A new approach to prison public health? Challenging and advancing the agenda for prison health

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization's vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.     

The World Health Organization European Health in Prisons Project after 10 years: persistent barriers and achievements

The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country's public health services.However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network's fundamental aim of noticeable improvements in the health and care of prisoners is further achieved.     

Framework and methodology for evaluating mental health policy and plans

The importance of monitoring and evaluation for mental health service planning and delivery is indubitable. Notwithstanding, monitoring and evaluation of mental health policy and plans has received only limited attention. This paper presents an approach developed by the World Health Organization for monitoring mental health policy and plans that can be adapted and utilized for evaluation and monitoring of policy and plans in most other health spheres as well. Four critical areas are outlined i.e., evaluation of the policy document and the plan derived from it; monitoring the implementation of the strategic plan; evaluation of the implementation of the plan; and evaluation of whether the objectives of the policy have been achieved. Overcoming difficulties in objective assessment of policy documents and plans is discussed and two WHO checklists for evaluating the process, content and operational aspects of policies and plans are introduced together with a five step guidance process for conducting policy and plan evaluations. Copyright © 2010 John Wiley & Sons, Ltd.     

Improving public health by respecting autonomy: Using social science research to enfranchise vulnerable prison populations

It is widely recognised that prisoners constitute a vulnerable population that is subject to numerous health inequalities and merits special protection. Improving prisoners' access to healthcare by ensuring adherence to the principle of equivalence has been the main focus of efforts to ensure that their health is not jeopardised. However, another means of respecting prisoners' autonomy and improving their health is to involve them (and prison staff) in social science research within prisons. Such research not only produces valuable data which can be used to assess whether the principle of equivalence is being respected; it also enfranchises prisoners by allowing them to air concerns about perceived ill-treatment and influence their environment. If prison authorities enable such research and adjust policy accordingly, both they and prisoners will benefit from the increased level of respect for prisoners' autonomy, and the improvements in individual and public health that flow from this. Conducting social science research in prisons enables the creation of a virtuous cycle of respect that makes prisons safer and healthier places.     

The future of global health cooperation: designing a new World Health Organization

This article discusses some needed changes to the functioning and management of the World Health Organization (WHO). WHO is unable to meet new challenges and needs reform. The Executive Board of WHO initiated an internal review in 1992 that led to a management-related focus, while informal groups within the agency tackled funding constraints. Some governments and nongovernmental groups have proposed reorganization of international health assistance. The authors urge that the public health sector and researchers join the reform effort. WHO was established in 1948 and was the sole global health agency. The demand for greater international health cooperation has increased over time. WHO is an association of sovereign states. WHO demonstrated success in eliminating smallpox, promotion of health policy, collection and dissemination of epidemiologic information, and establishment of standards in health care and medical ethics. WHO staff comprises about 5000 persons. The annual budget is too small at about US$900 million. In 1995 only 56% of receipts were collected. WHO's constitution mandates complete health for all, but there has been a widening gap between rich and poor and those with access to health services and those without. Absolute and relative poverty are the main determinants of premature mortality and ill health. The major challenge for health policy is this disparity; the focus of international collaboration should be on this issue. The machine metaphor of organizational structure no longer works in today's world. The authors propose that WHO limit functions in health development and create a full mandate for dealing with determinants of health. WHO should be participatory, open to constituents, autonomous, and flexible. Member states must be more powerful in policy formulation. Program implementation should occur in independent programs in a decentralized system.     

Drugs, prisons, and harm reduction

The use of drugs in society raises important considerations for health and social policy. Critical health and social care issues arise when drugs are used inside prisons. This paper argues that there is an urgent need for prison drug policies to adopt the principles of harm reduction. However, current policy orthodoxy emphasises the control of drugs and punishment for drug taking. Key components of harm reduction are operationalised in this article by exploring the potential for harm reduction in prison within the context of English drug policy. Whilst the focus is on English policy debates, the discussion will have wider international resonance.     

