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The health of prisoners is among the poorest of any population group and the apparent inequalities pose both a challenge and an opportunity for country health systems. The high rates of imprisonment in many countries, the resulting overcrowding, characteristics of prison populations and the disproportionate prevalence of health problems in prison should make prison health a matter of public health importance.Women prisoners constitute a minority within all prison systems and their special health needs are frequently neglected. The urgent need to review current services is clear from research, expert opinion and experience from countries worldwide. Current provision of health care to imprisoned women fails to meet their needs and is, in too many cases, far short of what is required by human rights and international recommendations. The evidence includes a lack of gender sensitivity in policies and practices in prisons, violations of women's human rights and failure to accept that imprisoned women have more and different health-care needs compared with male prisoners, often related to reproductive health issues, mental health problems, drug dependencies and histories of violence and abuse. Additional needs stem from their frequent status as a mother and usually the primary carer for her children.National governments, policy-makers and prison management need to address gender insensitivity and social injustice in prisons. There are immediate steps which could be taken to deal with public health neglect, abuses of human rights and failures in gender sensitivity.

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Предлагаемые в настоящем документе перечни контрольных вопросов являются важным инструментом, способствующим повышению качества и безопасности медико-санитарной помощи женщинам в местах лишения свободы, и разработаны в качестве подспорья для анализа и оценки действующей политики и практики в области охраны здоровья женщин, находящихся в заключении, Эти контрольные перечни составлены на базе совместной Декларации Европейского регионального бюро ВОЗ и Управления ООН по наркотикам и преступности (Киевской декларации) «Охрана здоровья женщин в местах лишения свободы. Устранить несправедливость на гендерной почве в области здравоохранения в местах лишения свободы» и вошедшего в ее состав справочно-аналитического документа, опубликованного в апреле 2009 г.. Несмотря на то, что главным образом эти контрольные перечни адресованы тем, кто принимает решения и формирует политику в этой сфере, а также администрациям и медицинскому персоналу пенитенциарных учреждений, между собой они очень тесно связаны. Они могут быть полезны также организациям гражданского общества, которые занимаются этими вопросами или осуществляют мониторинг ситуации, касающейся положения женщин и охраны их здоровья в местах лишения свободы.

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The checklists in this document are an important tool in ensuring greater safety and better quality medical care for women in prison, and are designed to assist a review of current policies and practices relating to women’s health in prisons. They follow from the Declaration on women’s health in prison: correcting gender inequity in prison health and a background paper on women’s health in prison, published in April 2009 by the World Health Organization Regional Office for Europe and the United Nations Office on Drugs and Crime, and are therefore based on the evidence presented. While the checklists are aimed primarily at decision- and policy-makers, senior prison managers and prison health staff, there are important interconnections between them. They can also be useful for civil society organizations working on or monitoring the situation of women and their health in prison settings.

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The work of the WHO Health and Prisons Project over the last 15 years has demonstrated the importance of health as a key area in managing the prison setting effectively, to the benefit of both prisoners and society in general. This briefing paper for Network Members provides a brief examination of rationale for, and experience of, integrating prison health services with public health services, and moving health care for prisoners out of the jurisdiction of the Ministry of Justice and into the Ministry of Health.

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The work of the WHO Health and Prisons Project over the last 15 years has demonstrated the importance of health as a key area in managing the prison setting effectively, to the benefit of both prisoners and society in general. This briefing paper for Network Members provides a brief examination of rationale for, and experience of, integrating prison health services with public health services, and moving health care for prisoners out of the jurisdiction of the Ministry of Justice and into the Ministry of Health.

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Based on the experience of many countries in the WHO European Region and the advice of experts, this guide outlines some of the steps prison systems should take to reduce the public health risks from compulsory detention in often unhealthy situations, to care for prisoners in need and to promote the health of prisoners and prison staff. This requires that everyone working in prisons understand how imprisonment affects health, what prisoners’ health needs are and how evidence-based health services can be provided for everyone needing treatment, care and prevention in prison. Other essential elements are being aware of and accepting internationally recommended standards for prison health; providing professional care with the same adherence to professional ethics as in other health services; and, while seeing individual needs as the central feature of the care provided, promoting a whole-prison approach to care and promoting the health and well-being of people in custody.

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The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country's public health services.However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network's fundamental aim of noticeable improvements in the health and care of prisoners is further achieved.

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