Themed Collection: UN Day 2023

October 24^th is UN Day. It marks the day in 1945 when United Nations officially came into being. The website notes that, ‘There is no other global organization with the legitimacy, convening power and normative impact of the United Nations’. Several organisations within the UN umbrella have used their influence to improve the health of those in detention. Therefore in this month’s them, WEPHREN is focusing on the work of the WHO & prisons & health. We hear from work done collaboratively with a national organisation, the UKHSA, and then more on the broader scope of the WHO Health in Prisons Programme’s work.

UK Health Security Agency and the World Health Organisation Health in Prisons Programme 

UKHSA remains committed to working in partnership with the WHO HIPP to improve the health of people in prisons across the whole of Europe. The recent UKHSA and WHO HIPP co-organised conference in June 2023 London 2023 Health in Prisons and Places of Detention International Conference, jointly organised by the UK Health Security Agency and the World Health Organization Regional Office for Europe: 'Making prisons and places of detention resilient to infectious diseases, including epidemic and pandemic threats' showcased the enthusiasm there is across member states to focus on improving the management of infectious diseases in prison and highlighted the wider community dividends that can be achieved from investing in this. Building on this UKHSA has been delighted to work with WHO HIPP on several key outputs in 2023 such as Prisons and other places of detention in pandemic preparedness plans across the WHO European Region in the context of the COVID-19 pandemic which highlights both best practice and also gaps in terms of the inclusion of prisons in pandemic preparedness plans. Disease outbreaks don’t respect international borders so it’s crucial all countries are supported to include prisons within their preparedness planning to protect both the health of those living and working inside prisons, but also wider international health security.

Working with the WHO HIPP team allows UKHSA to both share best practice and learn from other members states across Europe and is a core part of the UKHSA Health and Justice Team remit. Our ongoing collaborations through the WHO HIPP steering group and WHO HIPP representation within WEPHREN permits us the very best opportunities to foster ongoing international collaboration and knowledge exchange, which is widely valued across the whole of UKHSA.

Dr Chantal Edge, National Lead for Health and Justice, Health Equity and Inclusion Health Division, UK Health Security Agency 

Dr Chantal Edge is a Public Health Consultant and the National Lead for Health and Justice at the UK Health Security Agency (UKHSA). Here she is responsible for providing national leadership and guidance for health security issues and policy in English prisons and probation settings, immigration removal centres and the children and young people's secure estate. Chantal is an honorary clinical lecturer at UCL following completion of her PhD in prison health. She has given evidence in Welsh parliament related to women in prison, co-authored a SAGE report on COVID-19 in prisons, and is a member of the WHO Health in Prisons Steering Group.

WHO/Europe training course for prison health-care workers: prevention and management of infectious diseases in places of detention

UKHSA collaborates with World Health Organization Europe and SEICHE Centre for Health and Justice to bring guidance on infectious disease management to frontline staff in places of detention

This UN Day we celebrate the UN Charter and our Common Agenda across the globe, which is underpinned by global cooperation. This co-operation calls for inclusive, networked, and effective multilateralism to better respond and deliver for the people, ensuring we meet the Sustainable Development Goals. Our global response during the pandemic and our efforts to build back stronger communities has highlighted where we have strengths and challenges in this co-operation and where we need to focus our continued efforts to have resilient health systems against future threats.

One particular area for further development has been how we serve those who are in our detention settings. This year, the UK Health Security Agency (UKHSA) has collaborated with WHO Europe’s Health In Prison Programme and Yale University’s SEICHE Centre for Health and Justice to deliver a course on the Coursera platform for people who work in prisons to consider the principles of a resilient prison health system, how prisons contribute to health security, and the actions that individuals can take to influence improvements in the prevention and management of infectious diseases in places of detention.

The course looks at actions around prevention, preparation, detection, response and building connections with the wider public health systems in country. Expert speakers from around the globe gathered in June 2023 at the WHO Europe/UKHSA Conference in London and are featured throughout this free course to provide learners with different perspectives and case studies of promising practice.

Lead developer of the course, Sunita Sturup-Toft, Global Public Health Consultant in UKHSA, said, “In my experience of working in prisons, and more recently in low resourced countries, I cannot emphasize enough the importance of investing in the workforce and enabling opportunities for professional development. This course focuses on frontline practitioners, bringing policy briefings into practice so that we can improve the health status of people in prison and keep our countries safe and healthy.”

For more information about the course and to register your interest, please click here! 

Mrs Sunita Stürup-Toft, Global Operations, UK Health Security Agency. Sunita.sturup-toft@ukhsa.gov.uk

Sunita is a global public health specialist with an interest in working with marginalized populations, including people in prison. Working with the WHO HIPP for the last 8 years, Sunita has contributed to various parts of the programme, including most recently the WHO Framework for assessing prison health system performance and e-learning resources for frontline staff. Currently, Sunita is working with the UK Overseas Territories, a group of small island states with challenges around resources and capacity, to strengthen compliance with the International Health Regulations and public health approaches to improve health outcomes for people in prison and other vulnerable groups. 

