A new approach to prison public health? Challenging and advancing the agenda for prison health

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization's vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.