Health promotion and improvement

People in prison and on probation are at risk of premature death compared to people in the general population. Cardiovascular disease, stroke and chronic conditions such as heart failure and chronic obstructive pulmonary disease are among the leading causes of death for people in prison in England and Wales. The average prevalence of chronic illnesses such as cardiovascular disease (CVD), diabetes mellitus, hypertension and cancer is greater than the general population. The majority of ill health from these causes is driven by risk factors such as obesity and smoking, which are more common in the prison population than the general population. This premature poor health is therefore preventable. The prison population is getting older and this burden will therefore increase over time. People in prison should have access to the same health as the general population. However, prisons are generally considered unhealthy places, rather than being able to support and create health9. Accessing people in the places where they live their lives and make choices is a key public health approach. Prisons are, therefore, a prime opportunity to address the disproportionate health and social circumstances of people in prison and offer a way of tackling inequalities in health and justice, through promoting health, facilitating community integration and reducing reoffending. While this is not the primary business of prisons, they do provide access to marginalised and disenfranchised groups who would otherwise be classified as ‘difficult to reach’ in the wider community particularly in terms of primary healthcare and substance use. Improving the health of people in prison not only improves the health of individuals and therefore reduces their need for healthcare, but most people in prison return to the community, with many oscillating repeatedly between prison and community. Prison health is a concern for broader society and public health. It is also a unique opportunity for all aspects of health promotion, health education and disease prevention, for example: ■ developing specific, targeted interventions to address health inequalities ■ opportunities to access and address health needs ■ reducing the burden of disease and chronic illness (CVD, diabetes) through the prevention of ill-health while people are in prison, especially for long-term people in prison ■ an opportunity to promote the health of staff. This chapter sets out the imperative to promote health in prisons to address the priority health needs, and prevention of ill health, of people in prison. The ‘settings approach’ is used as a framework to illustrate the benefit of working across and engaging with the ‘whole prison’. This includes the importance of the environment in determining health outcomes, alongside access to good quality healthcare. The chapter concludes priority areas for health promotion, noting challenges and opportunities of implementation in the prison setting, supported with case study examples of good practice. [Reference: 9. De Viggiani, N Unhealthy prisons: exploring structural determinants of prison health. Sociol Health Illn.2007 (Jan);29(1):115-135.]