The prison setting as a place of enforced residence, its mental health effects, and the mental healthcare implications

The subject of place is salient certainly when deliberating the health of prisoners as a social group. This paper provides an overview and assessment of health and place in relation to mental health and the prison locale. Particular attention is devoted to prison culture, both staff and inmate. The incarceration experience (i.e. the nature of enforced residence in the prison environment) can affect negatively prisoners' mental health. The mental health of the prison population is poor, and mental health services in the prison setting have need of further improvement. However, the provision of mental healthcare and the pursuit of good mental health in the prison milieu are challenging. The prison-based—exceedingly complex—three-way relationship between culture–mental and health–mental healthcare is debated.     

Smoking in prisons: the need for effective and acceptable interventions

Tobacco-smoking prevalence has been decreasing in many high-income countries, but not in prison. We provide a summary of recent data on smoking in prison (United States, Australia, and Europe), and discuss examples of implemented policies for responding to environmental tobacco smoke (ETS), their health, humanitarian, and ethical aspects. We gathered data through a systematic literature review, and added the authors' ongoing experience in the implementation of smoking policies outside and inside prisons in Australia and Europe. Detainees' smoking prevalence varies between 64 per cent and 91.8 per cent, and can be more than three times as high as in the general population. Few data are available on the prevalence of smoking in women detainees and staff. Policies vary greatly. Bans may either be 'total' or 'partial' (smoking allowed in cells or designated places). A comprehensive policy strategy to reduce ETS needs a harm minimization philosophy, and should include environmental restrictions, information, and support to detainees and staff for smoking cessation, and health staff training in smoking cessation.     

Assessment of process quality in Tanzanian primary care

Process quality is the commonly used operational definition of health care quality. Its key components are technical and inter-personal skills, but most assessments undertaken in developing countries focus only on technical skills. This study from Tanzania used explicit observation checklists to review the process of providing antenatal, curative and nursing care in primary health units, assessing both technical and inter-personal skills. The study findings emphasize the weaknesses in available care, particularly in the attitudes of health staff but also in aspects of technical care. Differences in performance between health units appear to be influenced by factors such as workloads, structure and staff allocations. Differences between cadres were also identified and may underlie some of the inter-unit differences. The policy actions required to address the problems must reflect the diversity of the underlying influences, seeking to raise both technical and inter-personal quality, as the two are mutually reinforcing.     

HIV prevention in prisons. Do international guidelines matter?

BACKGROUND: In spite of the availability of international guidelines, HIV prevention and management of care in prison is still unsatisfactory in many countries. Factors affecting the quality of HIV prevention policies in prison have not yet been elucidated. The present study had two aims: i) to assess national HIV prevention policies in prison in a selected group of countries; and ii) to determine which factors influenced such policies at the country level. METHODS: HIV prevention policies in prison were reviewed comparatively in Moldova, Hungary, Nizhnii Novgorod region of the Russian Federation, Switzerland and Italy. The review of HIV prevention policies in prison was conducted through interviews with government officials, non-governmental organizations, professionals involved in this field, and visits to selected prisons. Information on the health of prisoners, including tuberculosis, sexually transmitted diseases, and other infectious diseases has also been collected. RESULTS: The results indicated that all countries had adopted a policy, irrespective of the burden of HIV infection in the prison system. The content of the policy mirrored the philosophy and strategies of HIV prevention and care in the community. The 1993 WHO Guidelines were fully implemented only in one country out of four (Switzerland), and partially in two (Italy and Hungary). CONCLUSIONS: A greater effort aimed at dissemination of information, provision of technical know-how and material resources could be the answer to at least part of the problems identified. In addition, greater national and international efforts are needed to stimulate the debate and build consensus on harm reduction activities in prison.     

A critical examination of the health promoting prison two decades on

Two decades since the WHO Regional Office for Europe outlined and published a report on health promotion in prison, which stimulated further debate on the concept of the ‘health promoting prison’, this paper discusses the extent to which the concept has translated into practice and the extent to which success has been achieved. This paper primarily focuses on why there has been a gap between the strategic philosophy of health promotion in prison and practical implementation, suggesting that factors such as ‘lifestyle drift’ and public and political opinion have played a part. A further argument is made in relation to the overall commitment of European countries and more broadly WHO in their support of settings-based health promotion in this context. It is proposed that there has been a weakening of commitment over time with a worrying ‘negative trajectory’ of support for health promoting prisons. The paper argues that despite these challenges, the opportunities and potential to address the needs of those who are often most vulnerable and excluded is colossal and acting to tackle this should be a greater priority.     

