Access to health care for offenders: Making prison a public health responsibility

The WHO recommends that prison health services should be the responsibility of the public health services of the country or state or should work closely together. Most prison health care worldwide, however, is the responsibility of Justice Departments. The prison population carries some of the poorest health profiles of any group and risks being further marginalised unless public health systems address their needs.In the UK, Prison Services have opted to switch responsibilities to Health Departments for reasons of social justice, better assurance of clinical standards and sound public health. The Scottish Prison Service in the UK together with local NHS Boards, is transferring services to the public health system. This process draws on experience from other countries that have carried out the objectives of the change programme. The presentation will detail both opportunities and challenges in the process of reform; perspectives from public health, management and clinical staff; and document the dynamic agenda of issues that arise. Key challenges include cultural differences between prison and public health systems, ensuring a two way exchange that enhances the appreciation of challenges health professionals face in a secure setting, accurate health assessment and clearing misperceptions of risk and dangerousness amongst prison populations.