Healthy Prisons Research Articles

Prison Overcrowding and Harsh Conditions: Health and Human Rights Concerns to Persons in Custody, Staff, and the Community

The article explored overcrowding in Ghana prisons and sought to understand its impact on the health and well-being of persons in custody and prison officers. Qualitative data from 38 participants who were serving terms or working in three prison facilities in Ghana revealed three themes, including (a) fear over the spread of communicable diseases, (b) limited access to basic resources, and (c) psychological and emotional burden, attributing them to overcrowding in the prisons. We discussed the findings from human rights and prison and public security perspectives and concluded that addressing overcrowding in prisons would ensure a healthy prison environment, which may have implications for the well-being and human rights of persons in custody, as well as public safety and the health of prison officers and the community. To achieve a healthy prison, policies should target prison depopulation and commitment from stakeholders to implement local and international prison rules and conventions.

Healthy prison cultures: factors influencing male prisoners' engagement in exercise and subsequent healthy behaviours.

The purpose of this paper is to identify the factors which influence male prisoners' motivation for, and engagement in, exercise and subsequent healthy behaviours. The first authors conducted 20 semi-structured interviews with male prisoners inside an English medium-security male prison. Interviews were recorded and transcribed, themes were identified using thematic analysis and a critical realist perspective applied to understand objective processes behind prisoners' experiences and shared meanings of exercise and engaging in healthy behaviours in prison. Emerging themes indicate that in the context of healthy behaviours male prisoners aspired to a masculine ideal that was characterised by a culture of either adaptive behaviours, or maladaptive behaviours. The former fostered an adaptive exercise culture which promoted psychological well-being through an autonomy-supportive environment, consequently internalising motivation and minimising perceived barriers to engaging in healthy behaviours. Conversely, a culture of maladaptive behaviours fostered a maladaptive exercise culture which led to negative psychological well-being, underpinned by external forms of motivation which emphasised barriers to engaging in healthy behaviours. Findings emphasise the need for prisons to promote an internal perceived locus of control for male prisoners when engaging in healthy behaviours. The authors adopt a rare interdisciplinary approach combining a psychological theory of motivation and criminological perspectives of prison culture to understand how best to minimise the impact of prisons as an institution on the psychological well-being of male prisoners.

Disrupting ‘healthy prisons’: Exploring the conceptual and experiential overlap between illness and imprisonment

AbstractOur aim in this conceptual article is to theoretically reimagine the concept of ‘healthy prisons’ in a way that more thoroughly grounds it in the everyday experiences of prisoners. Our point of departure is the observation that there seems to be an intriguing conceptual and theoretical overlap between first‐person oriented empirical studies of two spheres of human experience that are normally seen as separate: serious illness and imprisonment. Our analysis leads us to reimagine the term ‘healthy prisons’ in a way that increases its usefulness for anyone interested in making prisons healthier and more constructive and reinventive institutions.

Performing well: Male prisoner experiences of drama, dance, singing and puppetry in England

This paper outlines art form impacts used within Staging Time at an adult male sex offender prison in England by drawing on the voices of prisoners (aged 21–75 years), including those with undiagnosed autistic traits. We qualitatively investigate prisoner experiences from drama (n = 11), dance (n = 12), puppetry (n = 7) and singing (n = 15) projects using a theory of change approach. Based on a themed analysis of self-report data from 4 world cafés and 44 follow-up questionnaires, we conclude arts projects positively contribute to health and well-being, forming healthy relationships and prison culture. By applying a desistance theory lens, we argue arts projects provide building blocks towards crime abstinence. Whilst all arts projects improved prisoner well-being, dance had a greater propensity for increasing physical fitness. With a focus on dance impacts, our research widened to stakeholder and practitioner interviews (n = 4), alongside analysis of secondary data from dance performance audience feedback sheets (n = 48) collected by Staging Time. Audience members included prison staff, prisoners, prisoner family members and close friends and a small group of invited stakeholders. Arts projects have wider impacts on staff, other prisoners and family members.

Healthy prisons: analysis of health promotion in Catalonian prisons.