An evaluation of two ethical seminars

The aims of two ethical seminars for prison staff are outlined and an evaluation of the impact on those attending is given. The possible future use of such seminars for prison staff and possibly for public health practitioners is mentioned.     

Mass vaccination response to a measles outbreak is not always possible. Lessons from a London prison

In this study, we describe a contained measles outbreak in a London prison, the second such outbreak in a custodial setting. Once vaccination commenced, just under a third of eligible prisoners were immunised due to a low uptake of the vaccine. We conducted a root-cause analysis in order to identify factors which may have prevented or altered the course of the outbreak. Our analysis revealed that many of the factors identified are those that cannot be easily changed. It is unlikely that mass vaccination at the time, even in the absence of some of the more easily rectifiable issues, could have fully avoided further cases in the event of a mass outbreak. Both measles outbreaks in a custodial setting started with a member of staff and immunisation status of the staff were largely unknown. We argue that mass vaccination following an outbreak in a prison is unlikely to fully prevent a mass outbreak, and that implementing opt-out testing, empirical vaccination and insisting on full immunisation of staff are most likely to both prevent and contain outbreaks in the future.Key words: Measles, measles outbreak, prison, mass vaccination

In July 2016, a contained measles outbreak occurred in a London prison with more than 1500 inmates, of which two-thirds were sentenced and one-third constituted new influx. This was the second case of a reported measles outbreak in a custodial setting in England. The previous outbreak occurred in a Yorkshire prison in 2013 [1]. In both outbreaks, the source of infection originated from a member of staff and there was low known immunity of prisoners as well as staff at the time. However, in terms of characteristics, there were striking differences between the two prison settings: The prison in London housed about seven times as many inmates as the Yorkshire prison and their makeup was significantly different. Average custodial stay in this London male prison was around 6 weeks at the time of the outbreak. The majority of prisoners were between 18 and 39, two-thirds were Caucasian, with men from Black Caribbean origin the second largest group at just under 10%. Nearly half of the prisoners were foreign nationals, while in the Yorkshire prison outbreak 91% of inmates were of White British origin. Data on country of origin available to us was not consistent as it came from collected ethnicity data. We do, however, know that ‘Other White’ made up the largest group of inmates at around 70% of those who were foreign nationals. Almost a quarter had diagnosed mental ill health in the London prison.In July 2016, Public Health England (PHE) confirmed two cases of measles amongst prison staff and declared it an outbreak. Transfers in and out of prisons were stopped and immunity of prisoners was assessed to be unknown for about 50% of the prison population. The risk was deemed to be confined to the segregation unit (n = 30), where the two staff members with measles worked. However, by day 6 of the outbreak, a further two cases (one probable, one possible) amongst staff had been identified and four possible cases amongst prisoners. At this point, a mass vaccination programme was decided and a National Health Service England (NHSE) IMMS01 response was employed. IMMS01 is the name of the commissioning response to outbreaks of vaccination preventable diseases in London only [2]. There is a rota of the NHSE (London) immunisation commissioners, which changes weekly with first and second on-call personal. The first on call commissioner is responsible for organising the acquirement of vaccine stocks and evoking a service provider response. This is done following an agreed protocol between PHE (London) and NHSE (London). A total of 1600 vaccines (Measles Mumps Rubella (MMR)) were ordered with the intention to vaccinate on Friday, and a check of pregnancy status in female vaccinees amongst prison staff was made (day 8). Vaccine supply was delayed coming from the manufacturer and no protocol currently exists with other institutions such as PHE to release some of their stock in the meantime in the case of a supply shortage. The prison healthcare service had a high vacancy rate amongst staff and there was a shortage of prison officers to accompany prisoners to vaccination. Due to the weekend and annual leave, it was difficult to organise vaccinators from the contracted NHS immunisation task force provider to proceed with vaccinations on day 8 as planned. Logistics of getting security clearance to enable community healthcare staff to enter the prison and lack officers to escort staff/prisoners within the establishment, alongside the lack of suitable infrastructure, conspired to make delivering mass vaccination difficult. Between days 8 and 14 a total of 4 nurses (who were sourced across the local community healthcare system) vaccinated 241 prisoners out of a possible 800 with unknown immunity status (30%). This contrasts with the Yorkshire prison, where over 90% of inmates were vaccinated. No further cases occurred. There was a high refusal rate among prisoners.We conducted an evaluation of the service response to the outbreak with the purpose to share learning and to develop a protocol for future reactive responses to prison outbreaks of vaccine preventable diseases. All healthcare service participants were interviewed as part of a root-cause analysis using standard tools [3] including the nurses who delivered the vaccinations, NHSE (London) commissioners of health and justice system, the head of the prison healthcare service, heads of service at the contracted NHS immunisation task force provider, the commissioners of the National Offender Management Service (NOMS), the on-call IMMS01 commissioners