Over 10 million people are held in prisons worldwide. Prisoners have significant health needs, often including high levels of long-term physical and mental illness, blood-borne virus infections and substance misuse.

Older people, often with more complex health needs, are the fastest-growing group in the prison population in many countries; prisoners are relatively high users of both primary care and inpatient healthcare, and face long waits for assessment and treatment.

A stark fact is that the mortality rate for prisoners in England is 50% higher than that of the general population; with the average age of death being 56 compared with almost 81 years in England.

Generally, research into prison healthcare has tended to focus on specific problems, such as substance misuse, with less attention paid to the quality of ‘routine’ primary care.

A recent study led by Epidemiologist, Dr Tracey Farragher examined the quality of primary care in a sample of English prisons. Dr Farragher uses routine data to investigate public health and health inequalities, she said,

‘Concerted efforts are needed to move towards equivalence of healthcare and outcomes between incarcerated and community populations, as well as tackle inequalities in healthcare delivery amongst prisons.’

Significant areas of concern were identified, most notably decreasing antipsychotic monitoring and increasing opioid prescribing. Shorter lengths of stay in prisons were frequently associated with poorer outcomes, predominantly due to poor community links and reoffenders appear to ‘fall through the gaps’ in the system.

The study revealed that there is substantial scope for improvement and there are sizeable variations in quality, largely unaltered after adjustment for prison and prisoner characteristics. Prison healthcare faces challenges in providing a standard of care at least equivalent to that available in the wider community and neglecting the health needs of prisoners has negative consequences for both individuals and wider society.

This is just one example of how the Faculty of Biology, Medicine and Health are using our research around health service intervention, from policies to lab-based sciences, to demonstrate the impact on society more widely.

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