Toby Hall - ABC The Drum
At first glance, today's new report by the Australian Institute of Health and Welfare on the health of Australia's prisoners paints an encouraging picture.
Across a range of measures - mental illness, smoking, chronic disease - the health of prisoners is improving, sometimes markedly, while on the inside.
For those of us engaged in correctional health - St Vincent's Health Australia has been caring for inmates since 1839 - it's a sign we're making a difference.
But let's be clear, to some extent the health of Australia's inmates improves because the only way is up.
The bulk of offenders enter custody with some of the worst health profiles in the country.
Upon entering prison, almost half of Australia's inmates have a mental illness; one quarter have self-harmed; and one-third are in severe psychological distress.
Against every health indicator - infectious diseases, chronic respiratory and heart conditions, intellectual disabilities, addiction - Australia's inmates are behind the general population.
And with almost half unemployed before entering jail; one-third having never completed Year 10; and one-quarter homeless, if you needed evidence of the social determinants of health, look no further than Australia's prison population.
For many, jail is the first time they've ever received regular medical attention.
To some degree, their health can't not improve.
But even with the medical care available to them, those improvements often occur in spite of their environment.
Mental health services for inmates - including treatment and withdrawal programs for drug and alcohol addicts - are massively overstretched.
Given the prevalence of severe mental illness, repeated expert inquiries have called on state and territory governments to improve these mental health services but largely to no avail.
Victoria appears to be the only state that is responding, building a 75-bed specialist mental health unit as part of its new Ravenhall Prison scheduled for completion in 2017.
And long waiting lists - for most health needs, not just mental illness - are being exacerbated by unprecedented levels of overcrowding.
There are now around 34,000 prisoners in Australia, the highest number since 2004, having grown by 10 per cent over the past 12 months.
In NSW, prisoner numbers were predicted to reach 12,000 by June 2017; in fact, the state reached 12,250 earlier this month (with capacity now standing at 112 per cent).
As prisoner numbers have grown, the ratios of healthcare staff just haven't kept up and in some cases have gone backwards.
Overcrowding aggravates problems in an environment already unfavourable to good health.
Stacking vulnerable and unwell people together in confined spaces is a recipe for increased anxiety and depression; it stokes the likelihood of aggression and violence.
The challenges associated with the health of Australia's prisoners doesn't end at the front gate.
In Australia, the discharge of prisoners - what's known in the sector as "throughcare" - is notoriously poorly planned.
That homeless shelters across the country are full to the brim with ex-offenders with no health care plan, no employment and little or no prospects is all the evidence you need of the system's inadequacies.
Studies show that the mental health of prisoners commonly deteriorates in the year after their release.
Why should we care?
Because failing mental health and untreated addiction among desperate individuals is a recipe for re-offending behaviour.
If we don't do something about it, the "revolving door" between prisons and the community will continue.
If that wasn't enough, the looming health challenge for governments and prison authorities is the rapid ageing of Australia's inmate population.
Across Australia, there has been a 140 per cent increase in the inmate population aged over 65 in the last decade. In NSW, numbers have increased 225 per cent over the same period.
Older prisoners bring their own unique health challenges: diabetes, dementia, disabilities.
Australia's prisons are just not equipped to manage such a large number of elderly inmates.
Some of Australia's prisons were built in the 19th and early 20th centuries with narrow doorways and numerous stairs. They're not designed for elderly people with poor mobility, let alone wheelchairs.
In response, prison authorities must start planning to establish new, secure aged-care facilities outside the mainstream correctional system.
The challenge with tackling these problems - providing better access to services, improving our planning - is, of course, getting the attention of governments for whom the subject is hardly a priority or a vote winner.
But withholding resources on prisoner health is a false economy: the longer illnesses and disease go unmet, the greater the ultimate costs of treatment.
And once out of jail, if we let ex-offenders slip back into addiction and deteriorating mental illness, we all pay the price.