ldella salute 270 documenti info@antoniocasella.eu

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity [Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948].

Il carcere è una malattia incurabile (T. W. Adorno)

on being sane in insane places?

# Trib. sorv. Milano, ord. 24 marzo 2023 (dep. 27 marzo 2023), n. 3862, Pres. Di Rosa, rel. Anedda
Caso Cospito: il Tribunale di sorveglianza di Milano rigetta l'istanza di differimento dell'esecuzione della pena nelle forme della detenzione domiciliare

Comitato Nazionale per la Bioetica
# Comunicato stampa su Alfredo Cospito
# Riflessioni condivise
Roma, 6 marzo 2023
Il diritto inviolabile di vivere tutte le fasi della propria esistenza senza subire trattamenti sanitari contro la propria volontà – derivazione logica del diritto alla intangibilità della sfera corporea di ogni essere umano – costituisce un principio costituzionale fondamentale del nostro ordinamento.

L.Busatta, M.Piccinni, D.Rodriguez, G.Marsico, P.Zatti et al.
# Sciopero della fame. I diritti della persona detenuta che rifiuta di alimentarsi e doveri di protezione
https://www.quotidianosanita.it/ 22 febbraio 2023
Non risultano, né nell'ordinamento penitenziario né nelle leggi speciali che regolano lo status giuridico delle persone sottoposte a limitazioni della libertà personale, disposizioni che consentano di procedere alla nutrizione forzata della persona detenuta che rifiuta di alimentarsi. Il consenso o il rifiuto manifestato dalla persona detenuta adeguatamente informata va rispettato e mantiene la sua validità, qualora l’interessato perda coscienza, anche di fronte all'aggravarsi della sua situazione

World Health Organization
# Status report on prison health in the WHO European Region 2022
https://www.who.int/europe/ 15 February 2023
This report provides an overview of the performance of prison health systems in the WHO European Region. It contains 2020 data obtained through a survey collected from 36 countries, where a total of 613 497 people were deprived of their liberty. most prevalent condition was mental health disorders, but the ratio of psychiatrists to people in prison did not ensure equity of care and access to treatment was suboptimal. Harm minimization focused mostly on access to drug use treatment and less on safe injecting or tattooing practices. Access to hepatitis C (HCV) treatment was not on track to achieve HCV elimination and needs urgent attention. The most common cause of death in prisons was suicide, followed by COVID-19 and drug overdose. Overcrowding was reported in 20% of Member States.

Massimo Niro
# Tutela della salute del detenuto e obblighi informativi a carico dell’amministrazione penitenziaria: una importante precisazione giurisprudenziale
Ilcaso.it, 17 gennaio 2013
La Corte di Cassazione civile, con una recente sentenza, ha enunciato importanti princìpi di diritto in materia di tutela della salute dei detenuti (e del singolo detenuto) e obblighi di informazione gravanti sull’Amministrazione penitenziaria, precisando le possibili conseguenze in capo a quest’ultima in caso di mancato rispetto degli obblighi informativi...

Virginia Oddi
# L’estensione del diritto alla salute nella giurisprudenza di Lussemburgo: dalla disciplina del rimpatrio al MAE
https://www.sistemapenale.it/ 12 Gennaio 2023
# Sentenza CGUE - Causa C-69/21, 22 nocembre 2022

Vladimiro Zagrebelsky
# Biodiritto e detenzione. Orientamenti della Corte europea dei diritti umani sui diritti dei detenuti
BioLaw Journal - Rivista di BioDiritto, n. 4/2022

Catherine Agape
# Médecine et sentence pénale: l’efficacité d’une science dans la lutte contre la récidive
https://dumas.ccsd.cnrs.fr/dumas-03718109/ Submitted on 8 Jul 2022

Anne Bukten, Ingeborg Skjærvø, Marianne Riksheim Stavseth
# The association of prison security level with mortality after release from prison: a retrospective national cohort study (2000–16)
www.thelancet.com/public-health Vol 7 July 2022
Background Incarceration might contribute to increased mortality in an already marginalised population. A bette understanding of the prison-related factors that are associated with mortality is important for preventing the negative health consequences of incarceration. We aimed to investigate all-cause and cause-specific mortality following release
from high-security and low-security prisons.

World Health Organization
# Addressing the noncommunicable disease (NCD) burden in prisons in the WHO European Region: interventions and policy options
www.euro.who.int/ 10-05-2022
More than 1.5 million people are held in detention across the Region, and their health is more fragile than that of people in outside communities. Noncommunicable diseases cause 71% of deaths globally and present a challenge to health-care systems. However, NCDs are poorly recognized as an important health issue in prisons, where the main focus has traditionally been on the prevention of infectious diseases and injuries,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

Anna Arnone
# Il sovraffollamento nelle carceri: le alternative per la tutela della salute in tempi di Covid-19
www.giornalesanita.it/ 21 Aprile 2022

Kira Schacht
# How Europe’s prisons have fared in the Covid-19 pandemic
https://www.europeandatajournalism.eu/ 6 december 2021
Prisons make fertile breeding grounds for viruses, yet administrations have revealed little about Covid-19 cases, deaths and vaccinations in Europe’s prisons. Data from 32 countries show the pandemic’s impact on prisons... Outbreaks in prisons affect not only the people who are confined or working there, but also the surrounding communities. “It's not a totally closed environment... People come in and out every day. Not only staff, but also service providers, lawyers, and prisoners themselves. So, if you’re not protecting prisons, you’re not protecting the community.”

Aurélie Augsburger, Céline Neri, Patrick Bodenmann, Bruno Gravier, Véronique Jaquier & Carole Clair
# Assessing incarcerated women’s physical and mental health status and needs in a Swiss prison: a cross-sectional study
Health & Justice volume 10, 8 (2022)

Phaello Malataliana
# Striking a balance between decongesting prisons and successful offender reintegration: a critical analysis of massive offender releases in mitigating against spread of COVID 19 in prisons
Academia Letters July 2021

Chiara Princivalli, Alvise Sbraccia

# La "manica stretta". Ipotesi di regolazione della somministrazione di psicofarmaci in carcere

www.rapportoantigone.it/ XVII rapporto dulle condizioni di detenzione, 27 maggio 2021

Sophie Charlotte Monachini
# Carcere e Covid-19: pena arcaica, emergenza nuova. Il sistema penitenziario italiano in tempo di pandemia
Dpu Diritto Penale e Uomo, maggio 2021
Il sistema penitenziario italiano, in una situazione di cronico sovraffollamento, è stato investito dall’emergenza sanitaria Covid-19. Il presente contributo intende ricostruire le scelte adottate nella gestione dell’emergenza pandemica all’interno delle carceri, analizzando le numerose disposizioni normative del Governo e approfondendo il ruolo esercitato dalla Magistratura di Sorveglianza nella ricerca di soluzioni adeguate per garantire la tutela del diritto alla salute dei detenuti. L’emergenza sanitaria ha riproposto e acuito problemi strutturali del sistema penitenziario: il concetto di pena e di carcere necessitano di essere riletti alla luce di nuove politiche e di nuovi modelli  di risposta al reato più rispondenti al dettato costituzionale.

Nasrul Ismail, Audrey Lazaris, Éamonn O'Moore, Emma Plugge, Sunita Stürup-Toft
# Leaving no one behind in prison: improving the health of people in prison as a key contributor to meeting the Sustainable Development Goals 2030
BMJ Global Health 2021

Alexander Söderholm
# Prisons and COVID-19: Lessons from an ongoing crisis
www.ohchr.org/ idpc march 2021
The world’s overcrowded and under-resourced pris ons are simply not able to protect the health and rights of people deprived of liberty. This is especial ly true at times of COVID-19, but the issue of prison overcrowding pre-dated and will most likely outlive  the global pandemic. Furthermore, prisons are not an appropriate or just environment to address the caus es for people´s involvement in illegal drug activities.  Therefore, the recommendations provided in this pa per must be interpreted within a broader set of efforts  to reduce prison populations worldwide. As such,  measures aimed at curbing the number of people in  prison should be prioritised

Davide Cavaleri
# Epatite C nel mondo carcerario, la situazione italiana
pharmastar.it/ 27 gennaio 2021
Su una popolazione studiata di 2.687 soggetti il 4,6% (122) ha rifiutato la fase di educazione e quindi il test rapido e il 7% (189) era disponibile al percorso ma è stato rilasciato prima, così sono stati effettuati un totale di 2.376 test (88,4%), per una risultante siero-prevalenza del 10,4% (248) e una sieropositività a HCV-Rna del 40,7% (101/248).

Liana Milella
# Vaccinare i detenuti rispetta la Costituzione. Ma politici e tecnici si dividono sui tempi
La Repubblica, 4 gennaio 2021

Alessandro Delli Poggi, Giulia Pintus, Luca Meani, Federico Ruta, Manuela Batta, Emanuele Brai, Stefano Terzoni, Paolo Ferrara
# Valutazione e Gestione del Rischio di esposizione al COVID-19 degli Operatori sanitari che operano nei penitenziari italiani: uno studio osservazionale
Professioni Infermieristiche, Vol. 73 4 2020
Relativamente al rischio di esposizione, i dati hanno dimostrato che la maggior parte degli operatori che lavo rano in ambito carcerario (92,65%) sono esposti al rischio di  contagio da virus Covid-19 essendo venuti a contatto direttamente con pazienti positivi (90.69%) ed in situazioni in cui sono rimasti esposti durante proce dure assistenziali in cui venivano prodotto aerosol da parte dell’assistito (56.21%)....

Juliet Lyon CBE (Chair, Independent Advisory Panel on Deaths in Custody)
# Vaccinations for Prisoners
www.iapondeathsincustody.org/ 22 December 2020

The prison population is getting older, partly due to sentencing, but also aging prematurely. Men, who make up around 95% of the prison population, are thought to be more vulnerable to the virus. Ethnic minorities and lower socio-economic backgrounds are over-represented within the prison population and more at risk to the virus.... Transmission is enhanced by the high movement of people between establishments and staff within the community. A recent study, led by IAP member Professor Seena Fazel and international colleagues and published last month in BMJ Global Health, reviewed 28 studies looking at outbreaks of infectious diseases, including tuberculosis, influenza, measles and COVID-19, in prisons in high-income countries. It concluded that prisons “present high risk of rapid transmission from high population density and turnover, overcrowding and regular movement within and between establishments”...

Nayanah Siva
# Experts call to include prisons in COVID-19 vaccine plans
www.thelancet.com Vol 396 December 12, 2020
... Prisons are high-risk settings for the transmission of contagious disease, with considerable challenges in managing outbreaks in this setting. “Our research suggests that people in prison should be among the first groups to receive any COVID-19 vaccine to protect against infection and to prevent further spread of the disease”, Fazel said...

Susanna Ronconi
# La salute globale ai tempi del Covid19
www.transform-italia.it/ 23 Dicembre 2020
Da quando, fin dagli esordi dell’Organizzazione Mondiale della Sanità (OMS) e poi, in maniera più stringente, con la Dichiarazione di Ottawa del 1986, la salute cessa di essere “assenza di malattia” per divenire “stato di benessere fisico, psichico e sociale” di ogni individuo, la salute è diventata “un diritto che attraversa tutti i diritti” (un diritto inclusivo, nel linguaggio ONU), funzione complessa non solo dei sistemi di welfare e dell’accesso alle cure (che le malattie le prevengono, le curano o ne riducono l’impatto), ma di fattori ambientali e sociali, di variabili quali reddito, lavoro, istruzione, risorse abitative, nutrizione, qualità della vita urbana, coesione sociale, riduzione delle disuguaglianze, clima e qualità dell’aria e dell’acqua, non discriminazione, diritto alla vita.

Roni Caryn Rabin
# Prisons Are Covid-19 Hotbeds. When Should Inmates Get the Vaccine? Federal officials have suggested that corrections staff receive high priority for a coronavirus vaccine, but not the millions of vulnerable inmates held in U.S. facilities.
www.nytimes.com/ Nov. 30, 2020
They live in crowded conditions, sharing bathrooms and eating facilities where social distancing is impossible. They have high rates of asthma, diabetes and heart disease. Many struggle with mental illness. A disproportionate number are Black and Hispanic, members of minority communities that have been hard hit by the coronavirus pandemic. So should prisoners and other detainees be given priority access to one of the new Covid-19 vaccines?...

Angela Della Bella (ed)
# Salute e diritti fondamentali dei soggetti privati della libertà personale al tempo del Coronavirus
http://www.beccaria.unimi.it/ novembre 2020
Rapporto redatto dagli studenti della Clinica Legale di Giustizia Penale, in collaborazione con l’Ufficio del Garante dei diritti delle persone private della libertà personale del Comune di Milano: ... il punto sui problemi della tutela dei diritti fondamentali dei soggetti privati della libertà personale nella situazione di emergenza sanitaria. Ciò tanto con riferimento ai soggetti detenuti negli istituti penitenziari, quanto ai migranti, ristretti nei centri di detenzione amministrativa...

University of Oxford
# People in prison should be prioritised for any COVID-19 vaccine
www.ox.ac.uk/ 20 november 2020

According to the New York Times (16 November 2020), more than 252,000 people in prisons and jails have tested positive for COVID-19, and at least 1,450 have died from complications. In the UK (31 October 2020), the Ministry of Justice reports 55 COVID-related deaths of people in prison. Since the start of the pandemic, there have been 1,529 positive cases in the prison population in England and Wales across 99 establishments

Marcelo F. Aebi and Mélanie M. Tiago
# Prisons and Prisoners in Europe in Pandemic Times: An evaluation of the medium-term impact of the COVID-19 on prison populations
https://wp.unil.ch/ Strasbourg and Lausanne: 10 November 2020
In sum, the general trend observed in Europe is the following: The spread of the COVID-19 pandemic was accompanied by an overall decrease of European prison populations during the period of the lockdowns; that trend was stopped and, in several countries, reversed after the end of the lockdowns. The European trend can be explained combining three factors: • A decrease in the activities of the criminal justice system... • The release of inmates as a preventive measure to reduce the spread of COVID-19... • The lockdowns produced a crime drop...

Alexandria Macmadu, Justin Berk,Eliana Kaplowitz, Marquisele Mercedes, Josiah D Rich, Lauren Brinkley-Rubinstein
# COVID-19 and mass incarceration: a call for urgent action
www.thelancet.com/ november 2020

Compared with the general population, the number of COVID-19 cases is 5·5 times higher among people who are incarcerated... The outsized effect of the COVID-19 pandemic on people who are incarcerated and Black communities elucidates the inextricable links between health, race, and incarceration. Through decarceration, the largest COVID-19 outbreaks can be mitigated, hazardous conditions of confinement can be alleviated, and racial disparities in health can be reduced. Decarceration is urgently needed, particularly during a persisting and prejudicial pandemic.

# Lettera di Francesco Maisto, Garante dei diritti delle persone private della libertà personale del Comune di Milano, ai vertici degli uffici giudiziari
Milano, 4 novembre 2020

Camila Strassle, E. Jardas, Jorge Ochoa, Benjamin E. Berkman, Marion Danis, Annette Rid, Holly A. Taylor
# Covid-19 Vaccine Trials and Incarcerated People — The Ethics of Inclusion
www.nejm.org/ October 21, 2020
Incarcerated populations are especially vulnerable to acquiring infectious diseases like Covid-19 because of factors including overcrowding, confined spaces, high population turnover, poor sanitation, and poor access to health care. People who are incarcerated are also more likely than the general public to develop complications associated with infectious diseases because of their higher rates of underlying health conditions... Researchers are considering whether incarcerated people should be included in multisite efficacy trials of Covid-19 vaccine candidates after there is some evidence that such vaccines are safe.

Gabrielle Beaudry, Shaoling Zhong, Daniel Whiting, Babak Javid, John Frater, Seena Fazel
# Managing outbreaks of highly contagious diseases in prisons: a systematic review
https://gh.bmj.com/ BMJ Global Health, Oct 2020
COVID-19 has developed into an international public health crisis accompanied by restrictions on daily life and more targeted measures (eg, travel bans, school closures and remote working). In prisons, barriers to translating such interventions are considerable, and there is a high risk of rapid transmission due to high population density and turnover, overcrowding and frequent movements within and between establishments.1 2 In addition, there is a high proportion of people in prison (PIP) who may be more vulnerable to severe COVID-19 due to underlying risk factors (such as male sex, older adults and having chronic underlying health conditions).

Don Hummer

# United States Bureau of Prisons’ Response to the COVID-19 Pandemic

Victims & Offenders, october 2020
As the SARS-CoV-2 (COVID-19) spread across the United States in spring 2020, the Federal Bureau of Prisons (BOP) made the startling announcement that of its 2,700 initial screenings of inmates for the virus, 2,000 had tested positive – an astounding 70% positivity rate. It is obvious to assume that prisons and jails would be locations of outbreaks and rapid community spread given the close quarters, limited access to preventive methods, and movement of both inmates and staff in and out of facilities.

PRAP della Lombardia
# Riacutizzazione epidemiologica Covid-19. Linee operative finalizzate alla prevenzione e al contenimento dei rischi da contagio negli negli Istituti Penitenziari della Lombardia. Fase 3
Milano, Ottobre 2020

Mauro Marin
# Il Covid e il diritto dei detenuti di usufruire di cure mediche appropriate
quotidianosanita.it, 21 ottobre 2020
L'emergenza Covid-19 e l'alto rischio dovuto alla coesistenza di patologie croniche gravi hanno reso attuali le problematiche riguardanti i criteri di redazione del certificato medico di compatibilità o meno del regime carcerario per i reclusi con gravi patologie nell'organizzazione penitenziaria

Ministry of Justice
# HM Prison and Probation Service COVID-19 Official Statistics. Data to 30 September 2020
https://assets.publishing.service.gov.uk/ 9 october 2020
45 deaths since the start of the pandemic among HMPPS service users where COVID-19 was the suspected cause, of whom 23 were prisoners and 22 were probation service users. There have been no COVID-19 suspected deaths of service users in the last four months. • 630 prisoners or children tested positive for COVID-19 since the start of the pandemic, across 89 establishments, almost all of whom were adults. The number of new monthly confirmed cases has increased by 80 since August 2020. • 316 prisoners have been released under COVID-19 temporary release schemes, 54 were compassionate releases.

WHO Africa
# Ministry of Health and WHO Respond to a Spike of COVID-19 Infection in Amuru Prison
https://www.afro.who.int/ 14 September 2020

Lukas M. Muntingh
# Africa, Prisons and COVID-19
Journal of Human Rights Practice, 1-9, 2020
Africa’s prisons are a long-standing concern of human rights defenders. Overcrowding, poor nutrition, illness, disease, and rights violations, to name a few concerns, characterize Africa’s prisons. The possibility that a highly infectious virus for which there is no vaccine becomes prevalent in Africa’s prisons is a scenario almost too disastrous to contemplate. Many are familiar with the devastation that AIDS brought to Africa’s prisons and with underlying health conditions such as HIV/AIDS, tuberculosis (TB) and general poor nutrition, COVID-19 does conjure up images of an unprecedented prisons health crisis, as both the infection rate (the proportion of people infected) and the infection fatality rate (the proportion of infected persons who die) may be higher in prisons than that which may occur among the general population outside prison.

Equal Justice Initiative
# Covid-19’s Impact on People in Prison
https://eji.org/ Updated 08.21.20

Brendan Saloner, Kalind Parish, Julie A. Ward, Grace DiLaura, Sharon Dolovich
# COVID-19 Cases and Deaths in Federal and State Prisons
JAMA August 11, 2020 Volume 324, Number 6
By June 6, 2020, there had been 42 107 cases of COVID-19 and 510 deaths among 1 295 285 prisoners with a case rate of 3251 per 100 000 prisoners. The COVID-19 case rate for prisoners was 5.5 times higher than the US population case rate of 587 per 100 000. The crude COVID-19 death rate in prisons was 39 deaths per 100 000 prisoners, which was higher than the US population rate of 29 deaths per 100 000...

Nicholas Chan | NSW Bureau of Crime Statistics and Research
# The impact of COVID-19 measures on the size of the NSW adult prison population
www.bocsar.nsw.gov.au/ July 2020
Between 15 March and 10 May 2020 the NSW adult prison population decreased by 10.7% (1,508 people). Decreases in both the male and female custody population as well as the Aboriginal custody population were evident during this period. The majority of this decline was due to a drop in the remand population which fell by 21.2% (1,049 people). A smaller decline (6.1%) in the sentenced custody population was observed from 22 March The COVID-19 pandemic was associated with large falls in the NSW adult prison population. Most of this decline was due to a drop in remand receptions and increase in discharges to bail.

Luigi Spera
# Brasile. Nelle carceri il Covid corre veloce e a giugno +800% dei casi
Il Fatto Quotidiano, 15 luglio 2020
La gravità della situazione ha spinto 200 Ong attive nella difesa dei diritti umani a inviare un documento all'Onu, alla Commissione  interamericana dei diritti umani e alla stessa Oms, per denunciare le mancanze del governo. Nel limbo tra periferie e carcere, dove i confini tra dentro e fuori si confondono lungo perimetri estremamente porosi che dividono l'interno delle celle sovraffollate dal degrado esterno fatto di crimine, povertà e ingiustizia sociale, il coronavirus si diffonde rapido...

Mary Van Beusekom
# US prison inmates among those hit hard with COVID-19
cidrap.umn.edu/ CIDRAP News | Jul 09, 2020

Mariano Cingolani, Lina Caraceni, Nunzia Cannovo, Piergiorgio Fedeli
# The COVID-19 Epidemic and the Prison System in Italy
Journal of correctional health care: the official journal of the National Commission on Correctional Health Care, 2020 Jul 6
The Italian Ministry of Justice and that of Health have established two strategies to limit the spread of COVID-19 in prisons: progressive isolation from the external world and adoption of practices to identify possible cases and to treat infected subjects. After the announcement of regulations revolts erupted in numerous Italian prisons. The motivations and effects of these strategy are discussed critically into the search for a balance between the right to health and other rights of prisoners in Italian prisons with the problem of an occupancy level of 121.75%.

Brendan Saloner, Kalind Parish, Julie A. Ward, Grace DiLaura, Sharon Dolovich
# COVID-19 Cases and Deaths in Federal and State Prisons
JAMA American Medical Association, July 8, 2020
COVID-19 case rates have been substantially higher and escalating much more rapidly in prisons than in the US population. One limitation of the study is that it relied on officially reported data, which may be subject to inaccuracies and reporting delays... Mass testing in select prisons revealed wide COVID-19 outbreaks, with infection rates exceeding 65% in several facilities... 

Ecdc - European Centre for Disease Preventionn and Control
# Infection prevention and control and surveillance for coronavirus disease (COVID-19) in prisons in EU/EEA countries and the UK
www.ecdc.europa.eu/ 3 July 2020
According to the Council of Europe Annual Penal Statistics (SPACE), on 31 January 2019 approximately 1.5 million inmates were in penal institutions with available data in the European region [13]. The median age of this population was 35 years old, with 15% aged over 50, and 95% male. Fifteen countries reported overcrowding, of which 10 (8/10 EU Member States) reported serious over-crowding...

Andrew Welsh-Huggins
# New outbreaks push inmate coronavirus cases past 50,000
www.wwnytv.com/ Associated Press | July 3, 2020

At the end of June, the total number of coronavirus cases among prisoners had reached at least 52,649, an increase of 8% from the week before, according to data compiled by the Marshall Project, a nonprofit news organization focusing on criminal justice, and The Associated Press. Of those, at least 35,796 have recovered, and at least 616 inmates have died, the data showed. Among staff, more than 11,180 cases of coronavirus have been reported, including 43 deaths...

Pietro Buffa
# Carcere e pandemia
https://dirittopenaleuomo.org/ 1 luglio 2020
Nel frattempo il carcere, come gli ospizi, sono luoghi ove la strategia esterna delbdistanziamento non potrà essere mai applicata perché la nostra modernità democratica, via via, li ha già distanziati dalla società stessa e li affolla di scarti sociali frutto dell’incapacità di prendersi cura veramente dei problemi essenziali. Contenitori di disagio affrontato con l’allontanamento oggi saliti all’onor delle cronache per gli effetti che il virus ha avuto nelle R.S.A. e che potenzialmente poteva generare anche negli istituti di pena.

Rosanna Mancinelli, Fortunato Paolo D’Ancona, Sandro Libianchi, Alessandro Mustazzolu, Lara Tavoschi, Annalisa Pantosti
# Indicazioni per la prevenzione e il controllo di Covid-19 negli Istituti penitenziari e in altre strutture con limitazione delle libertà personali per adulti e minori
Notiziario Istituto Superiore Sanità, 2020;33(6):23-27

Al fine di fornire indicazioni per la prevenzione e controllo per COVID-19 nella popolazione di detenuti adulti e minori, presso l’Istituto Superiore di Sanità (ISS) è stato costituito un Gruppo di lavoro formato da ricercatori ISS ed esperti esterni. L’attività scientifica del Gruppo ha portato in evidenza problemi sanitari a oggi ancora poco conosciuti e rappresenta una opportunità per affrontare importanti problemi di salute pubblica e superare le diseguaglianze di salute attraverso lo sviluppo di specifiche strategie di intervento dedicate a questo gruppo di popolazione vulnerabile.

Francesco Maisto
# Il carcere: come non si è governata l’emergenza infezione
www.giustiziainsieme.it, 26 giugno 2020

Emily Widra, Dylan Hayre | ACLU - Prison Policy Initiative
# Failing Grades: States’ Responses to COVID-19 in Jails & Prisons

www.aclu.org/ June 25, 2020

When the pandemic struck, it was obvious what needed to be done: take all actions possible to “flatten the curve.” This was especially urgent in prisons and jails, which are crowded facilities where social distancing is impossible, sanitation is poor, and medical resources are extremely limited. Public health experts warned that the consequences of inaction or inadequate response were dire: prisons and jails would become petri dishes where, once inside, COVID-19 would spread rapidly, cause illness and death, and then boomerang back out to the surrounding communities with greater force than ever before...

Rosemary Ricciardelli, Sandra Bucerius
# Canadian prisons in the time of COVID-19: Recommendations for the pandemic and beyond
www.theglobeandmail.com/ June 23, 2020

Carlos Franco-Paredes, Katherine Jankousky, Jonathan Schultz, Jessica Bernfeld, Kimberly Cullen, Nicolas G. Quan, Shelley Kon, Peter Hotez, Andre´s F. Henao-Martinez, Martin Krsak
# COVID-19 in jails and prisons: A neglected infection in a marginalized population
https://journals.plos.org/ PLOS Neglected Tropical Diseases, june 22, 2020

Elisa Grisonich
# Un’interessante pronuncia di merito sulla configurabilità degli arresti domiciliari “a termine” tra assetto codicistico e decreto-legge n. 29 del 2020 - Trib. Lecce, sez. Riesame, ord. 1° giugno 2020
Sistema Penale, 12 giugno 2020

Marco Nardone
# Le Covid-19 en prison
in Fiorenza Gamba, Marco Nardone, Toni Ricciardi, Sandro Cattacin (eds), Covid-19. Le regard des sciences sociales, June 2020
Nous aimerions enfin mettre en garde les personnes qui se lanceraient dans l’analyse critique, de ne pas tomber ni dans le piège de la critique « carcéralo-centrée » vouée à perpétuer les dynamiques reproductives de l’institution carcérale et de son échec (ce qui arrive exactement lors des crises, où l’on tente de résoudre des problèmes urgents), ni dans le piège de la critique abolitionniste qui, par son opposition nette aux réformes de la prison, tendrait à négliger les besoins concrets et urgents d’améliorer l’état des personnes détenues

Maria Vittoria Ambrosone
# Emergenza sanitaria e sistema carcerario italiano
penaledp.it, 1 giugno 2020
Invero, il contesto nel quale la libertà personale subisce il maggiore grado di compressione consentito dalla nostra Costituzione è il carcere. Ebbene, anche nel caso in cui l’individuo si trovi in un ambiente per sua natura destinato a separarlo dalla società civile, la dignità della persona deve essere sempre tutelata, così come ci ricorda non solo la Corte Costituzionale, ma anche, a più riprese, la Corte europea dei diritti dell’uomo.

Radha Kothari, Andrew Forrester, Neil Greenberg, Natasha Sarkissian, Derek K Tracy
# COVID-19 and prisons: Providing mental health care for people in prison, minimising moral injury and psychological distress in mental health staff
Medicine, Science and the Law, May 29, 2020
As has often been repeated in relation to COVID19, perfect is the enemy of the good; however, whilst resources are stretched, failing to support our staff is a false economy. Presenteeism is a greater burden on organisations than absenteeism, and sickness rates and staff retention will be worse in those organisations which fail to support staff adequately.

Veronica Manca
# Umanità della pena, diritto alla salute ed esigenze di sicurezza sociale: l’ordinamento penitenziario a prova di (contro)riforma.
www.giurisprudenzapenale.com/ 5, 2020
1. Premessa e nota di metodo. – 2. Analisi della casistica. – 3. Il differimento pena: il concetto di “grave infermità fisica”. – 3.1. Dalla Costrizione agli standard europei dei diritti fondamentali dei detenuti. – 3.2. (Segue) I recenti orientamenti della Cassazione e la giurisprudenza di merito. – 3.3. La detenzione c.d. in “deroga”. – 3.4. L’applicazione provvisoria: “il grave pregiudizio”. – 3.5. Le altre misure extramurarie. – 4. Rimedi ex art. 39 Reg. Corte EDU, class actions e qlc su art. 147 c.p.? – 5. Suggestioni in chiave di (contro)riforma.

Matthew J. Akiyama, Anne C. Spaulding, Josiah D. Rich
# Flattening the Curve for Incarcerated Populations — Covid-19 in Jails and Prisons
www.nejm.org/ The New England Journal of Medicine, May 28, 2020
To promote public health, we believe that efforts to decarcerate, which are already under way in some jurisdictions, need to be scaled up; and associated reductions of incarcerated populations should be sustained. The interrelation of correctional-system health and public health is a reality not only in the United States but around the world.

World Health Organization - Regional Office for Europe
# Experience of health professionals, police staff and prisoners in Italy informs WHO COVID-19 guidelines for prisons
www.euro.who.int/ 28-05-2020
The Italian health system was another factor that contributed to the effectiveness of penitentiary infection control measures”, added Dr Roberto Ranieri, who also devotes his work to infection control in the San Vittore prison. March brought the third phase of infection control measures in Lombardy prisons, when the first cases of COVID-19 transmission in detention facilities were detected. On 9 March the news led to riots in numerous prisons all over Italy. “The riots calmed down really quickly, in a couple of days. It became evident that there was huge stress and concern among detainees, as well as among prison staff, so we set up compulsory psychological consultations for people to help them cope with stress”, Dr Giuliani recalls. Dr Roberto Ranieri points out that, overall, the measures would not have been a success without the detainees’ help...

Benedetto Saraceno (ed)
# Lezioni per il dopo: salute comunità democrazia
Communitas, Maggio 2020

Aldo Bonomi, Editoriale - Angelo Richetti, Il welfare da ricostruire. Una proposta. Dai budget educativi ai budget di salute

# UNODC, WHO, UNAIDS and OHCHR joint statement on COVID-19 in prisons and other closed settings
https://www.who.int/news-room/ 13 May 2020

We, the leaders of global health, human rights and development institutions, come together to urgently draw the attention of political leaders to the heightened vulnerability of prisoners and other people deprived of liberty to the COVID-19 pandemic, and urge them to take all appropriate public health measures in respect of this vulnerable population that is part of our communities.

Fabio Gianfilippi
# La rivalutazione delle detenzioni domiciliari per gli appartenenti alla criminalità organizzata, la magistratura di sorveglianza e il corpo dei condannati nel d.l. 10 maggio 2020 n. 29.
www.giustiziainsieme.it/ 12 maggio 2020
1. Il perimetro del nuovo intervento urgente. 2. La revoca della detenzione domiciliare surrogatoria del differimento della pena e la sua irretroattività. 3. La rivalutazione obbligatoria frequentissima delle detenzioni domiciliari connesse all’emergenza sanitaria concesse ai condannati per reati di criminalità organizzata e la sua portata retroattiva. 4. Competenza ed adempimenti istruttori. 5. La ratio dell’istituto, con lo sguardo più indietro che avanti.

Emilio Santoro
# Diritto alla salute e prevenzione in carcere: problemi teorici e pratici di gestione del coronavirus negli Istituti di pena
La legislazione penale, 4 maggio 2020

Se non si coglie la tremenda occasione della pandemia per inglobare definitivamente la prevenzione nel diritto alla salute dei detenuti, se qualcuno di loro risultasse contagiato, in una sezione in cui si trovava un agente o un detenuto positivo, questi potrebbe chiamare lo Stato italiano a rispondere del proprio contagio in base alla responsabilità da contatto sociale.

Laura Hawks, Steffie Woolhandler, Danny McCormick
# COVID-19 in Prisons and Jails in the United States
https://jamanetwork.com/ April 28, 2020
In the 2 weeks following release from incarceration, people are at increased risk of death, particularly from drug overdose and cardiovascular disease.9 If more people are to leave prisons and jails, correctional officials and community members should take steps to mitigate these risks. Pharmacologic treatment for opioid use disorder is now available via telemedicine, and all prisoners who might benefit from such programs should be referred to them. Similarly, older prisoners and those with chronic health conditions should have pre-arranged primary care follow-up, and the means (eg, an appropriate computer or smartphone) to engage in telehealth visits.

