Intended for healthcare professionals

Rapid response to:

Feature Healthcare and Justice

The prison service is still failing inmates’ healthcare needs

BMJ 2020; 368 doi: (Published 26 February 2020) Cite this as: BMJ 2020;368:m724

Linked Commentary

Incarceration is dehumanising, but good healthcare can restore dignity

Linked Opinion

Why we should worry about prisoners missing hospital appointments

Rapid Response:

COVID-19: Fighting coronavirus infection outbreaks in prisons

Stephen Armstrong reported the poorer healthcare in prison.[1] Improving the health service in prison is important, and it is urgent during epidemics, especially the current COVID-19.

On 20th February 2020, a surge in confirmed more than 500 COVID-19 cases within five prisons ended 16 days of continuous declines in new cases in China excluding Hubei Province.[2] Over half of the cases were in Hubei, the epicentre of the epidemic, including 230 at Wuhan Women’s Prison and 41 at Shayang Hanjin Prison. 207 cases, including seven prison guards, were diagnosed at Rencheng Prison in Shandong, and a further 34 at Shilifen Prison in Zhejiang. Several officials have been sacked for mismanagement over the infections. As the largest recent clusters of infection, prisons are becoming the new battleground in China’s fight against COVID-19.

The spread of infectious diseases results from interactions between agents and hosts. Prisoners, particularly older prisoners, pregnant women, and juveniles, are at higher risk of infectious diseases than communities outside.[3] The highly infectious environment in prisons is fuelled by overcrowding, poor health services, high risk behaviours, security vs public health concerns and lack of public empathy for prisoners.[4]

More than 10 million people are incarcerated worldwide.[5] The UN Basic Principles for the Treatment of Prisoners states that prisoners “shall have access to the health services available in the country without discrimination on the grounds of their legal situation”.[6] However, due to burgeoning prison populations and increasing epidemics, prison healthcare services have become increasingly strained. In China, there were 1.65 million prisoners in September 2018.[5] The 2003 severe acute respiratory syndrome (SARS) epidemic was a catalyst to reform China’s health system. There are approximately 16 000 health workers work in the nation’s prisons [7], but this is still insufficient. Infectious diseases are responsible for around 17.5% of prison mortality. For example, the prison tuberculosis infection rate of about 1 250 / 1000 000 is 3.4 times China’s national average.

COVID-19 has been a Public Health Emergency of International Concern. It is vital to fight the cluster infection globally. In the UK, to stop the possible spread in prisons, two inmates in Oxfordshire, England, were tested for coronavirus on 11th February.

The eruption of COVID-19 in Chinese prisons highlights the need to address prison healthcare.[3] Although attention has been focussed on Hepatitis C (HCV), human immunodeficiency virus (HIV) and tuberculosis (TB) within prisons, urgent research is required on Emerging Infectious Diseases including COVID-19. Health education for both inmates and prison staff must be intensified whilst increased funding should be allocated to medical treatment and prevention measures. Prison overcrowding is a significant factor that contributes to the spread of diseases such as COVID-19. More non-custodial sentences would decongest prisons reducing the potential for the flare-ups recently witnessed in China. Linkages between prison health and national health services should also be further strengthened.

Competing interests: None declared.

*Hong Yang [1], Julian R. Thompson [2]

1 University of Reading, Reading RG6 6AB, UK; 2 UCL University College London, London, WC1E 6BT, UK

1. Armstrong S. The prison service is still failing inmates’ healthcare needs. BMJ 2020;368:m724. 10.1136/bmj.m724
2. China Central Government. Report of COVID-19 on 21 February 2020. 2020.
3. Fazel S, Baillargeon J. The health of prisoners. Lancet 2011;377(9769):956-65. 10.1016/S0140-6736(10)61053-7
4. Simooya OO. Infections in prison in low and middle income countries: prevalence and prevention strategies. Open Infect Dis 2010;4(1):33-37. 10.2174/1874279301004010033
5. Walmsley R. World prison population list (Twelfth Edition). 2018.
6. United Nations. Basic principles for the treatment of prisoners, Adopted and proclaimed by General Assembly resolution 45/111 of 14 December 1990. New York: United Nations, 1990.
7. Li Y. Progress of prisoner's life and sanitation in China. Res Crime Reforma 2014(1):57-59.

Competing interests: No competing interests

27 February 2020
Hong Yang
Julian R. Thompson
University of Reading
University of Reading, Whiteknights, Reading, RG6 6AB, UK