From equivalence of standards to equivalence of objectives: The entitlement of prisoners to health care standards higher than those outside prisons

It is generally accepted that people in prison have a right to a standard of health care equivalent to that available outside of prisons. This “principle of equivalence” is one that enjoys broad consensus among international health and human rights instruments and organisations. However, given the extreme health problems evident in prisons worldwide, the legal obligations of the State to safeguard the lives and well‐being of people it holds in custody and the implications of poor prison health on overall public health, this article suggests that ‐ even if achieved ‐ standards of prison health care only equivalent to that in the community would in some cases fall short of human rights obligations and public health needs. The article argues it is time to move beyond the concept of equivalent standards of health care, and instead promote standards that achieve equivalent objectives. In some circumstances, meeting this new standard will require that the scope and accessibility of prison health services are higher than that outside of prisons.