Lisa Kerr
# Coronavirus in Canadian prisons
www.queensu.ca/ April 23, 2020
It is always the case that the interests of incarcerated people are closely tied to those of us living free in the community. The pandemic has altered much about normal life, including the ability to deny those ties.

Davide Galliani - Intervista di Michela Petrini
# Emergenza  Covid-19, carceri e diritto alla salute
Giustizia Insieme, n. 999, 11 aprile 2020
Lei mi chiede quali sono le ragioni del silenzio sul problema pandemia in carcere. La risposta più sincera e più giuridica che riesco a darle è questa: abbiamo smesso di provare i brividi che provoca l’umana miseria, e non comprendiamo che esitare significa morire...

Fabio Gianfilippi
# Emergenza sanitaria e differimento pena nelle forme della detenzione domiciliare: il fardello della M. di sorveglianza. Note a Trib.Sorv.Milano, 31.3.20.
www.giustiziainsieme.it/ 11 aprile 2020
1. L’ordinanza del Tribunale di sorveglianza di Milano. 2. L’accertamento in concreto della sussistenza delle condizioni che legittimano il differimento della pena. 3. Alcuni documenti in materia di detenuti in condizioni di fragilità di fronte all’emergenza 4. Il differimento della pena per condizioni di salute che espongono a particolari rischi in caso di contagio

Sofia Ciuffoletti

# Uno studio di 100 anni fa può insegnarci a gestire l'epidemia tra i detenuti
Il Foglio, 8 aprile 2020

Ministère des Solidarités et de la Santé
# Coronavirus (Covid-19). Fiche établissements pénitentiaires. Organisation de la prise en charge sanitaire des patients détenus nécessitant des soins psychiatriques
https://solidarites-sante.gouv.fr/ 2 avril 2020

ONUDC
# Note d'information. Covid-19: préparation et intervention en prison # COVID-19 preparedness and responses in prisons
www.unodc.org/ 31 mars 2020
Les prisons et autres lieux de détention devraient faire partie intégrante des plans nationaux de santé et d’urgence adoptés face à la pandémie de COVID-19. Les mesures de préparation, de prévention et d’intervention dans les établissements pénitentiaires devraient être conçues et mises en œuvre suivant les orientations spécialement élaborées par l’Organisation mondiale de la Santé (OMS). Elles devraient comprendre des évaluations des risques et des plans d’urgence spécifiques; des mesures renforcées d’hygiène et de contrôle des infections; la disponibilité ininterrompue des fournitures nécessaires, y compris des équipements de protection individuelle; l’entretien de liens étroits avec les autorités de santé publique locales et nationales; ainsi que le soutien et le renforcement des capacités du personnel pénitentiaire et des professionnels de la santé.

Brie Williams, Cyrus Ahalt , David Cloud, Dallas Augustine, Leah Rorvig, David Sears
# Correctional Facilities In The Shadow Of COVID-19: Unique Challenges And Proposed Solutions
www.healthaffairs.org/ March 26, 2020
In this moment we must all remember that incarcerated people, and all those who work in prisons and jails, are part of our families and our communities. We have constitutional and ethical obligations to protect these populations and to take all appropriate actions needed to mitigate the effects of a potential outbreak in correctional facilities.

US Centers for Disease Control and Prevention (CDC)
# Interim Guidance on Management of Coronavirus Disease 2019 (COVID-19) in Correctional and Detention Facilities
www.cdc.gov/ March 23, 2020

TJC The Justice Collaborative
#  COVID-19. Fact Sheet: Practices for Jails and Prisons
https://thejusticecollaborative.com/ March 2020
The growing number of older adults in prisons are at higher risk for serious complications from a viral infection like COVID-19. Releasing these vulnerable groups from prison and jail will reduce the need to provide complex medical care or transfers to hospitals when staff will be stretched thin

Stuart A. Kinner, Jesse T. Young, Kathryn Snow, Louise Southalan, Daniel Lopez-Acuña, Carina Ferreira-Borges, Éamonn O'Moore
# Prisons and custodial settings are part of a comprehensive response to COVID-19
www.thelancet.com/ March 17, 2020
Prison health is public health by definition. Despite this and the very porous borders between prisons and communities, prisons are often excluded or treated as separate from public health efforts. The fast spread of COVID-19 will, like most epidemics, disproportionately affect the most disadvantaged people. Therefore, to mitigate the effects of prison outbreaks on tertiary health-care facilities and reduce morbidity and mortality among society's most marginalised, it is crucial that prisons, youth detention centres, and immigration detention centres are embedded within the broader public health response.

Penal Reform Internationa
# Coronavirus: Healthcare and human rights of people in prison. Do no harm, equality, transparency, humanity: values should guide the criminal justice sector’s response to coronavirus
https://cdn.penalreform.org/ Briefing note, 16 March 2020
Under international human rights law, every human being has the right to the highest attainable standard of physical and mental health. When a state deprives someone of their liberty, it takes on the duty of care to provide medical treatment and to protect and promote his or her physical and mental health and well-being, as laid out by the United Nations Standard Minimum Rules for the Treatment of Nelson Mandela Rules). This duty of care is critical, because prisoners have no alternative but to rely on the authorities to promote and protect their health...

UNODC
# Suggestions about treatment, care and rehabilitation of people with drug use disorder in the context of the COVID-19 pandemic. A contribution to the health security of countries and communities
www.unodc.org/ March 2020

Glauco Giostra
# Disinnescare in modo sano la bomba-virus nelle carceri. Gli effetti della pandemia di Covid-19 sulla realtà dei penitenziari e le soluzioni possibili
Avvenire, 21 marzo 2020
... Se il virus comincia a circolare nelle vene penitenziarie sarà impossibile fermarlo alle mura del carcere... L'importante è agire subito, con la consapevolezza che ancora una volta i provvedimenti che fanno bene alla popolazione penitenziaria fanno bene alla società tutta.

Amanda Klonsky
# An Epicenter of the Pandemic Will Be Jails and Prisons, if Inaction Continues . The conditions inside, which are inhumane, are now a threat to any American with a jail in their county — meaning just about everyone.
www.nytimes.com/ March 16, 2020

World Health Organization
# Preparedness, prevention and control of COVID-19 in prisons and other places of detention. Interim guidance
www.euro.who.int/ 15 march 2020

Experience shows that prisons, jails and similar settings where people are gathered in close proximity may act as a source of infection, amplification and spread of infectious diseases within and beyond prisons. Prison health is therefore widely considered as public health... Efforts to control COVID-19 in the community are likely to fail if strong infection prevention and control (IPC) measures, adequate testing, treatment and care are not carried out in prisons and other places of detention as well.

Francesca Vianello
# Il carcere insostenibile
www.rivistailmulino.it/12 marzo 2020

WHO Regional Office for Europe
# Health in prisons: fact sheets for 38 European countries
http://www.euro.who.int/ 2019
The fact sheets for 38 countries in the WHO European Region present data on prison health systems and services, collected between 2016 and 2017. The purpose of the fact sheets is to present a snapshot of what is currently known about prison health-care systems and services across the European Region. Each fact sheet provides a summary of select indicators belonging to the eight domains of the Health in Prisons European Database (HIPED). The data presented for these indicators are grouped under the following headings: prison population, prison health systems, prison health-care workforce, prison environment and risk factors, disease screening, prevalence of communicable diseases, prevention of infection, treatment and mortality. The content comprises key aspects of prison health that are relevant to national decision-makers. The aim of this work is to improve monitoring and surveillance systems in prisons, and to improve broader health outcomes.

WHO Regional Office for Europe
# Status report on prison health in the WHO European Region
https://apps.who.int/ 2019
It is estimated that 6 million people are incarcerated every year in the WHO European Region. The prevalence of many health conditions is much greater among people in prison, who very often represent those “left behind”, compared with individuals in the community. Prison and other places of detention can provide an opportunity to deliver preventive and risk-reduction interventions and treatments to a population that previously may have had limited or no access to health care and healthy living. A large proportion of people in prison return to the community every year, so it is a public health imperative that management and treatment for health conditions, particularly (but not exclusively) infectious diseases, are provided in the prison environment to prevent transmission within the community upon release.

ISS - Rosanna Mancinelli, Marcello Chiarotti, Sandro Libianchi (a cura di)
# Salute nella polis carceraria: evoluzione della medicina penitenziaria e nuovi modelli operativi
www.iss.it/ Rapporti ISTISAN 19/22 - Roma, novembre 2019
La medicina penitenziaria è una materia in evoluzione continua, la cui nascita ufficiale in seno al Servizio Sanitario Nazionale risale a soli dieci anni fa, con il DPCM 1° aprile 2008. Il servizio sanitario penitenziario, nonostante la sua peculiarità di comparto letteralmente ‘confinato”, è completo di tutte le relative articolazioni funzionali: medicina d’urgenza, medicina di base, medicina specialistica, ricoveri, ecc. La problematica della sua creazione ex novo appare molto simile a quella che si ebbe nel 1978 con la nascita del servizio sanitario nazionale...

# Carceri. Aumentano i casi di tubercolosi, in calo i malati di Hiv, in cura i soggetti con Hcv
https://www.quotidianosanita.it/ 3 ottobre 2019

Babak Moazen, Shervin Assari, Florian Neuhann, Heino Stöver
# The guidelines on infection control in prisons need revising
www.thelancet.com Vol 394 July 27, 2019
Owing to a series of environmental and individual risk factors within prisons worldwide, major infectious diseases have become substantially more prevalent... Since most prisoners will eventually be released back into their communities, these individuals have the potential to further spread these contagious diseases, presenting a risk to society...

Charlotte Randall, Sara Nowakowski, Jason G. Ellis
# Managing Acute Insomnia in Prison: Evaluation of a “One-Shot” Cognitive Behavioral Therapy for Insomnia (CBT-I) Intervention
Behavioral Sleep Medicine, n. 6, 2019
An estimated 11–81% of prison inmates report insomnia symptoms. The wide variation among studies may be due to different criteria used to define insomnia as well as different measures used to assess insomnia symptoms. For example, requests for hypnotics were used as an indicator of insomnia in one study, whereas other studies, with much higher prevalence rates, used clinical screening instruments or general health questionnaires with one or two sleep-related items embedded within. The only study to date that has used an insomnia-specific measure, the Sleep Condition Indicator, suggests an overall prevalence rate for Insomnia Disorder of 61.6%, with women significantly more likely to report insomnia, in prison, compared to men...

James Woodall, Charlotte Freeman
# Promoting health and well-being in prisons: an analysis of one year’s prison inspection reports
Critical Public Health, May 2019
This paper, using content and the-matic analysis, analyses one year (2018) of inspection reports in 38 maleprisons. Analysis demonstrates that a‘whole-prison approach’to pro-moting health and well-being is poorly understood, with only 41% ofprisons showing characteristics of this approach. Of the male prisonsinspected in 2018, there was good availability of disease preventionactivities and screening programmes (88%) and smoking cessation sup-port (94%). The provision of peer support mechanisms, access to con-doms and access to health information was highly variable acrossprisons.

World Health Organization - European Center for Disease Prevention and Control (ecdc)
# Tuberculosis surveillanceand monitoring in Europe
www.ecdc.europa.eu/ 2019
Most EU/EEA countries, however, are low-incidence countries (a notification rate below 10 per 100 000) in which TB predominantly affects vulnerable populations, such as migrants, prison inmates or people coinfected with HIV... The highest TB-related risks in prison (rela-tive to incidence in the general population) are calculatedto be in Slovakia (52.3), Azerbaijan, Latvia and the Russian Federation (23 each)

World Health Organization
# Health in prisons: fact sheets for 38 European countries
http://www.euro.who.int/ 2019
While the health of incarcerated people is important in its own right, prison health is also a concern for the whole of society, as prisons are closely linked to communities. Most people in prison return to the community, and many people repeatedly come into contact with both settings. As articulated in the WHO Trenčín Statement, the WHO Moscow Declaration on Prison Health as a Part of Public Health, the WHO Good Governance for Prison Health Policy Brief and the Conclusions of the WHO International Meeting on Prisons and Health in Lisbon 2017), the good health of people in prison is an important part of broader public health

Francisco Job Neto, Raquel Barbosa Miranda, Ronaldo de Almeida Coelho, Cinthya Paiva Gonçalves, Eliana Zandonade, Angelica Espinosa Miranda
# Health morbidity in Brazilian prisons: a time trends study from national databases
https://bmjopen.bmj.com/ BMJ Open 2019
A total of 23235 cases of compulsory disease notification causing morbidity were reported in prison units in Brazil; of these cases, 20003 (85.6%) were men and 3362 (14.4%) were women. Over time, the proportion of prisoners increased from 1.92 per 1000 inhabitants in 2007 to 2.77 per 1000 inhabitants in 2014 (rising trend). From a total of 27 states, 12 of them presented a growth in disease notifications, 14 were stable and in only one state was there a decrease in notifications. There was an increase in notifications in the country as a whole. Tuberculosis (64.4%), dengue (9.1%), AIDS (9.0%) and viral hepatitis (5.9%) were among the most frequently reported diseases during the study period.ConclusionDespite showing stable tendencies, our results show high rates of diseases in Brazilian prisons. Prison health services should not be isolated but integrated into regional and national health and justice systems

Sarah Morey, Abi Hamoodi, Dee Jones, Tina Young, Craig Thompson, Julie Dhuny, Emma Buchanan, Carolyn Miller, Margaret Hewett, Manoj Valappil, Ewan Hunter, Stuart McPherson
# Increased diagnosis and treatment of hepatitis C in prison by universal offer of testing and use of telemedicine
J Viral Hepat. 2019;26:101–108.

It is known that approximately 60% of individuals whlari

o inject drugs have been in prison, and that 68% of in-carcerated individuals have injected drugs the previous year. As a result, HCV is common in incarcerated individuals, with previous es-timates suggesting ~7% of the UK prison population is HCV antibody (anti- HCV) positive. Studies from Europe, Australia and the United States suggest that the prevalence of anti-HCV in prison populations may be higher still, ranging from 8% to 57%

Kim Price, Barry Godfrey
# Victorian systems will not solve modern prison health problems
www.thelancet.com/ January 26, 2019
Modern society feels distanced from Victorian approaches to mental and physical health in prisons because medical science has brought curative and health benefits to everyon, including prisoners. Yet, westill lack an all-encompassing strateg, involving policies across different sector, to manage the health needs of prisoner, and improve their wellbeing. Custody presents challenges but also an opportunity to rethink how we approach these public health issues; in the UK various organisation, including the Howard League, have argued that a clean break from the past is needed to make better use of spaces of punishment.

# Babak Moazen, Shervin Assari, Heino Stöver, Florian Neuhann, Victorian systems will not solve modern prison health problems, www.thelancet.com/ September 21, 2019

George Karandinos, B.A., Philippe Bourgois
# The Structural Violence of Hyperincarceration — A 44-Year-Old Man with Back Pain
The New England Journal of Medicine, January 2019

Shivpriya Sridhar, Robert Cornish, Seena Fazel
# The Costs of Healthcare in Prison and Custody: Systematic Review of Current Estimates and Proposed Guidelines for Future Reporting
Frontiers in Psychiatry, 20 december 2018
Prison healthcare expenditure data was identified for 10 countries, and overall operating costs were reported for 12 countries. The most commonly reported healthcare cost was for primary medical care. Healthcare costs reporting varied widely, and few countries were comparable. We developed a set of guidelines for consistent and transparent reporting of healthcare costs... Few countries report the costs of healthcare services in prison. When reported, there is a lack of clarity and consistency as to what is included. Using the proposed reporting guidelines would enable national trends and international  comparisons to be investigated, and any recommended benchmarks to be monitored.

Franco Sicuro
# Il difficile bilanciamento fra certezza della pena, tutela del diritto alla salute ed esecuzione penale rispettosa del senso di umanità (una riflessione a margine di Cass.Pen., Sez. I, 18 aprile 2018-18 maggio 2018, n. 22307)
Osservatorio Costituzionale, 13 dicembre 2018      # Cass. 22307/2018
La prisiòn sòlo recibe al hombre. El delito queda en la puerta»1: questa la frase, densa di implicazioni umanitarie,che, per volere del direttore Manuel Montesinos, fu inscritta nel 1836 sulla porta di ingresso del carcere di San Agustin a Valencia. A distanza di quasi due secoli, la Corte di Cassazione italiana pare aver realmente «preso sul serio» il senso più profondo della medesima, testimoniando una sempre più spiccata sensibilità (costituzionale) nei confronti della situazione in cui versa gran parte della popolazione detenuta.

WHO World Health Organization - Regional Office for Europe
# Report on the health of refugees and migrants in the WHO European Region. No PUBLIC HEALTH without REFUGEE and MIGRANT HEALTH
https://apps.who.int/ 2018

Public Health England
# Hepatitis C in England 2018 report. Working to eliminate hepatitis C as a major public health threat
https://assets.publishing.service.gov.uk/ 2018
Hepatitis C affects a larger proportion of people in prison and other detention centres than the wider population, principally as a result of the relatively higher levels of injecting drug use that are observed among this population. Prison Health Performance Quality Indicators (PHPQI) have shown a steady rise in HCVtests performed, from5.3% in 2010/11 to 8.6% in 2013/14

Rob Bielen, Samya R. Stumo, Rachel Halford, Klára Werling, Tatjana Reic, Heino Stöver, Geert Robaeys, Jeffrey V. Lazarus
# Harm reduction and viral hepatitis C in European prisons: a cross-sectional survey of 25 countries
Harm Reduction Journal (2018) 15:25
Current estimates suggest that 15% of all prisoners worldwide are chronically infected with the hepatitis C virus (HCV), and this number is even higher in regions with high rates of injecting drug use. Although harm reduction services such as opioid substitution therapy (OST) and needle and syringe programs (NSPs) are effective in preventing the further spread of HCV and HIV, the extent to which these are available in prisons varies significantly across countries.

Tracie M. Gardner, Paul Samuels, Sarah Nikolic, Abigail Woodworth, Dan Fleshler | Legal Action Center
# Health and Justice: Bridging the Gap. Lessons from New York State Initiatives to Provide Access to Care After Incarceration
The Legal Action Center, 2018
Treating chronic medical conditions is key to ending an all-too prevalent and vicious cycle of incarceration and illness, especially in low-income communities of color. Failure to treat people has filled our prisons and jails, strained our hospitals and emergency rooms and overwhelmed our homeless shelters. These shortcomings have made communities sicker, not safer, reinforced racial and class disparities and wasted public funds.The financial and moral costs of failed policies have created a growing reform movement. In New York City and State, and across the country, communities are re-examining sentencing laws and monetary bail policies and seeking alternatives to locking people in prisons and jails. While those initiatives are vitally important, we cannot truly end mass incarceration and all its direct and collateral damage without addressing the health and health care disparities that have coincided with criminal justice involvement for millions of people, mostly black and brown.

House of Commons - Health and Social Care Committee
# Prison health. Twelfth Report of Session 2017–19
https://publications.parliament.uk/ 22 October 2018

Mauro Marin
# L’assistenza sanitaria penitenziaria tra norme e governo clinico
M.D. Medicinae Doctor, Anno XXV numero 7 - ottobre 2018
Ai sensi dell’art. 11 della legge n. 354/1975 (OP), per esigenze di tutela della salute individuale e collettiva prevalente sui diritti del singolo individuo, sono previsti in carcere tre tipi di controlli sanitari, effettuabili indipendentemente dal consenso informato (legge n. 219/2017) dell’interessato recluso: la visita medica generale per i nuovi giunti all’atto d’ingresso in istituto per attivare un piano di cura personalizzato (art. 23 del DPR n. 230/2000) e integrata da un colloquio psicologico, la visita medica  periodica, la sorveglianza sanitaria medica per i detenuti adibiti a mansioni lavorative (D.Lgs. n. 81/2008). La prima visita del nuovo giunto verifica anche la presenza di eventuali segni di maltrattamenti, a tutela del detenuto.

Fnomceo - Ufficio stampa

# Ai carcerati sia garantito il diritto alla salute, Governo e Parlamento avviino monitoraggio assistenza penitenziaria
https://portale.fnomceo.it/ 17 dicembre 2017

Luwam Ghidei, Sebastian Z. Ramos, E. Christine Brousseau, Jennifer G. Clarke
# Prison: Pipeline to Women’s Preventative Health
Rhode Island Medical Journal, October 2018
Incarcerated women disproportionately suffer from alcohol and drug abuse, sexually transmitted infections (STI), sexual and physical abuse, and mental illness, with rates of these conditions higher than those of incarcerated men... Ideally, healthcare in prison should serve as a safety net alongside a pipeline for preventative health to help women on the margins of society climb onto integrated, quality healthcare once they leave the system.

Pietro Fausto D’Egidio, Giorgio Barbarini (a cura di)
# La terapia della infezione da Hcv nei pazienti tossicodipendenti
FeDerSerD informa n. 31, giugno 2018
L’obiettivo è quello di avvicinarsi il più possibile alla eradicazione della infezione da HCV. Per riuscirci appare fondamentale e primario aggredire il serbatoio più importante dal punto di vista epidemiologico in riferimento alla diffusione del virus HCV che è rappresentatodai consumatori di droghe per via parenterale.Si stima infatti che la maggior parte delle persone infette nel mondo e in Italia abbiano contratto la infezione per l’uso non sicuro di siringhe usate per la assunzione di droghe.

EpaC - Simspe
# Enehide. Prevenzione dell'epatite C negli Istituti detentivi. Progetto pilota di informazione, educazione e prevenzione dell'epatite C realizzato nella Casa circondariale di Viterbo
EpaC onlus, maggio 2018
Il tema della salute in carcere è di sicuro interesse quando si parla di Sanità Pubblica poichè gli Istituti Penitenziari costituiscono purtroppo un potenziale serbatoio di infezione per le malattie trasmissibili quali: HIV, HBV (epatite B) e HCV (epatite C). In Italia, gli studi recenti di letteratura disponibili per quantificare la popolazione detenuta affetta da epatite C sono pochi, ma suggeriscono tutti una prevalenza molto elevata (25-30%). Considerando una popolazione detenuta di 58.285 unità (dato al 30 aprile 20184) è possibile stimare che vi siano tra 15 e 20 mila soggetti con infezione da HCV.

Lise Lafferty, T. Cameron Wild, Jake Rance, Carla Treloar
# A policy analysis exploring hepatitis C risk, prevention, testing, treatment and reinfection within Australia’s prisons
Harm Reduct J. 2018; 15: 39.
Hepatitis C (HCV) is a global public health concern. There is a global prevalence of 15% among the world’s prisoner population, suggesting the need for priority HCV treatment among this population group. New highly efficacious therapies with low side effects, known as directing-acting antivirals, became available under Australia’s universal healthcare scheme on 1 March 2016. This creates an opportune time to trial treatment as prevention as an elimination strategy for HCV in prison settings. This paper examines whether policies in Australian jurisdictions support treatment scale-up to achieve elimination among this priority population.

Agenzia regionale di sanità della Toscana
# La salute dei detenuti in Toscana a 10 anni dalla riforma. I risultati della IV rilevazione del 2018
serie In cifre - N. 15 - maggio 2018
Occuparsi della salute delle persone detenute equivale a mettere in atto interventi di salute pubblica nella accezione più ampia del termine. Molti studi internazionali hanno dimostrato, infatti, come la popolazione detenuta sia caratterizzata da un’alta prevalenza di persone con gravi condizioni di salute e, nonostante si tratti di una popolazione anagraficamente giovane, vi si rileva una prevalenza nettamente superiore, rispetto alla popolazione generale, di disturbi  psichici, di dipendenza da sostanze psicotrope, di malattie infettive e di alcune patologie croniche, Sappiamo, inoltre, che la maggior parte dei detenuti tornerà libera, portando con sé malattie che potranno potenzialmente rappresentare un rischio per la salute di tutta la comunità...

Timothy Papaluca, Alexander Thompson
# HCV elimination: breaking down the barriers to prison based care
Hepatoma Research, 4:64, 2018
There are an estimated 10 million prisoners worldwide, with over 2 million incarcerated in the USA alone. This population has an extremely high prevalence of chronic HCV infection. Conservative estimates suggest there are approximately 1.5 million prisoners living with HCV at any given time. This reflects the close association between people who inject drugs (PWID), incarceration and HCV due to the criminalisation of injecting drug use.

Elias Nosrati, Michael Ash, Michael Marmot, Martin McKee, Lawrence P King
# The association between income and life expectancy revisited: deindustrialization, incarceration and the widening health gap
International Journal of Epidemiology, 2018, 720–730
In the USA between 2001 and 2014, deindustrialization and incarceration subtracted roughly 2.5 years from the lifespan of the poor, pointing to their role as major health determinants. Future research must remain conscious of the upstream determinants and the political economy of public health. If public policy responses to growing health inequalities are to be effective, they must consider strengthening industrial policy and ending hyper-incarceration.

European Court of Human Rights ECHR
# Prisoners’ health-related rights
www.echr.coe.int/ Press Unit, March 2018

Cesare Lari – Direttore SC «Direzione Medica Penitenziaria»
# La prevenzione del rischio biologico nelle carceri
ASST Santi Paolo e Carlo, Milano 14 marzo 2018
CR Bollate, CC San Vittore, CR Opera: • Facendo riferimento alla citata alla D.G.R. N° X / 4716 del 13/01/2016 , sono presenti : • due medici in presenza attiva sulle 24 ore per 365 giorni anno, • due medici in attività di reparto dalle 8 alle 20 per 365 giorni anno.
• Sono inoltre garantite: • circa 30 ore al mese/100 detenuti di Psicologo Clinico, • circa 20 ore al mese/100 detenuti di specialista Psichiatra. • Gli specialisti ambulatoriali che operano all’interno dell’Istituto sono: Infettivologo, Urologo, ORL, Neurologo, Ortopedico, Radiologo, Cardiologo, Dermatologo, Oculista, Odontoiatra, Endocrinologo, Ginecologo, Chirurgo Generale, Chirurgo Vascolare, Pneumologo, Pediatra....

Pirous Fateh-Moghadam, Laura Battisti, Stefania Pancher, Pierino Anesin, Chiara Mazzetti, Claudio Ramponi e Silvio Fedrigotti
# Il monitoraggio della salute dei detenuti nel carcere di Trento. L'indagine PASSI in carcere, anno 2016
www.epicentro.iss.it/ Bollettino Epidemiologico Nazionale, 31(2), 2018
Particolarmente a rischio sono risultati i detenuti più giovani (53%, 18-24 anni; 47%, 25-34 anni; 48%, 35-49 anni; 12%, 50 anni e più), gli stranieri (49% vs 28% italiani), chi riportava difficoltà economiche (67% vs 35% con nessuna) e chi aveva problemi nel mantenere i rapporti familiari e amicali (51% vs 22% molto/abbastanza facile mantenere i rapporti). Il 46% (IC 95%: 37%-56%) dei detenuti che presentava sintomi depressivi non parlava con nessuno delle proprie difficoltà. Sono stati messi in evidenza aspetti rilevanti per la salute: il 72% dei detenuti fuma; il 44% di non fumatori è esposto al fumo passivo nella propria cella:  il 40% è sedentario; i detenuti non mangiano abbastanza frutta e verdura: solo il 13% mangia in carcere le 5 porzioni giornalieri raccomandate.

P. Bechtold P, A. Cilento, V. De Donatis, A. Donatini, C. A. Goldoni, S. Marchesi, A. Zacchia Rondinini, S.Zauli Sajani | Agenzia sanitaria e sociale regionale Emilia-Romagna
# La presa in carico del paziente affetto da patologie complesse negli Istituti penitenziari. Profili epidemiologici e contesto ambientale
http://assr.regione.emilia-romagna.it/ Dossier 263-2018, 31 gennaio 2018
... ha 52 anni, è italiano (81%), ha un livello di istruzione elementare o medio inferiore (oltre il 70%), è un fumatore (58%), sedentario; è obeso o sovrappeso (71%); il 57% non fa attività fisica... solo il 27% la pratica almeno due volte la settimana; solo un terzo lavora, di cui il 50% per meno di 20 ore settimanali; è spesso in situazione di disagio personale (52%)... con una notevole quota di insonnia (36%)... spesso utilizza psicofarmaci per dormire...quasi la metà dei diabetici (45%) non risulta a dieta. Una storia di tossicodipendenza riguarda un detenuto su quattro, per lo più da abuso di cocaina...

European Court of Human Rights | Cour Européenne des Droits de l’Homme
# Droits des détenus en matière de santé
www.echr.coe.int/ novembre 2017

Alessandro Attilio Negroni
# Trattamenti sanitari obbligatori e tutela della salute individuale e collettiva
www.forumcostituzionale.it/ 1 novembre 2017
1. Introduzione - 2. Le nozioni di “trattamento sanitario obbligatorio” e di “salute” - 3. Salute individuale, salute collettiva e legittimità costituzionale di un trattamento sanitario obbligatorio - 4. Il pericolo per la salute della collettività come condizione di legittimità di un trattamento sanitario obbligatorio - 5. La salute individuale come condizione di legittimità di un trattamento sanitario obbligatorio - 6. Il rapporto tra salute individuale e salute della collettività

European Court of Human Rights
# Prisoners’ health-related rights

# Detention conditions and treatment of prisoners

# Hunger strikes in detention
www.echr.coe.int/ Press Unit, November 2017
Under Article 3 of the European Convention on Human Rights, the State must ensure that a person is detained in conditions which are compatible with respect for his human dignity, that the manner and method of the execution of the measure do not subject him to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention and that, given the practical demands of imprisonment, his health and well-being are adequately secured by, among other things, providing him with the requisite medical assistance ...” [Kudła v. Poland, judgment (Grand Chamber) of 26 October 2000, § 94].

Antonella Massaro (a cura di)

# La tutela della salute nei “luoghi di detenzione”. Un’indagine di diritto penale intorno a carcere, REMS e CIE

Roma TrE-Press, Roma, 2017

Aline Chassagne, Aurélie Godard-Marceau, Régis Aubry
# La fin de vie des patients détenus. Des temporalités incertaines dans un espace contrôlé
Anthropologie & Santé. Revue internationale francophone d'anthropologie de la santé 15 | 2017
La fin de vie en UHSI interroge notre conception de la « bonne mort ». Aucune des personnes rencontrées n’envisageait la mort en milieu contraint comme pouvant être une « bonne mort ». En effet, la maladie, la fin de la vie et la mort telles qu’elles sont appréhendées dans l’approche palliative réinterrogent fortement le sens de la peine. Cette approche, qui a fortement contribué à construire ce que l’on nomme « la bonne mort » (Castra, 2003 ; Daneault, 2007) ou encore un « style de mort acceptable », englobe les soins physiques, psychiques et spirituels apportés au malade...

Lindsay Helen Dewa
# Insomnia in a prison population: A mixed methods study
University of Manchester (PhD), 2017
One study found hypnotic and anxiolytic prescriptions in both men and women were significantly more likely in prison (6.4% and 10.6%) than in the community (1.1% and 2.2% respectively). In the same study, in addition to hypnotic and anxiolytics, the antidepressant mirtazapine was found to be a particularly commonly prescribed drug in prison in comparison to the community... Research suggests confinement lessens natural light which is key to maintaining the natural circadian rhythm. Therefore, the effect of restrictive regimes on circadian disruption and sleep architecture is important to study in the future. Future research looking at the sleep-wake cycle and sleep typology in prisoners would also add to the sleep-prison literature.

Antoine Lefèvre
Rapport d'information fait au nom de la commission des finances sur les dépenses pour la santé des personnes détenues
www.senat.fr/ Enregistré à la Présidence du Sénat le 26 juillet 2017
Selon une étude récente, malgré la préconisation du Bureau régional de l’Organisation mondiale dela santé de «considérer la santé en milieu carcéral comme un problème prioritaire de santé publique», «il n’existe pas, à ce jour, en France, de surveillance épidémiologique de la santé en milieu carcéral. Seul es des études transversales nationales ponctuelles ont été réalisées (...) [et] hormis l’étude Prévacar (...) réalisée en 2010, ces études datent de plus de dix ans et nécessiteraient d’être actualisées».

Ministère de la Justice -- Ministère des Solidarités et de la Santé
# Prise en charge sanitaire des personnes placées sous main de justice. Guide méthodologique
https://solidarites-sante.gouv.fr/ 2017

S. Zauli Sajani, S: Marchesi - Regione Emilia Romagna
# Patologie croniche e microclima in carcere. Gli aspetti meteoclimatici
Bologna, 25 maggio 2017

Christopher Wildeman, Emily A Wang
# Mass incarceration, public health, and widening inequality in the USA
Lancet 2017; 389: 1464–74
The emerging literature on the family and community effects of mass incarceration points to negative health impacts on the female partners and children of incarcerated men, and raises concerns that excessive incarceration could harm entire communities and thus might partly underlie health disparities both in the USA and between the USA and other developed countries. Research into interventions, policies, and practices that could mitigate the harms of incarceration and the post-incarceration period is urgently needed, particularly studies using rigorous experimental or quasi-experimental designs

Dewa LH, Hassan L, Shaw JJ, Senior J,
# Trouble sleeping inside: a cross-sectional study of the prevalence and associated risk factors of insomnia in adult prison populations in England
Sleep Medicine (2017)
This study has identified the prevalence of insomnia and examined associated factors in prison populations. Notwithstanding limitations, the study suggests that the prevalence for possible ID is higher in prisons than in the general population. A range of associated factors for insomnia were identified, most notably a previous history of physical-ill health, and/or receiving help for insomnia, suicidality and depression. Poor sleep hygiene, maladaptive beliefs about sleep and the problematic prison environment may maintain symptoms of insomnia in prisoners. The current study findings are relevant to informing clinical practice in the screening, assessment and treatment of insomnia. Indeed, our study, alongside wider evidence, could be used as the basis of a clinical pathway to help effectively manage insomnia in prison.

