Prison Public Health Research Articles

Review: Captive Genders: Trans Embodiment and the Prison Industrial Complex, edited by Eric A. Stanley and Nat Smith

Review: Captive Genders: Trans Embodiment and the Prison Industrial Complex, edited by Eric A. Stanley and Nat Smith

A public health approach to imprisonment

Abstract This presentation explores the contested meaning of “prison public health”. European Public Health aligns itself with legal, ethical, political and economic principles that govern human rights, the rule of law and social justice. The UN Universal Declaration of Human Rights and the WHO Commission on the Social Determinants of Health infer an egalitarian approach towards social justice that supports rights of all citizens to have their basic needs met, unnecessary threats to wellbeing minimised, and social competence maximised. In the spirit of the WHO Ottawa Charter for Health Promotion, this means operationalising agency of individuals and communities and of the broad structural determinants of health: economic, political, legal and institutional. In contrast, the law conventionally positions criminal responsibility with the individual perpetrator who is held responsible for their ‘offending’ behaviour. In parallel, arguments surrounding responsibility for health have abounded for many decades, with the principle of collective responsibility for health forming the ethos of the Ottawa Charter. Only recently has it been acknowledged that criminogenic and pathogenic ‘determinants’ intersect, criminal risk behaviours and health risk behaviours sharing common aetiologies. This presentation will reinforce that a public health approach towards imprisonment is fundamentally egalitarian and commitment to social justice, recognising that structure and agency intersect and that the health of the prison is as important as that of the prisoner. It will argue that it is short-sighted to attend only to prisoner behaviour if the system surrounding the prisoner is failing in its duty of care and capacity to serve society. Most prison populations represent the most vulnerable or disadvantaged sectors of society. Governments must proactively facilitate sustainable human development and protection and empowerment of vulnerable groups including those in custody.

A new approach to prison public health? Challenging and advancing the agenda for prison health

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization's vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.

SPEAKING OUT to Improve the Health of Inmates

Prison public health is becoming increasingly important to our society as growing numbers of men and women are incarcerated and later released. Numerous studies indicate that the prison population has a higher risk of certain infectious diseases and a higher rate of mental illness than the general population. Two community leaders, Dr Melanie Spector in the area of public health and Judge Steven Leifman in the judicial system, have addressed the vital issues of women's health and mental illness, respectively. Their efforts have had a positive impact both on prisoners themselves and on the overall health of their communities.

Prison: shield from threat, or threat to survival?

The first reported HIV outbreak in a British prison, at Glenochil,1 is an alarming but not at all unpredicted event.2 Unfortunate, from the point of view of the national public health, is that prisoners do not stay in prison indefinitely - the uncontrolled spread of HIV infection between prisoners threatens the government's successful HIV control programme and presents a grave threat to the nation's health. In this outbreak the coincident presentation of jaundice due to hepatitis B led to the recognition of HIV infection. We have no direct knowledge of conditions in Glenochil and make no comment on the prison medical service in that prison. However, as a result of our considerable experience of treating or representing hundreds of opiate dependent subjects as patients or clients we are concerned that conditions seem to be ideal for the rapid but unrecognised transmission of HIV throughout the whole of the British prison system. We sympathise with the difficult working conditions and stressful professional relationships for doctors who work with prisoners. We also have come across individual instances of sympathetic provision of care by prison medical officers. However, more frequently described to us by former patients are feelings of injustice and antagonism towards the prison medical services. It is our view that this largely attributable to the consequences of the service enjoying the monopoly of clinical power within prisons. As it is the guardian of the prison public health and sole provider of primary care and of most secondary care, the health care service for prisoners must, in our view, assume much of the responsibility for this crisis. Our experience is principally of West Yorkshire, but this is probably representative of the prison service nationally. There is unequivocal evidence from published and unpublished Home Office statistics*RF 3-5* that the philosophy and …