Austria,

Both Ministry of Healthsituation

Other ministry in isolation