Adriano Martufi
# Il differimento facoltativo della pena per grave infermità fisica: tra “orizzonte di scopo” della pena carceraria e dignità del detenuto
Sommario: 1. Diritto alla salute e differimento (facoltativo) dell'esecuzione in carcere – 2. Il caso di specie: ambiguità dell'accertamento peritale e onere motivazionale del giudice – 3. L'ambito cognitivo del giudice e il requisito della “grave infermità fisica”: verso il superamento di una concezione soltanto relativistica? – 4. Conclusione: l'incerta discrezionalità della magistratura di sorveglianza e la necessità di riformare i rimedi a tutela della salute dei ristretti
# Cassazione Penale, Sez. I, 26 aprile 2017 (Ud. 29 Marzo 2017), n. 19677, Presidente Novik, Relatore Boni

Giulia Moscatelli
# Procedimento de libertate tra tutela del diritto alla salute e difesa personale nell’applicazione di misure cautelari
Archivio Penale, n. 3, 2017
1. Ricostruzione della vicenda. - 2. La tutela del diritto alla salute a livello normativo. - 3. L’evoluzione normativa sul rapporto tra tutela del diritto alla salute e rispetto di esigenze cautelari. - 4. Il diritto al contraddittorio nel procedimento de libertate. - 5. Perizie mediche sull’adeguatezza delle cure all’interno della struttura carceraria. - 6. Criteri di compatibilità dello stato detentivo con il diritto alla salute. - 7. Considerazioni conclusive.

Francesco Cecchini
# La tutela della salute in carcere nella giurisprudenza della Corte europea dei diritti dell'uomo
www.penalecontemporaneo.it/ 23 gennaio 2017 [destinato al volume A. Massaro (a cura di), # La tutela della salute nei “luoghi di detenzione”. Un’indagine di diritto penale intorno a carcere, REMS e CIE, Roma TrE-Press, Roma, 2017]
1. L’assenza del diritto alla salute nella CEDU e la sua tutela “indiretta” tramite l’interpretazione evolutiva della Corte: mancanza di un «nucleo irriducibile del diritto». – 2. Il divieto di tortura e pene o trattamenti inumani o degradanti (art. 3 CEDU) tra assolutezza, soglia minima di gravità e onus probandi. – 3. L’inversione del rapporto tra “dover essere normativo” ed “essere applicativo”. – 4. Obblighi degli Stati di assicurare health and well-being dei detenuti. – 4.1. L’apprestamento di cure mediche adeguate e tempestive. – 4.2. Compatibilità dello stato di salute con le condizioni “normali” di detenzione. – 4.3. Condizioni igienico-sanitarie in carcere. – 4.4. Detenzione e mental health. – 4.5. Trattamenti medici arbitrari e “sciopero della fame”. – 5. I rimedi alla violazione dell’art. 3 CEDU nell’Italia post-Torreggiani (cenni): una (ennesima) rinuncia ai tradizionali principi del nostro sistema? – 6. (Tentativo di) Conclusioni: la ricostruzione del “dover essere normativo” convenzionale

Accademia Svizzera delle Scienze Mediche ASSM
# Esercizio della medicina presso le persone detenute
www.samw.ch/ 2017

Approvate dal Senato dell’ASSM in data 28 novembre 2002. Il 1. Gennaio 2013 ha avuto luogo un adattamento al diritto di protezione degli adulti. L’allegato lett. G è stato integrato con la decisione del Senato del 19 maggio 2015. Alla stregua di qualsiasi situazione medica ordinaria, un medico chiamato ad intervenire in qualità di perito o terapeuta, può procedere ad un atto diagnostico o terapeutico su una persona detenuta soltanto se ne ha previamente ottenuto un consenso libero e informato («informed consent»). La somministrazione di farmaci, in particolare psicotropi, a persone detenute è possibile soltanto con il consenso del paziente e sulla base di una decisione prettamente medica...

Giacomo Galeazzi, Raphaël Zanotti
# Abusa di psicofarmaci un detenuto su due: "dipendenza nascosta"
La Stampa, 23 gennaio 2017
In un'indagine dell'Agenzia regionale della sanità Toscana che ha coinvolto 57 strutture detentive (il 30% di quelle italiane), cinque regioni (Toscana, Lazio, Umbria, Veneto, Liguria) e Asl di Salerno, per un totale di 15.751 detenuti, spicca un dato: il 46% dei farmaci prescritti sono psicofarmaci. La quasi totalità di questi (95,2%) appartiene al gruppo di molecole che agisce sul sistema nervoso, con gli ansiolitici (37,8% del totale) a fare la parte del leone...

Adam L. Beckman, Alyssa Bilinski, Ryan Boyko, George M. Camp, A. T. Wall, Joseph K. Lim, Emily A. Wang, R. Douglas Bruce, Gregg S. Gonsalves
# New Hepatitis C Drugs Are Very Costly And Unavailable To Many State Prisoners
Health Affairs, October 2016
Hepatitis C is the most common bloodborne viral infection in theUnited States.It was a cause of more deaths in 2013 than sixty other infectious diseases combined, including HIV, pneumococcal disease,and tuberculosis. While the prevalence of hepatitis C in the non institutionalized US populationis approximately 1 percent, the prevalence among prison inmates is about 17 percent.

European Court of Human Rights
# Elderly people and the European Convention on Human Rights
www.echr.coe.int/ October 2016

Maria Vittoria Arpaia
# Agorà Penitenziaria. Una nuova visione della salute in carcere
L'Opinione, 20 settembre 2016

Laurent Ridel, Caroline Touraut
# Personnes détenues en fin de vie: expériences individuelles et modalités de prise en charge
Cahiers d’études pénitentiaires et criminologiques, Septembre 2016 - n. 41
La question de la fin de vie en milieu carcéral est particulièrement sensible. Etroitement liée à celle du vieillissement et à celle de la maladie, elle suscite beaucoup d’angoisses en détention. Ce cahier, issu notamment d’une recherche consacrée au vieillissement en milieu carcéral, présente les aménagements institutionnels et législatifs récemment adoptés pour répondre aux besoins des personnes en fin de vie en prison. Leur prise en charge en établissement n’en fait pas moins l’objet de difficultés persistantes tant pratiques qu’au regard d’exigences éthiques. De même, la mise en oeuvre des dispositifs permettant la sortie des personnes en fin de vie nécessite une approche volontariste et exigeante de l’ensemble des acteurs concernés qui fait parfois défaut aujourd’hui encore.

Karishma A. Chari, Alan E. Simon, Carol J. DeFrances, Laura Maruschak
# National Survey of Prison Health Care: Selected Findings
National Center for Health Statistics, n. 96, July 28, 2016
In 2011, the percentages of prison admissions occurring in states that tested at least some prisoners for the following conditions during the admissions process were: 76.9% for hepatitis A, 82.0% for hepatitis B, 87.3% for hepatitis C, 100.0% for tuberculosis, 100.0% for mental health conditions and suicide risk, 40.3% for traumatic brain injury, 82.5% for cardiovascular conditions and risk factors using electrocardiogram, 70.0% for elevated lipids, and 99.8% for high blood pressure.

European Court of Human Rights
# Health-related issues in the case-law of the ECHR
www.echr.coe.int/ June 2015
Detainees are in a special situation because of their dependence on the authorities when it comes to their living conditions, including access to medical care. In addition, the fact that they are deprived of their liberty means that any acts and omissions of the authorities are likely to have a greater impact on their psychological well-being.The State must ensure that detainees are held in conditions which are compatible with respect for human dignity, that the manner and method of execution of the measure do not subject them to distress or hardship of an intensity exceeding the unavoidable level of suffering inherent in detention and that, given the practical demands of imprisonment, their health and well-being are adequately secured through, among other things, requisite medical assistance

Sanità Penitenziaria Veneto
# News
www.regione.veneto.it/sanitapenitenziaria - Giugno 2016

Sergio Babudieri
# Infezioni sessualmente trasmesse nelle persone detenute. Importanza di una valutazione clinica e dello screening all’ingresso
www.sanitapenitenziaria.org/ Sassari, 13 Giugno 2016
L’Organizzazione Mondiale della Sanità (OMS) stima che più di 1 milione di MST siano acquisite ogni giorno. Ogni anno sono stimati 357 milioni di nuove infezioni con 1 delle seguenti 4 MST: la clamidia (131 milioni), la gonorrea (78 milioni), la sifilide (5,6 milioni) e la tricomoniasi (143 milioni); circa 47 milioni sono nelle regioni OMS europee. Inoltre patologie quali la sifilide, aumentano il rischio di infezione da HIV di oltre tre volte. Come alcuni studi dimostrano, circa il 50% delle MST vengono sviluppate dalla popolazione compresa tra i 15 e i 24 anni di età, in tale fascia HPV, Clamidia e tricomoniasi rappresentano l’88% di tutti i nuovi casi di MST.

Kate Dolan, Andrea L Wirtz, Babak Moazen, Martial Ndeff o-mbah, Alison Galvani, Stuart A Kinner, Ryan Courtney, Martin McKee, Joseph J Amon, Lisa Maher, Margaret Hellard, Chris Beyrer, Fredrick L Altice
# Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees
www.thelancet.com/ 388: 1089–102, 2016
Of the estimated 10·2 million people incarcerated worldwide on any given day in 2014, we estimated that 3·8% have HIV (389 000 living with HIV), 15·1% have HCV (1 546 500), 4·8% have chronic HBV (491 500), and 2·8% have active tuberculosis (286 000). The few studies on incidence suggest that intraprison transmission is generally low, except for large-scale outbreaks. Our model indicates that decreasing the incarceration rate in people who inject drugs and providing opioid agonist therapy could reduce the burden of HIV in this population. The prevalence of HIV, HCV, HBV, and tuberculosis is higher in prison populations than in the general population, mainly because of the criminalisation of drug use and the detention of people who use drugs. The most eff ective way of controlling these infections in prisoners and the broader community is to reduce the incarceration of people who inject drugs.

Elizabeth M. La, Kristen Hassmiller Lich, Rebecca Wells, Alan R. Ellis, Marvin S. Swartz, Ruoqing Zhu, Joseph P. Morrissey
# Increasing Access to State Psychiatric Hospital Beds: Exploring Supply-Side Solutions
Psychiatric Services 67:5, May 2016
Some emergency departments in general hospitals have resorted to boarding people in psychiatric crisis for days while they wait for a bed to become available. In these circumstances, detained individuals can receive treatment only for life-threatening conditions — not for routine psychiatric care.

April Trotter, Margaret Noonan
# Medical Conditions, Mental Health Problems, Disabilities, and Mortality Among Jail Inmates
American Jail Association, May 3, 2016
The jail population is predominantly white (47%), black (36%), or Hispanic (15%), and the typical jail inmate is male, age 35 or younger, and usually held for a nonviolent offense... Reported inmate chronic conditions included: • Arthritis (13%) • Asthma (20%) • Cancer (4%) • Cirrhosis of the liver (2%) • Diabetes (7%) • Heart-related problems (10%) • High blood pressure (26%) • Kidney-related problems (7%) • Stroke (2%)...

 Bureau of Justice Statistics | Zhen Zeng, Margaret Noonan, E. Ann Carson, Ingrid Binswanger, Patrick Blatchford, Hope Smiley-McDonald, Chris Ellis

# Assessing Inmate Cause of Death: Deaths in Custody Reporting Program and National Death Index

www.bjs.gov/ April 2016

The Deaths in Custody Reporting Program (DCRP) is an annual Bureau of Justice Statistics (BJS) data collection. The DCRP collects national, state, and incident-level data on persons who died while in the physical custody of the 50 state departments of corrections or the approximately 2,800 local adult jail jurisdictions nationwide. The DCRP began in 2000 under the Death in Custody Reporting Act of 2000 (P.L. 106-297), and it is the only national statistical collection to obtain comprehensive information about deaths in adult correctional facilities. BJS uses DCRP data to track national trends in the number and causes (or manners) of deaths occurring in state prison or local jail custody.

Ministero della Salute - Ccm Centro nazionale per la prevenzione e il controllo delle malattie
# Relazione al Parlamento su alcol e problemi alcol correlati, anno 2015
www.ccm-network.it/ aprile 2016

Dipartimento dell'Amministrazione Penitenziaria
# La condizione di disabilità motoria nell'ambiente penitenziario - Le limitazioni funzionali
Lettera circolare - Roma, 10 marzo 2016

Eva Mariucci
# Detenzione cautelare e stato di salute particolarmente grave: “letture” consolidate e recenti prospettive
Processo penale e giustizia n. 2 | 2016
Il diritto alla salute costituisce prerogativa costituzionale del detenuto, ma non è sempre agevole operare il giusto bilanciamento tra esigenze collettive ed individuali; nel caso di detenzione ante iudicatum, poi, l’aspirazione alla effettiva salvaguardia del diritto è persino rafforzata dalla presunzione di innocenza. L’incauta formulazione dell’art. 275, comma 4-bis, c.p.p. amplifica le criticità, imponendo esplicite direttrici interpretative. In proposito, recenti approdi esegetici hanno enfatizzato diversi profili connessi alla tutela dell’integrità psico-fisica, chiarendo – forse una volta per tutte – che nelle ipotesi di malattia particolarmente grave, nonostante la compatibilità con la detenzione, il giudice dovrà in ogni caso pronunciarsi per l’inapplicabilità della custodia cautelare se l’adeguatezza di cure non può essere garantita all’interno del circuito penitenziario.

Gen Sander | Harm Reduction International
# HIV, HCV, TB and Harm Reduction in Prisons. Human Rights, Minimum Standards and Monitoring at the European and International Levels

# Monitoring HIV, HCV, TB and Harm Reduction in Prisons: A Human Rights-Based Tool to Prevent Ill Treatment
www.ihra.net/ February 2016
Prisons are particularly high-risk environments for the transmission of HIV, hepatitis C (HCV) and TB. There are several reasons for this, including the fact that harm reduction services remain extremely limited in prisons in comparison to what is available in the broader community. These issues have  serious public health and human rights implications. Increasingly, UN mechanisms and human rights courts are finding that they can contribute to, or even constitute, conditions that meet the threshold of ill treatment. For this reason, it is very important for prison monitoring mechanisms, particularly those that are mandated to prevent ill treatment, to consider issues relating to HIV, HCV, TB and harm reduction in a comprehensive and systematic manner during their visits...

Mirco Paglia
# La rilevanza penale del trattamento medico arbitrario
Università degli studi di Roma “Tor Vergata”, 2015

Brigit Toebes
# International health law: an emerging field of public international law
Indian Journal of International Law (2015) 55(3):299–328

Alexandria MacMadu, Josiah D. Rich
# Correctional Health Is Community Health
Issues in Science and Technology, Fall 2015
While the socioeconomic disparities between incarcerated and nonincarcerated populations are stark, the health disparities encountered in incarcerated populations are among the most dramatic. Over half of state prisoners and up to 90% of jail detainees suffer from drug dependence, compared with only 2% of the general population. Hepatitis C is nine to 10 times more prevalent in correctional facilities than in communities. Chronic health conditions, such as asthma and hypertension, and mental health disorders also affect prisoner populations at rates that far exceed their prevalence in the general population.

Margaret Noonan, Ingrid A. Binswanger, Patrick J. Blatchford, Hope Smiley-McDonald, Chris Ellis
# Linking Deaths in Custody Reporting Program (DCRP) and National Death Index (NDI) data: Assessing Cause of Death (COD) Data Reported to the DCRP
http://sites.usa.gov/ 2015
The Bureau of Justice Statistics (BJS) has collected, analyzed and reported on deaths in the U.S. correctional system annually since the passage of the Death in Custody Reporting Act (2000 DICRA, PL. 106-297) to address public concerns about the safety and humane treatment of suspects, defendants, and offenders while in contact with or under the control or supervision of criminal justice agencies. The 2000 DICRA required local jails, state prisons, and state, and local law enforcement agencies to report information on the circumstances of each death occurring while offenders were in custody or of persons in the process of arrest to the Department of Justice. The Deaths in Custody Reporting Program (DCRP) began in 2000.

Conseil de l'Europe - Assemblée parlementaire
Le sort des détenus gravement malades en Europe
# Résolution 2082 (2015)
# Recommandation 2082 (2015)

http://assembly.coe.int/

Margaret Noonan, Harley Rohloff, Scott Ginder
# Mortality in Local Jails and State. Prisons, 2000–2013 - Statistical Tables
Bureau of Justice Statistics, August 2015
In 2013, a total of 967 jail inmates died while in the custody of local jails. The number of deaths increased from 958 deaths in 2012 to 967 in 2013, while the jail population decreased 4%. As a result, the overall mortality rate in local jails increased from 128 per 100,000 jail inmates in 2012 to 135 per 100,000 in 2013. Suicide and heart disease have been the top two causes of death in local jails since 2000. Suicide has been the leading cause of death in jails every year since 2000. In 2013, a third (34%) of jail inmate deaths were due to suicide. The suicide rate increased 14%, from 40 suicides per 100,000 jail inmates in 2012 to 46 per 100,000 in 2013.

Harm Reduction International

# Submission: Impact of the world drug problem on the enjoyment of human rights
# Submission: Impact of the world drug problem on the enjoyment of human rights
# Submission: Impact of the world drug problem on the enjoyment of human rights
www.ihra.net/ 15 May 2015

Teresa Di Fiandra, Fabio Voller (coordinamento) | Giorgio Bazzerla, Eleonora Fanti, Fabio Ferrari, Marco Grignani, Sandro Libianchi, Gianrocco Martino, Antonio Maria Pagano, Franco Scarpa, Caterina Silvestri Settore sociale, Cristina Stasi | ARS Toscana
# La salute dei detenuti in Italia: i risultati di uno studio multicentrico
www.ars.toscana.it/ Aprile 2015

ANSA # Carceri: detenuti under 40 ma 70% malato, top disturbi psiche www.regioni.it/ giovedì 9 aprile 2015
Indagine in sei regioni italiane su circa 16.000 persone... Popolazione carceraria giovane ma oltre il 70% dei detenuti è affetto da almeno una patologia: soprattutto disturbi psichici, malattie infettive e disturbi dell'apparato digerente.

Regione Emilia-Romagna - Direzione Generale Sanità e Politiche Sociali

# Linee di indirizzo per la gestione clinica dei farmaci negli Istituti Penitenziari della Regione Emilia-Romagna

http://salute.regione.emilia-romagna.it/ Aprile 2015

Cyrus Ahalt, Marielle Bolano, Emily A. Wang, Brie Williams
# The state of research funding from the National Institutes of Health for criminal justice health research
Ann Intern Med. 2015 March 3; 162(5): 345–352

Marta Caredda
# La salute e il carcere. Alcune riflessioni sulle risposte ai bisogni di salute della popolazione detenuta
www.costituzionalismo.it/ Fasc. 2, 2015
Tutelare la salute dei detenuti in maniera paritaria rispetto alla popolazione generale è un obbligo che discende dai principi costituzionali (nonché da quelli espressi da norme sovranazionali), come accennavamo in precedenza. Ma c’è  di più: l’applicazione del principio di eguaglianza sostanziale determina la necessità di profondere un impegno particolare nella realizzazione di quella tutela, perché occorre affrontare una situazione nella quale il raggiungimento dell’obiettivo implica la “rimozione di ostacoli” (art. 3, comma II, Cost.), rappresentati da oggettivi «svantaggi situazionali»...

Presidenza del Consiglio dei ministri. Conferenza Unificata
# Accordo 22 gennaio 2015 "Linee guida in materia di modalità di erogazione dell’assistenza sanitaria negli Istituti penitenziari per adulti; implementazione delle reti sanitarie regionali e nazionali"
Gazzeta Ufficiale della Repubblica Italiana, Serie generale n. 64 - 18-3-2015

Laura M. Maruschak, Marcus Berzofsky
# Medical Problems of State and Federal Prisoners and Jail Inmates, 2011–12
Bureau of Justice Statistics, February 2015
In 2011–12, half of state and federal prisoners and local jail inmates reported ever having a chronic condition. Chronic conditions include cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma, and cirrhosis of the liver. Twenty-one percent of prisoners and 14% of jail inmates reported ever having an infectious disease, including tuberculosis, hepatitis B and C, and other sexually transmitted diseases (STDs). About 1% of prisoners and jail inmates who had been tested for HIV reported being HIV positive.

Julianne Holt-Lunstad, Timothy B. Smith, Mark Baker, Tyler Harris, David Stephenson
# Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review
Perspectives on Psychological Science, 2015, Vol. 10(2) 227–237
Actual and perceived social isolation are both associated with increased risk for early mortality... The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone.... . Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.

Settore Salute Mentale e Sanità Penitenziaria – Regione Veneto
# News Sanità Penitenziaria Veneto
Gennaio 2015

Département fédéral de justice et police DFJP | Informations sur l’exécution des peines et mesures
# Coup de projecteur: Soins en milieu carcéral
www.bj.admin.ch/ bulletin info 1/2015
Le concept de «médecine pénitentiaire» ou «médecine carcérale» englobe toutes les activités médicales et paramédicales de nature somatique et psychiatrique qui concernent les personnes exécutant une peine ou une mesure. La législation, que ce soit celle sur l’exécution des peines et des mesures ou sur la santé publique, relève de la compétence des cantons, ce qui explique qu’il n’existe pas de réglementation nationale uniforme concernant la médecine pénitentiaire. La réglementation en la matière peut donc varier d’un canton à un autre.

la Santé en action | Khadoudja Chemlal (ed)
# Dossier Prison : quelle place pour la promotion de la santé ?
www.inpes.sante.fr/ Décembre 2014 / Numéro 430

Développer le dialogue reste la meilleure façon de promouvoir la santé en prison. L’architecture carcérale est une question débattue actuellement, mais c’est toute une architecture de pensée, une manière d’appréhender les détenus qu’il faudra sans doute revoir, en y incluant les questions de santé et surtout l’ensemble des acteurs de la détention...

Franco Corleone
# Le ricette per garantire uguale dignità
Il Sole 24 Ore Sanità - Toscana - Dicembre 2014
Dal Mes-Sant’Anna il “bersaglio” sugli indicatori di cura in carcere. Quale salute per i detenuti. Screening e vaccinazioni da potenziare - Antidepressivi, allarme consumi | ... situazione oggettiva e soggettiva di differenza abissale tra i reclusi e i cittadini liberi. Lo Stato ha una responsabilità assoluta verso i corpi prigionieri e la salvaguardia della vita e la promozione della salute devono essere garantite in misura maggiore rispetto a coloro che hanno libertà di scelta.

Andres Lehtmets, Jörg Pont
# Prison health care and medical ethics. A manual for health-care workers and other prison staff with responsibility for prisoners’ well-being
Council of Europe, November 2014
Health‑care services for persons deprived of their liberty are also directly relevant to the prevention of ill‑treatment. An inadequate level of health care can lead rapidly to situations falling within the scope of the term “inhuman and degrading treatment”. Obliging prisoners to stay in an establishment where they cannot receive appropriate treatment due to lack of suitable facilities, or because such facilities refuse to admit them, is unacceptable. A violation of Article 3 of the European Convention of Human Rights (ECHR) was found by the European Court of Human Rights in several such situations

Fondazione Umberto Veronesi
# Ripensare il sistema sanzionatorio penale. Parere del Comitato Etico
6 novembre 2014

All’importante messaggio che il carcere deve essere l’extrema ratio, oramai lanciato dai recenti interventi di riforma, deve affiancarsi anche quello che l’alternativa al carcere non può essere unicamente la detenzione domiciliare...

# Fondazione Umberto Veronesi, Decalogo dei Diritti del Malato [ in Carcere ]

Margaret E. Noonan, BJS
# Mortality in Local Jails and State Prisons, 2000–2012 - Statistical Tables
www.bjs.gov/ Bureau of Justice Statistics October, 2014
In 2012, a total of 3,351 deaths (78% of all deaths in correctional facilities) occurred in state prisons, which was nearly equal to the number of deaths in 2011 (3,353). Although the number of deaths in state prisons remained constant, the overall mortality rate in prisons increased 2% in 2012. The increase from 2011 to 2012 was largely due to decrease in the prison population.

Emma Plugge, Ruth Elwood Martin, Paul Hayton
# Noncommunicable diseases and prisoners
www.euro.who.int/ 2014
The global burden of and threat from noncommunicable diseases (NCDs) constitute a major public health challenge that undermines social and economic development throughout the world. Prisoners are at greater risk for such diseases.• Most information on NCDs in prisoners comes from high-income countries despite the fact that globally, 80% of these deaths from these diseases are in lowand middle-income countries. • NCDs comprise mainly cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%) and diabetes (3.5%). They share four key behavioural risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Prisoners are more likely to smoke and to drink harmful amounts of alcohol than the general population...

European Court of Human Rights | Cour Européenne des Droits de l’Homme
# Droits des détenus en matière de santé
www.echr.coe.int/ octobre 2014
« (…) [L]’article 3 [de la Convention européenne des droits de l’homme, qui interdit les  traitements inhumains ou dégradants,] impose à l’État de s’assurer que tout prisonnier est détenu dans des conditions qui sont compatibles avec le respect de la dignité humaine, que les modalités d’exécution de la mesure ne soumettent pas l’intéressé à une détresse ou à une épreuve d’une intensité qui excède le niveau inévitable de souffrance inhérent à la détention et que, eu égard aux exigences pratiques de l’emprisonnement, la santé et le bien-être du prisonnier sont assurés de manière adéquate, notamment par l’administration des soins médicaux requis (…) » (Kudła c. Pologne, arrêt (Grande Chambre) du 26 octobre 2000, § 94).

The Pew Charitable Trusts | MacArthur Foundation
# State Prison Health Care Spending. An examination
www.pewtrusts.org/ July 2014
Inmates have a higher incidence of chronic and infectious diseases, such as AIDS and hepatitis C, and mental illness than that of the general population. These costly conditions, many of which are present prior to incarceration, place a significant burden on state correctional budgets, which assume the entire cost of care. In 2010, roughly 65 percent of incarcerated adults in prisons or jails met the medical criteria for an alcohol or drug use disorder, and inmates were seven times likelier than individuals in the community to have such a condition. Onethird suffered from mental illness, and one-quarter had a co-occurring mental illness and substance use disorder.

Chris Ford, Fergus Law
# Guidance for the use and reduction of misuse of benzodiazepines and other hypnotics and anxiolytics in general practice
www.smmgp.org.uk/ July 2014
Prison is a place where many people who use illicit drugs seek to address their drug problems, but is also where large numbers of them are housed in a confined space without access to the volume of illicit drugs available in the community. This presents a particular challenge to prison-based prescribers, who can find themselves a target for requests for benzodiazepines that prisoners intend to take and / or divert.

E Godin-Blandeau, C Verdot, AE Develay

# État des connaissances sur la santé des personnes détenues en France et à l’étranger.
www.invs.sante.fr / Saint-Maurice : Institut de veille sanitaire, juin 2014

Data result from sparse studies with important methodological limits, but their presence and complications are undeniable in prison. Considering the scarce results obtained notably on chronic diseases in this review, it appears essential to develop epidemiological studies in prison on these topics, in order to adapt prevention and care.

Speciale Il Sole 24ore Sanità
# Se il paziente è anche recluso
24-30 giugno 2014

Luciano Lucanìa, Imodelli di intervento dalle tossicodipendenze all’integrazione con il territorio... I modelli di intervento dalle tossicodipendenze all’integrazione con il territorio | Alfredo De Risio, Monitorare il disagio per prevenire i suicidi | Faissal Choroma, La «marginalità» dei detenuti migranti |  Sergio Babudieri, Nella detenzione una chance di cura. Obiettivo: raggiungere fasce altrimenti «invisibili» | Margherita Errico, Contro l’Hiv peer education e riduzione del danno

World Health Organization (WHO) | Pompidou Group | Council of Europe
# Strasbourg Conclusions on Prisons and Health - Final draft
www.euro.who.int/ 20 June 2014
Prisons are not healthy places. Rates of communicable diseases such as HIV/AIDS, hepatitis and tuberculosis are much higher in prisons than in outside communities, and prisoners are at a much greater risk of contracting these diseases than members of the general population. Mental health disorders and alcohol and drug dependence are also more widespread among people in prisons than in the wider community. There is vast evidence that prisoners carry a greater burden of disease compared to people living in the community. This is true for both somatic and mental disorders.

Josiah D. Rich, Scott A. Allen, Brie A. Williams
# The Need for Higher Standards in Correctional Healthcareto Improve Public Health
J Gen Intern Med, 2014, 30(4):503–7
With 2.2 million Americans behind bars, and 10 million cycling through correctional systems each year,5 U.S. correctional healthcare has provided medical care to 1 in 30 living American adults, themajority of whom are from impoverished communities, where poor healthcare access is the norm. Since more than 95% of prisoners eventually return to the community, correctional healthcare has the opportunity, and the obligation, to transform care for persons and communities most in need...

Stefan Enggist, Lars Møller, Gauden Galea, Caroline Udesen | WHO
# Prisons and Health
www.euro.who.int/ 2014
Some six million men and women are imprisoned in the WHO European Region every year. Most of these prisoners are from poor and vulnerable communities. Prisons are not healthy places. Communicable diseases are frequently transmitted among prisoners, and the rates of HIV, hepatitis and tuberculosis are much higher among them than in the general population. There is also a high prevalence of mental health problems, including substance abuse disorders, and a higher prevalence of non communicable diseases. Unhealthy conditions such as overcrowding and poor hygiene are common in many prisons. Prison health is part of public health and prisons are part of our society. One third of prisoners leave prison every year and the interaction between prisons and society is huge.

Pierpaolo Cavallo, Giulia Savarese, Luna Carpinelli
# Bruxism and health related quality of life in Southern Italy’s prison inmates
Community Dental Health (2014) 31, 1–10
1. the prevalence of bruxism is higher and Health-related Quality of Life is worse in the prison population than in the general population; 2. presence of bruxism is correlated with lower HRQoL levels; 3. the correlation is stronger for subjects serving a first prison experience and for higher education levels...

Colin A. Espie, Simon D. Kyle, Peter Hames, Maria Gardani, Leanne Fleming, John Cape
# The Sleep Condition Indicator: a clinical screening tool to evaluate insomnia disorder
BMJ Open 2014
Although insomnia is the most common of all mental health problems,it is seldom adequately assessed and treatment services are often poor. This perhaps reflects the perspective that insomnia is usually a symptom, coupled with minimal medical education on sleep and its disorders. However, there are three reasons why this perspective must now change. First, insomnia is not merely a symptom. It has for some time been proposed as a genuine diagnosis (see Harvey review), and recently the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Work Group recognised that the previous dichotomy of primary versus secondary insomnia is not evidence based. Accordingly, DSM-5 now recommends that ‘insomnia disorder’ should be coded “whenever diagnostic criteria are met whether or not there is a co-existing physical, mental or sleep disorder”

Prima Pagina News

# Congresso Simspe: tra Epatiti, Hiv e Tbc... le carceri italiane sono polveriera
20 maggio 2014
Il passaggio della Sanità Penitenziaria dal Ministero della Giustizia al Sistema Sanitario Regionale è un evento epocale che ha comportato un enorme cambiamento nell'assistenza ai pazienti detenuti, purtroppo non sempre e non da tutti recepito. Chi entra in carcere più facilmente può contrarre malattie come Aids, tubercolosi, epatiti, malattie sessualmente trasmissibili e altre patologie infettive. I prigionieri sono spesso soggetti all'obesità, sono fumatori e costretti ad una cattiva alimentazione.

Cour européenne des droits de l’homme
# Affaire G.C. c. Italie (Requête no 73869/10)
http://hudoc.echr.coe.int/ Strasbourg 22 avril 2014
La Cour, à l'unanimité, 1. Déclare la requête recevable ; 2. Dit qu’il y a eu violation de l’article 3 de la Convention à raison du retard dans l’administration de soins adaptés à l’état de santé du requérant ; 3. Dit qu’il n’y a pas eu violation de l’article 3 de la Convention à raison de la surpopulation carcérale ; 4. Dit a) que l’État défendeur doit verser au requérant, dans les trois mois à compter du jour où l’arrêt sera devenu définitif conformément à l’article 44 § 2 de la Convention, les sommes suivantes : i. 20 000 EUR (vingt mille euros), plus tout montant pouvant être dû à titre d’impôt, pour dommage moral, ii. 5 000 EUR (cinq mille euros)... # Comunicato DAP

Antonio Crispino
# Malati gravi lasciati morire in carcere. Alle famiglie: "è tutto sotto controllo"
Corriere della Sera, 24 marzo 2014
Avevano tumori, leucemie, distrofie muscolari, ulcere sanguinanti, anoressia... Morti in attesa di una cura o di poter fare ulteriori accertamenti. Mesi trascorsi chiedendosi l'origine di quei malori o sperando di iniziare la chemioterapia per fermare l'avanzata di un tumore. Giorni passati nell'impossibilità di fare qualcosa sapendo che quotidianamente la malattia ti consuma. Una vita legata al "sì" dei medici del carcere o del magistrato di sorveglianza che in alcuni casi non arriverà mai. O arriverà, beffardo, a morte ormai sopraggiunta. Ai parenti sempre una sola risposta: "È tutto sotto controllo, il paziente è curato e monitorato. Niente di preoccupante"...

