Health Promotion in Jails and Prisons: An Alternative Paradigm for Correctional Health Services

According to the Bureau of Justice Statistics, each year about 12 million people, representing 9 million unique individuals, pass through a jail. About 1.5 million individuals are in prison on any given day (Beck, 2006). These individuals include some of the nation’s most vulnerable populations, those suffering from or at higher risk of infectious and chronic diseases, addiction and mental illness, and victims and perpetrators of violence (BJS, 2006; Harlow, 1998; National Commission on Correctional Health Care [NCCHC], 2002). Not only are incarcerated populations themselves often unhealthy, but untreated they can also worsen the well-being and impose additional costs on their families and communities (Rogers & Seigenthaler, 2001). Unfortunately, the majority of people leave prison or jail without having their most serious health problems addressed and many correctional health systems see their main responsibility as providing only the most essential medical care to those in their custody. In this chapter, we consider whether the paradigm of health promotion can provide an alternative framework for correctional health and examine the scientific evidence, economic benefits, and legal and moral rationale for this perspective. According to the World Health Organization, health promotion describes the “process of enabling people to increase control over and to improve their health.” Health promotion seeks to bring about changes in individuals, groups, institutions, and policies in order to improve population health. The Ottawa Charter for Health Promotion, adopted by the WHO in 1986, identifies five critical activities for health promotion: developing personal skills for health, creating supportive environments, strengthening community action for health, reorienting health services, and building healthy public policy (Ottawa Charter for Health Promotion, World Health Organization, 1986). At first sight, this expansive conception of health promotion seems too idealistic to serve as a useful guide for the consideration of its role in prisons and jails. However, in this chapter, we make the case that a comprehensive definition of health promotion can serve as a useful paradigm that links correctional health care to the larger public health system, expands the focus of correctional health services from medical care during custody to preparation