[Health and risk behaviors and risky conditions: prison as a challenge for healthcare provision].

Incarceration is associated with significant health burdens. Prisoners suffer disproportionately from chronic diseases, mental disorders, and substance use disorders. While primary care in prisons is usually provided regularly and sometimes even faster than outside, care for more complex treatment needs is often limited to few facilities. Structural deficits include restricted freedom of physician choice, limited specialist access, separation from the regular health system, and gaps at the transitions from incarceration to release.Despite the principle of equivalence, prison healthcare often fails to meet the standards of the statutory health insurance (in German: Krankenversicherung [GKV]). International recommendations call for the inclusion of prisoners in the GKV as well as for a transfer of healthcare responsibility from ministries of justice to ministries of health.Particularly challenging is the treatment of individuals with substance use disorders: access to evidence-based therapies is inconsistent and varies greatly from region to region. Smoking cessation and psychosocial support are also inadequate. Nutrition is also often unbalanced, while sports and physical activities are often inadequately implemented.To date, a comprehensive interdisciplinary healthcare strategy aligned with the "Healthy Prisons" approach is largely absent in Germany. The Baden-Württemberg model featuring health reporting, telemedicine approaches, age-appropriate care, and quality circles, could serve as a nationwide example. A paradigm shift is required from institution-centered care toward participatory, preventive health promotion that involves both prisoners and staff.