Jo-Ann Brown | Alzheimer’s Australia NSW
# Dementia in Prison
https://fightdementia.org.au/ Discussion Paper #9 March 2014
A person with dementia in prison will, as they would in the community, struggle with gradual loss of: memory; functioning; coordination; health; and retaining their sense of identity. Behavioural and psychological symptoms of dementia such as agitation, aggression, paranoia, delusions, self-neglect and incontinence can commonly occur at some point in the course of dementia and provide challenges for their carers.

Il Sole 24 Ore Sanità
# «Malato il 60-80% dei detenuti nelle carceri italiane»: la denuncia delle Simspe
www.sanita.ilsole24ore.com/ 18 marzo 2014
Le stime sulla salute dei detenuti italiani elaborate dalla Simspe vedono in testa alla classifica delle patologie più diffuse le malattie infettive (48%); i disturbi psichiatrici (27%); le tossicodipendenze (25%); le malattie osteoarticolari (17%); le malattie cardiovascolari (16%); i problemi metabolici (11%); le patologie dermatologiche (10%). Per quanto riguarda le infezioni a maggiore prevalenza, il bacillo della tubercolosi colpisce il 22% dei detenuti, l'Hiv il 4%, l'epatite B (dormiente) il 33%, l'epatite C il 33% e la sifilide il 2,3%.

David Orenstein
# Experts call for prison health improvements
http://news.brown.edu/ March 3, 2014
Researchers have found that about two in five prisoners have a chronic medical condition (often first diagnosed in prison) and more than seven in 10 prisoners of state systems need substance abuse treatment. In fact, the illness of addiction is what lands many people in prison in the first place. But four in five prisoners don’t have health insurance when they leave.

Pompidou Group | WHO | Council of Europe
# Expert meeting. Prison health in Europe: Missions, roles and responsibilities of international organizations
www.europris.org/ Strasbourg, 13 february 2014
Prisoners’ health status is regularly lower than the health status of people in liberty. Prisoners mostly stem from poor and deprived segments of the population such as (illegal) migrants, ethnic minorities, people without employment, people with drug use disorders or sex workers. Many diseases concentrate in these groups. Since prisons are often overcrowded and do not offer healthy living conditions – e.g. lack of fresh air, hygiene or light – the risks of disease in prisons are often much higher than outside.

CEDU Cour Européenne des Droits de l'Homme
# Fiche thématique – Droits des détenus en matière de santé
www.echr.coe.int/ février 2014
« (…) [L]’article 3 [de la Convention européenne des droits de l’homme, qui interdit les traitements inhumains ou dégradants,] impose à l’État de s’assurer que tout prisonnier est détenu dans des conditions qui sont compatibles avec le respect de la dignité humaine, que les modalités d’exécution de la mesure ne soumettent pas l’intéressé à une détresse ou à une épreuve d’une intensité qui excède le niveau inévitable de souffrance inhérent à la détention et que, eu égard aux exigences pratiques de l’emprisonnement, la santé et le bien-être du prisonnier sont assurés de manière adéquate, notamment par l’administration des soins médicaux requis (…) »

Cour des comptes
# Rapport public annuel 2014 – La santé des personnes détenues: des progrès encore indispensables
www.ccomptes.fr/ février 2014

La population détenue, qui a atteint 67 683 personnes145 au 1er août 2013, présente d’importants besoins de santé. Aux dépendances à des substances psychoactives (38 % des détenus souffrent d’une addiction aux substances illicites, 30 % à l’alcool147 et 80 % fument du tabac quotidiennement), s’ajoute notamment une prévalence très forte des maladies psychiatriques et infectieuses. Au moins un trouble psychiatrique est identifié chez huit détenus sur dix, le taux de détenus atteints de schizophrénie étant quatre fois plus important que dans la population générale. La prévalence des virus du SIDA (VIH) et de l'hépatite C est respectivement six fois plus élevée...

WHO | Stefan Enggist, Lars Møller, Gauden Galea and Caroline Udesen (eds)
# Prisons and Health
www.euro.who.int/ 2014
The state has a special duty of care for those in places of detention which should cover safety, basic needs and recognition of human rights, including the right to health. Studies have consistently shown that the prevalence of poor mental health among prisoners is considerably higher than in the community. Prison mental health services should be based on the health needs of prisoners. This might require more intensive and integrated services than in the wider community.

Pierpaolo Cavallo, Giulia Savarese, Luna Carpinelli
# Bruxism and health related quality of life in Southern Italy’s prison inmates
Community Dental Health (2014) 31, 1–10
Bruxism prevalence is higher and HRQoL is worse in the prison population than in the general population; the presence of bruxism is correlated with lower HRQoL (Health related Quality of Life) levels, and correlation is stronger for subjects at irst prison experience and for higher education levels, thus suggesting higher effect of stress on these subjects...

Paolo Ferrario
# Troppi malati in carcere «Serve un Osservatorio»
www.avvenire.it/ 21 gennaio 2014

Se l’80% della popolazione di una città fosse malata, il sindaco ordinerebbe quanto meno una profilassi collettiva per arginare la trasmissione del virus. Ciò non avviene, invece, nel sistema carcerario italiano che, per dimensioni (64.758 i detenuti presenti al 30 settembre scorso), potrebbe benissimo stare tra i comuni italiani di medie dimensioni. In questa cittadina con le sbarre e circondata da alte mura, la concentrazione di malattie ha ormai abbondantemente superato il livello d’allarme...

Ombretta Di Giovine
# In difesa del c.d. decreto Balduzzi (ovvero: perché non è possibile ragionare di medicina come se fosse diritto e di diritto come se fosse matematica)
Archivio Penale, n. 1, 2014
Possiamo soltanto sperare (ma si tratta di un auspicio di difficile inveramento) che, nel riempire di contenuto la “colpa lieve”, la giurisprudenza smetta di ispirarsi opportunisticamente, strumentalmente, alle sole teorizzazioni dottrinali sulla misura oggettiva (invero ispirate al contrario intento di assicurare maggiore determinatezza al concetto di colpa), e che si apra invece finalmente anche ad una valutazione del concreto contesto fattuale, operazione mediabile soltanto attraverso le categorie (quali che esse siano: sul punto in dottrina non si è raggiunta una omogeneità interpretativa) impregnate di rimproverabilità soggettiva

Fati Mansour
# Dans la douleur des prisons
Le Temps, Jeudi 23 janvier 2014
...En parallèle, la plongée dans l’univers carcéral lui fait découvrir l’importance de l’héritage légué par le professeur Jacques Bernheim. Ce visionnaire a créé, à Genève, le premier service médical indépendant des autorités judiciaires et pénitentiaires du monde. Il a contribué à l’élaboration des principes fondamentaux qui veulent que les détenus bénéficient des mêmes soins qu’un patient libre, que la confidentialité leur soit assurée, que la prévention et l’intervention humanitaire se fassent aussi en prison et que l’indépendance et la compétence des professionnels œuvrant derrière les barreaux soient garanties. «Il faut éviter une sous-médecine comme cela se pratique aux Etats-Unis où, par exemple, ceux qui ont perdu le droit de pratiquer peuvent encore exercer en prison.»

Domenico Pulitanò
# Responsabilità medica: letture e valutazioni divergenti del novum legislativo
Diritto Penale Contemporaneo 4/2013
Letture fortemente divaricate contrassegnano le prime reazioni giudiziarie alla nuova disposizione speciale in materia di responsabilità penale dell’esercente la professione sanitaria, introdotta dalla legge n. 189/20121: da un lato, una eccezione d’illegittimità costituzionale di un giudice di Milano, dall’altro una sentenza della Corte di Cassazione che è subito stata colta come importante. I due provvedimenti, entrambi ampiamente motivati, sollecitano una riflessione non solo sul problema specifico della responsabilità medica e sulla nuova disposizione in materia, ma anche su tensioni che attraversano l’attuale situazione spirituale nel mondo penalistico.

European Court of Human Rights | Cour Européenne des Droits de l'Homme
# Case of Kutepov v. Russia
hudoc.echr.coe.int/ Strasbourg 4 december 2013
62. The Court considers that, as a result of the inadequacy of his medical treatment, the applicant has been exposed to prolonged mental and physical suffering diminishing his human dignity and lasting for several years. The authorities’ failure to provide the applicant with the medical care he needed thus amounted to inhuman and degrading treatment within the meaning of Article 3 of the Convention. 63. Accordingly, there has been a violation of Article 3 of the Convention.

UNODC - WHO
# Good governance for prison health in the 21st century. A policy brief on the organization of prison health
www.unodc.org/ 2013
Prison health is public health. Prisons are closely linked to communities. Prisoners go on leave, receive visitors and sometimes attend outside work placements or health care facilities. The vast majority of prisoners will eventually leave prison and reintegrate into society. Prison personnel constantly oscillate between prisons and their communities. Thus, prisons also affect public health in the wider community...

Task force report funded by IMAP/OSF
# Ethics Abandoned: Medical Professionalism and Detainee Abuse in the “War on Terror”
www.imapny.org/ Institute on Medicine as a Profession November 2013
The role of health professionals in complying with ethical responsibilities toward prisoners is considered so important worldwide that the United nations has promulgated professional standards on the subject. There is broad consensus within the field of military medicine, too, that the ethical principle of non-maleficence applies to military health professionals assigned to prisons, especially in the context of torture. According to the Un Principles of Medical Ethics, “it is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health.”

Groupe National de Concertation Prison
# La santé en prison : quelques éléments de compréhension
http://jnp.farapej.fr/ 20èmes Journées Nationales Prison du 25 au 30 novembre 2013
Les personnes incarcérées sont en moins bonne santé que la population française, lors de leur entrée en prison. Une fois en prison, la santé des personnes détenues se détériore. « Mais de nombreuses personnes sont déjà malades mentales lors de leur arrivée en prison » (Canetti)

Francesco Ceraudo

# La mappa dei rischi in carcere | Progetto salute in carcere Azienda USL 2 Lucca dicembre 2013

# Morire di carcere | Progetto salute in carcere Azienda USL 2 Lucca novembre 2013

Gianmario De Muro
# La ricerca scientifica e il diritto alla salute
AIC Associazione Italiana Costituzionalisti 06/12/2013
In sintesi, il diritto fondamentale alla salute è certamente un diritto alla prestazione di cure che, tuttavia, devono essere scientificamente testate. Il legislatore ha così trovato il suo limite d’intervento, lo ha trovato non lo ha costruito. La Corte esplicita questo limite: “sul merito delle scelte terapeutiche in relazione alla loro appropriatezza non potrebbe nascere da valutazioni di pura discrezionalità politica dello stesso legislatore, bensì dovrebbe prevedere l’elaborazione di indirizzi fondati sulla verifica dello stato delle conoscenze scientifiche e delle evidenze sperimentali acquisite, tramite istituzioni e organismi - di norma nazionali o sovranazionali - a ciò deputati, dato l’”essenziale rilievo” che, a questi fini, rivestono “gli organi tecnicoscientifici”  (cfr. sent. n. 185 del 1998); o comunque dovrebbe costituire il risultato di una siffatta verifica”.

Società Italiana di Medicina e Sanità Penitenziaria SIMSPe Onlus
# Audizione Commissione Igiene e Sanità – Senato della Repubblica 7 novembre 2013
www.senato.it  www.sanitapenitenziaria.it

Patologie particolarmente frequenti sono le dipendenze da droghe e alcol, quelle psichiatriche, associate sia ad elevati tassi di suicidi, frequentemente riportati anche dai mass-media, che ad altri atti di autolesionismo e quelle infettive. Le infezioni a maggior valenza in termini di salute pubblica sono rappresentate dal bacillo della tubercolosi (circa il 22% della popolazione detenuta), da virus dell’immunodeficienza umana (HIV: 4%), da virus dell’epatite B (HBV: 5% con infezione attiva, 33% con infezione criptica, cioè dormiente), da virus dell’epatite C (HCV: 33%) e dal Treponema pallido, agente della Sifilide (2,3%).

Alessandro Foti
# Il diritto alla salute. Tutela multilivello nei sistemi giurisdizionali nazionale, internazionale e sovranazionale
Università degli Studi di Catania, 2013

Nel 2012 e nel 2013 la Corte ha emesso nei confronti del nostro Paese tre sentenze in tema di salute. Si tratta dei casi Cara-Damiani contro Italia, Scoppola contro Italia e Cirillo contro Italia. In tutti e tre questi casi, i ricorrenti erano dei detenuti ed essi si erano rivolti ai giudici di Strasburgo sostenendo che le condizioni in carcere non fossero compatibili con i loro problemi di salute e che pertanto costituissero una violazione dell'articolo 3 della Convenzione, il quale proibisce i trattamenti inumani e degradanti.

The Pew Charitable Trusts | MacArthur Foundation
# Managing Prison Health Care Spending
www.pewtrusts.org/ October 2013
Inmates’ health, the public’s safety, and taxpayers’ total corrections bill are all affected by how states manage prison health care services. Effectively treating inmates’ physical and mental ailments, including substance abuse, improves their well-being and can reduce the likelihood that they will commit new crimes or violate probation once released.

Chaitra Gopalappa, Ya-Lin A. Huang, Thomas L. Gift, Kwame Owusu-Edusei, Melanie Taylor, Vincent Gales
# Cost-Effectiveness of Screening Men in Maricopa County Jails for Chlamydia and Gonorrhea to Avert Infections in Women
Sex Transm Dis. 2013 October
Compared with symptom-based testing and treating strategy, screening male arrestees of all ages and only those 35 years or younger yielded the following results: averted approximately 556 and 491 cases of infection in women at a cost of approximately US $1240 and $860 per case averted, respectively, if screened during physical examination (between days 8 and 14 from entry to jail), and averted approximately 1100 and 995 cases of infections averted at a cost of US $1030 and $710 per infection averted, respectively, if screened early, within 2 to 3 days from entry to jail.

Emmanuel Brillet
# Vieillesse(s) carcérale(s)
Cahiers d’études pénitentiaires et criminologiques, octobre 2013 - n. 38
Cette définition extensive de la « vieillesse », se justifie – selon Kuhlmann et Ruddell – par le fait que « les personnes incarcérées sont plus que proportionnellement susceptibles d’avoir adopté des styles de vie nocifs pour la santé préalablement à leur incarcération : consommation prolongée de drogues ou d’alcool, rapports non protégés » ; à quoi s’ajoutent « les effets à long-terme de la pauvreté : régimes alimentaires déséquilibrés, conditions de logement précaires, faible suivi sanitaire ».

Comitato Nazionale per la Bioetica
# La salute dentro le mura
27 settembre 2013 | pubblicato 11 ottobre 2013
1) Salute in carcere e diritti umani: i principi ispiratori - 2) La popolazione carceraria: lo stato di salute - 3) Un approccio globale alla salute in carcere: indicazioni internazionali - 4) Dalla sanità penitenziaria al Servizio Sanitario Nazionale: il decreto di trasferimento delle funzioni sanitarie e gli obiettivi di programmazione - 5) Tra diritto alla cura ed esigenze di sicurezza - 6) Il personale sanitario: aspetti etici specifici - 7) Aree chiave di intervento - 8) I migranti e i Centri di Identificazione ed Espulsione - 9) Raccomandazioni

Francesco Ceraudo

# Tabagismo e fumo passivo in carcere

Progetto salute in carcere Azienda USL 2 Lucca 26 settembre 2013

Carlotta Cherchi
# La salute detenuta. Un'indagine sulla sanità penitenziaria in Emilia-Romagna
Università di Bologna, 2012-2013

Physicians for Human Rights PHR
# Using science and medicine to stop human rights violations

http://physiciansforhumanrights.org/
PHR has investigated prison conditions in the US and abroad to expose human rights violations and promote humane conditions and the availability of health care, exposing violations of the Standard Minimum Rules for the Treatment of Prisoners promulgated by the UN.

Amy Smith
# Health and Incarceration: A Workshop Summary
www.nap.edu/ National Academy of Sciences 2013

Closing of mental hospitals in the 1970s (deinstitutionalization) was intended to shift patients to more humane care in the community; however, the authors argue that insufficient funding left many people without access to treatment. They note that individuals with mental health problems may engage in behaviors that draw attention and police responses and assert that many health professionals now feel such behavioral disorders have become criminalized.

Michael Levy, Heino Stöver
# Safer Prescribing of Medications in Adult Detention
http://oops.uni-oldenburg.de/ volume 24, 2013
Every prison health service has to assess its prescribing competence in light of conflicting forces: 1. Professional standards, first and foremost – what is the community practice? 2. Population needs and behaviours, as they may impact prescribing practices, including compliance and diversion of medications – within the prison, from the community into the prison, and from the prison into the community. 3. Environmental and institutional  forces that support safe prescribing, and their limitations which bring professional practice into disrepute...

Australian Institute of Health and Welfare
# The health of Australia’s prisoners 2012
www.aihw.gov.au/ Australian Institute of Health and Welfare 2013
Prisoners have far greater health needs than the general population, with high levels of mental health disorders, illicit substance use, chronic disease, communicable disease and disability. Mental health disorders and harmful drug use are particularly prevalent in the prisoner population with only about one-quarter of prisoners having neither problem... each year, thousands of prisoners are released back into the community and the health issues and concerns of prisoners become those of the general population. The World Health Organization’s Health in Prisons Project supports this view of prisoner health as an aspect of community health...

Fabiana Buffo
# Donne in carcere: modificazioni psiconeuroendocrine legate alla reclusione | Women in prison: psychoneuroendocrine modifications related to detention
Università degli Studi di Torino 2012-13

# News Sanità Penitenziaria Veneto - luglio 2013
www.regione.veneto.it/sanitapenitenziaria

Fabio Voller

# Progetto CCM 2012: Lo stato di salute dei detenuti degli istituti penitenziari de 6 regioni italiane: un modello sperimentale di monitoraggio dello stato di salute e di prevenzione dei tentativi suicidari

www.ars.toscana.it/ 5 giugno 2013

Seminario nella sede della Regione Liguria dal titolo “La tutela della salute negli istituti penitenziari” - Progetti e Servizi.
Si parte dalla constatazione, messa in luce dalla letteratura internazionale, che esistono importanti differenze in termini di salute rispetto alla popolazione generale : si rileva una prevalenza nettamente superiore di patologie croniche, psichiatriche ed infettive nei detenuti. Anche i dati a disposizione a livello nazionale confermano questo quadro. La presenza di una prevalenza così elevata di patologie induce a monitorare con particolare attenzione il trattamento che viene erogato ai soggetti detenuti attraverso Protocolli di prescrizione che risultino in linea con le principali linee guida internazionali.

Global Commission on Drug Policy
# The Negative Impact Of The War On Drugs On Public Health: The Hidden Hepatitis C Epidemic
www.globalcommissionondrugs.org/ May 2013
Hepatitis C is a highly prevalent chronic viral infection which poses major public health, economic and social crises, particularly in low and middle income countries. The global hepatitis C epidemic has been described by the World Health Organization as a ‘viral time bomb’, yet continues to receive little attention. Access to preventative services is far too low, while diagnosis and treatment are prohibitively expensive and remain inaccessible for most people in need. Public awareness and political will with regard to hepatitis C are also too low, and national hepatitis surveillance is often non-existent.

SIMSPE - A.S.L.TO2

# Prevalenza record di malattie infettive in carcere. “Le Malattie Trasmissibili dei Migranti in Ambito Penitenziario"

Sermig Torino 23 maggio 2013

Con i movimenti demografici degli ultimi dieci anni, nel nostro Paese ormai costantemente un 10% della popolazione risulta proveniente da altri Paesi o da altri continenti e quasi sempre da aree ad alta endemia per le malattie infettive. Il fenomeno delle malattie trasmissibili dei migranti diventa particolarmente rilevante in ambito penitenziario, dove in media la percentuale di stranieri sale a oltre il 30% del totale e dove l’ambiente ristretto e sovraffollato è un ulteriore fattore favorente la trasmissione delle malattie infettive

David Young, Clarann Weinert
# Improving Health Literacy With Inmates. Health literacy is defined as the capacity to obtain, process, communicate and understand basic health information and services needed to make appropriate health decisions
Corrections Today — November/December 2013
It is well-documented that inmates have a disproportionately higher incidence of chronic health conditions and poorer health outcomes compared to the general population. It is also well-documented that poor health literacy is associated with frequent hospitalizations, high health care costs, poor health outcomes and premature deaths. 

EpaC onlus | Cittadinanzattiva onlus
# Indagine civica sull’accesso alle nuove terapie per il trattamento dell’epatite C
www.sosfegato.it/ 2013
In Italia le epatiti virali costituiscono una vera e propria emergenza sanitaria, in particolare l’epatite C. È quanto emerge dai dati pubblicati nel Libro Bianco AISF 2011 e dal Technical Report sulle epatiti B e C del Centro Europeo per il Controllo e la Prevenzione delle Malattie (ECDC). Tali pubblicazioni che contengono una dettagliata analisi epidemiologica, sociale ed economica delle epatopatie in Europa, evidenziano il triste primato del nostro Paese in termini di numero di soggetti HCV positivi e di mortalità per tumore primitivo del fegato (HCC).

Regione Lombardia
# Programma per la realizzazione di strutture sanitarie extraospedaliere per il superamento degli Ospedali Psichiatrici giudiziari, ai sensi della L.17.02.2012, n.9 art. 3ter e successive modificazioni D.M. 28-12-2008
Deliberazione n° X / 122 Seduta del 14/05/2013

Ministerio del Interior | Secreteria General de Instituciones Penitenciarias
# Mortalidad en Instituciones Penitenciarias 2012
www.institucionpenitenciaria.es/ Mayo 2013

Annie Gjelsvik, Dora M. Dumont, Amy Nunn
# Incarceration of a Household Member and Hispanic Health Disparities: Childhood Exposure and Adult Chronic Disease Risk Behaviors
Preventing Chronic Disease, vol. 10 - May 2, 2013
Incarceration and health are associated in complex ways. Prisoners have a worse health profile than the general population, and more than 50% suffer from poor mental health, substance dependence, or both. Little attention focused on Hispanic incarceration and its aftermath. Because of our small sample size, power was too weak to assess the association between race, incarceration, and health among Hispanics. Future studies may investigate how race mediates the Hispanic experience of both incarceration and health, especially for Hispanics who would be identified as black by US society regardless of how they self-identify. Race may mediate health among Hispanics as well as non-Hispanics, though identifying this is difficult because Hispanics are less likely to adopt US conceptions of racial categories. However, Hispanics who identify as black may be at increased risk of hypertension...

The Hepatitis C Trust

# Addressing hepatitis C in prisons and other places of detention: Recommendations to NHS England
www.hepctrust.org.uk/ May 2013

Participants in the roundtable concluded that a cultural shift is required in prisons to destigmatise the condition and normalise testing. Training and education for all prison staff at every level, including healthcare and discipline, will be central to achieving this culture shift. The recommendations in this document will help to translate this culture shift into tangible outcomes of increased numbers of patients, diagnosed, educated about, treated and cured of the virus and help reduce the national burden of liver disease as required by the NHS Outcomes Framework.

Federal Bureau of Prisons BOP | Clinical Practice Guidelines

# Preventive Health Care
www.bop.gov/  April 2013

The BOP preventive health care program includes the following components: • A health care delivery system that uses a multi-disciplinary team approach, with specific duties assigned to each team member. • An emphasis on the inmate’s responsibility for improving his or her own health status and seeking preventive services. • Prioritization of inmates who are at high risk for specific health problems. • Recognition that routine physical examinations are not a recommended component of a preventive health care program.

Newly incarcerated inmates are screened for conditions that warrant prompt intervention: contagious diseases, active substance abuse, chronic diseases, and mental illness. Intake screening and prevention parameters are outlined in Appendix 1 (Preventive Health Care – Intake Parameters) and are governed by current BOP policy.

Ministry of Justice
# Safety in Custody Statistics. England and Wales. Update to December 2012
www.gov.uk/ Ministry of Justice Statistics bulletin, 25 April 2013
· 23,158 recorded self-harm incidents, compared with 24,648 incidents in the previous 12 months – a fall of six per cent; · 6,761 individuals who self-harmed, compared with 6,907 individuals in the previous 12 months – a fall of one per cent; · The rate of female individuals who self-harmed fell by 15 per cent to 264 individuals per 1,000 prisoners in 2012 from 311 in 2011.

Regione Lazio - Azienda Unità Sanitaria Locale RM A
# Deliberazione n. 235 del 17/04/2013. Costituzione Tavolo Tecnico per il monitoraggio dell'applicazione del D.P.C.M. 01/04/2008 e approvazione Carta dei Servizi Sanitari della Casa Circondariale di Regina Coeli
www.garantedetenutilazio.it/ 2013

Mika’il DeVeaux
# The Trauma of the Incarceration Experience
Harvard Civil Rights-Civil Liberties Law Review [Vol. 48 2013]

Reading Ervin Goffman’s book, Asylums, 86 helped me understand what was happening during my time in incarceration and what has happened since my release. The self that I had constructed prior to prison was assaulted at the beginning of my incarceration. My reactions to the physical and psychological attacks were defensive in nature. I did not know how to be a prisoner, and I was not willing to learn; even so, the socialization process was unavoidable when immersed in that environment. The degradation and humiliation I and others experienced during my reception was intentional and part of the process of institutionalization. Those feelings endured throughout my incarceration in every prison in which I was housed.

Ben Newman

# Jail and Prison Inmates’ Healthcare Issues Vary by Type of Facility
www.ultrariskadvisors.com/ April 16, 2013
Studies have shown that the biological age of inmates as a whole is significantly higher than their actual age because of poor health practices and high risk behavior. This places a high priority on the medical provider to give inmates high quality healthcare to help them return to their communities in a condition to be more productive members of society.

U.S. Department of Justice
# The Federal Bureau of Prisons’ Compassionate Release Program
www.justice.gov/ April 2013
In the Sentencing Reform Act of 1984, Congress authorized the Director of the Federal Bureau of Prisons (BOP) to request that a federal judge reduce an inmate’s sentence for “extraordinary and compelling” circumstances. Under the statute, the request can be based on either medical or non-medical conditions that could not reasonably have been foreseen by the judge at the time of sentencing ...

Arianna Giunti

# Malati di carcere. Diabete, leucemie, tumori. Persino disabili. Migliaia di detenuti faticano a ricevere assistenza adeguata. E l'Europa ci condanna.
L'Espresso, 4 aprile 2013

... Il 47% dei detenuti ha bisogno di assistenza per seri problemi medici e psicologici: quasi 31 mila persone... Dietro le sbarre moltissimi detenuti si ammalano di anoressia. Arrivano a perdere più della metà del peso e si riducono a larve umane esposte a a traumi e infezioni... Anche i disabili faticano a ricevere assistenza adeguata. Nelle carceri italiane sono quasi mille...

Marina Karanikolos, Philipa Mladovsky, Jonathan Cylus, Sarah Thomson, Sanjay Basu, David Stuckler, Johan P Mackenbach, Martin McKee
# Financial crisis, austerity, and health in Europe [Health in Europe 7]
www.thelancet.com Published online March 27, 2013

Bernd Rechel, Emily Grundy, Jean-Marie Robine, Jonathan Cylus, Johan P Mackenbach, Cecile Knai, Martin McKee
# Ageing in the European Union [Health in Europe 6]
The Lancet, March 27, 2013

Guido Rossi

# Diritto alla salute. Proteggere il welfare per salvare l'economia

il Sole 24ore, 12 maggio 2013

I tagli alla sanità pubblica costituiscono un pericolo per la salute dell'uomo, ma anche per lo sviluppo del sistema economico, con l'infausta conseguenza del passaggio dalla crisi economica a una devastante crisi sociale.

Gioacchino Bellone, Valerio Cellesi, Giulia Capitani, Caterina Silvestri, Stefano Bravi, Maria Antonietta Cruciata, Arcangelo Alfano, Daniel De Wet, Sonia Baronti, Chiara Mengoni, Fabio Voller, Caterina Silvestri, Stefano Bravi, Tommaso Bellandi, Alessandro Cerri

# il Sole 24 Ore Sanità Toscana 9 - 15 luglio 2013

www.regione.Toscana.it

Giulia Capitani | Laboratorio Management e Sanità Scuola Superiore S.Anna
# Il sistema di valutazione della salute in carcere - Bologna, 30 maggio 2013

Global Commission on Drug Policy
# The Negative Impact Of The War On Drugs On Public Health: The Hidden Hepatitis C Epidemic
www.globalcommissionondrugs.org/ Report May 2013

The silence about the harms of repressive drug policies has been broken – they are ineffective, violate basic human rights, generate violence, and expose individuals and communities to unnecessary risks. Hepatitis C is one of  these harms – yet it is both preventable and curable when public health is the focus of the drug response. Now is the  time to reform.

Roberto Cagarelli | Servizio Sanità pubblica
# Il ruolo della sanità pubblica nelle carceri dell’Emilia-Romagna
Bologna 30 maggio 2013

Marco Scoletta
# Rispetto delle linee guida e non punibilità della colpa lieve dell’operatore sanitario: la “norma penale di favore” al giudizio della Corte costituzionale
Diritto Penale Contemporaneo 29 Marzo 2013
Nota a  # Trib. Milano, sez. IX (ord.), 21.3.13 (dep.), Giud. Giordano, imp. Andreata e altri

# Corte cost., 6 dicembre 2013, n. 295, Pres. Silvestri, Rel. Frigo

La Corte Costituzionale dichiara la manifesta inammissibilità della questione di legittimità costituzionale dell’art. 3 del decreto-legge 13 settembre 2012, n. 158 sollevata dal Tribunale di Milano...

Lior Gideon
# Bridging the gap between health and justice
Health and Justice, 2013, 1:4
Health and justice are not that different from each other; they are two sides of the same coin, sharing a mutual aim of providing public safety. It is thus imperative that the two disciplines collaborate and learn from each other, not just in matters that pertain to the incarcerated population, but at all levels, with one aim in mind: promoting the health and safety of our communities. This is justice, and we should do everything in our power to restore and maintain it.

Phil Schaenman, Elizabeth Davies, Reed Jordan, Reena Chakraborty
# Opportunities for Cost Savings in Corrections without Sacrificing Service Quality
The Urban Institute 2013
Typically 9 to 30 percent of corrections costs go to inmate health care. This amounts to hundreds of millions of dollars nationally, and is an aspect of corrections about which the public and many decisionmakers are largely unaware. Inmate health care costs are high in both prisons and jails... Prisons and jails are required to provide health care to inmates at a level comparable to the care they could receive in the community if not incarcerated. It is considered an Eighth Amendment issue regarding cruel and unusual punishment, affirmed by the Supreme Court (Estelle v. Gamble 1976). Corrections institutions that do not provide adequate levels of care can be and have been sued, often for millions of dollar...

Ebin J. Arries, Sithokozile Maposa
# Cardiovascular Risk Factors Among Prisoners. An Integrative Review
International Association of Forensic Nurses, Volume 9 & Number 1 & January-March 2013
Incarceration is characterized by inequalities in disease burden and an increased risk for cardiovascular disease (CVD). The aim of this review was to critique published empirical research studies on cardiovascular risk factors among prisoners and to summarize and synthesize current knowledge and findings across these studies. A total of 12 studies that met the inclusion criteria were identified and analyzed. Hypertension, among other CVD risk factors such as smoking, physical inactivity and obesity, was one of the threemost common CVD risk factors found in prisoners.Women and young offenders had a higher prevalence of hypercholesterolemia. Identifying prevalent risks factors among prisoners might influence the development of CVD prevention strategies that are specifically directed to at risk prisoners.

Rallie Murray
# Invisible Bodies: The Politics of Control and Health in Maximum Security Prisons
Trans-Scripts 3 (2013)
Constructing health as a human right can have potentially devastating effects on the prison population, particularly since prisoners are usually people of color who are already rendered invisible by the traditional scope of the discourse of human rights. More to the point, I argue that prisoners, rendered politically illegitimate or excluded from the body politic, are no longer considered qualified human subjects in the biopolitical state.

