HEALTH PROMOTING PRISONS

Basanta Chalise, MHPE (01)

Chalisebt@gmail.com

Institute of Medicine

Kathmandu, Nepal1

OUTLINE OF THE PRESENTATION Introduction

Background

Importance

Challenges

Opportunities

Need of the prisoner

Prison Act 2019 and Regulation 2020 of Nepal

Balance approach

Whole prison approach

References

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INTRODUCTION

Health promoting prisons do not focus solely on prisoner

health. The health and well-being of staff is equally

important. Working in prison often involves being

confronted with difficult health matters, violence, bullying,

mobbing and mental health problems as well as with poor

quality and overcrowded living conditions for prisoners,

with severe consequences on their psychosocial well-

being.

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One of the central pillars of health promotion is the concept

of empowerment: the individual has to be able to make

healthy choices and has to be allowed to do so. In health

promotion in prisons, this approach is not possible. It is

therefore important that as much empowerment as possible

be built into the prison regime.

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BACKGROUND

The United Nations (1990) Basic Principles for theTreatment of Prisoners indicate how the entitlement ofprisoners to the highest attainable standard of health careshould be delivered: “Prisoners shall have access to thehealth services available in the country withoutdiscrimination on the grounds of their legalsituation”(Principle 9). In other words, the fact that peopleare in prison does not mean that they have any reducedright to appropriate health care. Rather, the opposite is thecase. When a state deprives people of their liberty, it takeson a responsibility to look after their health in terms both ofthe conditions under which it detains them and of theindividual treatment that may be necessary.

Prisoners should not leave prison in a worse condition than when they entered. 5

In 1995, WHO and the United Kingdom organized a pilot

meeting of some eight countries and various experts to

discuss the proposal to establish a network for the

exchange of experience in tackling health problems in

prisons.

WHO strongly recommends that prison and public health

care be closely linked. The Moscow Declaration on

Prison Health as a Part of Public Health (WHO

Regional Office for Europe, 2003) elaborated on some of

the reasons why close working relationships with public

health authorities are so important.

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WHY PRISON HEALTH IS IMPORTANT?

There are two compelling reasons for providing health care in

prisons.

First is the importance of prison health to public health in

general. Prison populations contain a high prevalence of

people with serious and often life-threatening conditions.

The second reason is society’s commitment to social

justice. Healthy societies have a strong sense of fair play:

those involved in the provision of health care are committed

to reducing health inequalities as a significant contribution to

health for all.

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In 2013, WHO and the United Nations Office on Drugs and Crime (UNODC) published a policy brief on the organization of prison health, Good governance for prison health in the 21st century, with the following main findings:

Prisoners share the same right to health and wellbeing as other people

Prisoners generally come from sociallydisadvantaged segments of the community andcarry a higher burden of communicable and non-communicable diseases compared with thegeneral population

Prisons are settings with high risks of disease

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States have a special, sovereign duty of care

for prisoners: they are accountable for all

avoidable health impairments to prisoners

caused by inadequate health care measures or

inadequate prison conditions with regard to

hygiene, catering, space, heating, lighting,

ventilation, physical activity and social contacts

Prison health services should work to at least the

equivalent professional, ethical and technical

standards to those applying to public health

services in the community

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Prison health services should be provided

exclusively to care for prisoners and must never

be involved in the punishment of prisoners

Prison health services should be fully

independent of prison administrations and liaise

effectively with them

Prison health services should be integrated into

national health policies and systems, including

the training and professional development of

health care staff

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CHALLENGES

Prison brings loss of freedom, and this has many challenges for health care.

The prisoners automatically lose the social component of health, including the loss of control of a patient’s circumstances, the loss of family and familiar social support and a lack of information and familiarity with their surroundings.

The environment of prison often poses a threat to mental well-being, especially a threat to a sense of personal security.

In most circumstances, prisoners are unable to choose their professional health care team. Similarly, primary care teams in prison cannot select their patients.

Neither the patient nor the health care team chooses the beginning and end of courses of treatment or of the clinician-patient relationship in general – this is largely decided by the courts.

Generally, patients who are prisoners need a high level of health care.

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OPPORTUNITY FOR ALL ASPECTS OF HEALTH

PROMOTION

Prison offers access to disadvantaged groups who would

normally be hard to reach. It is therefore a prime

opportunity to address inequalities in health.

