You can get garden variety health advice from the daily newspaper, the "health" section of most book stores, and of course thousands of web sites. I'm hoping to present thought provoking and maybe change provoking thoughts about individual and community health. This blog is not just what to do about health, but how to think about it. I'm looking forward to an exchange of ideas with readers. July, 2010


Thursday, September 20, 2012

Health Promotion Behind Bars

In the last few days, two unrelated cues came my way, both inspiring me for a blog posting. In my building we have a closed-circuit information TV screen system, that scrolls through announcements, birthday notices, a vocabulary “word of the day”, and inspirational quotes. This week the quote was from Nelson Mandela: “It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones.” Of course Mandela has credibility as a first-hand witness.

The other item that stopped my forward progress momentarily was an op-ed in the Washington Post, by Elton John, regarding the treatment of HIV positive individuals in U.S. jails and prisons, particularly in Alabama and South Carolina. John documents examples of unfair treatment experienced by these prisoners, particularly in those two states.

The Mandela quote and the John article both come together on the topic of prison health. Most societies make some effort to provide medical care and more generally, ethical and humane treatment for those persons incarcerated.

In all developed nations there is a social agreement, supported by some legal safeguards, that people locked up by society should be provided with basic resources to support life: air, food, shelter from the elements, personal hygiene facilities, and medical care. The principles that provide a rationale for the provision of these and similar services are several, but general in nature. They create an expectation for these basic provisions, but don't specify components and extent of services. For example, we agree that prisoners should be fed, but at what quality level? There is a lot of distance between the most inexpensive, barely adequate food and first quality protein, fresh produce, and whole grains. In most places this is simply a short-term budget issue, managed by bureaucrats in the correctional system, with no thought to long-term implications. However, society has a stake in these decisions, in the same way that all have a stake in the public school system, even those who don't have school-aged children.

Incarceration is mostly about punishment for misdeeds, some of which are truly heinous. However, there is a hope, for most prisoners, that prison time is the first step in personal rehabilitation. Spending time in a "correctional" institution is supposed to get people back into the community, making contributions in a pro-social way. Prison programs are judged, in part, by their recidivism rates: the frequency with which freed prisoners return with subsequent offenses and sentences. While there may not be much evidence that health promotion for prisoners decreases the recidivism rates, we can construct a limited extrapolation: healthier children perform better in school, and healthy workers are more productive for their companies.

The dilemma is how to apply health promotion practice principles within the unique setting of corrections. Prisoners are an interesting challenge for education programs. It can be predicted that the average resident of a state prison was not a model student. A large portion (23 %) of prisoners report learning disabilities. We would expect health literacy to be a particular concern, but this is only speculation because of a lack of definitive data. Prisoners have limited control over their health behavior, compared to other adults. For example, opportunities for a physically active lifestyle are narrow, and healthy nutritional choices are confined to foods provided by the warden. They also have limited opportunities to secure social support, and health promotion professionals will have limited prisoner exposure time and a much smaller range of tools. For example, social media would not generally be a feasible tool in the prison population.

The other type of intervention, policies, are also uniquely challenging. In this sense, prisons are parallel to corporate health promotion. Companies will only implement health promotion, including health policies, if there is real evidence that the investment will reap a return of increased productivity and improved profit. In the same way, prisons would be interested in health promotion only if it had a desirable impact on a few key things; 1) Does health promotion for prisoners have a positive impact on recidivism? 2) Does health promotion make for more contented, easily manageable inmates? 3) Does health promotion save money on healthcare, which amounts to billions of dollars nationwide?

The above questions represent a research agenda. Many answers are yet to be found. In the end, we have to find consensus regarding what is appropriate treatment for incarcerated criminal offenders. Does their criminal penalty also include having their medical problems neglected, no provisions for health promotion, and to be victimized by sexual assault and violence? President Mandela is challenging our national conscience, but for most people, prisoners are locked away where we don't have to glance at them. Perhaps it is time to think about health for all, including those on the other side of bars, walls and razor wire.

1 comment:

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