The link between prisons and disease has existed as long as prisons have been used for punishment. The prisons of the world still have high rates of infection with hepatitis, HIV, mental illness, and tuberculosis. TB is a major cause of death in prisons, mainly as a result of overcrowding, poor physical conditions, and lack of adequate treatment. The priorities of prisoners and of public health officials are often at odds with the priorities of prison administrators and prosecutors. Prison health care should be independent of prison administration and should be answerable only to the national public health program. Efforts should be made in those countries with the highest inprisonment rates to find other solutions to maintaining order in the interests of improving public health.