Unhealthy prisons: exploring structural determinants of prison health

Abstract

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...

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Exploring concepts of health with male prisoners in three category-C English prisons

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Demandes d’euthanasie dans les prisons belges. Entre souffrance psychique, dignité humaine et peine de mort

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