Catia Ferrieri

# Carcere e Disabilità: analisi di una realtà complessa

Università degli Studi di Perugia | POR Umbria FSE 2007-2013 , con la collaborazione dell’Ufficio Detenuti e Trattamento del Provveditorato dell’Amministrazione Penitenziaria dell’Umbria - 1 febbraio 2013

I detenuti disabili monitorati sono stati in totale 210... Il 35,7% dei detenuti disabili monitorati ha un età compresa tra i 40-50 anni, mentre il 20,2% ha un età compresa tra i 50-60 anni. Il 5,9% è ultra settantenne, mentre il 15,4% ha un età compresa tra i 30 e i 40 anni. Il 3,5% ha un età compresa tra i 20 e i 30 anni. Per il 9,5% del campione il dato non è conosciuto... Il 51,1% dei detenuti disabili monitorati è sottoposto ad esecuzione penale, mentre il 27,3% è in custodia cautelare, per il 19% il dato non è conosciuto... Il 34,5% dei detenuti disabili ha ottenuto la diagnosi di disabilità da parte dell'INPS; il 10,7% da parte di una commissione dell'Asl di appartenenza, mentre il 25% da parte del medico che opera all'interno dell'istituto penitenziario; il 4,7% da parte del medico che seguiva il detenuto in libertà. Per il 14,2% dei  detenuti disabili il dato non è conosciuto.

# Carcere, chi sono e come vivono i 240 detenuti disabili ristretti nelle carceri italiane
Redattore Sociale, 9 maggio 2013

Ricerca di Catia Ferrieri (Università Perugia) sulle condizioni dei detenuti disabili e dei reparti che li accolgono. Solo 10 regioni rispondono al questionario (14 istituti in tutto. 210 i detenuti disabili in Italia.

Gary Joad 

# The health care crisis in the US prison system

World Socialist Web Site | Published by the International Committee of the Fourth International (ICFI) |www.wsws.org/ 20 February 2013

More than 800,000 incarcerated persons in the US suffer from a chronic health problem needing regular attention, such as diabetes, hypertension, heart disease, HIV, and other blood-borne illnesses. According to an American Journal of Public Health 2009 study of federal, state, and “local” jails, access to care is poor. Mental health worsens with incarceration, with the AJPH noting “the prisons’ new societal role as asylums following the mass closures of inpatient mental health facilities in the 1980s (the largest mental institutions in the United States are urban jails).”

Michel Fix (ed)
# Dossier Médecine en milieu carcéral | Dossier élaboré avec les conseils scientifiques du Dr Michel Fix, chef de pôle de soins en milieu pénitentiaire UCSA-CSAPA-SMPR
France - La Revue du Praticien, vol. 63, Janvier 2013

P. 75 Michel Fix, Soigner en prison P. 77 L’offre de soins | P. 82 Catherine Paulet, Aspects particuliers de la pathologie psychiatrique et de sa prise en charge | P. 86 Marc-Antoine Valantin, Pathologie infectieuse | P. 90 Caroline Dagain, Prise en charge des personnes handicapées | P. 93 Betty Brahmy, Difficultés de prise en charge médicale des personnes placées sous main de justice... Soigner un(e) détenu(e), c’est se soumettre à une relation particulière dont le principe est « soigner sans juger »... La prison reste malgré tout un lieu de contradiction, entre exigences sécuritaires et accès aux soins. Néanmoins, la décision judiciaire qui prive une personne de sa liberté en l’incarcérant ne saurait la priver de tous ses autres droits, reconnus à chacun, et en particulier, l’accès aux soins identiques à ceux d’une personne libre...

Corte Europea dei Diritti dell'Uomo
# Causa Cirillo c. Italia - Ricorso n. 36276/10
Sentenza del 29 gennaio 2013
Le doglianze del ricorrente vertono sulla qualità delle cure che gli sono dispensate nel carcere di Foggia per il trattamento della sua patologia. La Corte osserva che il ricorrente ha chiesto più volte che la sua pena fosse sospesa per ragioni mediche. Tuttavia, né i medici, né i giudici che si sono occupati del caso del ricorrente hanno concluso che lo stato di salute di quest'ultimo fosse incompatibile con la detenzione ordinaria, affermando al contrario che le cure necessarie possono essere somministrate in ambiente carcerario (a contrario, Scoppola c. Italia (n. 4), n. 65050/09, § 52, 17 luglio 2012). In queste condizioni, la Corte non può concludere che il mantenimento in carcere del ricorrente sia di per sé incompatibile con l'articolo 3 della Convenzione.

Académie Suisse des Sciences Médicales (ASSM)

# Directives médico-éthiques. Exercice de la médecine auprès de personnes détenues

Approuvées par le Sénat de l’ASSM le 28 novembre 2002 | Au 1^er janvier 2013, les directives ont été adaptées au droit de protection de l’adulte.

ASSM 2013

L'intervention de médecins lors de mesures de contrainte policières appliquées notamment
à des personnes refoulées hors du pays suscite de nombreuses interrogations dans l'opinion publique. Pour répondre aux attentes des différents milieux concernés, l'ASSM a élaboré des directives pour les médecins susceptibles d'être sollicités dans un contexte aussi sensible et indubitablement à risque de dérapages éthiques... Les règles de base éthiques et juridiques qui régissent l'activité médicale notamment en matière de consentement et de confidentialité s'appliquent également lorsque la personne est privée de liberté.

Académie Suisse des Sciences Médicales (ASSM)
# L'exercice de la médecine auprès de personnes détenues. Directives médico-éthiques de l’ASSM
Approuvées par le Sénat de l’ASSM le 28 novembre 2002.

Adviceguide | Citizen advice bureau
# Health in prison. Getting medical treatment in prison
www.adviceguide.org.uk 2013

If you’re in prison, you should get the same health services as you'd get from the NHS. This includes mental health services. Qualified doctors, dentists, pharmacists and nurses provide health care in prison. If you need to see a doctor, ask the wing staff. You’ll be told if there’s a different arrangement in your prison

Conférence des directrices et directeurs des départements cantonaux de justice et police | Office
fédéral de la Justice | Office fédéral de la santé publique - Suisse
# Recommandations pour une harmonisation des soins dans les institutions pénitentiaires suisses
Projet Lutte contre les maladies infectieuses en prison (BIG) 2008-2011 | Adopté par le comité de pilotage du projet BIG le 18 janvier 2013

Le projet BIG poursuit les objectifs suivants : réduire les risques de transmission des maladies infectieuses en milieu carcéral ; réduire les risques de transmission des maladies infectieuses entre le milieu carcéral et le monde extérieur et inversement ; appliquer, dans le milieu carcéral, des mesures de prévention, de dépistage et de traitement des maladies infectieuses équivalentes à celles prises à l'extérieur ; mettre en place un traitement de la toxicomanie en milieu carcéral équivalent à celui prodigué à l'extérieur ; garantir la durabilité des mesures et instruments développés.

Élodie Godin-Blandeau, Charlotte Verdot, Aude-Emmanuelle Develay
# La santé des personnes dédetues en France et à l'étranger: une revue de la littérature
www.invs.sante.fr/ 07.01.2013
Malgré certaines limites méthodologiques, les données épidémiologiques disponibles sur la santé des personnes incarcérées rendent compte d’une surreprésentation de nombreuses pathologies dans cette population, notamment en matière de troubles psychiatriques, d’addictions et de maladies infectieuses...

Comitato Interministeriale per la Programmazione Economica
# Fondo sanitario nazionale 2011 - Ripartizione tra le regioni della quota destinata al finanziamento della sanità penitenziaria. (Delibera n. 144/2012). (13A03986) (GU n.107 del 9-5-2013) Delibera 21 dicembre 2012

Lesley Graham, Tessa Parkes, Andrew McAuley, Lawrence Doi | World Health Organization WHO Regional Office for Europe
# Alcohol problems in the criminal justice system: an opportunity for intervention
World Health Organization 2012

Alcohol problems are best detected through the use of a validated screening tool. There is, however, limited evidence of the effectiveness of screening tools in prison populations, with alcohol problems often subsumed into wider substance misuse and with heterogeneity across studies. Nevertheless, the WHO Alcohol Use Disorders Identification Test (AUDIT) screening tool would appear to be the most promising option in busy settings, given its increasing use in  criminal justice settings both for research and practice and its ability to differentiate between different patterns of drinking behaviour.

Ministero della Giustizia | Dipartimento dell’Amministrazione Penitenziaria | ISSP
# Riforma della sanità penitenziaria. Evoluzione della tutela della salute in carcere
Istituto Superiore di Studi Penitenziari, Numero 11, Dicembre 2012

Carmelo CANTONE “La riforma della sanità penitenziaria: Problemi e percorsi possibili” - Fabio GUI “Il Forum nazionale per il diritto alla salute delle persone private della libertà personale” - Francesca ACERRA “Problematiche relative alla gestione dei soggetti sottoposti alle misure di sicurezza detentive” - Antonietta DE ANGELIS “Il disagio mentale in ambiente penitenziario: strategie e competenze della polizia penitenziaria” - Febea FIORI “I minorati psichici nel sistema penitenziario italiano, profili di gestione e compatibilità con l’esecuzione penale” - 6. Stefania GRANO “Prospettive future degli OPG e gestione degli internati tra cura e detenzione: il ruolo della polizia penitenziaria” - Domenico MONTAURO “Studio comparativo sugli effetti della organizzazione/gestione dopo la riforma sanitaria” - Grazia SALERNO “Il ruolo della Polizia Penitenziaria nella gestione del detenuto affetto da disturbi mentali.” - Maria Luisa TATTOLI “Il diritto alla salute del detenuto: interazione e collaborazione tra l’Ordinamento sanitario e l’Ordinamento penitenziario.” - Domenico SCHIATTONE “Postfazione” .

J. García-Guerrero , A. Marco
# Sobreocupación en los Centros Penitenciarios y su impacto en la salud - Overcrowding in prisons and its impact on health
Revista Española de Sanidad Penitenciaria, vol.14 no.3 Barcelona nov.-feb. 2012

La sobreocupación o el hacinamiento de los centros penitenciarios es un problema frecuente que afecta a muchos países. Es difícil definir estos términos ya que no hay un estándar único internacionalmente aceptado. Sin embargo, son situaciones que deben ser combatidas ya que pueden producir alteraciones en el comportamiento de las personas con aumento de las conductas violentas auto y heteroagresivas. Además, tienen otros impactos en la salud y el bienestar de quiénes lo padecen y repercuten también negativamente en la salud pública y en el sistema penitenciario en cuanto pueden aumentar la prevalencia de enfermedades, sobre todo infectocontagiosas y psiquiátricas, pueden dificultar las labores de rehabilitación social y pueden llegar a constituir un trato inhumano, cruel o degradante.

www.ultrariskadvisors.com
# The Origin of “deliberate indifference” Cases in Correctional Health
November 20, 2012

The Supreme Court observed that the government has an obligation to provide prisoners medical care and that, in some cases, the failure to provide that care may actually produce the type of “physical pain or death,” which may also be seen as cruel and unusual punishment and that is what the Eighth Amendment was intended to prevent.

Federal Bureau of Prisons BOP | Clinical Practice Guidelines

# Preventive Dentistry: Oral Disease Risk Management Protocols

www.bop.gov/ November 2012

Caries risk assessment includes evaluation of physical, biological, environmental, behavioral, and lifestyle-related indicators such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, cariogenic diet, and low socioeconomic status. However, the most consistent predictor of caries risk is past caries experience. The approach to primary prevention should be based on common risk indicators. Secondary prevention and treatment should focus on the management of the caries process over time for individual patients, with a minimally invasive, tissue-preserving approach.

Michael W. Ross, Amy Jo Harzke
# Toward healthy prisons: the TECH model and its applications
International Journal of Prisoner Health Vol. 8 n. 1 2012, pp. 16-26
The concept of the ‘‘healthy prison’’ represents a complete transformation of the ‘‘total prison’’ concept. In a total prison, the organization, the regime and the physical prison structure are dedicated to punishment, to making prison a profoundly negative experience that would serve as a deterrent to crime. The healthy prison, on the other hand, is the product of an environment that, within the confines of the law and the penal system, promotes and maintains health. Møller et al. (2007, p. 1) use the terms ‘‘health promoting prison’’, and ‘‘whole-prison approach’’ to describe such a system, and note that ‘‘sustainability’’ is the characteristic of achieving a healthy prison. The health of the whole prison must be considered – that of both staff and inmates as well as the environment (including occupational health and safety). The process of achieving a healthy prison, however, particularly in resource-poor areas, has not been clearly addressed, and this paper attempts to provide an appropriate and simple process  model based on risk reduction models...

Jakov Zlodre, Seena Fazel
# All-Cause and External Mortality in Released Prisoners: Systematic Review and Meta-Analysis
American Journal of Public Health | December 2012, Vol 102, No. 12
The health of prisoners following release from prison is less understood. At the end of 2009 in the United States, 819 308 prisoners were on parole or release following a prison term,15 and in England and Wales 20 895 offenders were released from prison in the first quarter of 2011.16 Despite these high absolute numbers, research has demonstrated that most sampled US jails did not plan for release of prisoners with mental illness, cardiovascular disease, or HIV/AIDS even though they considered it important. Mortality from suicide and drug-related causes has been reported to be particularly high in the immediate postrelease period, and, thus, public health interventions to target this period for those with a history of substance misuse have been outlined...

Andrea B.E. Laltoo, Lindsay M. Pitcher
# Oral health needs of Canadian prisoners as described by formerly incarcerated New Brunswickers
Canadian Journal of Dental Hygiene. 46.3 (Aug. 2012)
The oral health of prison populations in several countries has been shown to be compromised. However, little published research on Canadian prison populations is available. The purpose of this research paper is to determine whether such populations in Canada also suffer from compromised oral health. Methods: A convenience sample of forty-one formerly incarcerated individuals participated in the study in three New Brunswick urban centres. The study consisted of a questionnaire administered as a structured interview. Results: Reported risk factors included tobacco use (74% of respondents), type 2 diabetes (13%), drug or alcohol dependency (38%), and consumption of cariogenic foods and beverages (100%).

Cour Européenne des Droits de L'Homme  | European Court of Human Rights

# Causa Scoppola c. Italia (N^o 4)
Strasburgo 17 luglio 2012

Il ricorrente è nato nel 1940, ha settantadue anni ed è affetto da patologie cardiache e metaboliche, da diabete, soffre di un indebolimento della sua massa muscolare aggravata da una frattura del femore subita nel 2006, di ipertrofia prostatica e di depressione. Dal 1987 si sposta con la sedia a rotelle... La Corte Dichiara che vi è stata violazione dell’articolo 3 della Convenzione.

Federal Bureau of Prisons BOP | Clinical Practice Guidelines

# Management of Diabetes
www.bop.gov/ June 2012

Diabetes screening in the BOP should be instituted as part of the facility’s preventive health care program. Utilize a fasting serum glucose test (confirming with a fasting plasma glucose test for values that are borderline high). Routine universal screening for diabetes is not recommended.  There is only one group of asymptomatic, otherwise low-risk individuals for whom routine diabetes screening is warranted. Those with a blood pressure greater than 135/80 (treated or untreated) should be screened every 3 years. Otherwise, glucose screening should be performed as clinically indicated, i.e., in association with management of hyperlipidemia, cardiovascular disease, peripheral vascular disease, history of gestational diabetes, or history of polycystic ovary disease.

Federal Bureau of Prisons BOP | Clinical Practice Guidelines
# Evaluation and Treatment of Hepatitis C and Cirrhosis
www.bop.gov/ March 2012

Inmates who are candidates for hepatitis C treatment, but whose anticipated length of stay will not allow sufficient time to complete therapy, should ordinarily not be started on antiviral therapy unless continuation of treatment within the community is deemed likely. This includes inmates housed in short-term BOP detention facilities (including pre-trial and non-sentenced federal detainees), or inmates whose anticipated release date will not allow sufficient time to complete treatment. The potential for interruption of antiviral therapy for hepatitis C places an inmate at risk for a number of adverse outcomes, including: treatment failure, if the course of treatment is not completed, and adverse effects from medications, if the inmate does not receive the required laboratory and clinical monitoring upon release or transfer.

National Association of Counties NACo
# County Jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage
NACo’s Health, Human Services and Justice programs - March 2012

Medicaid Inpatient Billing for Incarcerated Individuals. While federal law does not allow for the reimbursement of inmate medical care under Medicaid, there is an important exception to this rule. Specifically, the exception states that federal financial participation (FFP) is permitted “during that part of the month in which the individual is not an inmate of a public institution.” 1 The Centers for Medicare and Medicaid Services has verified through guidance letters issued in 1997 and 1998 that this exception applies to incarcerated individuals once they are admitted as an inpatient in a hospital, nursing facility, juvenile psychiatric facility or intermediate care facility that is not part of the state or local correctional system. Therefore, if an inmate is eligible for Medicaid and is transported out of a correctional facility to receive inpatient hospital services, Medicaid can be billed to cover the cost of these services.

Public Health England | Health Protection Services Prison Network | Health Protection Agency

# Standards for Health Protection Units in relation to Health Protection in Prisons

www.hpa.org.uk/ July 2012
This document has been developed by the HPS Prison Network and describes the standards that HPUs should meet in supporting the delivery of the PHPQIs alongside delivery of HPA key programmes. The prevention and control of communicable disease in prisons is a priority for the Health Protection Agency (HPA).

Maura Gobbi

#  “La salute detenuta: tra diritto e sicurezza”. Un’indagine nella Casa Circondariale di Rimini.

Bologna 2012

Matteo Paolucci

# La tutela del diritto alla salute delle persone detenute

Tesi - LUISS, 2012

Catherine Ritter | Office fédéral de la santé publique OFSP - Suisse
# Maladies transmissibles et addictions en prison. Vade-mecum
www.bag.admin.ch/ OFSP octobre 2012
Ce Vade-mecum a été élaboré dans le cadre du projet «Bekämpfung von Infektionskrankheiten im Gefängnis» (BIG) (Lutte contre les maladies infectieuses en milieu carcéral), mandaté et financé par l’Office fédéral de la santé publique (OFSP), l’Office fédéral de la justice (OFJ) et la Conférence des directrices et directeurs des départements cantonaux de justice et police (CCDJP)...

Ministère de la Justice | Ministère des Affaires sociales et de la Santé
# Prise en charge sanitaire des personnes placées sous main de justice. Guide méthodologique
www.sante.gouv.fr/ 2012

Donatella Barus | Fondazione Veronesi

# Dalle carceri italiane è evasa la salute

www.fondazioneveronesi.it - 9 novembre 2012

... Sono 5 gli obiettivi necessari: il rispetto dei diritti umani fondamentali dei prigionieri; riservatezza e fiducia fra detenuti e operatori sanitari; l’integrazione della politica sanitaria del carcere nella politica nazionale per la Salute; servizi per le tossicodipendenze e maggiore attenzione alla malattia mentale...

Regione Emilia Romagna | Direzione Generale Sanità e Politiche Sociali |  Servizio Salute Mentale, Dipendenze Patologiche e Salute nelle Carceri
# Assistenza Sanitaria erogata negli Istituti Penitenziari della Regione Emilia-Romagna nell’anno 2011 | Relazione per la Commissione IV, Politiche per la Salute e Politiche Sociali, e la Commissione VI, Statuto e Regolamento convocate in seduta congiunta martedì 3 luglio 2012
www.saluter.it/ 3 luglio 2012

Saluter | il portale del servizio sanitario regionale dell'Emilia Romagna
# Anche in carcere la salute è un diritto
Newsletter Saluter notizie, Anno IX, 16 luglio 2012
All’interno degli istituti penitenziari per adulti dell'Emilia-Romagna operano complessivamente 88 medici e 105 infermieri impegnati nell'assistenza primaria; i medici specialisti sono 97 (in particolare psichiatri, odontoiatri, infettivologi, cardiologi e dermatologi) ai quali si aggiungono 25 psicologi e 15 assistenti sociali ed educatori. In tutti gli istituti della regione sono presenti le attrezzature per la gestione delle emergenze e le Aziende Usl garantiscono, tra l'altro, la consulenza specialistica in infettivologia, l'assistenza psichiatrica e l'assistenza per le dipendenze patologiche

VG Sequera, JM Bayas
# Vacunación en población encarcelada. Una revisión
Rev Esp Sanid Penit 2012
Desde el primer día en un centro penitenciario la persona privada de libertad se expone y expone al resto de la población del centro a varios tipos de enfermedades transmisibles, muchas de ellas prevenibles a través de la vacunación. El riesgo de adquirir estas enfermedades durante el periodo de reclusión probablemente supera al riesgo que existe fuera del centro penitenciario. Este exceso de riesgo puede explicarse tanto por factores estructurales y logísticos, como por el comportamiento habitual o adquirido durante el periodo de reclusión. El centro penitenciario es para gran parte de los reclusos una gran oportunidad de acceso al sistema sanitario, por lo tanto, una ocasión ideal para actualizar el calendario vacunación del adulto. La concepción tradicional de que los centros penitenciarios únicamente estén orientados a garantizar la seguridad pública debería complementarse con el aporte que pueden ofrecer activamente al aspecto sanitario al resto de la población, una manera más de enfocar la seguridad pública.

Avril Taylor, Alison Munro, Elizabeth Allen, Karen Dunleavy, Matthew Hickman, Sheila Cameron, Laura Miller
# Hepatitis C Prevalence and Incidence among Scottish Prisoners and Staff Views of its Management. Final Report
www.sps.gov.uk/ May 2012

Worldwide, varying prevalence rates of hepatitis C infection within prisons have been reported. A meta-analysis of studies conducted with serum samples reported that prevalence rates ranged from 9% – 46% in studies which examined prevalence on entry to prison, and from 2% – 58% in studies which assessed prevalence during imprisonment. However, owing to the heterogeneity of the studies included in the analysis, the authors caution against being able to make any direct comparisons between the studies’ results. The meta-analysis did conclude however that in the 30 studies pooled in the analysis, prisoners who were current or former injecting drug users were 24 times more likely than non- injecting prisoners to be HCV positive.

Louise Robinson, Michael D. Spencer, Lindsay D. G. Thomson, Andrew C. Stanfield, David G. C. Owens, Jeremy Hall, Eve C. Johnstone

# Evaluation of a Screening Instrument for Autism Spectrum Disorders in Prisoners

www.plosone.org/ PLoS ONE May 25, 2012

There have been concerns that individuals with autism spectrum disorders (ASDs) are over-represented but not recognised in prison populations. A screening tool for ASDs in prisons has therefore been developed... 2458 prisoners were screened using the tool, and 4% scored above the cut-off. 126 prisoners were further assessed using standardised measures. 7 of those 126 assessed scored 32 or above (cut-off) on the AQ. 44 interviews were completed with prisoners’ relatives, no prisoner reached the cut-off score on the ASDI. Scores on the screening tool correlated significantly with AQ and ASDI scores, and not with the Ekman 60 Faces Test or IQ. Sensitivity was 28.6% and specificity 75.6%; AUC was 59.6%.

Leonidas K. Cheliotis
# Suffering at the hands of the state: Conditions of imprisonment and prisoner health in contemporary Greece
European Journal of Criminology 9(1) 3–22 2012
With imprisonment rates rising in a large number of jurisdictions worldwide, ever more research attention has been paid to conditions of imprisonment and prisoner health. With a view to contributing to the emerging body of literature, this article offers a systematic summary of key findings from Greece. Prison establishments in this country are vastly overcrowded and material conditions of detainment are deplorable. Healthcare provision in prison is minimal and the prevalence of serious transmittable diseases and mental disorders amongst prisoner populations  is high, as are the rates of deliberate self-harm, suicide and death more generally. Prisoner use of prescribed and illicit drugs is alarmingly common, especially as regards injection drugs, and drug overdose appears to account for the majority of deaths in custody.

David L. Rosen, Wizdom P. Hammond, David A. Wohl, Carol E. Golin
# Disease Prevalence and Use of Health Care among a National Sample of Black and White Male State Prisoners
J Health Care Poor Underserved, February 2012
Several reports suggest that prison populations have a high burden of disease, and as correctional populations grow—and age—a wider spectrum of medical and mental health conditions will become increasingly prevalent within U.S.prisons... The ability and willingness of state and federal prison systems to address growing and often costly health care needs remains undetermined, and in the 35 years since Estelle, there have been few published assessments of health care services available in prison or prisoners’ use of  health care.

Irene Biglino, Anthony Olmo | LDF Laboratorio dei Diritti Fondamentali
# La salute come diritto fondamentale: una ricerca sui migranti a Torino
http://labdf.eu/ Rapporto di ricerca LDF > 1 2012
Sebbene la migrazione non costituisca di per sé un rischio per la salute, il processo migratorio può comportare una maggiore vulnerabilità a problemi di salute fisica, mentale e sociale a seconda delle condizioni vissute dalle diverse persone.4 Il processo migratorio può inoltre avere particolari ripercussioni negative sulla salute di specifici sottogruppi vulnerabili, quali le vittime di tratta, i richiedenti asilo, i migranti irregolari e i minori non accompagnati.

Frédéric Le Marcis
# L’impossible gouvernement de la santé en prison? Réflexions à partir de la MACA (Côte d’Ivoire)
http://www.scielo.br/ 2012
La promotion de la santé en prison repose sur un paradoxe originel: l’univers carcéral comme lieu de privation de liberté est en contradiction avec le principe même de l’éducation à la santé: celui de l’autonomie du patient. Une fois incarcéré, le corps de l’individu est remis à une autorité qui exerce sur lui sa souveraineté. Privé de liberté, l’individu voit sa capacité de prendre des décisions et d’agir également limitée, ou pour le moins cette capacité s’exerce sous contraintes

Paolo Piras
# La diagnosi differenziale in medicina: principi giurisprudenziali
Nota a Cass. pen., sez. IV, 12.7.2011 (dep. 26.9.2011) # n. 34729, Ravasio, Est. Romis e Cass. pen., sez. IV, 27.9.2011 (dep. 14.10.2011) # n. 37043, Pierfederici, Est. Romis
www.penalecontemporaneo.it 18 Gennaio 2012

... L 'individuazione della malattia è (rectius: dovrebbe essere) la tappa di arrivo di un percorso intellettuale per esclusione. La malattia viene quindi individuata per via residuale, una volta che le ipotesi alternative sono state eliminate. Eliminazione che avviene sia mediante l'esame diretto sul paziente, la c.d. clinica, sia mediante le indagini strumentali: analisi di laboratorio o immagini diagnostiche. E l'individuazione della malattia altro non è che la diagnosi. Quando si parla di diagnosi differenziale si fa appunto riferimento a questo percorso per esclusione.

Judge Michael Reilly  Inspector of Prisons Ireland

# Guidance on Physical Healthcare in a Prison Context. Presented to the Minister for Justice and Equality pursuant to Part 5 of the Prisons Act 2007.
Inspector of Prisons 18th April 2011
The provision of adequate healthcare to prisoners should be regarded as a public health issue. Prisoners come from the community and the majority of them will return to the community at some point. In 2009 there was an average of 3,881 prisoners in our prisons on a daily basis and a total of 12,339 prisoners passed through the system that year76. There are not more up to date statistics but it is clear from the published statistics of the day to day prison population to date that the number for 2010 will greatly exceed those for 2009. I stated at paragraph 3.3 that prisoners are more likely to suffer from ill health than the general population. The public health hazard that this presents should not be underestimated77. It will benefit the community at large if prisoners return to the community in good health.

Jeremy Travis | John Jay College of Criminal Justice
# Understanding the public health challenges in the era of mass incarceration
www.jjay.cuny.edu/ March 22, 2012
It’s time to view correctional health care as more than simply an institution-based health care delivery system. We should also view correctional health care as a platform for leveraging significant changes in community well-being. It’s time to look outside the walls of our prisons and jails to create common cause with health care providers in the community and to demand that they see the same big picture that we see. It’s time to set goals for our institutional systems that are in synch with the health goals of our communities, and measure our progress in terms of those external yardsticks. We should set as a goal that every person in our care is treated as a patient first, with the same expectations of quality care and probability of recovery, as if that individual came into a primary care practice on the outside...

Leonidas K. Cheliotis
# Suffering at the Hands of the State Conditions of Imprisonment and Prisoner Health in Contemporary Greece
European Journal of Criminology 9(1) 3–22 (2012)

Against the background of an immense growth in the use of imprisonment in Greece over the last three decades or so, it is shown that prison establishments are greatly overcrowded and material conditions of detention are deplorable. Healthcare provision is minimal, and the prevalence of serious transmittable diseases and mental disorders amongst prisoner populations is high, as are the rates of deliberate self-harm, suicide, and death more generally. Indeed, the officially recorded incidence of prisoner deaths has risen at a faster pace than imprisonment itself.

Tina Maschi, Kelly Sullivan Dennis, Sandy Gibson, Thalia MacMillan, Susan Sternberg,  Maryann Hom

# Trauma and St ress Among Older Adults in the Criminal Justice System: A Review of the Literature with Implications for Social Work

Journal of Gerontological Social Work, 54:4, 390-424 (2011):

Marcus Bicknell, Iain Brew, Cathy Cooke, Howard Duncalf, Jan Palmer, Jimi Robinson
# Safer Prescribing in Prisons. Guidance for clinicians. RCGP Secure Environments Group
Nottinghamshire Healthcare, November 2011
This guidance is written to assist clinicians working in prisons but it also has relevance for clinicians working in other secure environments. It will be of use to prescribers working in the community whose patients regularly have periods in custody or when a patient is expecting a custodial sentence. Community clinicians should be aware of important prescribing issues in the prison system when patients enter custody. Rationalisation of a patient’s care before detention may help the transition into custody and the care provided by the prison healthcare team. Other clinicians who may find the guidance a useful reference are: forensic physicians and custody nurses; consultant psychiatrists; pain clinic prescribers; hospital prescribers.

Sam Himelstein, Arthur Hastings, Shauna Shapiro, Myrtle Heery
#  Mindfulness training for self-regulation and stress with incarcerated youth: A pilot study
Probation Journal 59(2) 2011
The current study investigated the feasibility of implementing a 10-week mindfulnessbased intervention with a group of incarcerated adolescents. Before and after completion of the 10-week intervention, 32 participants filled out self-report questionnaires on trait mindfulness, self-regulation, and perceived stress. We hypothesized that selfreported mindfulness and self-regulation would significantly increase, and perceived stress would significantly decrease, as a result of participation in the treatment intervention.

Federal Bureau of Prisons BOP | Clinical Practice Guidelines

# Sexually Transmitted Disease Treatment Tables
www.bop.gov/ June 2011

• Genital HPV Infection: HPV and Men • Genital Herpes • Gonorrhea • Lymphogranuloma venereum (LGV) • Pelvic Inflammatory Disease • STD Detection and Treatment in HIV Prevention • STDs and Pregnancy • Syphilis: Syphilis and Men Who Have Sex with Men • Trichomoniasis...

Jason Schnittker, Michael Massoglia, Christopher Uggen
# Incarceration and the Health of the African American Community
Du Bois Review, 8:1 (2011) 1–9
This article reviews evidence linking incarceration and health, with a particular focus on African Americans, who are disproportionately affected by the incarceration system. Although inmates generally suffer from worse health than comparable, non-institutionalized adults, this comparison is not uniformly the case, and some of the strongest negative effects of incarceration emerge after release, suggesting that the struggles of reintegration into society are as important as the conditions of incarceration. We review evidence for the basic relationship between incarceration and health from individual-level and aggregate-level studies, as well as from evidence and speculation regarding potential mediating mechanisms. Many questions remain regarding these mechanisms and, by extension, which policies are most promising for reducing incarceration’s impact on health. Among other issues, the incarceration-health connection also raises fundamental questions regarding the level of harm society is willing to accept as part of routine punishment for criminal behavior.

Roberto Hugh Potter, Hefang Lin, Allison Maze, Donell Bjoring
# The Health of Jail Inmates: The Role of Jail Population ‘‘Flow’’ in Community Health
Criminal Justice Review, 2011
Finally, because the majority of persons flowing through jails are released so quickly, health problems identified among this segment of the criminal-justice-involved population are most likely ‘‘sentinels’’ of health problems of the communities from which the detainees come...

Paule Bayle, Aude Lagarrigue, Norbert Telmon
# Diabetes in prison: double the sentence or an opportunity for treatment?
DiabetesVoice September 2011 • Volume 56 • Issue 2
A large-scale study of diabetes prevalence and care in prisons was conducted in the French Consultation and
Ambulatory Care Units (CACU) in 2007. It found a population of 24,489 prisoners with diabetes in 69 prison infirmaries ‒ 27% of whom had type 1 diabetes and 73% type 2 diabetes. The  overall prevalence of diabetes was 6.7%,  which is high compared to the estimated 3.5% among the general population in France.

Cyrus Ahalt,Ingrid A. Binswanger, Michael Steinman, Jacqueline Tulsky, Brie A. Williams
# Confined to Ignorance: The Absence of Prisoner Information from Nationally Representative Health Data Sets
J Gen Intern Med 27(2):160–6 2011
Emerging evidence suggests strong associations among incarceration, poor health and high health care costs. Prior to incarceration, prisoners report high rates of inadequate access to health care and adverse behavioral health risk factors, such as tobacco, alcohol, and drug use. During incarceration, prisoners have higher rates of most chronic medical conditions than age-matched nonprisoners, including diabetes, heart disease, and cancer... Over 50% of former prisoners report at least one chronic health condition, 70% report past substance abuse or dependence, and 80%are unable to secure health insurance for at least 8 to 10 months following release.10 Former prisoners also have higher rates of emergency services use and mortality than other adults...

