Prison health services

On any day the number of imprisoned people throughout the world will number 30 to 50 million. Most periods of incarceration are short, so that four to six times those numbers pass through prisons every year. As imprecise as these figures are, one thing is certain: the numbers are increasing. Prison is a regulated but not a closed system, simply because of the numbers of people who enter, leave, and re-enter custodial institutions. So health problems in prison move between the two sides of the wall, in a seemingly chaotic manner.1 Incarceration means that personal freedoms are denied to the prisoner—loss of choice over sanitation, diet, recreation, and cell mates to name a few. Moreover, overcrowding provides ideal circumstances for stress related disorders and transmission of diseases such as tuberculosis and HIV, as illustrated in this issue by Reyes and Coninx (p 1447).2 The more prisoners' freedoms are limited, and the worse the general prison conditions, the greater the responsibility …