Integration of prison health care into national disease surveillance and health informatic systems: opportunities and challenges for Europe and beyond

Approximately six million people are incarcerated annually in the WHO EURO region. The majority of these people spend only a minority of their lives in prison. Many people living in prison (PLP) experience significant health & social care inequalities/inequities and have higher levels of health & care needs than their peers in the community. Imprisonment can represent a public health opportunity to identify and address such needs. Programmes delivered in prisons targeting infectious diseases like HBV, HCV, HIV and tuberculosis (TB) can improve active case finding specifically in prison settings but can also impact on elimination and control targets for whole populations by addressing high risk transmission networks centred in and around prison associated populations. But too often prisons represent a ‘black hole’ for health & care data flows, neither receiving health information from community-based health systems nor providing, in an accessible way, details of health interventions delivered in prisons. The result is discontinuity of care and inefficiencies (economic&clinical) in treatment and care programmes. For example, people being screened multiple times for an infection (e.g. HCV) but not receiving treatment, or starting and stopping multiple courses of treatment in a chaotic way which could add to public health risks, e.g. multi-drug resistant TB. National disease surveillance systems missing data on prison populations also risk health security given the ability of prisons to amplify infectious diseases which could pose health threats to wider communities. Significant efforts are required to ensure that national disease surveillance and health information systems routinely include PLP to improve health intelligence, health security and continuity of care. This can support delivery of screening, diagnostic and therapeutic services. But can also enable health service evaluation, health & care needs assessment, and quality improvement programmes.