Corte Suprema di Cassazione - Prima Sezione Penale

# Sentenza n. 33059 del 2 settembre 2011 (c.c. 14 luglio 2011)

In tema di estinzione delle misure cautelari personali, il giudice non può rigettare la richiesta di sostituzione
da parte dell’imputato, per ragioni di salute, senza disporre una perizia medico-legale, in quanto la disposizione di cui all’art. 299, secondo periodo, comma 4-ter, c.p.p., prevede espressamente che, quando il giudice non ritenga di accogliere la richiesta di sostituzione sulla base degli atti, basata sulle condizioni di salute di cui all’art. 275, comma 4-bis, c.p.p. debba disporre con immediatezza gli accertamenti medici sulle condizioni di salute dell’imputato eseguendoli, pur nella speditezza richiesta, con le formalità e le garanzie previste per la perizia, ex art. 220 e seguenti c.p.p.

Corte Suprema di Cassazione - Sezione. Sesta Penale

# Sentenza n. 8493 del 03.03.2011

Nella ritenuta persistenza di esigenze cautelari di eccezionale rilevanza, pur a fronte di un quadro di patologie sanitarie particolarmente gravi non trattabili adeguatamente in ordinario regime carcerario, il giudice -in applicazione dell'articolo 275 c.p.p., comma 4 ter - deve, anche di ufficio, disporre il trasferimento del detenuto, e non un eventuale ricovero temporaneo, in regime di arresti domiciliari presso idoneo "luogo di cura, di assistenza o di accoglienza". La norma in esame impone al giudice l'obbligo di provvedere in tal senso e non una mera facoltà, il cui esercizio vulnererebbe il diritto alla salute cui ogni cittadino, ancorché detenuto, ha diritto per dettato costituzionale (articolo 32 Cost.) ed Europeo (articolo 3 CEDU). In alternativa alla collocazione dell'imputato in idoneo luogo di cura carcerario, in ipotesi non praticabile, il giudice procedente o, per esso, il giudice dell'appello cautelare deve comunque sostituire la cautela carceraria con una delle previste meno afflittive misure. L'unica condizione subordinata che consente la permanenza del regime carcerario e' costituita dalla possibilità del ricovero del soggetto "presso idonea struttura sanitaria penitenziaria", la cui attitudine ad un efficace trattamento terapeutico del detenuto non e' rimessa all'esclusiva determinazione della direzione del sanitaria e amministrativa del carcere, ma e' pur sempre ancorata alla decisione del giudice, che ne verifica l'attuabilità anche con il supporto di utili contribuiti tecnici.

Gabriele Prati, Sara Boldrin
# Fattori di stress e benessere organizzativo negli operatori di polizia penitenziaria
Giornale Italiano di Medicina del Lavoro ed Ergonomia Supplemento B, Psicologia,  2011; Vol. 33, N. 3: B33-B39
Il presente studio ha preso in esame i predittori del burnout e del benessere psicologico in un campione di operatori di Polizia Penitenziaria italiani. Metodo. Il campione del presente studio è costituito da 188 operatori di polizia penitenziaria (138 uomini e 33 donne) che prestano servizio in quattro istituti penitenziari del Piemonte. I partecipanti hanno compilato un questionario in cui erano presenti misure di burnout, benessere psicologico (General Health Questionnaire), stressor organizzativi ed esposizione  a eventi critici di servizio. Risultati. I risultati hanno mostrato che né le variabili demografiche (età e genere) né le variabili lavorative (anzianità lavorativa e contatto con i detenuti) sono associate a burnout e benessere psicologico... . Il benessere organizzativo dell’operatore  di polizia è legato alle condizioni di lavoro ma anche  agli eventi critici di servizio.

David L. Rosen, David A. Wohl, Victor J. Schoenbach,
# All-cause and cause-specific mortality among Black and White North Carolina state prisoners, 1995-2005
Ann Epidemiol. 2011 October ; 21(10): 719–726.
Mortality of Black prisoners was lower than that of Black state residents for both traumatic and chronic causes of death. Mortality of White prisoners was lower than that of White state residents for accidents, but higher for several chronic causes of death. Future studies should investigate the effect of prisoners’ pre-incarceration and in-prison morbidity, the prison environment, and prison healthcare on prisoners’ patterns of mortality.

Royal College of General Practitioners | Royal Pharmaceutical Society | Marcus Bicknell, Iain Brew, Cathy Cooke, Howard Duncalf, Jan Palmer, Jimi Robinson
# Safer Prescribing in Prisons. Guidance for clinicians
www.emcdda.europa.eu/ November 2011

Keith Booles
# Survey on the quality of diabetes care in prison settings across the UK
Journal of Diabetes NursingVol 15 No 5 2011
In 2008, the RoyalCollege of Nursing Diabetes Nursing Forum identified an issue relating to the care and management of prisoners with  diabetes while in detention.Itwas agreed that an audit should be undertaken to examine the currentcare available to prisoners with diabetes. The project aimed to audit prisons in the UK to ascertain the current expertise and knowledge of clinicians within the prison sector and recognise the strengths and weaknesses of currentcare management strategies for people with diabetes in the prison environment. The results of this analysis were to be used to support prison governors and nurses working in prison settings to improve diabetes care and management. The audit highlighted areas of good practice throughout the prison diabetes services as well as issues within diabetes care and management that need to be addressed.

Ministry of Justice | National Offender Management Service
# The Care and Management of Transsexual Prisoners
www.insidetime.org/ 2011
When a prisoner proposes to undergo, is undergoing or has undergone a process (or part of a process) for the purpose of reassigning their sex by changing physiological or other attributes of sex, the prisoner is considered to have the protected characteristic of gender reassignment for the purposes of the Equality Act 2010 and must not be discriminated against or harassed because of this.

Hans Wolff, Paul Sebo, Dagmar M Haller, Ariel Eytan, Gérard Niveau, Dominique Bertrand, Laurent Gétaz, Bernard Cerutti

# Health problems among detainees in Switzerland: a study using the ICPC-2 classification
www.biomedcentral.com/ BioMed Central Public Health 2011, 11:245
A total of 2195 health records were reviewed. Mean age was 29.5 years (SD 9.5); 95% were male; 87.8% were migrants. Mean length of stay was 80 days (SD 160). Illicit drug use (40.2%) and mental health problems (32.6%) were frequent, but most of these detainees (57.6%) had more generic primary care problems, such as skin (27.0%), infectious diseases (23.5%), musculoskeletal (19.2%), injury related (18.3%), digestive (15.0%) or respiratory problems (14.0%). Furthermore, 7.9% reported exposure to violence during arrest by the police. Conclusion: Morbidity is high in this young, predominantly male population of detainees, in particular in relation to substance abuse. Other health problems more commonly seen in general practice are also frequent. These findings support the further development of coordinated primary care and mental health services within detention centers.

WPATH World Professional Association for Transgender Health
# Standards of Care per la Salute di Persone Transessuali, Transgender e di Genere Non-Conforme
www.wpath.org/ 14 settembre 2011

Merete Berg Nesset, Åse-Bente Rustad, Ellen Kjelsberg, Roger Almvik, Johan Håkon Bjørngaard
# Health care help seeking behaviour among prisoners in Norway
BMC Health Services Research 2011, 11:301
There is strong evidence that incarcerated people have higher rates of mental and physical illness and have a higher risk of suicide than the general population. Prisoners have higher levels of anxiety, sleep problems and depression than the general population. Furthermore, comorbidity of mental health problems and substance misuse disorders is common. Furthermore, communicable diseases such as HIV and hepatitis B infections are especially prevalent. Asthma and chronic obstructive pulmonary disease are also among the most frequent physical disorders. Despite high morbidity, it is suggested that prisoners underuse health services.

Seena Fazel, Jacques Baillargeon
# The health of prisoners
Lancet 2011; 377: 956–65
More than 10 million people are incarcerated worldwide; this number has increased by about a million in the past decade. Mental disorders and infectious diseases are more common in prisoners than in the general population.  High rates of suicide within prison and increased mortality from all causes on release have been documented in many countries. The contribution of prisons to illness is unknown, although shortcomings in treatment and aftercare provision contribute to adverse outcomes. Research has highlighted that women, prisoners aged 55 years and older, and juveniles present with higher rates of many disorders than do other prisoners. The contribution of initiatives to improve the health of prisoners by reducing the burden of infectious and chronic diseases, suicide, other causes of premature mortality and violence, and counteracting the cycle of reoff ending should be further examined.

WHO UNODC
# Women’s health in prison. Action guidance and checklists to review current policies and practice
www.euro.who.int/ 2011
Prison health is an integral part of public health, and addressing health and health care in prisons will lead to an overall improvement in public health. This is an essential starting point, from which more specific recommendations can be formulated. All policies affecting women in the criminal justice system must recognize the gender specific needs of women and the significant variations in needs that can exist between different groups of women. Health service provision and programming should specifically address mental illness, in particular disorders relating to substance use and post-traumatic stress disorder. This is essential in any prison health care system.

Supreme Court of United States
# Brown,Governor of California, et Al. v. Plata et Al.
Decided May 23, 2011 - Appeal from the United States District Courts for the Eastern and Northern Districts of California...
In Plata v. Brown, filed in 2001, the State conceded that deficiencies in prison medical care violated prisoners’ Eighth Amendment rights and stipulated to a remedial injunction... If a prison deprives prisoners of basic sustenance, including adequate medical care, the courts have a responsibility to remedy the resulting Eighth Amendment violation...

Moshe Birger, Tal Bergman-Levy, Oren Asman
# Treatment of Sex Offenders in Israeli Prison Settings
J Am Acad Psychiatry Law 39:100 –3, 2011
The number of incarcerated sex offenders in the Israeli prison system has steadily increased during the past decade. While treatment of sex offenders is complex, treatment of those in prison seems to be more challenging. This publication presents major considerations and dilemmas, clinical as well as ethics-related, derived from the experience of the psychiatric division in the Israeli prison service in treating sex offenders in this special setting. The psychiatrist treating the incarcerated offender must always maintain a sensitive balance between the needs and wishes of his patient and the potential threat to society stemming from recidivism.

Ross M. Kauffman, Amy K. Ferketich, David M. Murray, Paul E. Bellair, Mary Ellen Wewers
# Tobacco Use by Male Prisoners Under an Indoor Smoking Ban
Nicotine & Tobacco Research, Volume 13, Number 6 (June 2011) 449–456
Indoor smoking bans do not promote cessation in prisons but may reduce the amount of tobacco consumed. Though smoking is commonplace in prisons, most prisoners recognize the risks involved and wish to quit. This creates an ideal setting for intervention. Evidence-based cessation assistance should be made freely available to all incarcerated smokers.

Vincent Marsala, Catherine Pautrat | Inspection générale des affaires sociales
# Evaluation du dispositif d'hospitalisation en soins somatiques des personnes détenues
www.ladocumentationfrancaise.fr/ Juin 2011
L'Inspection générale des affaires sociales et l'Inspection générale des services judiciaires ont été saisies d'une demande de mission conjointe sur la place effective des Unités Hospitalières Sécurisées Inter régionales (UHSI) dans le recours aux soins des personnes détenues, leur complémentarité avec les autres structures d'hospitalisation des personnes détenues et l'évolution éventuelle à prévoir du dispositif actuel. Le présent rapport rappelle tout d'abord la réforme introduite par la loi du 18 janvier 1994, décrit le dispositif d'hospitalisation des personnes détenues mis en place par le niveau national puis dresse un bilan de celui-ci. Enfin, ce rapport fait des préconisations visant à adapter ce dispositif et améliorer son fonctionnement dans un souci de meilleure réponse aux besoins des personnes détenues, et de plus grande efficience.

M. L. Fadda
# Il trattamento rieducativo dei detenuti sex offenders
Riv. Sessuol. - Vol. 35 - n. 2 Aprile/Giugno 2011
Per i detenuti in espiazione di pena in carcere, la legge prevede l’effettuazione di un trattamento rieducativo finalizzato al reinserimento sociale e al contenimento del pericolo di recidiva. Questo intervento si propone di valutare individuare quale sia l’intervento rieducativo più idoneo in relazione alle specifiche problematicità degli autori di reati a sfondo sessuale che si trovano in stato di detenzione, prestando attenzione anche alle diverse tipologie di reati, esponendo come esempio di buona prassi l’esperienza del progetto a trattamento avanzato per autori di reati sessuali in corso presso la casa di reclusione di Milano-Bollate.

Maria Laura Fadda | CSM - Incontro di studio
# I reati con vittima vulnerabile: indagini e giudizio
Roma 31 gennaio - 2 febbraio 2011
Importante è soprattutto il fattore riguardante la violenza subita nell’infanzia, sia per quanto riguarda la crescita psicologicamente equilibrata e il rischio di diventare da soggetto abusato a soggetto abusatore. Non ci sono sudi scientifici discriminanti su ambedue tali correlazioni e questo perché, come è evidente, è troppo complessa la ricerca metodologica in quanto o il campione è troppo ridotto o sono  diverse le definizioni di abuso o sono diverse le tecniche di campionamento. Comunque, con riferimento alla prima problematica, è stata evidenziata, soprattutto sulla scorta di studi anglosassoni, una correlazione da quattro a sei volte superiore tra i soggetti che avevano subito abusi fisici di tipo incestuoso nell’infanzia con la presenza in età adulta di psicopatologie come disturbo affettivo maggiore, di ansia, della condotta, di personalità.

Corte Suprema di Cassazione - Prima Sezione Penale

# Sentenza n. 30511 del 30.07.2010
Essere malati in carcere porta una sofferenza aggiuntiva, derivante proprio dalla privazione dello stato di libertà in sé e per sé considerata e questo nonostante la fruibilità di adeguate cure in stato di detenzione. Ai malati gravi va evitata la prigione, anche se la patologia è compatibile con la detenzione e con le possibilità di cura fornite dalla struttura carceraria. La Corte di cassazione afferma la priorità della tutela della salute dei detenuti e invita i giudici a scegliere le misure alternative al carcere anche quando il tipo di reato non le contempla...

Corte Suprema di Cassazione - Prima Sezione Penale

# Sentenza n. 43488 del 24.11.2010

In tema di differimento facoltativo dell'esecuzione della pena, è contraria al senso di umanità la detenzione di un soggetto prossimo a compiere 78 anni affetto da patologie ad andamento cronico progressivo, quali l'encefalopatia multinfartuale con progressivo deterioramento cognitivo, la cardiopatia fibrillante ed il diabete mellito, che gli impediscano di percepire il senso stesso della detenzione, sia nel suo profilo retributivo che in quello risocializzante. Annulla con rinvio, Trib.sorv. Bari, 02 febbraio 2010

Corte Suprema di Cassazipone, Sezione Prima Penale
# Sentenza del 04 febbraio 2010, n. 8100
In tema di differimento facoltativo dell'esecuzione della pena , è contraria al senso di umanità la detenzione di un soggetto affetto da patologia cerebrale cronica su base degenerativa - vascolare che gli impedisca di percepire il senso stesso della detenzione, sia nel suo profilo retributivo che in quello risocializzante.

Conferenza Nazionale delle Regioni e delle Province Autonome - Ministero della Salute
# Piano Sanitario Nazionale 2011-2013
18 novembre 2010
Accanto alla diffusione epidemiologica dei disturbi psichici, sempre più rilevante è l‟emergere dei “nuovi bisogni“ in un scenario sociale e sanitario mutato, che in psichiatria sempre interagisce profondamente con le metodologie e i sistemi diagnostici, terapeutici, riabilitativi, preventivi. In particolare vanno evidenziate le seguenti aree di bisogno  prioritarie:.. disturbi psichici dei detenuti, degli internati e dei minori sottoposti a provvedimento penale • disturbi di personalità... Punti critici da affrontare per superare l‟eccessiva disomogeneità regionale sono... l‟area dipendenze patologiche e doppie diagnosi, con la necessità di attuare percorsi clinici adeguati e organicamente integrati nell'ambito dei DSM, a cui i SERT dovrebbero di norma afferire;... le carenze conoscitive e operative per i problemi della psichiatria negli istituti di pena e il percorso di superamento degli OPG; • il tema dei comportamenti che destano allarme sociale...

Uma Viswanathan, Amanda Beaumont, Eamonn O’Moore, Mary Ramsay, Richard Tedder, Samreen Ijaz, Koye Balogun, Patrick Kirwan
# Hepatitis B transmission event in an English prison and the importance of immunization
Journal of Public Health | Vol. 33, No. 2, pp. 193 –196 | 21 October 2010
Immunization against hepatitis B virus (HBV) is recommended for all sentenced prisoners and all new entrants to prison in the UK. In November 2008, acute hepatitis B was confirmed serologically in a 27-year-old man (Case 1) who had been incarcerated since February 2007. The cell mate of Case 1, a 26-year-old man was an established HBV carrier. A home-made tattoo gun was confiscated from their prison cell. In the absence of other clearly identifiable risk behaviours, tattooing was deemed to be a possible route of HBV transmission. Transmission of hepatitis B in a prison setting is a real concern and this report highlights the importance of immunizing prisoners against hepatitis B and should encourage health professionals to communicate the benefits of immunization to inmates to increase vaccine uptake.

Alcione Cavalheiro Faro Stief et al.
# Seroprevalence of hepatitis B virus infection and associated factors among prison inmates in State of Mato Grosso do Sul, Brazil
Revista da Sociedade Brasileira de Medicina Tropical 43(5):512-515, set-out, 2010
Studies have reported that the prevalence of HBV infection is higher in the prison population than in the general population. International studies show that the overall HBV infection ranges from 1.8% to 62% among adult inmates. Studies conducted with prisoners in Brazil determined HBV seroprevalence ranging from 11.1% to 26.4%. This population is considered to be at high risk of HBV infection due to the prison lifestyle, including illicit drug use, unsafe sex with multiple sexual partners, homosexuality and tattooing. In addition, the prison inmates are characterized by pervasive social health problems, illegal behavior and limited educational opportunities.

Amy J. Harzke, Karen J. Goodman, Patricia Dolan Mullen, Jacques Baillargeon
# Heterogeneity in Hepatitis B Virus (HBV) Seroprevalence Estimates from US Adult Incarcerated Populations: A Systematic Review and Meta-Regression Analysis
International Journal of Prisoner Healt IJPH, Volume 6 Number 1, June 2010
Hepatitis B virus (HBV) seroprevalence estimates from US incarcerated populations are relatively high. However, the usefulness of these estimates for guiding HBV-related correctional healthcare policy is limited by wide variation in estimates across studies and little understanding of the sources of this variation. The authors systematically reviewed studies indexed from 1975-2005, meeting pre-specified criteria and reporting HBV seroprevalence estimates from US adult incarcerated populations. Using meta-regression techniques, the authors investigated report type, geographical region, serum collection year, facility type, serum source, sampling procedures, sample characteristics, and measurement procedures as potential study-level sources of heterogeneity in prevalence estimates for common HBV seromarkers. In bivariable meta-regression analyses, mean age ≥31 years was strongly associated with increased HBsAg prevalence (POR = 2.6), and serum collection year before 1991 was strongly associated with increased prevalence of any positive marker (POR = 2.0). Other moderate-to-strong associations were observed, but these were considered less certain because of small numbers of observations, influence of single studies, or potential confounding. Potential sources of heterogeneity should be considered when comparing HBV seroprevalence estimates in adult US incarcerated populations and when developing HBV screening and vaccination protocols in correctional settings.

Amy J. Harzke, Jacques G. Baillargeon, Sandi L. Pruitt, John S. Pulvino, David P. Paar, and Michael F. Kelley

# Prevalence of Chronic Medical Conditions among Inmates in the Texas Prison System
J Urban Health. 2010 May; 87(3): 486–503.
Given the rapid growth and aging of the US prison population in recent years, the disease profile and health care needs of inmates portend to have far-reaching public health implications. Although numerous studies have examined infectious disease prevalence and treatment in incarcerated populations, little is known about the prevalence of non-infectious chronic medical conditions in US prison populations. The purpose of this study was to estimate the prevalence of selected non-infectious chronic medical conditions among inmates in the Texas prison system.

J.-P. Rieder, B. Gravier, D. Bertrand, C. Pasche, P. Bodenmann, H. Wolff
# Santé en milieu pénitentiaire : vulnérabilité partagée entre détenus et professionnels de la santé
Revue Médicale Suisse – www.revmed.ch – 28 juillet 2010
La médecine pénitentiaire est un exercice sous pression. Le professionnel de santé (PS) est confronté à des situations cliniques ou éthiques extrêmes, majorées par la violence du contexte et la détresse de certains. Jeûne de protestation, refus de soin, risque suicidaire, demande de traitement sous contrainte, les situations limites sont fréquentes. Les balises éthiques, déontologiques et légales sont indispensables...

Antonio Salvati
# Il passaggio dell’assistenza sanitaria in carcere al sistema sanitario nazionale
www.amministrazioneincammino.luiss.it/ 20.04.2010
Dal 1  giugno 2008, le competenze sanitarie della medicina generale e specialistica penitenziaria, i rapporti di lavoro e le risorse economiche e strumentali, prima di allora in capo al Ministero della Giustizia, sono state trasferite al Sistema sanitario nazionale e quindi a Regioni e Asl. Il D.P.C.M. 30 maggio 20081 completa il trasferimento di competenze iniziato con il D.Lgs. n. 230/19992, dell’allora ministro della salute Rosi Bindi, attraverso il quale era stata decisa la riconduzione della sanità penitenziaria nel Servizio sanitario nazionale. Si è trattato, indubbiamente, di un passaggio assai importante, epocale per alcuni, frutto di un ampio e lungo dibattito sviluppatosi nel corso degli anni 90, grazie a un movimento di opinione a favore del passaggio delle competenze sanitarie penitenziarie al servizio sanitario nazionale che, partendo dall’esperienza di singoli e passando attraverso le associazioni di volontariato attive nelle carceri, arrivò a coinvolgere Enti locali, sindacati, autorità politiche. Si tratta di una pietra miliare per la tutela della salute dei detenuti e di un importante passo avanti per la civiltà stessa dell’ordinamento penitenziario...

Niyi Awofeso
# Prisons as Social Determinants of Hepatitis C Virus and Tuberculosis Infections
Public Health Reports / 2010 Supplement 4 / vol. 125
Among many vulnerable populations, prisons are evolving as one of the social institutions that determine their health status and health outcomes. This article highlights the effects of prisons in mediating the risk of hepatitis C virus and tuberculosis infections, as well as feasible interventions and policy approaches for limiting the deleterious consequences prisons exert on the transmission and clinical courses of these diseases.

Joel H. Thompson
# Today’s Deliberate Indifference: Providing Attention Without Providing Treatment to Prisoners with Serious Medical Needs
Harvard Civil Rights-Civil Liberties Law Review, Vol. 45, 2010
The Supreme Court recognized a prisoner’s Eighth Amendment right to adequate medical care in 1976 in Estelle v. Gamble. This result was consistent with the opinions of several circuit courts that had confronted the question in the preceding years. The Supreme Court found the denial of medical care to prisoners incompatible with evolving standards of decency, by which the court determines whether a type of punishment runs afoul of the Eighth Amendment.

Ingrid A. Binswanger, Joseph O. Merrill, Patrick M. Krueger, Mary C. White, Robert E. Booth, Joann G. Elmore
# Gender Differences in Chronic Medical, Psychiatric, and Substance-Dependence Disorders Among Jail Inmates
American Journal of Public Health | March 2010, Vol 100
Women in jail had a higher burden of chronic medical disorders, psychiatric disorders, and drug dependence than men, including conditions found more commonly in men in the general population. Thus, there is a need for targeted attention to the chronic medical, psychiatric, and drug-treatment needs of women at risk for incarceration, both in jail and after release.

Ingrid A. Binswanger
# Chronic Medical Diseases Among Jail and Prison Inmates
http://societyofcorrectionalphysicians.org/ Posted on March 3, 2010
Jail and prison inmates are known to have a higher burden of infectious diseases, substance use disorders and psychiatric illness than the general, non-institutionalized population, but do they also have a higher burden of other chronic medical conditions, such as hypertension, diabetes, and asthma? The absolute prevalence of chronic medical conditions among inmates seems high. Over one third of inmates in federal prisons (39%), state prisons (43%) and local jails (39%) reported a chronic medical condition, as described in recent publications by Dr. Wilper and colleagues and the Bureau of Justice Statistics.

Suzy Teutsch, Fabio Luciani, Nicolas Scheuer, Luke McCredie, Parastu Hosseiny, William Rawlinson, John Kaldor, Gregory J Dore, Kate Dolan, Rosemary French, Andrew Lloyd, Paul Haber, Michael Levy
# Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort
BMC Public Health 2010, 10:63
HCV incidence was examined in a longitudinal cohort of 488 Australian prisoners with a history of IDU and documented to be seronegative within 12 months prior to enrolment. Inmates were tested for anti-HCV antibodies and viremia, and interviewed about demographic and behavioral risk factors for transmission. Results: The cohort was predominantly male (65%) with high rates of prior imprisonment (72%) and tattooing (73%), as well as longstanding IDU (mean 8.5 years). Ninety-four incident HCV cases were identified (incidence 31.6 per 100 person years). Independent associations were observed between incident infection and prior imprisonment (p = 0.02) and tattooing (p = 0.03), and surprisingly also with methadone maintenance treatment (MMT) (p < 0.001). Conclusions: High rates of new HCV infection were found in this prisoner cohort reflecting their substantive risk behavior profile, despite having remained uninfected for many years. The association with MMT is challenging and highlights the need for better understanding of prison-specific HCV transmission risks, as well as the uptake and effectiveness of prevention programs.

Evelyn J. Patterson
# Incarcerating Death: Mortality in U.S. State Correctional Facilities, 1985–1998
Demography, Volume 47-Number 3, August 2010: 587–607
Using data from the U.S. Bureau of Justice Statistics and Census Bureau, I estimate death rates of working-age prisoners and nonprisoners by sex and race. Incarceration was more detrimental to females in comparison to their male counterparts in the period covered by this study. White male prisoners had higher death rates than white males who were not in prison. Black male prisoners, however, consistently exhibited lower death rates than black male nonprisoners did. Additionally, the findings indicate that while the relative difference in mortality levels of white and black males was quite high outside of prison, it essentially disappeared in prison. Notably, removing deaths caused by firearms and motor vehicles in the nonprison population accounted for some of the mortality differential between black prisoners and nonprisoners. The death rates of the other groups analyzed suggest that prison is an unhealthy environment; yet, prison appears to be a healthier place than the typical environment of the nonincarcerated black male population. These findings suggest that firearms and motor vehicle accidents do not sufficiently explain the higher death rates of black males, and they indicate that a lack of basic healthcare may be implicated in the death rates of black males not incarcerated.

Epilepsy Action | Registered as a Charity (No. 234343)
# Epilepsy information for prisoners
www.epilepsy.org.uk - March 2009 | Review date: March 2011

Josiah D. Rich, M.D., M.P.H., Sarah E. Wakeman, M.D., and Samuel L. Dickman, A.B

# Medicine and the Epidemic of Incarceration in the United States

N Engl J Med. 2011 June 2; 364(22): 2081–2083

Deinstitutionalization of the mentally ill over the past 50 years and severe punishment for drug users starting in the 1970s have shifted the burden of care for addiction and mental illness to jails and prisons. The largest facilities housing psychiatric patients in the United States are not hospitals but jails. More than half of inmates have symptoms of a psychiatric disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and major depression and psychotic disorders are four to eight times as prevalent among inmates as in the general population — yet only 22% of state prisoners and 7% of jail inmates receive mental health treatment while incarcerated.

Josiah D. Rich

# Epidemic of Incarceration

www.prisonerhealth.org 2012

Reentry: But They All Come Back | •95% of prisoners are released to their communities | •735,000 individuals released from state and federal prisons in 2008 | •Approximately 9 million individuals are released from jail each year. Prisoner Health and Human Rights: •The landmark 1976 Supreme Court case Estelle v. Gamble found that not providing community standard of care constituted cruel and unusual punishment. •For many, the medical care they receive while incarcerated is life-saving, yet correctional facilities are fundamentally designed to confine and punish.

Christopher Wildeman
# Invited Commentary: (Mass) Imprisonment and (Inequities in) Health
American Journal of Epidemiology, January 14, 2011
Research shows that the lifetime risk of imprisonment for adult men has increased dramatically in the United States in the last 35 years and that having ever been imprisoned is associated with poor life chances. In the second of these areas, the article by Spaulding et al. is an exemplar. These are important initial steps, for sure, but research must push beyond descriptions and associations that may (or may not) be causal in order to understand the implications of mass imprisonment for health inequities.

Claire Fortin
# A breeding ground for communicable disease: what to do about public health hazards in New York Prisons
Buffalo Public Interest Law Journal Vol. XXIX 2010-2011
In the United States, prisoners have limited health care rights and have the right to be free from cruel and unusual punishment. Allowing communicable diseases to flourish in prisons, and go untreated, will inevitably have a negative impact on the public’s health and safety. Leaving diseases untreated may cause the formation of a strand of the disease that is resistant to existing treatments, and because many incarcerated individuals will one day reenter their communities, this may open the door to further spread of disease outside prison walls. Because prisons are not closed communities, people are constantly detained and released, and prisoners are in close contact with one another, visitors, and prison staff every day. The spread of communicable diseases in prison will affect anyone who may enter the facility, including fellow prisoners, guards, medical personnel, family and friends, and law enforcement...

Australian Government
# The health of Australia’s prisoners
Australian Institute of Health and Welfare 2010

An estimated 50,000 people are released from prison each year in Australia. This means that the health of prisoners has a significant impact on the health of the wider community, yet until now very little was known about the health of prisoners nationally. In response to the paucity of national data in the prisoner health area, the Prisoner Health Information Group led by the AIHW has been working for several years to develop a set of indicators and data collection that will allow us to monitor the health of prisoners and their access to services over time.

European Court of Human Rights | Cour Européenne des Droits de l'Homme
# V.D. v. Romania
http://hudoc.echr.coe.int/ 16.02.2010
V.D. suffers from a number of chronic health problems, including digestive, liver and psychiatric disorders. He has serious dental problems: as he has virtually no teeth, he requires a dental prosthesis, a fact recorded by doctors on several occasions in 2002 while he was in prison. Due to his extreme poverty, known to the authorities from the outset, he is unable to pay his costs... The Government had not given a convincing explanation as to why the applicant had not been provided with a prosthesis in 2004, when the regulations in force had provided for the cost to be met in full. Similarly, the Court noted that the applicant had still not obtained a prosthesis in spite of new legislation entitling persons in his situation to be provided with one free of charge. In view of all these considerations, the Court held unanimously that there had been a violation of Article 3.

Conferenza Unificata Stato Regioni

# Strutture sanitarie nell’ambito del sistema penitenziario italiano - Accordo, ai sensi dell’articolo 9 del decreto legislativo 28 agosto 1997, n. 281, sul documento proposto dal Tavolo di consultazione permanente sulla sanità penitenziaria recante: “Strutture sanitarie nell’ambito del sistema penitenziario italiano”

26 novembre 2009, n. 81 - CU | Gazzetta Ufficiale 4 gennaio 2010, n. 2

Her Majesty’s Inspectorate of Prisons
# Commissioning healthcare in prisons. The results of joint work between the Healthcare Commission and Her Majesty’s Inspectorate of Prisons in 2007/08
Commission for Healthcare Audit and Inspection and HM Inspectorate of Prisons 2009

PCTs aspired to ensure that those in prison receive the same access to healthcare as everyone else, and generally believed that they achieved or exceeded this, particularly in the case of primary care. However, half of the PCTs had no formal measurement of access to healthcare to establish whether this was true, representing little progress from the findings in 2006/07.

Regione Lombardia
# Linee di indirizzo regionali per la sanità penitenziaria in attuazione della DGR N. 8120 del 1.10.2008 |  Decreto Direzione Generale Sanità n. 14230 del 21/12/2009

www.sanita.regione.lombardia.it/

UNODC United Nations Office on Drugs and Crime | World Health Organization WHO Europe

# Women’s health in prison. Correcting gender inequity in prison health
World Health Organization 2009

Although women should be entitled to the same rights as men, prison systems were primarily designed for men, and many prisons do not have adequate facilities to protect women’s rights or to promote their health. Compounding the difficulty of addressing this problem is the lack of data and research about women’s health status while in prison. Health systems must include penitentiary health policies that integrate women’s health needs in all phases of planning and implementation.

Pablo Sáiz de la Hoya (coord)
# Recomendaciones para el manejo de la hepatitis B en el medio penitenciario
http://sesp.es/ Sociedad Española de Sanidad Penitenciaria 2009
La infección por el Virus de la Hepatitis B pertenece a las patologías que hemos visto  incrementadas en estos últimos años, tras la llegada a nuestro medio de internos procedentes de lugares de alta endemia como el Este Asiático y el África Subsahariana. Este hecho, unido a los nuevos avances terapéuticos, capaces al menos de controlar la replicación viral, que como sabemos está unida a su posible evolución a cirrosis y hepatocarcinoma, entre otros, y también los nuevos conceptos de etiquetaje de la infección, han determinado que consideráramos, desde el Grupo de Trabajo en Enfermedades Infecciosas de la Sociedad Española de Sanidad Penitenciaria (GEISESP), la necesidad de elaborar un documento práctico que facilite la actualización de los profesionales de la Atención Primaria Penitenciaria, en el conocimiento y manejo evolutivo de la infección por el VHB.