IntroductionThere is currently sufficient evidence that health can be created through certain strategies combined and maintained long enough to produce measurable results: this is what is called health promotion. The World Health Organization has promoted programs based on healthy environments; among them we highlight healthy prisons. Living conditions in a penitentiary are extraordinarily specific, and involve limitations that can have significant health consequences. However, prisons can be environments for health, since there is the effective possibility of promoting it.ObjectivesTo analyze the implementation of health promotion in prisons in Catalonia.Material and methodRetrospective and observational cross-sectional multi-centre study, carried out on a sample of 29 nurses who worked in the closed-regime prisons in Catalonia between 2019 and 2020. The information collection instrument is made up of an ad-hoc questionnaire (Annex 1). A descriptive analysis of the socio-demographic variables and the variables of the study was carried out. A comparative analysis is performed using correlation and linear regression models.Results 82.8% of those surveyed state that a health promotion project is being carried out in the prison where they work, with mental health being the most carried out programs, followed by tobacco and drug cessation.Discussion The results show that health promotion policies are currently being developed in the Catalan prison environment.

No Place for Old Men? Meeting the Needs of an Ageing Male Prison Population in England and Wales

Recent years have witnessed significant increase in numbers of older men imprisoned in England and Wales; a phenomenon experienced across the western world. Those aged fifty and over represent the fastest-growing demographic group in prison in England and Wales. This article summaries explanations for and implications of this increase and the characteristics, needs and lived experiences of this population, before critically reflecting on current policy and practice responses; and how responses highlight definitional and policy ambiguities around older prisoners. The article discusses a multi-agency initiative developed at one prison in northern England that recognised the uniqueness of older prisoners, modified regimes and changed physical environments. Impact is benchmarked against Her Majesty’s Inspectorate of Prisons four tests of a healthy prison, followed by discussion of findings and implications for policy and practice. The article argues for expanded collaboration to better manage challenges posed by older prisoners, supported by a national strategy.

Long Road to Nowhere: How Southern States Struggle with Long-Term Incarceration

The Deep South is the epicenter of mass incarceration. The United States incarcerates more people per capita than any other country, with prison populations growing by 86% between 1990 and 2019. For Southern states, prison populations exploded by 127% during that same period. During this time in history, America implemented “tough on crime” policies that responded to public health issues like the drug epidemic with incarceration instead of rehabilitation. Laws for even nonviolent crimes became more punitive with longer sentences, and people of color were disproportionately pushed into prisons with little hope for parole. Today, incarceration rates for Latinx and Black people are more than two and five times the incarceration rate of whites, respectively. The commitment to the “tough on crime” narrative led to significantly overcrowded prisons, which not only put a strain on state budgets, but also created human rights challenges regarding how to maintain a safe and healthy prison environment. Three Southern states in particular — Alabama, Florida, and Louisiana — exemplify how prison populations have grown to be problematic in three unique ways. Alabama is home to the most overcrowded prisons in the country, currently at 151% of capacity. Even after sentencing reforms were passed in 2017, recent legislation concerning the Alabama Board of Pardons and Paroles has severely diminished the parole chances of currently incarcerated people. Florida, with over 95,000 imprisoned people, has the third-largest prison population of any state in the country, and still adheres to a “Truth in Sentencing” rule requiring incarcerated people to serve at least 85% of their sentences, regardless of any demonstration of rehabilitation. As a result, Florida has grown to have the oldest prison population in the South, a group whose care is increasingly expensive. Louisiana has been known as the “incarceration capital of the world” for consistently having incredibly high incarceration rates. A large factor is the number of people serving life sentences without the possibility of parole, including juveniles. The lack of early prison release is just one of many contributors to mass incarceration in the South. The solutions also vary — from expanding parole eligibility and making it retroactive, to increasing incentives for rehabilitation credits, to re-calibrating triggers for life without parole sentences. This report will investigate the impact that over-incarceration has had in three Southern states, and provide recommendations on how each state can address the issue through policy change.