and the PHE health protection team. A thematic analysis was conducted to elicit the key points of learning. These are illustrated in detail in Figure 1. There were a number of issues which delayed or prevented mass vaccination, only some of which can be easily pre-empted for future outbreaks. For example, ensuring adequate training for potential vaccination staff or creating sharing protocols to enable a swift sourcing of vaccinations in case of shortage could have helped in recruiting vaccinators and securing vaccines more quickly. However, even with adequate number of vaccinators and timely vaccine supplies it was clear that any future reactive mass vaccination response would be hindered by ongoing staff shortages in the prison workforce (health and non-health) and the design of the physical environment which was not conducive to vaccination provision (i.e. prisoners needed to be accompanied to a room for vaccination where adequate cold chain and sharps disposals could be maintained. Rooms and staff were not readily available to enable this). A further obstacle was the high refusal rate amongst prisoners, something which may be addressed with education campaigns but is less likely to be sustainable due to the rapid turnover of the prison population. The rapid turnover will also make proactive vaccination programmes suggested by the World Health Organisation Health in Prisons Programme (WHO HIPP) [4] difficult and their cost effectiveness is unknown. A short programme of for example the measles vaccine offered over a period of weeks to prisoners may be less effective when there is high prison population churn. In addition, the challenges facing London prisons [5] may prohibit such pro-active vaccination initiatives at present. Open in a separate windowFig. 1.Fishbone diagram of factors contributing to the delay in delivery and low uptake of mass vaccination.Crick et al. [1] in their analysis of the outbreak in Yorkshire concluded that the outbreak would have been unlikely to have been stalled by mass vaccination of prisoners. It was recommended to have comprehensive documentation of the immune status of staff and prisoners. We concur with the authors and go further in our recommendations. We found that mass vaccination was difficult to implement. In the Yorkshire prison, the majority of prisoners born after 1987 had a vaccination status reported in a retrospective data gathering exercise. However, 91% of inmates were White British, while the population of inmates in London was to a large extend made up of foreign nationals where vaccination cannot assume to be as consistent as in the UK. In addition, the majority of inmates in Yorkshire were vaccinated following the outbreak, while in London only a minority consented to vaccination. Language barriers, differing understanding or knowledge, lower immunisation rates in countries of origin as well as the high number of prisoners with mental health problems may have contributed to this.Going forward, we suggest that since the measles outbreak in the London and Yorkshire prisons originated with prison staff, it is first important to ensure that all staff are vaccinated with MMR and have their annual influenza vaccine. Vaccination provision by Her Majesty''s Prison and Probation Service (HMPPS) occupational health service would help avoid potential future outbreaks being brought into prisons. Whilst not uncontroversial, one could argue that the proven immunisation status of prison staff should be part of the occupational health assessment at employment similar to health workers. Had infected staff been exposed to the entire prison as in Yorkshire and not predominantly the segregation unit, a mass outbreak may well have occurred. All adults born from 1970 onwards are entitled to the two doses of MMR for free on the NHS and this can be obtained through general practice. Influenza vaccine can also be received from participating pharmacies.Second, we would also argue that the only way to avoid mass outbreaks, in the long run, is to ensure recording of vaccination status and offer of a vaccine along with education during the admissions process for prisoners. There should be a reliable secondary assessment in prison settings to establish immunity and utilising the initial health assessment at reception or comprehensive second assessment following a first reception for identification and/or provision of opportunistic vaccinations. An opt-out approach to testing was shown to be highly effective and could be adopted to test for measles immunity [6].Finally, one could also conclude that instead of testing for immunity first in the event of an outbreak, a proactive vaccine could be given, saving time and resources. Whilst the London Region advocates for opportunistic vaccines during outbreaks, particularly in schools, this is not part of the Health Protection Team (HPT) plan at present, which tends towards treating the outbreak disease. It might be worth reviewing the opportunistic approach in the light of this outbreak.In summary, this was the second outbreak of measles in a custodial setting and both times the outbreak started with a member of staff. Our root-cause analysis revealed that many of the factors identified are those that cannot be easily changed, including challenges facing prisons such as inadequate infrastructure, staff shortages and a high turnover of inmates. A low immunisation rate and low uptake during mass vaccination are also factors that do not lend themselves to rapid correction. It is unlikely that mass vaccination at the time, even in the absence of some of the more easily rectifiable issues such as staff training, vaccinator availability and vaccine supply, could have fully avoided further cases in the event of a mass outbreak. A three pronged approach of ensuring full immunisation of prison staff, detailed recording, opt-out testing and/or empirical vaccination of prisoners as well as the offer of the opportunistic vaccine in the event of an outbreak may help prevent a mass outbreak in the future.     

