Prisoner health is influenced as much by structural determinants (institutional, environmental, political, economic and social) as it is by physical and mental constitutions of prisoners themselves. Prison health may therefore be better understood with greater insight into how people respond to imprisonment -the psychological pressures of incarceration, the social world of prison, being dislocated from society, and the impact of the institution itself with its regime and architecture. As agencies of disempowerment and deprivation, prisons epitomise the antithesis of a healthy setting. The World Health Organisation's notion of a 'healthy prison' is in this sense an oxymoron, yet the UK government has signalled that it is committed to WHO's core health promotion principles as a route to reducing health inequalities. This paper reports on the findings of an ethnographic study which was conducted in an adult male training prison in England, using participant observation, group interviewing, and one-to-one semi-structured interviews with prisoners and prison officers. The paper explores how different layers of prison life impact on the health of prisoners, arguing that health inequalities are enmeshed within the workings of the prison system itself. Keywords: prison health, health determinants, healthy prisons IntroductionPenal institutions are generally sick places. Offenders sent to prison enter a complex social world of values, rules and rituals designed to observe, control, disempower and render them subservient to the system. Emotional and psychological survival partly depend upon an individual's ability to tolerate the deprivations of prison. Most prisoners, however, come from the poorest or most socially excluded tiers of society and often have the greatest health needs. Prison may therefore be the worst place to send them given that, in the main, they are likely to be highly vulnerable or susceptible to poor health. This arguably reduces the chances of returning offenders to society in a fit state to rebuild their lives. Nonetheless, the UK Government has signalled its commitment to reducing health and social inequalities (Acheson 1998, DoH 2003) with respect to prisons by signing up to the World Health Organisation's Health in Prisons Project (WHO 1996(WHO , 2000. Recent reorganisation of prison healthcare services in England under the management of the NHS has revealed some commitment to the WHO approach, with a new emphasis on health needs assessments and health development plans for prisons (DoH 1999a, 2004, HM Prison Service and DoH 2001, de Viggiani et al. 2005. This paper reports on some of the findings of an ethnographic study, conducted with adult male prisoners and prison officers in an English prison between 1998(de Viggiani 2003, which explored how the health of prisoners was shaped or influenced by their prison experience. The findings provide useful insight into understanding prison health determinants, fuelling the argument that to make real progress, a much broader and more radica...

Young people in the criminal justice system experience significant health and wellbeing issues that often stem from poverty and disadvantage and, in turn, are linked with offending and reoffending behaviour. There is ongoing interest in interventions such as participatory music programmes that seek to foster social reintegration, support mental wellbeing and equip young offenders with life skills, competencies and emotional resilience. However, there is a need for a situated understanding of both positive and negative experiences that shape potential outcomes of music projects. This article reports on a research study undertaken between 2010 and 2013 with 118 young people aged 13-21 years across eight youth justice settings in England and Wales. Using mixed methods we explored the experiences of young people and their responses to a participatory music programme led by a national UK arts charity. Here, we explore the impact of young people's encounters with music and musicians with reference to the notion of 'musical affordances' (DeNora 2000(DeNora , 2003. We examine the ways that such affordances, including unintended outcomes, are mediated by features of the youth justice environment, including its rules and regulations, as well as issues of power, identity and social relations.Keywords: teenagers/adolescents, coping/coping strategies, inequalities/social inequalities in health status, medical humanities/arts, social exclusionThe age of criminal responsibility for England and Wales, where this study took place, is 10 years. Common offences for which young people are convicted include violence, theft and handling stolen goods, public order offences, drugs-related and motoring offences (Youth Justice Board [YJB] 2014). Young people aged 10-17 years are managed by the YJB through a network of organisations that provide community-based prevention, surveillance and rehabilitation, as well as secure accommodation for those in detention, while young people aged 18-21 years are managed by HM Prison Service. A small proportion of those convicted enter custody, while the remainder are subject to community supervision. The youth justice population has declined in recent years but remains significant, with over 33,000 young people having been sentenced in England and Wales in 2013/4 (YJB 2015). Just

Youth justice is an important public health issue. There is growing recognition of the need to adopt effective, evidence-based strategies for working with young offenders. Music interventions may be particularly well suited to addressing risk factors in young people and reducing juvenile crime. This systematic review of international research seeks to contribute to the evidence base on the impact of music making on the health, well-being and behaviour of young offenders and those considered at risk of offending. It examines outcomes of music making identified in quantitative research and discusses theories from qualitative research that might help to understand the impact of music making in youth justice settings.

Prison social environments play an important role in the health of prisoners. How they respond to imprisonment is partially dependent upon how effectively they integrate into an institution's social structure, learn to fit in with others and adapt to and cope with becoming detached from society, community and family *hence, how they personally manage the transition from free society to a closed carceral community. This paper reports on findings of an ethnography conducted in an adult male training prison in England, which used participant observation, group interviewing, and one-toone semi-structured interviews with prisoners and prison officers. The research explored participants' perceptions of imprisonment, particularly with regard to how they learned to adapt to and 'survive' in prison and their perceptions of how prison affected their mental, social and physical well-being. It revealed that the social world of prison and a prisoner's dislocation from society constitute two key areas of 'deprivation' that can have important health impacts.

Expert views of peer-based interventions for prisoner health AbstractPurpose: Formalised support services for prisoners that rely on peer methods of delivery show promising health and social outcomes but there is also conjecture that negative effects, both at an individual and organisational level, can occur.Design/methodology/approach: Individuals with recognised professional expertise from various sectors (including ex-prisoners) were invited to contribute to an expert symposium to share their perceptions of the positive and negative effects of peer interventions in prison.Discussions and debate were audio recorded with the consent of all delegates and verbatim transcripts were analysed using Framework Analysis.Findings: According to the participants, peer interventions in the prison setting created both positive and negative impacts. It was clear from the evidence gathered that peer interventions in prisons can impact positively on health outcomes, but these effects were perceived to be more well-defined for peer deliverers. The notion that peer deliverers can be subjected to 'burnout' suggests that supervisory processes for peer workers need to be considered carefully in order to avoid the intervention from being counter-productive.Organizationally, one of the salient issues was the adverse effects that peer interventions cause to the security of the prison. Originality/value: To our knowledge, this is the first time an expert symposium has been conducted to specifically examine peer interventions in prison and to consider the effects, both positive and negative, of such schemes.

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Prisons are social communities where people commonly conform to normative institutional and cultural values and ideologies. Conforming as a man in prison may involve performing or projecting prison masculinities to ensure emotional, psychological, and social survival, employing strategies to mask self-perceived weaknesses or vulnerability and to attain status and legitimacy. While few men are likely to subscribe to archetypal masculine roles or stereotypes, ethnographic research with adult male prisoners revealed that individuals endeavored to fit in and become socially accepted into the prison community, commonly aligning themselves with normative values, attitudes, and behaviors of prison life, and striving for social legitimacy. “Front management” strategies were employed by individuals to convey “masculine” personas consistent with the prison code, a system of values based on aggression, violence, control, and exploitation—or “dog eat dog” and “divide and rule”—where individuals would become situated within the hegemonic social hierarchy. Participants equated emotional, psychological, and social survival with health and well-being, which was in turn dependent in part on their social status and legitimacy. Paradoxically, this disempowering and divisive hegemony could lay vulnerable individuals open to exploitation and harm, while also undermining prisoners' personal efforts to improve themselves, physically, emotionally, intellectually, and vocationally. Prisoners' efforts to fit into an excessively performance-orientated masculine culture are therefore likely to work against criminal justice goals to reintegrate offenders back into society.