01.02.2010 A BIG project for health promotion in prisons
A BIG project for health promotion in prisons. Studies show that prison inmates are affected by infectious diseases more frequently than the general population. The «BIG» project has been set up to combat the problem of infectious diseases in prisons and to bring healthcare in prisons up to the same standard as that available in the community.
The risk of infection is greater in prisons than it is in the community. In addition to prison conditions – no free choice of doctor, no free access to preventive and curative healthcare products – the composition of a prison population is also a risk factor, having an above-average proportion of dependent drug users and individuals from countries with a high prevalence of infectious diseases. Switzerland has 117 prisons, housing an average daily total of around 6,000 inmates. Depending on custody type – police detention, detention awaiting trial, open or closed prison sentence, prison sentence with compulsory treatment, custody pending deportation – the proportion of foreign nationals lies between 60 and 100%. In total, around 50,000 new admissions and over 2 million days of detention are recorded every year.
Pilot studies on harm reduction strategies
As early as the 1990s, the Federal Office of Public Health (FOPH) was working actively to improve prisoner health. At that time, the main issues were related to harm reduction measures for offenders who were drug users. With support from the federal government, a number of pilot studies involving the distribution of clean injection equipment to drug users in prisons were successfully conducted. Internationally these projects are still seen as groundbreaking in the field of public health interventions in prisons. Nonetheless, there have been very few attempts to pursue and expand these approaches since.
The BIG project – controlling infectious diseases in prisons
In 2008, the FOPH joined with the Conference of Cantonal Justice and Police Directors and the Federal Office of Justice to launch a project entitled «Controlling infectious diseases in prisons (BIG) 2008–2010». The threefold support being provided clearly underscores the significance of the project: it represents a commitment on the part of the prison and healthcare systems to improve health in prisons at both federal and cantonal level. This is a minor revolution, given the prior consensus that every aspect of the entire prison system lay almost exclusively within the jurisdiction of cantonal judicial authorities. The BIG project is based on expert reports on the right to health during imprisonment and on research studies on healthcare in Swiss prisons. Its aim is to minimise infection and transmission risks both within prisons and between prisons and the community, thereby implementing the «equivalence principle» – in other words, ensuring that medical care in prisons is equivalent to that available in the community. The following thematic areas are being developed in a participatory process involving all the relevant occupational and specialist groups (prison doctors, health services, directorates):
1. Establishment of a sound epidemiological surveillance framework;
2. Development of training and communication measures for inmates, enforcement and healthcare personnel and prison doctors aimed at ensuring the safe handling of infection risks and treatment of individuals with diseases or drug dependence according to specific standards;
3. Development of binding standards for the prevention, testing and treatment of infectious diseases and for the treatment of drug dependence;
4. In addition, work is planned to delineate and, where possible, resolve overarching issues. These include, for example, the estimated 30% of prison inmates who do not have any health insurance, or the question of whether to bring in interpreters when treating non-native-speaker prisoners.
In spring 2010, a package of measures covering the four thematic areas will be presented to the tripartite steering committee for approval and implementation. The challenge here will be to derive a top-down mandate for the relevant judicial and health bodies from the grassroots-oriented work process.
Stefan Enggist, FOPH, firstname.lastname@example.org