Monitoring health status of people living in prison in Europe: insights from HIPED

Aiming to improve the information available about the health status of people living in prisons in the WHO European region, a survey was sent to Member States (MS) in the Region whose Ministry of Health nominated a focal point. The survey used was derived from the operationalization of the WHO Prison Health Framework which contains 8 domains that characterize the population, the health system, the healthcare services available and the health outcomes at the individual level, in addition to influencing factors and cross-cutting principles. Data from 613 497 people living in prison establishments in 2020 was obtained from 36 MS and suggested the most common way of delivery of prison health care to be shared between the Ministry of Health and the Ministry of Justice. Many MS (⅔) experienced difficulties reporting individual data that would allow the quality of primary care to be characterized. Only 4-10 MS (11.1-27.8%) could provide data on health behaviours and 14- 28 figures on the number of individuals with diagnoses on record (except for oral health status; only 4). The most prevalent condition was mental health disorders (32.8%) and 2.6% of individuals were reported to be living with HIV; in both cases suggesting severe underreporting. Weak links with community care were obvious (e.g. 47.2% of MS had a support service to register people with community health services upon release; and 11.1% did not provide any medication upon release), and possibly aggravated by poor health information systems, where most countries still keep paper-based records and among those with electronic records, most did not have interoperable systems. Even death data was poorly linked with national surveillance systems and only 18 MS had a formal data transfer system in place. Investments are needed so that prison health may be fully integrated into public health to be able to monitor progress in SDGs.