Smoking, prisons and human rights Translated title: Tabaquismo, centros penitenciarios y derechos humanos

Abstract

The smoking pandemic is an international health problem that affects approximately 1.3 billion people according to the World Health Organisation (WHO). It is a pandemic that we ourselves have created, and it has led to devastating medical, social, economic and environmental consequences, while also placing obstacles in the path of sustainable development. Smoking is defined as a chronic, addictive and relapsing disease, which generates other chronic diseases, some of which are considered to be primary causes of mortality. Tobacco is a psychoactive substance that is addictive and conflictive, and which causes direct, cultural and structural violence. It is the cause of premature death for about 8 million people a year, 60,000 of whom are Spanish. Many of these victims live in mid and low income countries. 11.5% of global mortalities can be attributed to its effects 1 . The prevalence of smoking amongst prison inmates is about 70%, while prison staff are twice as likely to smoke as members of the general public, with the added aggravating effect of being passive smokers. More than 14.5 million people in prisons smoke every year around the world 2 . There are currently about 46,000 inmates in Spanish prisons, of whom 3,500 are women, with an average age of between 40 and 41 years, 75% of whom are Spanish. The prevalence of smoking in prisons is 74.4% amongst men and 67.4% amongst women, just under double the figures for the general public in Spain. Tobacco is by far the legal or illegal drug most commonly consumed by the inmate population 3 . Although prisons are punitive spaces, it should not be forgotten that their main objectives are re-education and social reintegration. They also fulfil an important role in public health through their work in health restoration, prevention and promotion, and by implementing healthy habits and reducing high-risk ones amongst inmates. It is a well known fact that “prison health is public health” 4 . Smoking cessation is not easy, but it is not impossible. It is a decision made by the smoker, in the exercise of their personal autonomy, and external help is usually required. Inmates do try to give up smoking, as do those outside prison, and although it is more difficult for them than it might be for the general public, interventions to help incarcerated smokers have achieved notable levels of success 5 . In addition, prohibitions against smoking in prisons have been shown to improve air quality by notably reducing second-hand smoke 6 , which minimises the effects for passive smokers and benefits both inmates and the personnel that care for and attend them. Likewise, the implementation of smoke-free prison policies has increased the dispensation of nicotine substitute therapies, which implies an increase in abstinence, a decrease in smoking cessation habits, and fewer prescriptions for medications to treat smoking related problems, such as respiratory and cardiovascular diseases 7 . This in turn implies that the prison population’s overall health has improved. The most evident benefit of smoke-free prisons in terms of the individual rights of inmates and the persons who care for them is in health protection. It is a right of these groups and public administrations are obliged to implement policies and measures that make this right a reality. But it is not the only one. Anti-smoking in prisons is linked to some other individual and fundamental rights. The right to life is evidently the first one; by improving inmates’ health one improves their life expectancy. Other rights connected to anti-smoking are the right to physical integrity and equality between persons. Tobacco has been and continues to be used as a means of exchange in prisons, and, as I mentioned above, possessing tobacco can be a cause for violence and inequalities between inmates. This state of affairs is such that the European Court of Human Rights (ECHR) has taken action over this issue for some years now, especially in cases where the protection of passive smokers is involved (cases: “Stoine Hristov vs. Bulgaria” of 16 January 2009 and “Elefteriaidis vs. Rumanía” of 25 January 2011). Public administrations are obliged to promote, shield and protect the exercise of individual human rights. The logical consequence of all the foregoing is that they should implement measures, and oversee and demand their compliance, with a view to reducing and even suppressing the use of tobacco in prisons. Ahmad Khalaf Specialist in Internal Medicine. Expert in Tobacco Control. President of the Azahar Association for the prevention of smoking and its diseases. Castellón.