This journal published an article on prison over-occupation and its impact on individual
and collective health in 2012
1
, and we have been asked to reflect on this issue eight years later. In 2012, there
were 10.2 million inmates/day worldwide
2
. This figure now stands at 11 million, although the growth in the number of inmates
has been very similar to the increase of the world population (3.7% vs. 3.0%, respectively
in the last 3 years)
3
and so it can reasonably be assumed that the prison population has remained stable
over this period.
The fact that prison over-occupation is unacceptable and negatively impacts health
is undeniable. One the one hand it is a breach of international prison standards
4
-
7
and is also: a) a hazard to inmates’ psychological and physical health; b) a public
health risk; c) an underlying cause of danger for prisoners and prison professionals;
and d) a breach of human rights, in which cruel and degrading treatment may be involved.
The number of references in the literature on how this phenomenon affects the psychological
and physical domains at individual, collective and environmental levels is immense.
The term “overcrowding” has been and continues to be widely used to refer to large
numbers of inmates in penitentiary spaces that do not have the space to house them.
However, this term is open-ended and lacks any clear consensus as to what it is exactly
and how it can be measured
8
. There is an increasing tendency therefore to use the term over-occupation, which
is more specific and measurable. In any case, there continues to be a certain degree
of conceptual confusion, and it is not uncommon to find that the incarceration rate
is used to indicate excess occupancy, which is really the rate of persons incarcerated
per 100,000 inhabitants, without making any reference to the space or its characteristics.
The level of prison occupation and the incarceration rate, or the crime rate, which
is another concept that is often used, are not similar concepts, although they are
sometimes indiscriminately and erroneously used. Spain for example has a crime rate
(rate of crimes and misdemeanours per 1,000 inhabitants) of 45.6
9
, which is considered to be a low one, and as a country it does not occupy a high
place in the European classifications for the main types of crime (homicide, rape
or robbery), and so it is regarded as one of the safest countries in Europe. However,
the rate of incarceration or imprisonment, which in 2019 was 111 in Catalonia and
128.5 in the rest of Spain
10
, is one of the highest in Europe and almost double that of other countries in northern
Europe, where the lowest rates are to be found. To measure prison occupation, the
Council of Europe recommends using the “density”; or rather, the ratio between the
number of inmates and the number of available places, expressed as the number of inmates
per 100 places available. When this yardstick is used, there are about one hundred
countries with prisons whose capacity is exceeded by more than 10%. There are more
than 20 countries with over-occupation that exceeds 200%, a few countries whose over-occupation
exceeds 400% or 500% and there is even one in the Republic of the Congo, which exceeds
600%
3
. Spain has an occupancy rate of 80%. It is important to point out that over-occupation
is not only a patrimony of poor countries. According to the SPACE report of 2020
11
, 15 European countries acknowledged that they had over-occupied prisons and 10 (8
of 10 member states of the European Union) defined the levels of over-occupation as
“severe”.
The increasingly common use of “density” as a unit of measurement of occupation enables
rates of occupation to be compared according to countries, geographical areas, socio-economic
levels, etc., although there are still debates about this issue or on particular features
that have yet to be agreed on. An example of this is the term “social density”, which
measures the number of persons per given area, per wing, and even per dormitory or
cell, and which may not positively or negatively coincide with the evaluation of global
density.
As regards the occupation of the cells, the Mandela Rules or the United Nations Standard
Minimum Rules for the Treatment of Prisoners
12
recommend individual cells, although a Spanish study
13
showed that 85% of inmates considered that sharing a cell with a fellow inmate could
have some positive aspects (company, makes imprisonment more bearable, less anxiety,
etc.), as well as the classic negative aspects (insecurity, lack of privacy, etc.).
There may also be other permanent or temporary reasons to justify exceptions to the
individual use of compartments, such as family reunification or a recommendation by
medical staff.
Neither is there a definitive consensus on the minimum space that a cell should have.
The European Prison Rules of the Council of Europe
5
give no specific requirements for minimum space, but there are other recommendations
that state that cells should have at least 5.4 square metres if they are individual
ones
6
, others that consider that they should not be less than seven square metres
14
while some that recommend that modern facilities should provide cells of at least
9-10 square metres
14
-
15
. In Spain, the European Convention for the Prevention of Torture and Inhuman or Degrading
Treatment or Punishment recently published a report on visits made to prisons in Catalonia
between 6 and 13 September 2018, which comments on the “good overall conditions of
detention, with cells of 10 m2 that are usually occupied by just one prisoner”
7
. The CPT had planned to extend its periodic visits to other Spanish closed prisons
in 2020, where the inmates’ living conditions are likely to be similar to those in
Catalonia.
The space and the number of inmates housed per cell is important, but there are also
other relevant factors that might have an influence on inmates’ level of health and
which have not been studied to any great extent. The general recommendation is that
inmates should spend at least 10 hours a day outside their dormitories or cells and
participate in activities (exercise, work, training, religious activities, library,
games, etc.), although other factors should also be taken into consideration, such
as the quality of life, provision of staff and the range of activities on offer
4
. Many of these factors may be limited by the socio-economic level of the prisons’
location.
A prison has rehabilitative functions, but alongside those it also serves the purpose
of detaining and holding in custody persons incarcerated as a result of legal rulings.
Inmates depend on the Administration, which should guarantee: a) adequate environmental
conditions, to the extent that imprisonment does not become hazardous for the inmate’s
life or health; and b) suitable structural conditions and human and material provisions.
Some of these, such as medical personnel, are clearly lacking at present; at least
in prisons managed by the Spanish Ministry of the Interior. The Administration has
the obligation to improve environmental conditions so as to prevent the loss of freedom
from also becoming a loss of health. To do so, it is essential to assign specific
economic resources that ensure that structural deficits are eliminated and that also
improve healthcare conditions for the prison population.