01.03.2012 At first hand

Editorial Karen Klaue. The risk of contracting an infectious disease such as HIV/AIDS, hepatitis or tuberculosis is greater in prisons than in the community. Research conducted both in Switzerland and abroad has confirmed this. While detainees do not have the right to free choice of doctor nor do they have automatic access to preventive and curative healthcare, however, it is essential that they have the same chance of enjoying the best possible health and benefiting from the same health counselling, care and support services as people who live in the community.

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The equivalence principle applies here, and it is not only a moral but also a legal imperative. According to the Swiss Constitution, the Swiss Criminal Code and human rights agreements, the State is responsible for preventing impairment of health in individuals whom it holds in places of detention. It is obliged to undertake any supervisory and preventive measures judged to be reasonable. These measures are not confined to the provision of syringes or condoms. They must also ensure a healthy diet and opportunities for physical activity. Then there is the issue of protecting the mental health of detainees – one of the most controversial, and as yet unresolved, problems, in which the requirements of justice have to be reconciled with those of public health.
Switzerland is one of the countries to have pioneered prevention in penal institutions. An automatic syringe dispenser was installed in Hindelbank women’s prison as early as 15 years ago. Now Switzerland is implementing the BIG project – “Combating infectious diseases in prisons”. Its aim is to prevent the transmission of infectious diseases within prisons, but also between prisons and the community. Responsibility for the penal system and prison healthcare in Switzerland rests with the cantons. The necessary equivalence unfortunately falls short of requirements in a number of cantons. The BIG project also seeks to combat this problem by laying down minimum standards that have to be respected.
Linguistic and cultural barriers also often hinder access to healthcare: more than two thirds of all prison inmates in Switzerland are from other countries. Services such as intercultural translation and interpreting by linguists on site or over the phone facilitate such access. It is the State’s responsibility to provide these services in prisons as well.  
Prison health is public health. Improving the – in some cases parlous – health situation in Swiss penal institutions is in everybody’s interests. This applies not least because diseases tend not to stay enclosed within prison walls.

Karen Klaue
BIG Project Manager, Federal Office of Public Health

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