The World Health Organisation 

To celebrate this day, and reaffirm the principles of the UN charter, we would like to reflect on the extent to which UN and its agencies have been able to move progress towards achieving the sustainable development goals (SDGs). The World Health Organization (WHO) is a specialized UN agency responsible for international public health. WHO is organized into headquarters (with a global and mostly normative function) and six regional offices (more focused on regional needs and direct country support). The Thirteenth General Programme of Work (GPW 13) defines WHO’s strategy for the five-year period, 2019-2023 and focuses on triple billion targets to achieve measurable impacts on people’s health at the country level: to have one billion more people benefiting from universal health coverage; one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being. Access to health is a Human Right, and therefore efforts should be made to ensure all citizens are included and that no one is left behind. Being deprived of liberty should be enough punishment and no human being deserves to also be deprived of healthcare, as recognized by the Universal Declaration of Human Rights. When a state deprives people of their liberty it has a special duty to care for their health. In the resolution A/RES/70/175, the scope of Nelson Mandela Rules was expanded in order to promote humane conditions of imprisonment and to raise awareness about people living in prisons being a continuous part of society.

Nelson Mandela stated that “It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones”. 

The United Nations’ 17 Sustainable Development Goals (SDG) aim to achieve decent lives for all on a healthy planet by 2030, including the 11 million people held in detention on a global scale. In 1995, the WHO Regional Office for Europe created the Health In Prisons Programme (WHO-HIPP), whose primary goal is to improve the health of people deprived of liberty. WHO-HIPP is primarily focused on SDG 3 and SDG 10, but it has been argued that improving the health of people in prison can contribute to achieving 15 SDGs (1). Over these past 28 years, WHO-HIPP has worked on various topics and developed several actions to meet its primary goal. The mission, vision and pillars driving action have been established (WHO Health in Prisons fact sheet) and the current action plan summarizes some of the most recent ones, whilst presenting its five strategic goals and identifying priorities for action in the future (WHO Action Plan).

WHO-HIPP works closely with other UN and European agencies, including UNODC and EMCDDA, on drug-related issues and has focused some attention on this issue as people detained for drug-related offenses represent an important proportion. Although criminal law varies widely across the world, it has been commonly agreed by the United Nations that whenever the offenses and the context justify it, alternative means of incarceration and rehabilitation should be promoted considering that certain disorders frequently treated as crimes can be more effectively be tackled through a public health approach (4). We have also worked to raise awareness about this issue working with people with lived experience (5).

Over the course of 2022 we have focused our attention on noncommunicable diseases (NCDs) and have developed policy briefs (6), technical documents highlighting inequalities in service provision (7) and train-the-trainers courses to better equip the workforce to deal with NCDs and develop strategies aligned with international approaches tailored to the detention context (8).

Access to preventive services may be conditioned in certain circumstances or areas of the globe, which has led WHO-HIPP to also work with Penal Reform International and UNODC to advocate for equal access to effective technologies such as vaccines for all people living and working in detention (9).

Over the course of 2023, WHO-HIPP has been focusing on communicable diseases, working jointly with the United Kingdom Health Security Agency, to stress the relevance of considering prisons when developing pandemic preparedness plans at national level (10). In June, an international conference was held in London bringing together worldwide experts to discuss and update their knowledge around this topic (11). Recently, an e-learning course developed also jointly with SEICHE Center for Health and Justice of Yale University (12), has become openly available through the Coursera platform to provide healthcare professionals with the knowledge and skills to protect people deprived of liberty and surrounding communities from epidemic and pandemic threats (13).  More focused approaches to harm minimization (14) or to the development of resilient prison health systems (15) have been highlighted through case studies portraying good practice examples and that may modify in the future the current Status of Prison Health in the WHO European Region (16). Transparency is key to the development of evidence-based policies across all sectors and aiming to contribute to this aim, WHO-HIPP has also made its data publicly available, aiming to foster further research (17).

There is still much more that needs to be done before we can say we have reached universal health coverage and that all people deprived of liberty in the WHO European Region have their health needs appropriately addressed. We will keep working to achieve this aim, so keep visiting WHO-HIPP’s website to see our upcoming resources that may support the workforce, researchers and policymakers in the region- Prisons and health EURO (who.int).

Filipa Alves da Costa, WHO Regional Office for Europe, Health in Prisons Programme, azevedof@who.int

Specialist in public health and health policy, working for the Alcohol, Illicit Drugs & Prison Health Programme, at WHO Regional Office for Europe since 2020. Most of her work focuses on prison health information systems and using data to inform policy and practice change. She led the development of a surveillance system for COVID-19 in detention settings, triggering response at country level; and the WHO prison framework to evaluate performance of prison health systems, used to support periodic evaluations feeding into the Health In Prisons European Database and ad-hoc evaluations in Eastern Europe and Central Asia countries.