A NEW APPROACH TO PRISON PUBLIC HEALTH?

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A NEW APPROACH TO PRISON PUBLIC HEALTH? Nick de
Viggiani University of the West of England,
Bristol. Nick.deviggiani_at_uwe.ac.uk Michelle
Baybutt University of Central Lancashire,
Preston. Mbaybutt_at_uclan.ac.uk
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People in prison have poorer health than the
population at large and many of them have
unhealthy lifestyles. Many will have had little
or no regular contact with health services before
coming into prison, and prison populations reveal
strong evidence of health inequalities and social
exclusion. Initiatives to improve health of
prisoners offer a valuable opportunity to
identify and tackle the wider health needs of a
vulnerable and socially excluded population.
Prison Health - new UK policy objective UK
Department of Health 1999 Saving Lives Our
Healthier Nation Prison identified as a key
setting for health promotion 2005 Choosing
Health Prisoners identified as a group with
specific health challenges
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UK research confirms that the physical and mental
health of prisoners is poorer than that of their
respective general populations Specifically
Most prisoners are young and male Most are in
custody for weeks or months Two thirds have used
illicit drugs before prison Two thirds of
intravenous drug users have served time in prison
Around 80 regularly smoke tobacco Two thirds
have suffered two or more mental disorders Male
prisoners are 6 times more likely to have been a
young (teenage) father.
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Traditional / Orthodox Conceptualisation of
Prison Health Long tradition of medical
treatment dominance of the biomedical
paradigm Traditional epidemiological focus
morbidity, mortality, risk Problematisation of
prisoner health / crisis approach (containment
vs. prevention)
Alternative Conceptualisations Prisoners health
concerns different to those of professionals
(e.g. mental social wellbeing) (Greenwood et al
1999) Prison health services dont respond well
to prisoners health needs (esp. social or
emotional) (Cassidy et al 1998) Professionals
display brief and cursory commitments towards
prisoners needs (Fitzgerald Sim
1982) Professionals are unable to meet the
diversity of prisoners needs (Hughes 2000)
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Example of Drug Misuse Orthodox
Strategies (based upon medical, lifestyle, risk
oriented approaches) Detoxification Rehabili
tation Harm Reduction Upstream Public Health
Strategies (focusing on health
determinants based upon social, cultural,
systemic approaches) Availability of
Drugs Support for Vulnerable Prisoners Recepti
on and Induction procedures Prevention of Debt
and Baroning within Prisons Unequal wages for
prisoners Emotional or psychological harms
arising from imprisonment Separation from
family / community
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Prisons Inspectorate of England Wales,
2000 Key determinants of prison
health Offending background Prison
environment Quality of prison healthcare Breakdown
of family networks Overcrowding Cultures of
violence Emotional deprivation
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Marshall et al (2000) Socioeconomic
background Childhood experiences Stressful life
events Adverse prison experiences Experience of
victimisation which precipitate neurotic
disorders self-harm suicide epilepsy asthma,
CHD dental morbidity infectious diseases
maternal/obstetric problems.
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DEPRIVATION perspective (1) Imprisonment as
Deprivation (of liberty, goods services,
relationships, autonomy, security) the
individuals picture of himself as a person of
value as a morally acceptable, adult male who
can present some claim to merit in his material
achievements and his inner strength begins to
waver and grow dim. (Sykes, 1958) (2) Prison
Deprivations (pains of imprisonment) physical,
mental and social harms (3) Prisonisation
(Clemmer 1958) self-centred, egotistical,
alienative modes (Sykes) servility and
exploitation (King Elliott (1977) institution
alised symbolic rituals (Sim 1994)
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IMPORTATION perspective presenting culture of
prisoners Spencer (2001) The seeds of poor
health are sewn for the majority long before they
entered an institution. Wider social
environments of social exclusion and
deprivation. offender pathways overlapping
settings Short (1979) The prison system is a
repository for the failures of our social
system (education, housing, religion, mental
care, etc.)
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World Health Organisation Health in Prisons
Project (HiPP) established 1995 to create
a whole climate for improving health. Smith
(2000) prison public health strategy should
focus on collective and structural determinants
of poor health rather than individually-focused
resolutions After all, unhealthy lifestyles are
the effects rather than the causes of poor
health.
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To date, there has been little theoretical or
critical debate over prison health. Prison
health is generally accepted as an all-embracing
term. Important questions that need to be
explored does prison make people sick?, does
prison healthcare work? does prison work? is
it appropriate to think in terms of
custody? Individualism as a core value of
criminal justice and prison healthcare This
broader debate is necessary in order to recognise
the value that an upstream public health
approach can bring to prisoner health.