Are we neglecting the well-being of prisoners?
The five suicides in Hong Kong's jails over eight months and the subsequent inquest into the deaths - in which the jury made a number of recommendations to try to prevent similar events in future - provide a good opportunity to look at the issue of health in prisons.
The report of the inaugural International Conference on Healthy Prisons, held over a decade ago, already found that prisons in most countries failed to promote good health. A lack of privacy, stress, reduced opportunities for social support, hygiene issues and overcrowding all have a negative impact on a person's health. Then there are problems associated with a prisoner's mental health, and a previously unhealthy lifestyle that could have included smoking, drug abuse and alcohol dependence.
A high proportion of prisoners who commit suicide have a history of psychiatric problems, with a history of inpatient admissions.
To tackle these problems, some European countries have started a programme of health promotion in prisons, with the focus on a supportive environment and directing resources towards improving prisoners' practical skills and life skills.
Emphasis is also placed on creating a balance between the need for care and the need for control that does not prevent prisoners or prison staff from pursuing opportunities for health, and making sure that links are developed and maintained with the community outside the prison, to reduce the trauma of the transition from jail to freedom, and vice versa.
The maintenance of high standards of physical, occupational and mental health of prison staff is also key to a successful healthy prison environment.
Of course, conditions in Hong Kong prisons may not be identical to those in other jurisdictions, and we must look into the problems faced by our local prisons. While the Correctional Services Department is following up the recommendations made by the jury at the inquest, there are big advantages to enlarging the scope of the review.
A working group should be established to find out the major health problems in local prisons, estimate the resources needed to improve conditions and set out the priorities in order to improve and protect the health of prisoners and staff.
There must be equal opportunities for health, access to health care and health promotion for all citizens, and that includes prisoners. The vision of a healthy prison is not a dream but can be readily realised if the government and the community work together to promote the health of our prison population.
Lee Shiu-hung is emeritus professor of community medicine at the Chinese University of Hong Kong
