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In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

Health care practitioners in prison face the challenge of providing high standards of health care within the unique peculiarities and restraints of the prison environment. The strict adherence to principles of medical ethics by the prison health care staff and the knowledge and acceptance of these principles by the whole prison community not only results in ethical conduct but also yields practical professional advantages such as guidance in situations of conflict, promotion of confidence and avoidance of misunderstandings. The internationally consented conventions, declarations and recommendations relevant on medical ethics in prison are presented and their basic principles ‐ the primary task of the prison doctor, access to a doctor, equivalence of care, patient’s consent and confidentiality, preventive health care, humanitarian assistance, professional independence, professional competence ‐ are discussed. In addition, the personal obligation of the prison doctor for ethical reflection and decision making in individual ethical issues not covered by the quoted documents and in ethically controversial issues is emphasized. A training course and published guidelines for ethical conduct in prison health care are recommended.

Mental illness affects the majority of prisoners. Mental health issues are beginning to take a central position in the development of prison health services, reflecting this burden of disease. This change in focus is not before time. But prison mental health services cannot exist in isolation. Public health systems should lead provision of care for patients with acute and severe illness. A whole prison approach to health and, specifically, mental health will offer the greatest likelihood that offenders will thrive, benefit from imprisonment, and lead law‐abiding lives after release. Public awareness of the scale and commitment of prisons to mental health and illness, and understanding of prisons’ role in society, are necessary developments that would protect and enhance public mental health, as well as creating a healthier and safer society. This article draws on recent reviews, information and statements to set out a public health agenda for mental health in prisons.

In Kyrgyzstan the prevalence of injecting drug behaviour is among the highest found throughout the world. Health promotion training, improved health care and needle/syringe exchange (NSE) programmes have been shown to decrease risk behaviour among injecting drug users. In Kyrgyzstan, an intervention study with training of prison staff and prisoners was performed in one prison. Before and after the training, a random selection of the prisoners answered a questionnaire about drug use, risk behaviour and health care. The survey was carried out in both the intervention prison and in a reference prison. The number of drug users, the use of drugs and risk behaviour were improved significantly within half a year and, especially, the injection and use of drugs decreased in the intervention group. The study clearly shows that increased focus, improved healthcare and training of prisoners and staff on drug use and harm reduction can reduce both use of drugs and risk behaviour.

A cross‐section of 1980 US data on the prison population and its rate of inflow is examined. Regression analysis is used to investigate the impact of prison overcrowding, race, crime and unemployment on the above variables. Racial composition and overcrowding are found to have significant positive impacts on the numbers in prison and the rate of inflow. Unemployment does not have a significant influence, nor does the crime rate influence inflow, but it does have a significant positive correlation with the level of the prison population.

The purpose of this paper is to provide education on blood-borne viruses (BBVs) to prison staff to help reduce stigma within the prisons, improve the care prisoners receive and reduce the risk of occupational transmission.

An e-module was used to improve staff understanding of hepatitis B (HBV), hepatitis C (HCV) and HIV at a prison in Wales, UK. An assessment was used to gather data on prison staff understanding of BBVs prior to undertaking the e-module.

In total, 530/697 (76 per cent) prison staff completed the BBV e-module. Average pre- and post-course assessment scores were 8.6/11 and 10.85/11, respectively. Most staff understood the modes of hepatitis transmission, however, gaps in understanding were highlighted. In total, 22 per cent of staff believed HBV and HCV were airborne, 9 per cent believed transmission occurred through sharing cutlery. In total, 31 per cent of staff believed prisoners with hepatitis should declare their status to the prison.

The e-module significantly improved staff understanding of BBVs and should be incorporated into future prison training packages. Future education should include how BBVs are not transmitted with an emphasis on casual contact. Medical confidentiality in prisons should also be addressed. Improving understanding will help reduce the stigma of BBVs within prison and improve the multidisciplinary care the prisoner receives.

To the authors knowledge this is the first published evaluation of a BBV learning package for custodial staff. Evaluation of this educational package demonstrates a unique and valuable insight into the general understanding of BBVs by prison staff in Wales, UK.

From first contact with the police to release from prison, people with mental ill health who come into conflict with the law often find that their mental health needs are neglected while they are under the authority of the criminal justice system. In 2008, the Prison Reform Trust surveyed independent monitoring boards in England and Wales, asking them to comment on mental health care. Topics included the adequacy of court diversion schemes, assessments carried out in prison reception units, and preparations to ensure continuity of care upon release. The responses documented some of the consequences of neglect in prisons in England and Wales. Over half of the boards felt that they frequently saw prisoners who were too ill to be in prison. Boards also expressed concerns about assessment processes in prison reception areas, which were by no means adequate to identify mental health problems. A number of boards stated that, too often, people with severe mental illnesses are held in segregation units, where they endure an impoverished regime. The boards observed that many prisons lack any means of identifying people who have learning disabilities, and often their disabilities restrict their capacity to engage fully with the regime.

There were 89,708 prisoners in Indonesia in April 2006. The majority were charged for narcotics related crimes. Prisons are working at over‐capacity and with miniscule healthcare budgets. There has been an increase of deaths due to AIDS, particularly among people who inject drugs. Official data shows that HIV prevalence averages 22% in prisons. In late 2002, the Ministry of Justice (MOJ) decided to promote HIV/AIDS prevention and care activities for prisoners to prevent the spread of HIV within prisons, and from there to the community as a whole. In 2005, MOJ launched the Indonesian National Strategy for HIV/AIDS Prevention, Care and Support for Prisoners. The Indonesian HIV/AIDS Prevention and Care Project has been actively involved in the design of these programs and supported their implementation in several prisons, together with other organizations. The Indonesian National Strategy is the first of its kind in Asia, and one of only a few dedicated national strategies for HIV/AIDS prevention and care for prisoners. It has enabled education, as well as the provision of condoms, bleach, methadone and antiretroviral therapy for prisoners. This paper describes the National Strategy for HIV/AIDS Prevention, Care and Support for Prisoners, which will help control the HIVepidemic among people who inject drugs and ultimately be beneficial for the community as a whole.

The general theme for this conference is ‘prisons and public health’. Therefore, let me begin with an obvious, but often ignored point, by saying: the best tool for improved prison health is to reduce the prison population. Such a measure would also reduce crime, but I ignore that point here, and concentrate on health. Punishment is intended delivery of pain. Prisons represent a major instrument for the delivery of that pain. Those working in the prisons do much to alleviate pain, as beautifully illustrated by Alison Liebling (2004) in her book Prisons and their moral performance. In individual cases, prisoners might also profit from spending some time in prison.2 None the less, prisons are close relatives to capital punishment. Not the whole life, but parts, of a person’s life is taken. I have never been able to forget an elderly man I once met in the major prison in Oslo. ‘Spring is the worst’, he said. ‘Not because of the explosions in green pleasures outside, but because it was in spring that I was imprisoned. Each new spring is a reminder that one more year is lost. There are not so many left.’