Sociedad Española de Sanidad Penitenciaria (S.E.S.P.) - Sociedad Española de Neumología y Cirugía Torácica (S.E.P.A.R.) - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (S.E.I.M.C.) - Subdirección General de Sanidad Penitenciaria. Ministerio del Interior
# Documento de consenso para el control de la tuberculosis en las prisiones españolas
http://sesp.es/ Sociedad Española de Sanidad Penitenciaria 2009
Las prisiones, además, concentran una población con factores de riesgo de todo tipo (sociales, económicos, sanitarios, etc.), constituyendo un grupo especialmente vulnerable sobre el que las acciones de salud pública tienen un impacto grande. Esto es así también en el caso de la tuberculosis. Los presos ingresados en Centros Penitenciarios españoles responden a un perfil demográfico que incluye casi todos los factores de riesgo identificados para la TB. Dado que la permeabilidad entre la población penitenciaria y la población general es elevada, un buen control de la TB en los Centros Penitenciarios beneficia a todos. Esta ha sido siempre la visión tanto de las autoridades de las Instituciones Penitenciarias españolas como de la Sociedad Española de Sanidad Penitenciaria.

Denis Lafortune, Marion Vacheret
# La prescription de médicaments psychotropes aux personnes incarcérées dans les prisons provinciales du Québec
Santé mentale au Québec, 2009, XXXIV, 2, 147-170
L’étude porte sur un échantillon de 671 personnes détenues, soit 500 hommes et 171 femmes. Globalement, 40,3 % des incarcérés ont reçu au moins une ordonnance de médicament psychotrope dans la période comprise entre 2002 et 2007. Les résultats démontrent que les femmes sont plus susceptibles d’avoir fait usage de médicaments que les hommes. Les personnes incarcérées ayant reçu au moins une prescription sont en moyenne plus âgés que les autres. Une majorité d’ordonnances a été émise par des omnipraticiens et les cas de polypharmacie sont nombreux. Sur une période de cinq ans, la classe de médicaments la plus prescrite est celle des anxiolytiques/hypnotiques, suivie des antidépresseurs et des antipsychotiques.

Michael Roguski, Fleur Chauvel
# The Effects of Imprisonment on Inmates’ and their Families’ Health and Wellbeing
https://nhc.health.govt.nz/ November 2009
Sixty-three inmates participated in semi-structured interviews while incarcerated and, of these, 26 were interviewed six to eight weeks after their release from prison. Forty pre-release participants were men and 23 were women. The majority of participants identified as Māori. Ages ranged between 18 and 56 with a mean age of 34 years. Post-release participants comprised 17 men and nine women with a mean age of 29. Fourteen adolescent and adult family members participated in nine of the 26 post-release interviews. This resulted in a multi-generational account of the effects of imprisonment. Interviews ranged between 45 minutes and two hours.

Slim Slama, Hans Wolff and Louis Loutan
# The Right to Health in Prisons: Implications in a Borderless World
Swiss Human Rights Book Vol. 3 - 2009

Minimal standards of living conditions and access to health care for prisoners are often inadequate, if not totally inexistent. Prisons and jails in even the richest and most developed countries are still plagued by severe overcrowding, decaying physical infrastructure, a lack of medical care, security abuses and corruption, and prisoner-on-prisoner violence. Rates of infection with regards to tuberculosis, HIV and hepatitis are much higher than in the general population, and chronic diseases, especially psychiatric conditions, are often neglected.

Centers for Disease Control and Prevention (CDC) | Centers for Law and the Public’s Health | National Tuberculosis Controllers Association
# Tuberculosis Control Laws and Policies: A Handbook for Public Health and Legal Practitioners
www.cdc.gov/ October 1, 2009
Under the U.S. Supreme Court’s modern interpretation of the First, Fifth, and Fourteenth Amendments, it may be unconstitutional to physically force a citizen (or other person in the U.S.) to undergo treatment without consent98 except in cases involving minors, persons with mental disabilities, or prisoners.44 This interpretation is consistent with ethical principles of autonomy and societal views of personal liberty. The tension between protecting the public’s health and respecting personal decisions concerning medical care is heightened concerning TB control because of the contagious nature of TB and the potential for MDR and XDR TB to develop in patients who may not adhere to treatment regimens.

Andrew P. Wilper et al.
# The Health and Health Care of US Prisoners: A Nationwide Survey
American Journal of Public Health | April 2009, Vol 99, No. 4
Improved management of chronic conditions in prisons and jails may have important implications for community health and in reducing health care disparities, because the vast majority of inmates are eventually released. Approximately 12 million inmates are released annually... This high turnover of a population with elevated rates of treatable conditions offers a substantial public health opportunity.

Lois M. Davis, Nancy Nicosia, Adrian Overton, Lisa Miyashiro, Kathryn Pitkin Derose, Terry Fain, Susan Turner, Paul Steinberg, Eugene Williams III
# Understanding the public health implications of prisoner reentry in California : phase I report
Rand Corporation.2009
The past few decades have witnessed a significant increase in the number of ex-prisoners returning to communities nationwide. These trends are important for a number of reasons, not the least of which is that this population presents multiple needs for services, including employment, housing, and social services. Often overlooked are the physical and social-behavioral  health concerns of this population and, consequently, the role that health care plays in influencing the success of reintegration. Examining the demographic and health profiles of the  prison population shows that it is disproportionately sicker on average than the U.S. population in general, with substantially higher rates of infectious diseases (such as HIV/AIDS, tuberculosis, and hepatitis B and C), serious mental illness, and substance abuse disorders...

Emily A. Wang, Mark Pletcher, Feng Lin, Eric Vittinghoff, Stefan G. Kertesz, Catarina I. Kiefe, Kirsten Bibbins-Domingo
# Incarceration, Incident Hypertension, and Access to Healthcare: Findings from the Coronary Artery Risk Development In young Adults (CARDIA) Study
Arch Intern Med. 2009 April 13; 169(7)
Incarceration is associated with future hypertension and left ventricular hypertrophy (LVH) among young adults. Identification and treatment of hypertension may be important in reducing cardiovascular disease (CVD) risk among formerly incarcerated individuals.

United Nations Office on Drugs and Crime (UNODC) | Tomris Atabay
# Handbook on Prisoners with special needs
http://www.unodc.org/ New York 2009
This handbook covers the special needs of eight groups of prisoners, which have a particularly vulnerable status in prisons. They are: Prisoners with mental health care needs; Prisoners with disabilities; Ethnic and racial minorities and indigenous peoples; Foreign national prisoners; Lesbian, gay, bisexual, and transgender (LGBT) prisoners; Older prisoners; Prisoners with terminal illness and Prisoners under sentence of death.

Ingrid A. Binswanger, Patrick M. Krueger
# Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population
J Epidemiol Community Health 2009; 63:912–919
Jail and prison inmates had a higherburden of most chronic medical conditions than the general population even with adjustment for importants ociodemographic differences and alcohol consumption... Inmates may be at increased risk of poor medical outcomes compared with the general population due to circumstances before and during incarceration. Inmates often come from disadvantaged backgrounds and have low levels of education; report high levels of smoking, drinking and illicit drug use before incarceration; have poor nutrition and limited physical activity in jail or prison...

Leonidas K. Cheliotis
# The 2008 hunger strikes in Greek prisons and their aftermath
Lo squaderno 14: 29–34 (2009)

Il sistema carcerario greco è stato scosso alle radici nel novembre 2008. Per 18 giorni consecutivi circa 6.000 prigionieri, metà della popolazione carceraria, sono entrati in sciopero della fame. Durante questo periodo due  prigionieri sono morti, uno ha tentato il suicidio e decine si sono cuciti le labbra per protesta contro l’ingiustizia, il sovraffollamento, la mancanza di assistenza sanitaria e gli abusi...

Brenda J van den Bergh, Alex Gatherer, Lars F Møller
# Women’s health in prison: urgent need for improvement in gender equity and social justice
Bull World Health Organ, 2009;87:406
Although there are major differences in the methods that countries use to address the special needs of women in their criminal justice system, the evidence is clear and consistent. Current arrangements for dealing with women offenders fail to meet their basic needs and are far short of what is required by human rights, by accepted international  recommendations and by social justice.  Health is after all a fundamental human right, for women in detention as well as for those in the community.

Andrea Franceschini
# La medicina penitenziaria

in "Trattato di medicina legale e scienze affini" a cura di Giusto Giusti, Vol. VIII Cap. CCLII CEDAM 2009

Valeria Pini
# Giustizia: denuncia di medici carcerari "siamo all’emergenza"
La Repubblica Salute, 15 gennaio 2009
L’80% è malato. "In carcere", dice Andrea Franceschini della Società italiana di medicina e sanità penitenziaria (Simspe), "arrivano spesso persone che provengono da ambienti disagiati e già questo porta a un concentramento di patologie".
Il 21% dei detenuti è tossicodipendente, il 15% ha problemi di masticazione, il 16% soffre di depressione o di altri disturbi psichiatrici, il 13% di malattie osteoarticolari, l’11% di malattie del fegato, il 9% di malattie gastrointestinali e il 6,6% di malattie infettive. La tossicodipendenza è spesso associata a Aids, epatite C e disturbi mentali.
"Secondo uno studio del Simspe il 17% dei detenuti è affetto da patologie virali croniche, fra cui l’epatite C", dice Franceschini. "Per quanto riguarda l’hiv il calcolo è più complesso, dal momento che il test non è obbligatorio e solo il 30% dei detenuti accetta di farlo. Per questo il dato reale può essere diverso rispetto alle stime".

Giusto Giusti
# Incompatibilità carceraria
http://giustogiusti.blogspot.it/ Lunedì 7 settembre 2009

... è bene ricordare, che per la Cassazione 7.7.1994, n.2080, le condizioni di guaribilità o di reversibilità della malattia, non sono elementi considerabili , infatti in tale sentenza si legge:"La guaribilità o reversibilità della malattia non sono requisiti richiesti dalla normativa vigente in tema di differimento dell'esecuzione della pena, per la cui concessione è sufficiente che l'infermità sia di tale rilevanza da far apparire l'espiazione della pena in contrasto con il senso di umanità."

Organización Panamericana de la Salud
Guía para el control de la tuberculosis en poblaciones privadas de libertad de América Latina y el Caribe
Washington, D.C.: OPS, 2008
En general, los problemas sanitarios que se encuentran en los centros penitenciarios de América Latina
se deben a: i) Condiciones intrínsecas de insalubridad de los centros de reclusión; ii) Características inherentes a los detenidos, quienes por lo general provienen de los estratos más pobres de la sociedad y que por consiguiente presentan problemas de salud preexistentes, conductas de riesgo, abuso de sustancias, etc.); iii) Ausencia de una eficaz organización/coordinación de la atención sanitaria en los centros de reclusión. La coordinación y organización entre el ministerio de salud y el ministerio o la instancia encargada de la administración del sistema penitenciario se dificulta debido a los siguientes factores, compartidos por ambas instancias40 : • Recursos limitados (humanos y financieros). • Prioridades diferentes. • Insuficiente e inefectivo entrenamiento del personal. • Problemas relacionados con la estructura administrativa. • Insuficiente o inexistente comunicación. • Deficiencia de datos e información. Estos factores son responsables de las deficientes condiciones sanitarias de los centros penitenciarios, en los que los principales problemas de salud incluyen en general VIH, tuberculosis, hepatitis, enfermedades psiquiátricas, drogodependencias, ectoparasitosis, afecciones respiratorias agudas y crónicas, infecciones del tracto digestivo y micosis.

José Escobar Solimano, Berty González Jaramillo, María Margarita Quiroz Beiza, Gastón Rodríguez Sandoval | Gendarmería de Chile | Universidad de Chile
# Decesos en el sistema penitenciario: una descripcion preliminar por tipo de muertes
Revista de Estudios Criminológicos y Penitenciarios Número 13 Diciembre 2008

Cour Européenne des Droits de l'Homme - European Court of Human Rights

# Scoppola c. Italia

Strasburgo, 10 giugno 2008

In base ad una relazione medica del 9 gennaio 2006, effettuata su richiesta del collegio difensivo del ricorrente, le condizioni di salute di quest’ultimo venivano definite come “ampiamente incompatibili con la detenzione in carcere ed imponenti l’adozione di misure ad esse alternative, quali il trasferimento ad un ospedale esterno alla prigione idoneo a fornire al ricorrente le cure adeguate e necessarie, oppure presso una struttura specializzata nella cura e riabilitazione dei detenuti di lungo corso necessitanti assistenza continuativa 24 ore su 24”... La corte Ritiene che vi è stata violazione dell’articolo 3 della Convenzione

Jeff Mellow, Steven K. Hoge, Joshua D. Lee, Mangai Natarajan, Sung-suk Violet Yu, Robert B. Greifinger, Gary Belkin
# Mapping the Innovation in Correctional Health Care Service Delivery in New York City
www.jjay.cuny.edu/ Spring 2008
In order to aid in the analysis of the living arrangements of released inmates, DOC provided individual case data on the 77,735 inmates discharged from DOC in calendar year 2005. Of that total, 50,974 inmates returned to the City’s boroughs in 2005. A sample of 40,684 inmates (80 percent) was geocoded and analyzed. The sample was selected based on the following criteria: 1) inmate had a known home address at the time of incarceration; 2) inmate was released to one of the City’s five boroughs (i.e., Brooklyn, Bronx, Manhattan, Queens, or Staten Island); and 3) only the inmate’s last discharge from DOC in 2005 was counted to avoid double-counting inmates. Among the 10,230 cases that were not geocoded, 2,584 cases were identified as homeless or living in an institution.

Charlie Brooker, Clare Fox, Paul Barrett, Linda Syson-Nibbs
# A Health Needs Assessment of Offenders on Probation Caseloads in Nottinghamshire and Derbyshire. Report of a Pilot Study
www.nacro.org.uk/ April, 2008
Overall, the findings indicate that offenders’ health is significantly worse than the general population and the health of female offenders is both significantly worse than their male counterparts and the general population. 27% of the sample had been seen formally by a mental health service at some point; the majority of the diagnoses reported by offenders were depression and/or anxiety.

Progetto gestione sanitaria | Afis - Nuova Matricola
# Cartella sanitaria del detenuto
05-marzo-2008

America Diabets Association
# Diabetes Management in Correctional Institutions
Diabetes Care, vol. 31, Suppl. 1, January 2008
At any given time, over 2 million people are incarcerated in prisons and jails in the U.S. It is estimated that nearly 80,000 of these inmates have diabetes, a prevalence of 4.8% (2). In addition, many more people pass through the corrections system in a given year. In 1998 alone, over 11 million people were released from prison to the community. The current estimated prevalence of diabetes in correctional institutions is somewhat lower than the overall U.S. prevalence of diabetes, perhaps because the incarcerated population is younger than the general population. The prevalence of diabetes and its related comorbidities and complications, however, will continue to increase in the prison population as current sentencing guidelines continue to increase the number of aging prisoners and the incidence of diabetes in young people continues to increase

DPCM di attuazione dell'art. 2 (comma 283) della legge finanziaria 2008 - Trasferimento al Servizio Sanitario Nazionale delle funzioni sanitarie, dei rapporti di lavoro, delle risorse finanziarie e delle attrezzature e beni strumentali in materia di Sanità penitenziaria

# Decreto del Presidente del Consiglio dei Ministri - testo 1 aprile 2008

# Decreto del Presidente del Consiglio dei Ministri scheda sintetica

The Federal Bureau of Prisons BOP
# Efforts to Manage Inmate Health Care
U.S. Department of Justice | Office of the Inspector General
Audit Division - February 2008

World Health Organization WHO Europe

Edited by: Lars Møller, Heino Stöver, Ralf Jürgens, Alex Gatherer and Haik Nikogosian
# Health in prisons. A WHO guide to the essentials in prison health

WHO Regional Office for Europe 2007

The phrase health promoting prison is used to cover the prisons in which: the risks to health are reduced to a minimum; essential prison duties such as the maintenance of security are undertaken in a caring atmosphere that recognizes the inherent dignity of every prisoner and their human rights; health services are provided to the level and in a professional manner equivalent to what is provided in the country as a whole; and a whole-prison approach to promoting health and welfare is the norm... Good prison health creates considerable benefits. It prevents the spread of diseases and promotes health through awareness of what everyone can do to help maintain their own health and well-being and that of others. In addition, however, it can help to improve the health status of communities, thus contributing to health for all...

Queensland Corrective Services
# Healthy Prisons Handbook Queensland Corrective Services
www.correctiveservices.qld.gov.au/ Healthy Prisons Handbook – Version 1 – November 2007
Whether or not a correctional facility can be considered “healthy” largely depends on how well it achieves the following outcomes for prisoners: 1. Appropriate steps are taken to ensure that individual prisoners are protected from harm by themselves and others. 2. Prisoners are treated with respect for their dignity while being escorted to and from prison, in prison and while under escort in any location 3. Prisoners are held in conditions that provide the basic necessities of life and health, including adequate air, light, water, exercise in the fresh air, food, bedding and  clothing.  4. Prisoners are treated with respect by centre staff. 5. Good contact with family and friends is maintained.  6. Prisoners’ entitlements are accorded them in all circumstances without their facing difficulty. 7. Prisoners take part in activities that educate, develop skills and personal qualities and prepare them for life outside prison. 8. Health care is provided to the same standard as in the community, available in response to need, with a fullrange of preventative services, promoting continuity with external health services upon release. 9. Appropriate steps are taken to ensure thatprisoners are reintegrated safely into the community and where possible into a situation less likely to lead to their further involvement in crime.

Lawrence O. Gostin
# Biomedical Research Involving Prisoners: Ethical Values and Legal Regulation
http://scholarship.law.georgetown.edu/ JAMA 737-740 (2007)

Lawrence O. Gostin, Cori Vanchieri, Andrew Pope (eds)
# Ethical Considerations for Research Involving Prisoners
www.ncbi.nlm.nih.gov/ 2006

Angela Tripp, Natalie Holbrook, Raymond Charles Walen, Robert R. Walsh
# Tolerating Failure: The State of Health Care and Mental Health Care Delivery in the  Michigan Department of Corrections
American Friends Service Committee and Prison Legal Services of MI - 2007
When men and women enter the world of prison, they bring with them their existing medical conditions and mental health issues. They are put under the care of the state and the state is mandated by the Eighth Amendment to provide them with adequate health and mental health care. This report is a refl ection of our fi ndings regarding the systemic failures within Michigan’s prison health care system. These systemic failures lead to real human suffering and pain and, at times, to death...

Joseph A. Bick
# Infection Control in Jails and Prisons
http://cid.oxfordjournals.org/ Clinical Infectious Diseases 2007; 45:1047–55
Most jails and prisons were constructed to maximize public safety, not to minimize the transmission of disease or to efficiently deliver health care. The probability of transmission of potentially pathogenic organisms is increased by crowding, delays in medical evaluation and treatment, rationed access to soap, water, and clean laundry, insufficient infection-control expertise, and prohibitions against the use of proven harmreduction tools, such as condoms and sterile needle exchange. The abrupt transfer of inmates from one location to another further complicates the diagnosis of infection, interruption of transmission, recognition of an outbreak, performance of a contact investigation, and eradication of disease.

Michael D. Cohen, Kathryn Godley |  Diabetes support group at Great Meadow Correctional Facility Comstock, New York
# Prisoner Diabetes Handbook. A Guide to Managing Diabetes for Prisoners, by Prisoners
Diabetes Care, volume 30, Supplement 1, January 2007

This handbook is a summary of the ideas and experiences discussed during the approximately ten years of regular meetings of the diabetes support group at Great Meadow Correctional Facility in Comstock, NY. Many people contributed to this handbook. The most important contributors are the past and present group participants. Prisoners at Great Meadow joined the group for various reasons. Some had diabetes themselves and wanted to learn more about how to take care of themselves. Others had family members with diabetes and wanted to understand more about their family members’ health needs. Through their willingness to share their stories, concerns, and lessons learned, they taught us a lot about how to live with diabetes in very diffi cult circumstances...

WHO Regional Office for Europe
# Status Paper on Prisons and Tuberculosis
World Health Organization 2007
A review of the current position concerning the prevalence of tuberculosis (TB) showed that, despite the progress being made, TB remains a major problem in prisons in parts of Europe and for Europe as a whole. There is an urgent need for all those concerned, including public health policy-makers and prison staff, to understand the nature of the challenge stemming from the characteristics of the disease and from the particular realities of life in prison and among prison populations. This report provides evidence for what must be done, and outlines the well-established ways by which this life-threatening disease can be detected, treated and brought under control in prisons and in the community. With such understanding, and with resources for trained staff, for laboratory testing and for curative medicines, TB programmes in prisons as part of national strategies can bring about major public health gains and contribute towards a world without TB.

Christopher J. Mumola
# Medical Causes of Death in State Prisons, 2001-2004
Bureau of Justice Statistics, January 2007
Between 2001 and 2004, State prison authorities nationwide reported a total of 12,129 State prisoner deaths to the Deaths in Custody Reporting Program (DCRP). Nearly 9 in 10 of these deaths (89%) were attributed to medical conditions. Fewer than 1 in 10 were the result of suicide (6%) and homicide (2%), while alcohol/drug intoxication and accidental injury accounted for another 1% each. A definitive cause could not be determined for 1% of these deaths.

Società Italiana di Medicina e Sanità Penitenziaria Onlus (SIMSPe)
# La medicina in carcere e l’epatite C: prima indagine sulle carceri italiane [I. Cecchini]
Roma, 2 Ottobre 2007
La salute delle carceri, è un problema di Salute pubblica. Basta un dato per far capire la drammaticità della situazione e quanto sia presente nelle pieghe della Società: l’Epatite C è la malattia virale più diffusa in carcere perché è qui che vengono raccolte le sacche di emarginazione sociale. Sovraffollamento, scarse attenzioni alle basilari norme igieniche di prevenzione ed enormi difficoltà nelle cure fanno il resto. La detenzione media è, in genere, di 120 giorni. Con i pochi mezzi a disposizione non riusciamo neanche a impostare non dico una terapia ma neanche una proposta terapeutica. E, una volta usciti, di molti si perdono le tracce. Senza esserne nemmeno consapevoli gli ex detenuti alimentano le epidemie tra la popolazione generale. E qui c’è il pericolo di commettere un altro grave errore: quello di considerare l’ex detenuto o il detenuto in permesso-premio come un possibile “untore”. Si aggiungerebbe discriminazione a discriminazione. Quello che si deve fare è intervenire a monte, mettendo in condizioni il personale sanitario che opera nelle carceri di fare una buona diagnosi prima e una buona terapia poi. Solo così si può iniziare a pensare di “guarire” il carcere malato.

Silvia Calliari
# “L’aria divenne stretta”. Corpo e malattia in carcere
Università di Bologna 2007

E' il carcere in sé che fa ammalare; sono gli effetti del suo ambiente che intervengono fatalmente sulla persona reclusa. “So anche che un detenuto, già dopo la prima ora di carcere, è una persona mentalmente squilibrata”, scrive Victor Serge... Quanto è risaputo, nel senso comune, che la prigione causa una sofferenza anche fisica incalcolabile? Ci siamo mai chiesti cosa stia dietro all’espressione ‘carcere modello’, o anche solo ‘moderno’? O sarà forse che in fondo, i condannati devono soffrire, come parte irrinunciabile della pena che spetta loro?...

Catia Ferrieri, Chiara Crisci
# Osservatorio sulla Corte Europea dei diritti dell'uomo in tema di diritto alla salute del detenuto: analisi della sentenza n. 8684/04 Erol Zavar/Turchia
www.penale.it | settembre 2007

Il principio di giustizia, in base anche ai dictat della Corte europea, si traduce, nell’adozione di due canoni correlati: 1) il canone della imparzialità, fondato sull’uguale dignità degli uomini; implica che tutti hanno diritto ad eguale trattamento per mezzo della garanzia dei “beni” fondamentali. 2) il canone dell’equa distribuzione delle risorse, fondato sul riconoscimento del principio della solidarietà; esige che sia data stessa possibilità di accesso ai beni per convenire ad un’adeguata realizzazione personale, primo fra tutti i beni quello della salute.
Se si conviene come giusto che sia, come un diritto assoluto, intangibile della persona, si nota come a cascata né discendano plurimi principi: 1) quello della autonomia che rispecchia, il rispetto del diritto del soggetto all’autodeterminazione; 2) quello di beneficialità, il quale, impone la ricerca di ogni mezzo atto a tutelare la salute in primis ed il benessere poi, della persona; 3) quello di non-maleficità il quale, esige di non recar danno alla persona; 4) quello di giustizia che si fonda sulla non discriminazione.

Ingrid A. Binswanger et al.
# Release from Prison — A High Risk of Death for Former Inmates

The New England Journal of Medicine, January 11, 2007
Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years.  The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide.

Susan J. Klein, Lester N. Wright, Guthrie S. Birkhead, Benjamin A. Mojica, Linda C. Klopf, Laurence A. Klein, Ellen L. Tanner, Ira S. Feldman, Edward J. Fraleye
# Promoting HCV Treatment Completion for Prison Inmates: New York State’s Hepatitis C Continuity Program
Public Health Reports / 2007 Supplement 2 / Volume 122
This article describes the development of a statewide program providing continuity of hepatitis C virus (HCV) treatment to prisoners upon release to the community. We discussed length of stay as a barrier to treatment with key collaborators; developed protocols, a referral process, and forms; mobilized staff; recruited heath-care facilities to accept referrals; and provided short-term  access to HCV medications for inmates upon release. The Hepatitis C Continuity Program, including 70 prisons and 21 health-care facilities, is a resource for as many as 130 inmates eligible to start treatment annually. Health- care facilities provide fairly convenient access to 87.1% of releasees, and 100% offer integrated HCV-human immunodeficiency virus/acquired immunodeficiency syndrome care. As of March 2006, 24 inmates had been enrolled. The  program was replicated in the New York City Rikers Island jail. The program is operational statewide, referrals sometimes require priority attention, and data collection and other details are still being addressed.

A. Story, S. Murad, W. Roberts, M. Verheyen, A. C. Hayward
# Tuberculosis in London: the importance of homelessness, problem drug use and prison
www.ncbi.nlm.nih.gov/ Thorax 2007;62:667–671
In the developed world, tuberculosis (TB) is increasingly concentrated in subgroups of the population in large urban centres. TB is a major public health problem in London, where there was an 11% increase in new reported cases between 2004 and 2005 and now accounts for 45% of all cases reported in England. High levels of infectious and drug resistant disease, poor adherence and loss to follow-up care indicate that TB is not effectively controlled among homeless people, prisoners and problem drug users in London.

Bernice Simone Elger
# Insomnia in places of detention: a review of the most recent research findings
Medicine, Science and the Law, 2007, vol. 47, no. 3, p. 191-199
Up to 40% of prisoner patients in a general medicine outpatient service seek medical consultation for sleep problems. This paper provides a brief overview of what is known about insomnia and its treatment from studies on non-detained patients and discusses the relevance of the findings from studies in liberty for prison health care. The clinical and ethical issues of insomnia in prison are described, followed by a summary of the existing studies on insomnia in prison. The results of the reported studies show that insomnia in places of detention should not be reduced to a secondary problem related to substance abuse and mental illness, as it appears to be an independent situational problem. Correctional health care physicians' evaluation of insomnia is insufficient. Drug prescription works well in some patients, but has a limited effect on insomnia relief in others. A clear need exists for the education of prison health care professionals on insomnia evaluation and management. Additional non-pharmacological treatment in the prison health care setting should be used more frequently. Prison health care services should develop clear guidelines based on research evidence about insomnia and which contain treatment recommendations based [...]

Nick de Viggiani
# Unhealthy prisons: exploring structural determinants of prison health
Sociology of Health & Illness Vol. 29 No. 1 2007 I
Prisoner health is influenced as much by structural determinants (institutional, environmental, political, economic and social) as it is by physical and mental constitutions of prisoners themselves. Prison health may therefore be better understood with greater insight into how people respond to imprisonment – the psychological pressures of incarceration, the social world of prison, being dislocated from society, and the impact of the institution itself with its regime and architecture.

Federazione Nazionale degli Ordini dei Medici Chirurghi e degli Odontoiatri
# Codice di Deontologia Medica
16 Dicembre 2006

Alessandro Centonze

# L'esecuzione della pena detentiva e la ricostruzione sistematica della nozione di gravità delle condizioni del detenuto

Rassegna penitenziaria e criminologica, n. 3 - 2006

... l'ampiezza della formula normativa utilizzata dal legislatore è funzionale ad ampliare gli spazi di discrezionalità del giudice, permettendogli di intervenire a favore del condannato anche quando, in astratto, la patologia di cui è affetto potrebbe essere curata nell'ambito delle strutture del circuito sanitario penitenziario...

Paul Hayton, John Boyington

# Prisons and Health Reforms in England and Wales
American Journal of Public Health | October 2006
Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by overmedicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty’s Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.

Comité Consultatif National d’Ethique pour les Sciences de la Vie et de la Santé
# La santé et la médecine en prison. Avis n° 94
www.ccne-ethique.fr/ 26 octobre 2006
La question de la protection de la santé en prison est essentielle pour tous les détenus. Mais plusieurs catégories de détenus posent des problèmes particuliers qui nécessitent des efforts spécifiques de prise en charge... La prison est de plus en plus un lieu confronté à la maladie mentale. La prison devient de plus en plus un lieu d’enfermement des malades psychiatriques : le taux de pathologies psychiatriques est 20 fois plus élevé en prison que dans la population générale... . La prison est aussi cause de maladie et de mort : c’est un lieu de régression, de désespoir, de violences exercées sur soi-même, et de suicide...

World Medical Association
# Medical Ethics and Human Rights
World Medical Journal, vol. 52, n. 2, June 2006

Medicalisation of hunger strikes often occurs and can threaten physicians’ ability to act independently. Local law may require medical monitoring of the hunger strike and the status of a particular hunger striker can also influence the attention given to that person. Physicians may have to balance objective medical observations with pragmatic face-saving situations, in order to buy time for essential negotiations to produce results. They must avoid pandering to any particular interest group by giving medical information or advice that is scientifically questionable or inaccurate.

AA Javadi, M Avijgan, M Hafizi
# Prevalence of HBV and HCV Infections and Associated Risk Factors in Addict Prisoners
Iranian J Publ Health, Vol. 35, No. 4, 2006, pp.33-36
High prevalence of HBV and HCV infections in prisoners suggests them as one of the main infection source in community. Preventive measures can possibly decrease their rate of infection and infectivity. We evaluated prevalence of HBV and HCV infections and their relation to dangerous behavior in addict prisoners. This was a cross-sectional study included prisoners of central provinces of Iran who were evaluated for HBV and HCV in 2003. All of 1431 prisoners filled out questionnaires that were evaluated for HBsAg and HCV antibody. There were 51 prisoners (3.5%) who were HBsAg positive and 513 prisoners (35.8%) had HCV antibody. Odd`s ratio for HBV and HCV were 10.3 and 9.6 for IVDA, respectively. This study showed that the HBV and specially HCV infection had high prevalence among prisoners. In comparison to rate of HBsAg and HCV infection in general population of Iran, this study showed that the HBsAg was 2 times and HCV infection was 70 times more frequent in prisoner than in general population of Iran. The education for dangerous behavior is strongly recommended to control this persistent infection source for hepatitis B and C in the community.

Seena Fazel, Ram Benning

# Natural deaths in male prisoners: a 20-year mortality study
European Journal of Public Health, Vol. 16, No. 4, 441–444 | 2006

Although morbidity is high in prisoners compared with the general population, uncertainty exists over rates for natural causes of death. We investigated natural deaths in prisons in England and Wales over a 20-year period. Methods: All men who died in English and Welsh prisons from 1978–1997 were identified. All deaths received a post-mortem. Death certificates were obtained to provide mortality information according to ICD-9. Standardised mortality ratios (SMRs) for major causes of natural death were calculated in those <60 years. Results: 574 male prisoners died in custody from natural deaths, of which 307 (53%) deaths were from circulatory diseases and 91 (16%) from respiratory causes. Overall, SMRs for natural deaths were significantly lower than the general population (SMR¼0.70; 95% CI¼0.65– 0.76). However, SMRs from respiratory pneumonia (SMR ¼ 2.35; 1.75–3.16) and from other infectious causes were higher (SMR ¼ 1.52; 1.03–2.23). Conclusion: There are important methodological challenges in calculating SMRs in prisoners. Bearing these in mind, we found increased mortality ratios for respiratory pneumonia and other infections. These findings highlight the need for the screening and effective treatment of infectious diseases in prisoners.

Paul Hunt | UN Special Rapporteur on the right to the highest attainable standard of health

# The human right to the highest attainable standard of health: new opportunities and challenges
Transactions of the Royal Society of Tropical Medicine and Hygiene (2006) 100, 603—607
The health and human rights communities have much in common. Both are animated by the well-being of individuals and populations. In both communities, many have a particular preoccupation with discrimination and disadvantage. While human rights violations often lead to higher morbidity and mortality, health programmes have a crucial contribution to make towards the realization of human rights. Increasingly, health and human rights professionals are recognizing their common interests and mutually reinforcing goals.

