Aims <p>This study aims to examine how infectious disease prevention mechanisms are constructed and operationalized within carceral settings in transitional states, using China as a representative case. It focuses on the discursive and structural strategies employed by stakeholders to navigate institutional challenges in epidemic control and to delineate responsibilities across health and justice sectors, while also considering the ethical implications of these strategies and upholding the dignity and rights of individuals affected.</p> Methods <p>Guided by the epidemiological triangle model, the study adopts a dual-method qualitative design. First, it conducts a normative analysis of Chinese legal and administrative frameworks related to prison-based disease prevention. Second, it integrates empirical fieldwork based on 21 semi-structured interviews with correctional staff, health administrators, and incarcerated individuals across three provinces, supported by thematic and content analysis.</p> Results <p>Findings reveal that China’s carceral health governance has undergone a three-stage transformation—from institutional neglect to legal formalization, and ultimately to preventive risk management. Stakeholders engage in discursive boundary work by aligning prison health efforts with national public health objectives, while structural boundary work manifests in spatial segregation, surveillance routines, and inter-agency protocols. Digital surveillance and health monitoring systems, as part of these structural strategies, have contributed to improving public health outcomes in carceral settings by enabling real-time data sharing and timely intervention. However, these systems also raise ethical concerns: individuals with drug use histories or criminal records often worry that such monitoring, linked to stigmatized or criminalized practices, may be used for punitive purposes or excessive control rather than solely for health protection. Despite advances, gaps remain in enforcement consistency, resource allocation, and the legal clarity of emergency mandates. Additionally, carceral settings have long been plagued by systemic issues such as overcrowding, inadequate basic health services, and the erosion of human dignity, which create favorable conditions for the rapid spread of infectious diseases—these structural deficiencies are key drivers of high disease transmission rates in such environments.</p> Conclusions <p>The study highlights boundary work as a central mechanism for institutional adaptation in prison health governance. China’s evolving approach offers scalable insights for other transitional states, emphasizing the need for integrated, context-aware strategies that reconcile biopolitical control with human rights considerations, and explicitly address ethical dilemmas arising from surveillance and other intervention measures. Effective prison health reform requires not only legal mandates but also infrastructural investment to address overcrowding and inadequate health services, intersectoral cooperation, sustained political commitment, and a fundamental commitment to restoring and upholding the human dignity of individuals in carceral settings. It also necessitates establishing safeguards to ensure that monitoring tools are used strictly for health purposes and do not become instruments of unfair control or discrimination.</p>