Comorbidity pattern of personality disorder and reliability of diagnostic and statistical manual-111-R and international classification of diseases-10 in assessing personality disorders

Background: Comorbidity of personality disorders (PD) is mostly assessed in relation to axis1 disorders in spite of its high prevalence in clinical practice. It’s assessment in the prison community, a non-clinical setting, using the diagnostic and statistical manual (DSM-111-R) and the international classification of diseases (ICD-10) may reveal the natural pattern of axis-11 comorbidity and test the reliability of both instruments in assessing PD. Objectives of the study were to determine the pattern of comorbidity of PD in a non-clinical setting and to confirm the reliability of DSM-111-R and ICD-10 in assessing PD.Methods: Healthy prison inmates who consented to the study were interviewed using international personality disorder examination (IPDE), a semi structured questionnaire modified to conform to DSM-111-R and ICD-10 classifications and approved by World health organization (WHO). The data obtained was fed into the statistical package for social sciences (SPSS/PC+). Cross tabulation of variables using chi-square and t-tests. Agreement between both instruments was examined with kappa.Results: The study shows that ICD-10 is more likely to diagnose PD than DSM-111-R. Both instruments showed good concordance for schizoid, histrionic, and dependent PD, poor concordance for obsessive and borderline PD and very poor concordance for avoidant PD. The likelihood of having more than one axis-11 disorder is high lightened.Conclusions: Pattern of PD in the prison has been established. DSM-111-R and ICD-10 have been found reliable in assessing PD except for avoidant PD where they disagreed. The high rate of multiple PD diagnoses in prison inmates calls for functional health care programs in the prisons.

A tribute to some of the doctors who died from COVID-19

A tribute to some of the doctors who died from COVID-19

Rolling back the prison estate: the pervasive impact of macroeconomic austerity on prisoner health in England.

Prisons offer policymakers an opportunity to address the pre-existing high prevalence of physical and mental health issues among prisoners. This notion has been widely integrated into international and national prison health policies, including the Healthy Prisons Agenda, which calls for governments to address the health needs of prisoners and safeguard their health entitlement during imprisonment, and the Sustainable Development Goals 2030 concerning reducing inequality among disadvantaged populations.However, the implementation of the austerity policy in the United Kingdom since the re-emergence of the global financial crisis in 2008 has impeded this aspiration. This interdisciplinary paper critically evaluates the impact of austerity on prison health. The aforementioned policy has obstructed prisoners’ access to healthcare, exacerbated the degradation of their living conditions, impeded their purposeful activities and subjected them to an increasing level of violence.This paper calls for alternatives to imprisonment, initiating a more informed economic recovery policy, and relying on transnational and national organizations to scrutinize prisoners’ entitlement to health. These systemic solutions could act as a springboard for political and policy discussions at national and international forums with regard to improving prisoners’ health and simultaneously meeting the aspirations of the Healthy Prisons Agenda and the Sustainable Development Goals.

Using laws to further public health causes: the Healthy Prisons Agenda.

In this commentary, we propose using laws in implementing the Healthy Prisons Agenda. We evaluate the efficacy of laws in tackling health inequalities in prisons, provide recommendations on how states can uphold their international commitments that safeguard prisoners' right to healthcare, and frame prisons as health-promoting settings. We also assess the challenges that can thwart this proposal, such as the non-binding nature of international obligations, global prison overcrowding and the dependency on prison governors and staff for implementation of the Agenda. The commentary concludes by recommending further evaluation of our proposal and testing its potential generalisability to other health-promotion agendas.

Just add water: Prisons, therapeutic landscapes and healthy blue space

‘Healthy prisons’ is a well-established concept in criminology and prison studies. As a guiding principle to prisoners’ quality of life, it goes back to the 18th century when prison reformer John Howard regarded the improvement of ventilation and hygiene as being essential in the quest for religious penitence and moral reform. In more recent, times, the notion of the ‘healthy prison’ has been more commonly associated with that which is ‘just’ and ‘decent’, rather than what is healthy in a medical or therapeutic sense. This article interrogates the ‘healthy prison’ more literally. Drawing on data gathered from a UK prison located on a seashore, our aim is to explore prisoners’ rational and visceral responses to water in a setting where the very nature of enforced residence can have negative effects on mental health. In expanding the possibilities for the theorization of the health benefits that waterscapes may generate, and moving the discussion from healthy ‘green space’ to healthy ‘blue space’, the article reveals some of the less well-known and under-researched interconnections between therapeutic and carceral geographies, and criminological studies of imprisonment.