Overview of research activities associated with the World Health Organization: results of a survey covering 2006/07

Background

This paper presents the first comprehensive effort to provide an overview of the research associated with the World Health Organization (WHO) headquarters in 2006/07.

Methods

Information was obtained by questionnaire and interviews with senior staff operating at WHO headquarters in Geneva. Research type, purpose and resources (both financial and staff) were defined and compared for each of the 37 departments identified and a comparative analysis was made with the global burden of disease as expressed by Disability Adjusted Life Years (DALY).

Results

Research expenditure in 2006/07 was estimated at US$215 million. WHO is involved in more than 60 research networks/partnerships and often WHO itself is the network host. Using the DALY model, 84% of the funding WHO allocates to research goes to DALY Type I diseases (communicable, maternal, perinatal and nutritional diseases) which represents 40% of DALY. 4% is allocated to Daly Type II (non-communicable diseases) which contributes to 48% of DALY. 45% of WHO permanent staff are involved with health research and the WHO's approach to research is predominantly focused on policy, advocacy, health systems and population based research. The Organization principally undertakes secondary research using published data and commissions others to conduct this work through contracts or research grants. This approach is broadly in line with the stated strategy of the Organization.

Conclusions

The difficulty in undertaking this survey highlights the complexity of obtaining an Organization-wide assessment of research activity in the absence of common standards for research classification, methods for priority setting and a mechanism across WHO, or within the governance of global health research more generally, for managing a research portfolio. This paper presents a strategic birds-eye view of the WHO research portfolio using methodologies that, with further development, may provide the strategic information required if there is to be balancing of research efforts between communicable disease, non-communicable disease and other pressing public health needs. As the rollout of the WHO strategy on research for health proceeds we would hope to see similar exercises undertaken at the WHO Regional Offices and in support of capacity building of national health research systems within Member States.     

Agricultural safety efforts by county health departments in Wisconsin.

OBJECTIVE: The authors sought to improve the agriculture safety prevention efforts of county health departments in Wisconsin by examining current programs, staffs'' perceptions of the farm safety problem, and the need for new resources. METHODS: A survey instrument was completed by a professional staff member of the local health department in each of Wisconsin''s 69 counties. RESULTS: Usable responses were obtained from 84% of the counties. Forty-five percent of the responding staff members conducted some agricultural safety and health programs, most often health screenings or group meetings conducted collaboratively with county agricultural Extension agents. There were no major differences in county demographics or other service provision variables between staff members who conducted programs and those who did not. Staff members perceived the largest barriers to better safety as lack of staff time and difficulty getting farmers to attend safety programs. Most failed to place more emphasis on training agricultural workers to permanently correct hazards than on training them to work safely around hazards. However, the staff members ranked safety inspection checklists as the most needed new material and ranked Extension agents and farmers as the most appropriate people to conduct inspections using such checklists. CONCLUSION: County public health professionals want more staff time and new materials to increase the effectiveness of their agricultural safety efforts. Encouraging agricultural workers and family members to identify and correct hazards would be a more effective use of staff time than training people to work safely around hazards.     

