Health and Health Improvement in Secure Institutions

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The World Health Organisation (WHO) notes the high burden of communicable and non-communicable diseases in prisoners, who are mostly from ‘socially disadvantaged segments of the community’. WHO concludes that ‘the public health challenges of prisons are not [yet] adequately met’.

In 2011, responsibility for health care in Scottish prisons transferred from the Scottish Prison Service (SPS) to the NHS. Strategies for promoting prisoners’ health are informed by a framework based on three elements:

  • developing policies in prisons which promote health
  • promoting an environment that is actively supportive of health
  • prevention, health education and other initiatives which address health needs.

The framework notes that a large number of formal health promotion activities are already happening in prisons, but their provision, delivery and reach to prisoners is often ad hoc and variable across the prison estate, and rarely formally evaluated against their impact on prisoner health and wellbeing.

We aim to address these gaps. Of 11 priority areas for health promotion within the framework outlined for the Scottish Prison Service, four are particularly relevant to our work: reducing use of tobacco; increasing physical activity; increasing uptake of healthy eating and reducing obesity; and improving mental health. Prisons, in Scotland and beyond, are an important setting in which to develop interventions to:

  • improve public health outcomes
  • reach often multiply-disadvantaged populations and reduce inequalities
  • potentially - through improving mental, physical and behaviour outcomes in prisoners - impact on partners, children and other family members.

However, programmes are only likely to be successful, acceptable and implementable in the long-term with an understanding of the physical, social and cultural context of this challenging environment For example, in countries without a prison smoking ban, smoking is part of prison culture and seen as ‘the norm’: prisoner smoking rates are very high, typically three or four times those of the general population. Our Tobacco in Prisons study (TIPs) is investigating second-hand smoke, health, the role of e-cigarettes, support for prisoners to give up smoking, and what prison staff and prisoners think about smoking and smoking bans. TIPs second-hand smoke measurements helped to inform the SPS announcement that all Scottish prisons will become smoke-free on 30th November 2018, and information gathered from both staff and prisoners via TIPs surveys, interviews and discussion groups is helping SPS with decisions around the best ways to move to smoke-free prisons.

Ian MacNeill’s PhD research is investigating the potential for sport-based interventions to support young prison leavers. Clair Woods-Brown’s PhD research will examine the importance of food for women prisoners and how it might be used to lead to a more constructive custody experience.

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