Improving the quality of formal and informal education should be one of the justice system's priorities to change the justice space, particularly the penitentiary, from a punishment environment to a learning one. More than 1.5 million people in the European Region live incarcerated daily. One-fifth are women, many coming from marginalized populations.
The judicial institution is often the place of first contact with preventive health services, thus making prisons a unique place to improve universal health coverage. In addition, an educated prison population would help improve prison care, as those detained are more vulnerable to health risks than the general population. Additionally, risk factors for incarceration, like lack of income and social protection, low education, job insecurity, unfavourable working conditions, food insecurity, and subpar housing, can exacerbate health risks in detention facilities.
The educational activities in the area of justice should abide by the same components of excellence and quality assurance for the general public: institutional capacity (logistic endowment, managerial capacity, human resources, administrative capacity), educational effectiveness (the content of the programs, results, research activities, budget management) and quality management (strategies and procedures for quality assurance, procedures for the design, monitoring, and review of study programs and activities, accessibility of learning resources, transparency, etc.).
Our proposal addresses all these components through an evidence-based approach to program development and adapting a pre-existent successful model by a multinational team of experts.
Most current health education programs in the justice system address the general incarcerated population without being gender specific and failing to solve the instructional needs of those involved in the justice space.
Women in the justice system need tailored health education programs that address gender-specific topics such as cervical and breast cancer prevention and screening, sexually transmitted diseases, and family planning. In addition, this instruction should be adequate to address their level of health literacy, evidence-based on proven strategies for its content, production value and delivery, adequate for a penitentiary environment to promote the engagement of learners with the instructional content and include process and impact metrics for accountability.
Improvements in inmates' education in these high-interest and impact health topics will contribute to more effective social reintegration and improvement in their quality of life before and after release.
Maintaining the best health and well-being of people in prisons can benefit everyone, making communities safer and decreasing the healthcare costs. With this aim, our project proposes a new Health Education Framework focused on women to standardize the assessment of needs and develop more specific health programs.
According to Eurostat, in 2020 there were 104 prisoners per 100,000 persons in the EU, or about 463,700. Of the adult population of prisoners, 5.3%, or about 24,000, were women. WHO estimates that about 100,000 women are in prison in Europe on any given day. Although, overall, the number of prisoners at the EU level has decreased in 2020 compared to 2021, Romania and Greece are two of the only three EU countries who have seen the numbers of prisoners going up. Romania has 23160 prisoners in 2023 of which 2,28% are women (1013 of which 231 in Gherla prison).
Although the share of women in prison varies among EU member states, Finland is one of the countries with the highest share (ranked second with 8.1% after Latvia with 8.3%). Women incarcerations has shown an ascendent trend in the EU over the last decade (Annex 2). Women prisoners often come from marginalized and underserved populations, have low literacy, have a history of drug use and violence, increased tobacco use, and are at high risk for transmissible diseases and cancer.
A recent report by the WHO more research data is needed to understand what kind of healthcare programs and practices are needed and are the most effective in addressing preventive practices and in eliminating health inequities.
According to Dr Filipa Alves da Costa, a public health specialist working in the health in prisons program at the WHO European Office for the Prevention and Control of NCDs, “another success factor is health education program. In prisons, they can improve screening rates and health literacy among people with low socioeconomic status.” (Reference: Protecting prisoners from cancer: new WHO report explains how to fight health inequities).
Women prisoners have more specific health needs than male prisoners and often place a higher demand on prison health services (Reference: https://www.scielosp.org/pdf/bwho/v89n9/a16v89n9.pdf ).
A lack of health-related education, and low health literacy are contributing factors. In Gherla penitentiary in the last 3 months there have been 400 requests for consultations from the 231 women inmates just to request health information which puts a lot of pressure on the 15 medical staff who ensure medicalassistance for the entire prison (931 inmates) and this situation is happening in all 44 prisons in Romania.
Health education programs in prison are often inadequate, poorly implemented, or those developed fail to fully address the needs of the population of women prisoners. There is an acute need to improve these programs. Our team proposes an evidence-based, multi- centric, community-grounded, stakeholder-driven solution to this problem.
Co-funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.