Knowledge and attitudes of prison staff towards HIV/AIDS: a European study

The goal of this European pilot study was to evaluate the knowledge, attitudes and beliefs of prison staff from five countries towards HIV infection and to identify factors related to the potential discrimination of HIV-positive inmates. The survey revealed that the levels of knowledge with regard to HIV transmission and the degrees of tolerance varied significantly between prisons. A large proportion of staff overestimated the prevalence of HIV in their prison and feared being contaminated. The willingness of the staff to know the inmates' HIV seropositive status was negatively correlated to their level of tolerance; however, it was positively correlated to their knowledge of the modes of HIV transmission. This study underlines the necessity to improve HIV/AIDS prevention policy for prison staff in order to strengthen good practice in terms of managing the risk of contamination and hindering discrimination.     

The prevention of tuberculosis in prison staff

The Joint Tuberculosis Committee of the British Thoracic Society (BTS) recommends that all new prison staff be screened for tuberculosis (TB) as 'at risk' health workers. This study of prisons in the West Midlands area of England shows that there are considerable variations in the practice of TB control amongst prison staff and that the recommendations of the BTS committee are not routinely implemented. The study highlights the need for a routine and robust system of TB surveillance and prevention amongst prison staff which can be applied nationwide.     

Ethics and values in prison practice

A small series of pilot seminars on ethics and values in prison practice have been held over the past two years. This article outlines the background, the content and the relevance to prison staff. It concludes that a full trial of the approach for both staff and prisoners would seem to be necessary and that the seminars should be tried with public health practitioners.     

Health needs assessment in a male prison in England

Objectives

To assess the health needs of prisoners in a male category B prison in Bristol, England, to identify areas for improving health in the prison.

Study design

Cross-sectional and qualitative.

Methods

Analysis of prisoners’ self-reported health needs at reception and at a secondary health screen; prisoners’ access to primary care, inpatients, mental health, sexual health and substance misuse services; and prescribed medications. Random selection of prisoners for interviews. Focus groups and interviews with staff and stakeholders.

Results

18 prisoners were interviewed (29% of those randomly selected), five focus groups were held with staff and stakeholders involved in health care provision in the prison and four interviews were held with staff and stakeholders. The areas of greatest health needs were identified as dental care, mental health and substance misuse. Prisoners and staff generally reported good access to most health care staff, provision of prescribed medication, bloodborne virus vaccination and treatment of substance misuse. Twenty nine recommendations were identified with five high-priority areas for improvement including an urgent review of dental services; stronger joint commissioning arrangements for health and social care; installing an integrated IT system; prevention of disease and health promotion; better use of the voluntary sector. A detailed action plan was developed to address all the recommendations and this has formed the basis of a programme of ongoing quality improvement work which is monitored by the Prison Partnership Board. Progress has been made against all key areas.

Conclusions

The mixed methodology which involved analysis of health data and talking to a wide group of stakeholders, including prisoners, helped triangulate the data. The process of undertaking the health needs assessment shifted the focus from ’health care’ to ’health’. This has facilitated a significant reframing of the concepts of ’health’ and ’health need’ with ongoing work now focused on the prison as a whole system, not merely on the provision of health care within the prison. Many improvements have already been made in response to the assessment.     

Alcohol and prisons: report of a workshop held by WHO HIPP at the Eurocare Bridging the Gap Conference, Helsinki, November 2006

A major European Alcohol Policy Conference, Bridging the Gap,was held in Helsinki, Finland from 20th to 22nd of November2006. The World Health Organisation Health in Prison Project(WHO HIPP)¹ convened a workshop on the subject of Alcohol inPrisons. The workshop was led by Dr Alex Gatherer, WHO HIPP;Dr Andrew Fraser, Director of Health and Care, Scottish PrisonService; Dr Lesley Graham, Public Health Specialist, ScottishPrison Service and Dr Heikki Vartiainen, Medical Director, PrisonHealth Services, Helsinki, Finland. Major strategic objectives of WHO HIPP were outlined, namely,to harmonize and integrate public health with prison healthand to promote international awareness and best practice. Arecent development in global public health thinking is the underpinningof human rights, and therefore the right to health, as a driverfor health development and health for all.