The prison health staff have the further responsibility to ensure that the prison environment in respect to hygiene, sanitation, water supply, lighting and ventilation, as well as the food, are not detrimental to the health of the detainees. As such they must routinely inspect the premises, in particular the sanitary facilities, and the food, including the kitchens, and make any necessary recommendations for improvement to the prison administration.
Numerous factors in prisons contribute to a higher prevalence and a greater incidence (new cases) of certain diseases and health problems. The prison population includes many vulnerable groups including victims of physical and sexual abuse, injecting drug users, alcohol dependency, and the mentally ill. Coupled with conditions of detention which can include overcrowding, poor hygiene, sanitation and ventilation, poor nutrition, inter-detainee violence and at risk behaviour such as injecting drugs, tattooing and also sexual contacts, diseases such as HIV, Hepatitis B and C, Sexually transmitted infections and Tuberculosis are more common in prisons. Many of these factors can also contribute to an increase number of cases of mental illness, and to acts of self-harm and suicide, particularly in new admissions who are particularly vulnerable.
The healthcare services, together with the prison administration and the Ministry of Health, have a responsibility to ensure that in particular national programs against tuberculosis and HIV-AIDS are included in prison health. In situations where Tuberculosis is recognised as a problem, the health staff may need to conduct active case finding, in which they directly screen the prison population and staff so as to identify, medically isolate and treat cases of TB. Education and information campaigns will also need to be conducted to increase the detainees, as well as prison staff awareness of the risks and of the availability of treatment.
The spread of HIV within the prison population requires specific action, and yet in many countries there is little attention paid to the issue. Countries must implement the comprehensive package of interventions for prison recommended by the UN and WHO, including access to voluntary testing, needle and syringe exchange, provision of condoms, drug dependency treatments etc.
In line with a public health approach to prisons, the health staff must also ensure that policies and programs for the protection and promotion of mental and physical health are included in the prisons. For example programs to improve attitudes to nutrition and exercise, for stopping smoking, anti-bullying, identifying and treating victims of physical and psychological violence, including sexual and domestic violence.
If it does not exist, the prison service should establish a health information system for the collection of epidemiological data on health in prisons. The basis for the system is the maintenance of individual medical files together with the routine collection of health data such as the types and the number of cases of specific diseases, any deaths in custody, and a record of the types and quantities of medicines prescribed. The data should be compiled in the same format as national epidemiological data collection and can be used to assist in health budget calculation and the maintenance of a central and prison level pharmacy stock.