We are very happy to reintroduce our “Meet the Blogger” section with the contribution of Dr. James Woodall. James is a Reader in Health Promotion and currently co-directs the Centre for Health Promotion Research at Leeds Beckett University, UK. James’ specific research interests are in prison health. His PhD completed in 2010 examined the health promoting prison and how values central to the health promotion discourse are applied to the context of imprisonment.
Enjoy and let us know what you think!
Of all the concerns facing public health practitioners, policy-makers and academics, the health of the prison and offender population is one area receiving relatively limited attention. Shelving, for a moment, readers’ political ideology and views on crime and punishment, there is no disputing that the prison and offender population is growing and with it public health challenges. The global prison population, as an example, has grown exponentially in all five continents, to a reported 10 million people and it is now widely acknowledged that the prevalence of ill health in this population is higher than that reported in the wider community. Mental health problems, communicable disease, long-standing physical disorders and drug and alcohol issues are increasingly becoming commonplace.
Surprisingly, I often find myself having to justify why an increased focus on prison and offender health is desperately needed by the public health and health promotion community. A recent teaching session I delivered to Postgraduate Students studying Public Health – Health Promotion allowed me to rehearse the arguments, albeit to a section of the class whose ideological views on the issue differed from my own:
- Perhaps the most fundamental point is the humanitarian argument – premised on the notion that offenders are ‘citizens’ that have rights to health. The deterioration of health should not be part of the punishment process.
- There is a growing evidence base that demonstrates how well-coordinated public health interventions have the potential to reduce health inequalities and address the health needs of those who are the most marginalised in society – clearly a laudable aim for public health.
- Prisoners’ health and the public’s health are inextricably ‘intertwined’ as most prisoners serve short sentences and return back to families and communities after their sentence. The proportion of individuals who are serving life sentences – where life means life – is miniscule.
On a global level, the World Health Organisation (WHO), at least in their rhetoric, are wholly supportive of addressing the disproportional and unacceptable concentration of disease and ill-health in the prison and offender group. However, public health practice varies hugely between continents. The health-promoting prison philosophy, endorsed by WHO, is less well developed in resource-poor regions. In sub-Saharan Africa for example, prisons were recently summarised as being often inhumane, not spacious enough and not providing adequate food or health care.
More radical ways of promoting health and preventing disease in the prison and offender population are urgently needed. I struggle with the pre-occupation of individual-level approaches to address prison and offender health, focussing on behaviour change and lifestyle factors. Indeed, evidence shows that allowing prisoners adequate time out of their cells and providing meaningful occupation (e.g. skills, education etc.) may reap huge health gains. Other practical strategies could include considering architecture, policies, structures, prisoner-staff relationships and how these impact on the health of individuals. For example, ensuring that sufficient occupational activities are provided in prison; regular contact is maintained with families; and opportunities for accessing fresh air, exercise facilities and nutritious food is available.
The intention of the blog was to stimulate some thoughts and discussion amongst the public health community. I look forward to people contacting me, perhaps via twitter, to share their views. A brief search within the International Journal of Public Health revealed very few articles or commentary focussing on the offender population. I hope that this changes given that the public health challenges of the prison and offender population are not going away any time soon.