Challenges for prison governors and staff in implementing the Healthy Prisons Agenda in English prisons.

In the two decades that have passed since the World Health Organisation established the Healthy Prisons Agenda, there has been no research conducted to investigate barriers and challenges prison managerial and operational staff encounter in implementing the Agenda in the English prison context. This article debates sectoral, institutional and occupational challenges perceived to hinder effective implementation of the Agenda, based on a qualitative study involving prison governors and operational staff. Qualitative study taking a grounded theory approach. Semistructured interviews were conducted with 30 participants comprising prison governors, prison officers and external stakeholders with key strategic and operational roles across the prison estate. The interviews were analysed and coded into themes using constant comparative method. The research identified a range of managerial and operational factors that impeded recognition, acceptance and successful implementation of the Healthy Prisons Agenda. These were found to be associated with scarcity of resources, low prioritisation, perceived low importance, and pressures at operational, managerial and strategic levels to adhere to standard operating procedures. Security, control and discipline tended to supersede other imperatives considered of secondary importance to the effective running of prisons. Sustainability of the Healthy Prisons Agenda can only be assured by raising its significance and importance across prison hierarchies and within policies and practices through which operational and strategic objectives are realised. This means achieving wholesale commitment by prisons-among staff at all levels-towards public health goals that are fundamental to a successful and effective criminal justice system.

Just design: Healthy prisons and the architecture of hope

This article develops the notion that institutional places and spaces are layered with meaning and that their architecture and design have a profound psychological and physiological influence on those who live and work within them. Mindful of the intrinsic link between ‘beauty’ and ‘being just’, the article explores the potential ‘healing’ or rehabilitative role of penal aesthetics. As many countries modernise their prison estates, replacing older facilities that are no longer fit-for-purpose with new, more ‘efficient’ establishments, this article discusses examples of international best (and less good) practice in penal and hospital settings. It reflects on what those who commission and design new prisons might learn from pioneering design initiatives in healthcare environments and asks whether the philosophies underpinning the ‘architecture of hope’ that Maggie’s Cancer Care Centres exemplify could be incorporated into prisons of the future. The article was originally presented as a public lecture in the annual John V Barry memorial lecture series at the University of Melbourne on 24 November 2016.

Exploring crucial aspects of diabetes and obesity

Exploring crucial aspects of diabetes and obesity

Bearing Witness to the ‘Pain of Others’: Researching Power, Violence and Resistance in a Women’s Prison

Addressing the dynamics of interpersonal violence, institutionalised abuses and prisoner isolation, this article consolidates critical analyses as challenges to the essentially liberal constructions and interpretations of prisoner agency and penal reformism. Grounded in long-term research with women in prison in the North of Ireland, it connects embedded, punitive responses that undermine women prisoners’ self-esteem and mental health to the brutalising manifestations of formal and informal punishments, including lockdowns and isolation. It argues that critical social research into penal policy and prison regimes has a moral duty, an ethical obligation and a political responsibility to investigate abuses of power, seek out the ‘view from below’. Challenging the revisionism implicit within the ‘healthy prison’ discourse, it argues for alternatives to prison as the foundation of decarceration and abolition.

The role of sport in promoting prisoner health.

The existing evidence base and policy context of sports-based prisoner health promotion is evaluated, and an original analysis of current provision and best practice in delivering sport to address physical, mental and substance misuse needs among prisoners across the secure estate in England and Wales is presented, with a focus on the variability of provision across different prison establishments. Inspectorate reports published by Her Majesty's Inspectorate of Prisons (n=184) were analysed to assess the extent to which health promotion objectives are being implemented through physical education in prisons across England and Wales. Examples of innovative sport-based health promoting programmes are drawn upon in order to illustrate principles of best practice. Despite health promotion being engrained in existing policy, the degree to which physical, mental health and substance misuse needs are addressed through sport in prison remains highly variable and locally contingent across the secure estate, although examples of innovative practice are evident. For sport to promote prisoner health most effectively, tailored sports provision should be embedded within multi-modal interventions which draw on internal and external partnerships and promote opportunities for ongoing sporting participation. Further research is required to delineate principles of best practice applicable to discrete prisoner populations. Sport can play a key role in addressing a multitude of prisoner health needs whilst contributing to achieving "healthy prison" objectives in practice. Sport and physical activity clearly offers a valuable way of motivating prisoners to engage in health promoting initiatives.

