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Expert Perspectives on Western European Prison Health Services: Do Ageing Prisoners Receive Equivalent Care?


Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

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  1. American Civil Liberties Union. 2012. At America’s expense: The mass incarceration of the elderly. June 13. Accessed April 30, 2014.

  2. Charles, A., and H. Draper. 2012. “Equivalence of care” in prison medicine: Is equivalence of process the right measure of equity? Journal of Medical Ethics 38(4): 215–218.

    Article  PubMed  Google Scholar 

  3. Council of Europe, Committee of Ministers. 1998. Recommendation No. R (98) 7 of the Committee of Ministers to Member States concerning the ethical and organisational aspects of health care in prison. Accessed April 30, 2014.

  4. Council of Europe, European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. 2013. CPT standards. Strasbourg: Council of Europe. Accessed April 30, 2014.

  5. Curran, N. 2000. Blue hairs in the bighouse: The rise in the elderly inmate population, its effect on the overcrowding dilemma and solutions to correct it. New England Journal on Criminal and Civil Confinement 26: 225–264.

    Google Scholar 

  6. Dawes, J. 2009. Ageing prisoners: Issues for social work. Australian Social Work 62(2): 258–271.

    Article  Google Scholar 

  7. Department of Health, HM Prison Service. 2004. 22. Health services for prisoners. Accessed April 30, 2014.

  8. Elger, B.S. 2008a. Medical ethics in correctional healthcare: An international comparison of guidelines. The Journal of Clinical Ethics 19(3): 234–248.

    PubMed  Google Scholar 

  9. Elger, B.S. 2008b. Towards equivalent health care of prisoners: European soft law and public health policy in Geneva. Journal of Public Health Policy 29(2): 192–206.

    Article  PubMed  Google Scholar 

  10. Elger, B.S. 2011. Prison medicine, public health policy and ethics: The Geneva experience. Swiss Medical Weekly 141: w13273. doi:10.4414/smw.2011.13273.

    CAS  PubMed  Google Scholar 

  11. Exworthy, T., S. Wilson, and A. Forrester. 2011. Beyond equivalence: Prisoners’ right to health. The Psychiatrist 35(6): 201–202.

    Article  Google Scholar 

  12. Fazel, S., T. Hope, I. O’Donnell, M. Piper, and R. Jacoby. 2001. Health of elderly male prisoners: Worse than the general population, worse than younger prisoners. Age and Ageing 30(5): 403–407.

    CAS  Article  PubMed  Google Scholar 

  13. Handtke, V., W. Bretschneider, T. Wangmo, and B.S. Elger. 2012. Facing the challenges of an increasingly ageing prison population in Switzerland: In search of ethically acceptable solutions. Bioethica Forum 5(4): 134–141.

    Google Scholar 

  14. Hayes, A.J., and J. Shaw. 2011. Practice into policy: The needs of elderly prisoners in England and Wales. Prison Service Journal, no. 194: 38–44.

  15. HM Chief Inspector of Prisons for England and Wales. 2004. “No problems—old and quiet”: Older prisoners in England and Wales: A thematic review. Accessed November 29, 2013.

  16. HM Chief Inspector of Prisons for England and Wales. 2012. Annual report 2011–12. Norwich: The Stationery Office Limited.

  17. Hill, T., B. Williams, G. Cobe, and K. Lindquist. 2006. Aging inmates: Challenges for healthcare and custody: A report for the California Department of Corrections and Rehabilitation. San Francisco: Lumetra.

  18. Howse, K. 2003. Growing old in prison: A scoping study on older prisoners. London: Prison Reform Trust. Accessed April 30, 2014.

  19. Human Rights Watch. 2012. Old behind bars. The aging prison population in the United States. New York: Human Rights Watch.

  20. Jotterand, F., and T. Wangmo. 2014. The principle of equivalence reconsidered: Assessing the relevance of the principle of equivalence in prison medicine. American Journal of Bioethics. (in press)

  21. Kingston, P., N. Le Mesurier, G. Yorston, S. Wardle, and L. Heath. 2011. Psychiatric morbidity in older prisoners: Unrecognized and undertreated. International Psychogeriatrics 23(8): 1354–1360.

    Article  PubMed  Google Scholar 

  22. Lines, R. 2006. From equivalence of standards to equivalence of objectives: The entitlement of prisoners to health care standards higher than those outside prisons. International Journal of Prisoner Health 2(4): 269–280.

    Article  Google Scholar 

  23. Maschi, T., J. Kwak, E. Ko, and M.B. Morrissey. 2012. Forget me not: Dementia in prison. The Gerontologist 52(4): 441–451.

    Article  PubMed  Google Scholar 

  24. Mitka, M. 2004. Aging prisoners stressing health care system. The Journal of the American Medical Association 292(4): 423–424.

    CAS  Article  Google Scholar 

  25. Morton, J.B. 2001. Implications for corrections of an aging prison population. Corrections Management Quarterly 5(1): 78–88.

    Google Scholar 

  26. Niveau, G. 2007. Relevance and limits of the principle of “equivalence of care” in prison medicine. Journal of Medical Ethics 33(10): 610–613.

    PubMed Central  Article  PubMed  Google Scholar 

  27. Swiss Association of Medical Sciences (SAMS). 2013. Medical practice in respect of detained persons. Basel: Swiss Association of Medical Sciences. Accessed April 30, 2014.

  28. Tarbuck, A. 2001. Health of elderly prisoners. Age and Ageing 30(5): 369–370.

    CAS  Article  PubMed  Google Scholar 

  29. Turner, S., and C. Trotter. 2010. Growing old in prison? A review of national and international research on ageing offenders. Melbourne: State of Victoria Department of Justice.

  30. United Nations. 1982. Principles of medical ethics relevant to the role of health personnel, particularly physicians, in the protection of prisoners and detainees against torture and other cruel, inhuman or degrading treatment or punishment. Accessed April 30, 2014.

  31. Wilson, S. 2004. The principle of equivalence and the future of mental health care in prisons. The British Journal of Psychiatry 184(1): 5–7.

    Article  PubMed  Google Scholar 

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We express our gratitude to all study participants who shared their knowledge and devoted time and energy to this study. Additionally, we highly appreciate the support provided by our study collaborators and research team members, particularly V. Handtke, T. Wangmo, and C. Ritter, who contributed to data collection. We thank V. Handtke and T. Wangmo also for their help with data analysis.

Funding Support

This paper is based on data gathered as part of the research project “Agequake in Prisons: Reality, Policies, and Practical Solutions Concerning Custody and Health Care for Ageing Prisoners in Switzerland,” funded by the Swiss National Science Foundation (SNSF).

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Correspondence to Wiebke Bretschneider.

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Bretschneider, W., Elger, B.S. Expert Perspectives on Western European Prison Health Services: Do Ageing Prisoners Receive Equivalent Care?. Bioethical Inquiry 11, 319–332 (2014).

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  • Ageing
  • Prisoners
  • Equivalence
  • Experts
  • Qualitative research