Each prison has potential to be a healthy setting: spiritual

physical social and economic health and well-being can all

be addressed within a single institution.

The strategy sets out clearly health promotion needs that

are common to all prisoners (such as prevention of

communicable diseases or measures to promote mental

well-being).

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HEALTH PROMOTION NEEDS OF PRISONERS

Prevention of communicable diseases e.g. advice on preventing communicable diseases, including advice on avoiding STI/HIV, Hep. B immunization

Advice on high-risk lifestyles, including advice on avoiding drug overdose on leaving prison, protection against harm caused by smoking (including passive smoking)

Support in adopting healthy behaviour, including appropriate levels of physical activity and a balanced diet;

Measures to promote mental health, including adequate time for association; a meaningful occupation, contact with the outside world and help to maintain family ties

Health education and health-related education, including practical skills training, training in job search skills, parenting education, training in social and life skills, dietary advice and advice on physical activity and smoking.

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PRISON ACT 2019 AND REGULATION 2020

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SITUATION OF PRISON HEALTH IN NEPAL

Accommodations, recreational and educational

facilities in prisons are reported to be

inadequate. Food is of poor quality and is

insufficient to sustain good health.

Overcrowding is a major concern.

General medical care is limited and access is

impeded by the requirement in many cases that

prisoners fund their own treatment.

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HEALTH WORKFORCE UNDER PRISON MANAGEMENT

DEPARTMENT

Prison Offices/Hospital/Department Sanctioned Post of Health

Professionals

Prison Management Department;

Prison Office Jagannathdewal;

Prison Office Nawalparasi

No post of Health Professionals

Central Prison Hospital Jagannathdewal Consultant Psychiatrist/Me.Su.-1;

Medical Officer-1; Health Assistant-2;

Staff Nurse-1; Lab Technician-1;

Radiographer-1; AHW-1; ANM-1

(Total-9)

Prison Office Parsa Medical Officer-1; Health Assistant-1

(Total-2)

Prison Office Jhumka AHW-1; ANM-1

(Total-2)

70 Prison Offices in rest of the districts Health Assistant-1 X 70 = 70

(Total-70)

Total 83 Health ProfessionalsSource: Prison Management Department, Ministry of Home Affairs, Government of Nepal

BALANCE APPROACH

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A balanced approach based upon the concept of

decency all prisons should be:

Safe

Secure

Reforming and health promoting

Grounded in the concept of decency

These elements are interdependent and in balance

in a properly functioning prison.

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The concept of decency is an important foundation for promoting health because it underpins all aspects of prison life. Without it health cannot be achieved. If the following measures are attained then a basis exists from which to promote health. It includes:

Treatment within the law

Delivering promised standards

Maintaining facilities that are clean and properly equipped

Providing prompt attention to prisoners’ proper concerns

Protecting prisoners from harm

Providing prisoners with a regime that makes imprisonment bearable

Fair and consistent treatment by staff

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A WHOLE-PRISON APPROACH TO HEALTH PROMOTION

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The approach recognises the potential of prisons as

‘healthy settings.’

Promoting health in a social context or setting has its

origins in the World Health Organisation (WHO) Health

for All movement and Ottawa Charter of 1986. In a later

development in 1996 the 15 nation WHO Health in

Prisons Project was begun, and the Prison Health Policy

Unit is the WHO Collaborating Centre for the project

today.

The Whole Prison Approach must recognise and value

the importance of initiatives such as skills development

and preparation for work on release as important health

building measures in their own right.

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THE THREE ELEMENTS IN A

WHOLE PRISON APPROACH

1. Creating an environment within each prison,

through procedural and capacity building

measures, that is supportive of health and the

concept of decency.

- Support, encouragement and recognition at

national and area/regional level an infrastructure

that develops and supports this work

- Development of ‘healthy policy’ both nationally and

locally

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2. Policies which specifically promote the health of staff

and prisoners

- No Smoking Policy

- policy determining the education opportunities

3. Health education (including harm minimisation, patient

education and disease prevention)

- injecting drugs

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REFERENCES:

Donev D, Pavlekovic G, Kragelj L. J. Health Promotion

and Disease Prevention: Hans Jacobs Publishing

Company; 2007

Prison and Health. WHO: 2014

Prison act and regulation Nepal

Prison health policy unit and Task force work

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