Management of diabesity in primary care: individualisation of care

Management of diabesity in primary care: individualisation of care

Toward healthy prisons: the TECH model and its applications.

This paper aims to explore how the TECH Model (testing for and treating infectious diseases and vaccination; environmental modification to prevent disease transmission; chronic disease identification and treatment; and health maintenance and education) can be used for assessing and achieving healthy prisons. This paper explores the concepts of "health in prison" and "healthy prisons" in the context of recent research and guidance. The paper then considers the TECH Model as an approach to achieving healthy prisons. Under each of the four TECH Model domains are tasks to achieve a healthy prison. For prisons with poor or no resources, each domain contains steps that will improve prison health and move towards a healthy prison for both prisoners and staff. Implementation can thus be "low-TECH" or "high-TECH" depending on the setting and the available resources and the model is specifically designed to provide options for resource-poor as well as resource-rich correctional settings. The TECH Model is a first step in characterizing the components of a healthy prison and the processes to achieve this. This Model could be implemented in all levels of prisons internationally.

Abstract 883: Interaction between cigarette smoking and polymorphisms of xenobiotic-metabolizing genes on risk of oral premalignant lesions among male prisoners in Taiwan

Abstract Background and Objective: The relationship between cigarette smoking and oral premalignant lesions has been previously demonstrated with strong epidemiological evidence. Glutathione S-transferases (GSTs) and cytochrome P450 1A1 (CYP1A1) and 2E1 (CYP2E1) are the key enzymes that metabolize cigarette smoking derived toxin and may be relevant to smoking-induced carcinogenesis. This case-control study was designed to examine whether polymorphisms of GSTM1, GSTT1, GSTP1, CYP 1A1, and CYP2E1 genes play roles in susceptibility to smoking-related oral premalignant lesions. Methods: We recruited participants who had undergone an oral screening from a penitentiary in Taiwan. Cases (n = 224) were prisoners who had more than 5 year imprisonment and confirmed oral premalignant lesions and controls were age and gender matched healthy prisoners (n = 492). Information about soci-demographic factors and smoking status were obtained by a self-administered questionnaire. Genotypes of GSTM1, GSTT1, GSTP1 Ile105Val, CYP1A1*2C* (A4889G), CYP2E1 Pst I (−1293G>C), and CYP2E1 Rsa I (−1053C>T) polymorphisms were determined by polymerase chain reaction or in combination with restriction fragment length polymorphism methods. Conditional logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Results: We found that the GSTM1 null genotype was more prevalent in cases than in controls (57.1 % vs. 49.4 %, p=0.054). After adjusting for BMI, cigarette smoking, alcohol drinking and betel nut chewing, the GSTM1 null genotype compared to the GSTM1 present genotype was moderately significantly associated with increased risk for oral premalignant lesions (OR = 1.36, 95% CI = 0.98-1.88), especially for leukoplakia (OR = 1.44, 95% CI = 1.00-2.07). This adverse effect was pronounced among smokers consuming cigarette ≫ 13 pack-years with ORs were 1.57 (95% CI = 0.99-2.46) and 1.62 (95% CI = 0.99-2.63), respectively. However, the interaction between GSTM1 genotype and cigarette use was not statistically significant. Similarly, comparing to the CYP1A1*2C A/G+G/G genotype, the CYP1A1*2C A/A genotype was more presented in all cases or leukoplakia (OR=1.36 and 1.65, respectively). The corresponding risk among heavy smokers were 1.69 (95% CI = 1.07-2.67) and 2.19 (95% CI = 1.31-3.65), respectively. There was no significant association between GSTT1, GSTP1 and CYP2E1 polymorphisms and risk of oral premalignant lesions. Conclusion: Our findings suggest that the GSTM1 null genotype and CYP1A1*2C A/A genotype may increase the risk of oral premalignant lesions, especially among heavy smokers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 883. doi:10.1158/1538-7445.AM2011-883