Australian Institute of Criminology
# Mortality and morbidity in prisoners after release from prison in Western Australia 1995–2003
Michael Hobbs, Kati Krazlan, Steve Ridout, Qun Mai, Matthew Knuiman, Ralph Chapman
www.aic.gov.au/ 2006
Prisoners, both in custody and after release, are widely recognised as having poorer health than members of the general community. Several   previous studies have highlighted the greater risk of death after release, while others have described in detail the poor health often suffered by prisoners in custody, including cases of hepatitis C, HIV-AIDS and a significantly higher prevalence of mental disorders...

Robert B. Greifinger
# Inmates as Public Health Sentinels
Journal of Law & Policy Vol. 22:253 2006
The conditions in some correctional facilities are redolent of conditions in prisons in the United States a century ago. In 1894, Dr. Julius Ransom, a prison physician, reported that 25% of the 1000 inmates at the prison in Dannemora, New York had active tuberculosis. In his report to Congress in 1907 the rates were unchanged and half of the prison mortalities were attributed to tuberculosis. One hundred years later (and despite the widespread availability of modern diagnostics, knowledge about containment, and multi-drug regimens for communicable disease) some American prisons remain incubators of this same scourge. Too little attention is being paid to inmates as public health sentinels. Too little attention is paid to preventing, diagnosing, and treating conditions that can poison life for families and members of the free-world society.

Rick Lines
# From equivalence of standards to equivalence of objectives: The entitlement of prisoners to health care standards higher than those outside prisons
International Journal of Prisoner Health, December 2006; 2(4): 269 280
It is generally accepted that people in prison have a right to a standard of health care equivalent to that available outside of prisons. This ‘‘principle of equivalence’’ is one that enjoys broad consensus among international health and human rights instruments and organisations. However, given the extreme health problems evident in prisons worldwide, the legal obligations of the State to safeguard the lives and well-being of people it holds in custody and the implications of poor prison health on overall public health, this article suggests that even if achieved standards of prison health care only equivalent to that in the community would in some cases fall short of human rights obligations and public   health needs. The article argues it is time to move beyond the concept of equivalent standards of health care, and instead promote standards that achieve equivalent objectives. In some circumstances, meeting this new standard will require that the scope and accessibility of prison health services are higher than that outside of prisons.

Jennifer Prah Ruger
# Health, Capability, and Justice: Toward a New Paradigm of Health Ethics, Policy and Law
Cornell Journal of Law and Public Policy, Vol. 15, No. 2, 2006

Richard Wilkinson, Michael Marmot (eds)
# I determinanti sociali della salute. I fatti concreti | II edizione
Organizzazione Mondiale della Sanità 2003 | Giunta della Provincia Autonoma di Trento 2006
L’esclusione sociale è anche l’esito di razzismo, discriminazione, stigmatizzazione, ostilità e disoccupazione. Questi processi impediscono alle persone di partecipare all’istruzione o alla formazione nonché alla possibilità di accedere a servizi e attività rivolte ai cittadini. Sono inoltre dannosi sotto l’aspetto sociale e psicologico, costosi sotto l’aspetto materiale, e pericolosi per la salute. Le persone che vivono in queste condizioni oppure che sono stati ospiti presso alcune istituzioni, come il carcere, il riformatorio o l’ospedale psichiatrico sono particolarmente vulnerabili.

Alessandro Centonze

# L'esecuzione della pena detentiva e la ricostruzione sistematica della nozione di gravità delle condizioni di salute del detenuto
Rassegna Penitenziaria e Criminologica, Numero 3 - 2006

Mark Williamson
# Improving the health and social outcomes of people recently released from prisons in the UK. A perspective from primary care
The Sainsbury Centre for Mental Health, January 2006
The focus of the paper has been on prisoners and their needs, particularly in the post release period. It has been necessary throughout, due to lack of research, and literature, to rely on extrapolation, of prisoner characteristics, and informed conjecture, of reasons for the poor outcomes, in the examination of the post release phase. It is imperative that we build the evidence base in this country and work with international colleagues to improve our wider understanding. The term prisoner has tended to be used throughout, with occasional use of the term offender. Many offenders do not become prisoners and yet share many of the same characteristics and will use the same health, criminal justice and social services. The development over time of a more coherent and seamless understanding of the needs of offenders, prisoners and the marginalised and vulnerable of society needs to be built with a broader approach to evidence building and policy development

Giuseppe Mosconi

# Il carcere come salubre fabbrica della malattia
Rassegna Penitenziaria e Criminologica, Numero 1 - 2005

Alexey Bobrik, Kirill Danishevski, Ksenia Eroshina, Martin McKee
# Prison Health in Russia: The Larger Picture
Journal of Public Health Policy (2005)
Russia, despite recent legal reforms, still has one of the highest rates of imprisonment in the world. There are many reports of the adverse conditions in Russian prisons, often highlighting the consequences for health, in particular risks of HIV, tuberculosis, and other infectious diseases. However, there are no reviews of the broader health issues in the Russian penal system

Vivienne Heines

# Speaking Out to Improve the Health of Inmates
October 2005, Vol 95, No. 10 | American Journal of Public Health

Prison public health is becoming increasingly important to our society as growing numbers of men and women are incarcerated and later released. Numerous studies indicate that the prison population has a higher risk of certain infectious diseases and a higher rate of mental illness than the general population.  Two community leaders, Dr Melanie Spector in the area of public health and Judge Steven Leifman in the judicial system, have addressed the vital issues of womens health and mental illness, respectively. Their efforts have had a positive impact both on prisoners themselves and on the overall health of their communities.

John Jacobi
# Prison Health, Public Health: Obligations and Opportunities
Seton Hall Public Law Research Paper No. 43 - August 18, 2005
This paper argues for a new vision of prison health reform. It argues that reform arguments should couple humanitarian impulses with pragmatic concerns. Almost all prisoners are eventually released. Poor prison health care is increasingly creating public health risks to the general population, and in particular to the communities to which prisoners return. Failure to treat chronic conditions and mental illness creates strains on community health providers and families, and causes recidivism. Failure to properly treat communicable diseases such as tuberculosis, HIV disease, hepatitis C, and syphilis harms the public more directly by exposing them to infection...

Marie-Claude Mouquet
# La santé des personnes entrées en prison en 2003
drees | Études et Résultats N°386 • mars 2005
En effet, 4,4 % des entrants déclarent prendre des broncho-dilatateurs ou antiasthmatiques, 2,3 % des médicaments... en 2003, un entrant en prison sur cinq déclare avoir fait un test de dépistage de l’hépatite B avant son incarcération et le taux de séropositivité déclaré pour cette maladie s’élève à 0,8 %. Enfin, trois nouveaux détenus sur dix déclarent avoir fait un test de dépistage de l’hépatite C et 3,1 % être séropositifs pour cette maladie, très peu de ces derniers (1,5 %) déclarant un traitement en cours par médicament antiviral.

J M Feron, D Paulus, R Tonglet, V Lorant, D Pestiaux
# Substantial use of primary health care by prisoners: epidemiological description and possible explanations
J Epidemiol Community Health 2005;59:651–655
Prisoners consulted the general practitioner (GP) 17 times a year on average (95%CI 15 to 19.4). It is 3.8 times more than a demographically equivalent population in the community. The most common reasons for encounter were administrative procedures (22%) followed by psychological  (13.1%), respiratory (12.9%), digestive (12.5%), musculoskeletal (12%), and skin problems (7.7%). Psychological reasons for consultations (n = 481) involved mainly (71%) feeling anxious, sleep disturbance, and prescription of psychoactive drugs. Many other visits concerned common problems that in other circumstances would not require any physician intervention. Conclusion: The most probable explanations for the substantial use of primary care in prison are the health status (many similarities noted between health problems at the admission and reasons for consultations during the prison term: mental health problems and health problems related to drug misuse), lack of access to informal health services (many contacts for common problems), prison rules (many consultations for administrative procedures), and mental health problems related to the difficulties of life in prison.

Michael Marmot
# Social determinants of health inequalities
www.who.int/ Lancet 2005; 365: 1099–104
Inequalities in health between and within countries are avoidable. There is no necessary biological reason why life expectancy should be 48 years longer in Japan than in Sierra Leone or 20 years shorter in Australian Aboriginal and Torres Strait Islander peoples than in other Australians. Reducing these social inequalities in health, and thus meeting human needs, is an issue of social justice.

Roger Watson, Anne Stimpson, Tony Hostick

# Prison health care: a review of the literature
International Journal of Nursing Studies 41 (2004) 119–128

The prison population is increasing and the health problems of prisoners are considerable. Prison is designed with punishment, correction and rehabilitation to the community in mind and these goals may conflict with the aims of health care. A literature review showed that the main issues in prison health care are mental health, substance abuse and communicable diseases. Women prisoners and older prisoners have needs which are distinct from other prisoners. Health promotion and the health of the community outside prisons are desirable aims of prison health care. The delivery of effective health care to prisoners is dependent upon partnership between health and prison services and telemedicine is one possible mode of delivery.

Daryl Matthews
# Physicians' Obligation to Speak out for Prisoners' Health
Virtual Mentor | American Medical Association Journal of Ethics | September 2004, vol. 6, n. 9

While a host of professional ethical codes would support involvement in the debate over the detentions, one need go no further than the Declaration of Professional Responsibility: Medicine's Social Contract with Humanity, adopted by the AMA House of Delegates in December, 2002, and by a host of other professional organizations.

Ministère de la santé et de la protection sociale | Ministère de la justice
# Guide methodogique relatif a la prise en charge sanitaire des personnes detenues
www.sante.gouv.fr/ Septembre 2004

Jennifer Prah Ruger
# Ethics of the social determinants of health
www.thelancet.com/ Vol 364 September 18, 2004

Observatoire régional de la Santé (ORS)
# La santé des détenus. Etat des lieux national
www.orshn.fr/ Mars 2004
La prison concentre des populations marginalisées et précarisées issues du milieu libre et qui y retournent avec la difficulté supplémentaire de se retrouver dans une société de plus en plus marquée par la précarité. La prise en charge tant de la maladie (tuberculose, infection au VIH ou hépatite C) que des facteurs de risque (toxicomanies) mérite d’être assurée de manière globale, coordonnée et continue. Pour mieux connaître la situation et faire face à ces problèmes, des études épidémiologiques ont été menées. Nous ferons état dans ce document de divers travaux menés depuis 10 ans sur la santé des détenus...

United Nations Office on Drugs and Crime - Vienna
# Ethical challenges in drug epidemiology: issues, principles and guidelines. Global Assessment Programme
on Drug Abuse
www.unodc.org/ 2004
The Global Assessment Programme on Drug Abuse (GAP) Toolkit Module 7: Ethical challenges in drug epidemiology: issues, principles and guidelines, was prepared by the United Nations Office on Drugs and Crime as part of the activities of GAP. The main objectives of GAP are to help countries to (a) collect reliable and internationally comparable data on drug abuse; (b) build capacity at the local level to collect data that can guide demand reduction activities; and (c) improve cross-national, regional and global reporting on drug trends.

Tribunale di Sorveglianza di Torino | Dott. Paolo Gibelli, Presidente | Dott. Fabio Fiorentin, Giudice di Sorveglianza

# Ordinanza 13 gennaio 2004 [Alternativa tra differimento della pena e detenzione domiciliare...]

Nel caso in esame, le obiettive conseguenze invalidanti delle patologie che interessano il detenuto ne comprimono irrimediabilmente la possibilità di percepire il contenuto rieducativo della pena nonché di partecipare alle attività trattamentali proposte dagli educatori, di tal che, nella fattispecie, la finalità di reinserimento sociale della pena appare del tutto compromessa. Conseguentemente la prosecuzione della detenzione carceraria si risolve, nel caso concreto, in un fatto contrario al senso di umanità. Ad analoga conclusione si perviene qualora si consideri che le obiettive limitazioni imposte al condannato dal suo stato di salute, imponendogli l'aiuto esterno per il compimento dei più banali atti della vita quotidiana, contribuiscono a rendere ancor più affittiva l'espiazione della pena, così ponendosi in contrasto con il canone costituzionale sopra indicato (Cass.,1,n.4836 dd.27/11/1987, RV.  177126, Nuvoletta; Cass., 1,n.3894 dd.23/09/1999, RV.  214370, Nezi).

Chad Kinsella
# Corrections Health Care Costs
The Council of State Governments - January 2004
In 2002, there were two million inmates housed in federal, state and local jails, with the majority of inmates housed in state prisons. Many of these inmates have one or more medical problems, lead lifestyles that make them extremely at risk to communicable diseases, have higher rates of mental illness and are likely to have chemical dependency problems.

Laura Baccaro
# Carcere e salute
Sapere Edizioni 2003

È il dolore del se relazionale che con la reclusione viene amputato e sottoposto a torsione... il recluso attraverso i suoi sintomi dice: ‘Sono un essere umano, una presenza umana, e come tale vorrei essere considerato. E, a ben vedere, quella catena di sintomi è la modalità creativa che il recluso, al momento, intravede: il suo modo di esternare la sofferenza, di comunicarla. Una cura estenuante, come una danza senza fine che il farmaco aumenta anziché lenire.  Mai, come in questo caso, è più vero il paradosso secondo cui: la malattia è la cura".

P. Verger, M. Rotily, J. Prudhomme, S. Bird
# High Mortality Rates Among Inmates During the Year Following Their Discharge from a French Prison
J Forensic Sci, May 2003, Vol. 48, No. 3

While the poor health status of prisoners has been highlighted in Western countries, the surveillance of their mortality has been neglected. We studied the mortality of 1305 prisoners released during 1997 from a French prison. Vital status after release was obtained for 86.4% of them. Compared with the general population, ex-prisoners non-natural mortality rates were significantly increased both in the 15–34 and 35–54 age categories (3.5-fold and 10.6-fold respectively) and the risk of death due to overdose was 124 and 274 times higher in the same categories respectively. Prevention and care should be reinforced in the pre-release period without waiting more epidemiological data

World Health Organization
# WHO Moscow Declaration on Prison Health as a Part of Public Health
www.euro.who.int/ 24 October 2003
Penitentiary populations contain an over-representation of members of the most marginalized groups in society, people with poor health and chronic untreated conditions, drug users, the vulnerable and those who engage in risky activities such as injecting drugs and commercial sex work... The living conditions in most prisons of the world are unhealthy. Overcrowding, violence, lack of light, fresh air and clean water, poor food and infection-spreading activities such as tattooing are common. Rates of infection with tuberculosis, HIV and hepatitis are much higher than in the general population.

Geneviève Guérin (ed)
# La santé en prison
Actualité et dossier en santé publique - adsp n° 44 septembre 2003
La réforme de janvier 1994 a eu des effets globalement positifs sur la prise en charge sanitaire en milieu carcéral, en dépit de problèmes de fonctionnement liés aux contraintes de la vie carcérale… Cependant, deux difficultés majeures sont liées à l’organisation même du dispositif :  la permanence des soins n’est pas assurée de façon satisfaisante pour garantir la sécurité de la population détenue placée sous la responsabilité du service public hospitalier ;  le principe d’égalité d’accès aux mêmes soins que ceux dont dispose la population en milieu libre n’est pas respecté en ce qui concerne la prise en charge des pathologies mentales...

Celia Wainstein (ed) | Cárceles-Servicios de Salud Pública (Argentina)
# Cárceles saludables. Promoviendo la salud para todos
http://publicaciones.ops.org.ar/ Organización Panamericana de la Salud, 2003
La realidad de las cárceles muestra una cantidad ilimitada de factores que inciden de manera negativa en la salud integral de estas personas. Las condiciones de sobrepoblación y hacinamiento, a veces difíciles de controlar, facilita el desarrollo de enfermedades infectocontagiosas. Además, es conocido que la presencia de hechos de violencia, de conductas adictivas y de riesgo de enfermedades de transmisión sexual son elementos intrínsecos de la vida en prisión, constituyendo una amenaza constante para la calidad de vida de las personas detenidas. Un gran porcentaje de la población privada de la libertad proviene de áreas marginales, cuyas condiciones están enmarcadas en una cultura caracterizada por la pobreza, el desempleo, la violencia, las adicciones, y la inasistencia sanitaria. El sistema de detención opera como un círculo vicioso para esta población...

J. John Mann
# Neurobiology of Suicidal Behaviour
Nature Review | Neuroscience, vol. 4 October 2003
Suicidal behaviour refers to the occurrence of suicide attempts, which I define here as self-directed injurious acts with at least some intent to end one’s own life. Suicidal behaviour ranges from fatal acts (completed suicide), to highly lethal and failed suicide attempts (where high intention and planning are evident, and survival is fortuitous), and to low-lethality attempts (usually impulsive attempts that are triggered by a social crisis, seem to be ambivalent and contain a strong  element of an appeal for help). Intent and lethality are correlated positively, and are related to biological abnormalities that mostly involve the serotonergic  system. The clinical and neurobiological study  of failed suicides can inform us about completed  suicide because the two populations are similar, clinically and demographically.

Marco Ruotolo

# Diritto alla salute e trattamenti sanitari
da M. Ruotolo, "Diritti dei detenuti e Costituzione”, Giappichelli 2002
Le situazioni d’incompatibilità possono essere "relative" o "assolute". Nel primo caso può essere, ad esempio, disposto il ricovero presso un centro diagnostico terapeutico dell’amministrazione penitenziaria, nel secondo si proporrà l’alternativa tra il ricovero in un istituto di cura extra carcerario o la concessione degli arresti domiciliari. In sostanza, il differimento dell’esecuzione della pena potrà essere concesso solo in caso di grave infermità, rispetto alla quale si attesti l’impossibilità di praticare utilmente le cure nel corso dell’esecuzione, soprattutto in quei casi in cui l’accertata infermità sarebbe potenzialmente aggravata dalla condizione carceraria.

Jacques Baillargeon, Sandra A. Black, John Pulvino, Kim Dunn
# Disease Profile of Texas Prison Inmates
www.ncjrs.gov/ April 2002

Infectious diseases (29.6 %) constituted :he most prevalent major disease category among inmates. This was followed by diseases of the musculoskeletal system  and connective tissue (15.3 %), diseases of the circulatory system (14.0 %), mental disorders (10.8 YO), and diseases of the respiratory system (6.3 %). Among the specific  conditions examined, evidence of tuberculosis inlection without active pulmonary disease (20.1 %) was found to be the most prevalent condition, followed by hypertension (9.8 %), asthma (5.2 %), low back pain (5.1 %), and viral hepatitis (5.0%)

Amartys Sen
# Health: perception versus observation. Self reported morbidity has severe limitations and can be extremely misleading
BMJ vol. 324 13 April 2002

Luke Birmingham
# Doctors working in prisons. Prison service to have more links with outside bodies including NHS
BMJ VOLUME 324 23 FEBRUARY 2002 bmj.com

The Prison Service has struggled to cope with the huge healthcare burden imposed by sick prisoners, particularly those with problems related to mental health and substance misuse, and it has been repeatedly criticised for providing inferior health care. Previous reports focusing on doctors working in prisons found that recruitment was a real problem, prison doctors were inadequately trained, and they were working beyond the limits of their ability.

National Commission on Correctional Health Care NCCHC

# The Health Status of Soon-To-Be-Released Inmates: A Report to Congress, Volume 1
# The Health Status of Soon-To-Be-Released Inmates: A Report to Congress, Volume 2
www.ncjrs.gov/ NCCHC March - April 2002
The inmate population in the United States has been growing rapidly since the early 1970s: As of 1999, an estimated 2 million persons were incarcerated in the Nation’s jails and prisons, compared with 325,400 in 1970—an increase of about 500 percent. Approximately 11.5 million  inmates were released into the community in 1998, most from city and county jails. As explained below, these inmates have high rates of  communicable disease, chronic disease, and mental illness. Coupled with the expanding inmate population, these high rates of disease create a critical need for preventing, screening, and treating illness before inmates are released into the community. Why?

Robert D. Morgan, Richard A. Van Haveren, Christy A. Pearson
# Correctional Officer Burnout. Further Analyses
Criminal Justice and Behavior, Vol. 29 No. 2, April 2002
The purpose of this study was to examine the relationship of several variables that have led to inconsistent results in previous studies on correctional officer stress, as well as expand previous research by exploring the relationship of two new variables (i.e., occupational title and work station) with correctional officer stress. Participants in this study consisted of 250 correctional officers from a Southwestern state department of corrections. Results indicated that older and more educated officers reported increased levels of personal accomplishment, whereas less experienced officers and officers with increasing job responsibilities experienced increased levels of depersonalization and emotional exhaustion and decreased levels of personal accomplishment. Furthermore, gender comparisons indicated that female correctional officers were less likely to respond impersonally to inmates than their male counterparts. Implications and areas for future research are discussed. 

American Medical Association
# Declaration of Professional Responsibility: Medicine's Social Contract with Humanity
House of Delegates of the American Medical Association in San Francisco, California on December 4, 2001

Nicholas Freudenberg
# Jails, Prisons, and the Health of Urban Populations: A Review of the Impact of the Correctional System on Community Health
Journal of Urban Health: Bulletin of the New York Academy of Medicine Vol. 78,No. 2,June 2001
This review examined the interactions between the correctional system and the health of urban populations. Cities have more poor people, more people of color, and higher crime rates than suburban and rural areas; thus, urban populations are overrepresented in the nation’s jails and prisons. As a result, USincarceration policies and programs have a disproportionate impact on urban communities, especially black and Latino ones. Health conditions that are overrepresented in incarcerated populations include substance abuse, human immunodeficiency virus (HIV) and other infectious diseases, perpetration and victimization by violence, mental illness, chronic disease, and reproductive health problems. Correctional systems have direct and indirect effects on health. Indirectly, they influence family structure, economic opportunities, political participation, and normative community values on sex, drugs, and violence. Current correctional policies also divert resources from other social needs. Correctional systems can have a direct effect on the health of urban populations by offering health care and health promotion in jails and prisons, by linking inmates to community services after release, and by assisting in the process of community reintegration. Specific recommendations for action and research to reduce the adverse health and social consequences of current incarceration policies are offered.

Theodore M. Hammett

# Making the Case for Health Interventions in Correctional Facilities

Journal of Urban Health 236 (2001)

Correctional facilities are important settings for interventions because here a population that bears a disproportionately heavy burden of disease and that is disproportionately affected by related risk behaviors may be efficiently reached with interventions...

Tom Marshall, Sue Simpson, Andrew Stevens | Department of Public Health & Epidemiology - Public Health Building
University of Birmingham
# Health care in prisons: A health care needs assessment
Febrary 2000
Prisoners have a very high incidence of mental health problems, in particular neurotic disorders, compared to the general population. By ICD-10 criteria, in any week, almost half of prisoners are suffering from a neurotic disorder such as anxiety or depression. One in ten prisoners has suffered from a psychotic disorder in the past year. Suicide is about eight times more common among prisoners than in an equivalent community population. Suicides most frequently occur within the first weeks and months of imprisonment. Incidents of deliberate self-harm are reported in one in sixty prisoners a year. Half of prisoners are heavy alcohol users and about one in twenty has a serious alcohol problem. About half of prisoners are dependent on drugs (principally opiates, cannabis and stimulants) and at least one quarter have injected drugs. A minority of prisoners continue to use drugs while in prison.

World Health Organization | Stop TB Department - Communicable Diseases

# El control de la tubercolosis en prisiones. Manual para directores de programas

WHO/CDS/TB/2000

La salud se ve amenazada en ambientes de pobreza, conflicto, discriminación y desinterés. La prisión es un ambiente que concentra precisamente estos problemas. La tuberculosis (TB) es una causa importante de enfermedad y muerte en las prisiones, junto con el VIH-1, la desnutrición, las enfermedades mentales y la violencia. Directa o indirectamente, estas amenazas afectan no sólo a los presos, sino a toda persona que entra en contacto con las prisiones y por último a toda la sociedad.

Ministro della Sanità - Ministro della Giustizia

# Approvazione del progetto obiettivo per la tutela della salute in ambito penitenziario

Decreto ministeriale 21 aprile 2000 - Gazzetta Ufficiale 25 maggio 2000, n. 120

L'art. 1 del decreto legislativo del 22 giugno 1999, n. 230, stabilisce che i detenuti e gli internati, al pari dei cittadini in stato di liberta', hanno diritto alla erogazione delle prestazioni di prevenzione, diagnosi, cura e riabilitazione previste nei livelli essenziali e uniformi di assistenza individuati nel piano sanitario nazionale, nei piani sanitari regionali e in quelli locali...

Kathleen Auerhahn, Elizabeth Dermody Leonard
# Docile Bodies. Chemical Restraints and the Female Inmate
J. Crim. L. & Criminology 599 (1999-2000)
The use of psychotropic medications as a means of controlling inmate populations is not a new phenomenon. Spieglman's 1976 study of medical and psychiatric care in prison documented the common practice of "chemical pacification" with Thorazine in a California prison... In Life Without Parole: Living in Prison Today, an insightful memoir, author Victor Hassine devotes a chapter to the practice of drugging inmates in both prisons and jails. Hassine asserts that the number of inmates "doing the brake-fluid shuffle" has risen in response to facility overcrowding...

Giuseppina Cersosimo, Raffaele Rauty
# Riflessioni sul controllo sociale: dalla normalità della devianza alla normalità della malattia
Kéiron, n. 5, dicembre 2000
Malattia, corpo, individuo e scienza sono i pilastri della medicina tecnico-scientifica. È concentrandosi sulle differenti manifestazioni del corpo al fine di identificarle, organizzarle in insiemi più vasti, reperirne i meccanismi e svelarne le diverse cause, che la medicina ha costruito il suo oggetto: la malattia. Il discorso medico, anche nella riduzione del tempo del rapporto (durante l'anamnesi) e nella estraneità progressiva verso il soggetto intero che gli sta davanti, finisce per essere spesso solo un discorso sulla malattia e non sull’uomo, il rapporto con uno stato, con una condizione e non con un essere: il malato sembra esserci solo come informatore di una condizione manchevole del corpo.

Alan Berkman
# Prison Health: The Breaking Point
American Journal of Public Health, December 1995, Vol. 85, No. 12
The buildup in the prison population has been accompanied by a systematic campaign to dehumanize those in prison. Politicians and  policymakers increasingly use terminology such as "animals" and "subhumans" to describe street criminals. The historic racial implication of this  language is widely understood but rarely challenged. The intended result is to demonize those in prison, implicitly relieving society of any obligation to supply decent living conditions or medical care.

Matthew DS Klein
# On Being a Doctor. "The Prison Patient"
www.acponline.org/ 1997

Frédéric Baillette
# Corps reclus, Corps torturés
Quasimodo – n° 2 (« Corps incarcérés »), janvier 1997, Montpellier, p. 33-46
Le corps pris au piège de l'espace disciplinaire est forcé de subir les impératifs de l'espace/temps pénitentiaire, à son corps dé-fendant. Il est par définition un corps contraint, un corps torturé qui doit endurer des pressions, des privations, des sévices. En effet, lorsqu'il est ainsi pris entre quatre murs, mis au secret, en -chaîné, parfois encagoulé, c'est bien souvent pour être « tourmenté », supplicié, torturé à mort. Le corps  ne devient plus alors qu'une chair meurtrie, un corps de souffrance sur lequel s'éprouve la lutte entre la résistance du torturé (sa conviction rivée au corps) et l'inventivité sadique du bourreau. Ces professionnels de l'ex-torsion de l'aveu ont ainsi développé un savoir tout particulier du corps humain, de ses points de faiblesses comme de ses résistances.

Her Mayesty's Inspectorate of Prisons - Her Majesty's Chief Inspector of Prisons, Sir David Ramsbotham
# Patients or Prisoner?
Home Office 1996

Consiglio d'Europa – Comitato europeo per la prevenzione della tortura e delle pene o trattamenti inumani o degradanti (CPT)
# Servizi di assistenza sanitaria in carcere - Estratto dal 3° Rapporto Generale del CPT, pubblicato il 1993
https://rm.coe.int/ CPT/Inf(93)12-part

Marcel E. Salive, Gordon S. Smith, T. Fordham Brewer
# Death in Prison: Changing Mortality Patterns among Male Prisoners in Maryland, 1979-87
Am J Public Health, 1990
The leading causes of death (rate per 100,000 prisoneryears) in Maryland state prisons for the period 1979-87 were circulatory system disease, suicide (40), and homicide and legal intervention (30). Acquired immunodeficiency syndrome (AIDS) became the leading cause of death in 1987. Homicides declined after 1980; drug overdose deaths peaked in 1981 and later disappeared. Male inmates have 39 percent lower all-cause death rates than the general population of Maryland after adjustment for age and race.

Richard Lichtenstein - Annette Rykwalder

# Licensed Physicians Who Work in Prisons: a Profile
Public Health Reports - November-December 1983

The population of 382 prison physicians comprised two major groups-those who worked in prisons full time and those who worked in them part time. Part-time physicians, who represented the majority of physicians involved in prison work (58 percent), were found to resemble closely the typical physician in the United States; they were predominantly trained in America, specialized, and board certified. In contrast, full-time prison physicians, who accounted for 73 percent of the total hours physicians spent working in prisons, differed significantly from the typical U.S. physician. They were older, less specialized, less likely to be board certified, and more likely to be graduates of non-U.S. medical schools.

Supreme Court of United States
# Estelle, Corrections Director, et al. v. Gamble
Argued October 5, 1976 | Decided November 30, 1976.
We therefore conclude that deliberate indifference to serious medical needs of prisoners constitutes the "unnecessary and wanton infliction of pain," Gregg v. Georgia, supra, at 173 (joint opinion), proscribed by the Eighth Amendment. This is true whether the indifference is manifested by prison doctors in their response to the prisoner's needs or by prison guards in intentionally denying or delaying access to medical 105*105 care or intentionally interfering with the treatment once prescribed. Regardess of how evidenced, deliberate indifference to a prisoner's serious illness or injury states a cause of action under § 1983.

World Medical Association WMA

# WMA Declaration of Tokyo - Guidelines for Physicians Concerning Torture and other Cruel, Inhuman or Degrading Treatment or Punishment in Relation to Detention and Imprisonment

Tokyo October 1975 - Divonne-les-Bains May 2005 and May 2006

The physicians shall not countenance, condone or partecipate in the practice of torture or other forms of cruel, inhuman or degrading procedures, whatever the offense of which the victim of such procedures is suspected, accused or guilty, and whatever the victim's beliefs or motivies, and in all situations, including armed conflict and civil strife.

Nicola Mead, Peter Bower
# Patient-centredness: a conceptual framework and review of the empirical literature
Social Science & Medicine 51 (2000)

Fausto Giunta
# Il consenso informato all'atto medico tra principi costituzionali e implicazioni penalistiche
Ann. Univ. Ferrara - Sc. giur. - Nuova serie . Vol. XIII (1999)

E. Emanuel - L. Emanuel
# Four models of the physician-patient relantionship
JAMA. 1992 Apr 22-29;267(16):2221-6.

Transgender

Alexander Schuster
# La rettificazione di sesso: criticità persistenti
www.forumcostituzionale.it/ 13 luglio 2017
1. Le «intervenute modificazioni» e la rettificazione di un dato dello stato civile – 2. Il processo di mutamento quale indizio – 3. Caratteri sessuali e identità di genere – 4. Patologizzazione e medicalizzazione – 5. La depatologizzazione medica – 6. L’intreccio patologia e diritto – 7. Da protocollo diagnostico a protocollo giuridico – 8. La medicalizzazione in Cass. 15138/2015 – 9. Sterilità e genitorialità – 10. L’impatto della medicalizzazione sull’accertamento giudiziario – 11. Un processo rispettoso dell’identità di genere: i caratteri sessuali – 12. La novella ‘processuale’ del 2011 e l’abbandono della doppia fase – 13. Conclusioni

Anna Lorenzetti
# Carcere e transessualità: la doppia reclusione delle persone transgeneri
www.articolo29.it/genius/ GenIUS. Rivista di studi giuridici sull’orientamento sessuale e l’identità di genere, 2017/1
1. Introduzione al tema – 2. Le criticità della condizione transgenere nel contesto carcerario: le prassi e le normative di riferimento – 2.1. La collocazione delle persone transessuali all’atto della reclusione – 2.2. La salute reclusa – 2.2.1. La complessità della condizione transgenere in carcere: la somministrazione di ormoni – 2.2.2. La variabilità nelle tutele durante la detenzione: le diverse fasi del percorso di transizione – 2.3. La persona transgenere come “disturbo” della vita carceraria – 3. Transessualità, detenzione e tutela della salute. 

Stephen B. Levine
# Reflections on the Legal Battles Over Prisoners with Gender Dysphoria
J Am Acad Psychiatry Law 44:236–45, 2016
The minority rights paradigm assumes that the treatment of Gender Dysphoria should primarily be determined by the patient’s wishes, because individuals have the right to express their gender as they see fit. Comorbidity and patient capacities matter little... The minority rights paradigm perceives trans inmates as similarly misunderstood, marginalized, diagnosed, stigmatized, and cruelly ignored or inappropriately delayed in their  medically necessary endocrine and surgical therapies. As a result, inmates are in need of a vigorous legal defense of their basic rights to self- expression and medical and surgical treatment to support that self- expression...

Cour Européenne des Droits de l'Homme - European Court of Human Rights